Educational Triage in Open Distance Learning: Walking a Moral Tightrope

Directory of Open Access Journals (Sweden)

Paul Prinsloo

2014-09-01

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

The Copenhagen Triage Algorithm

DEFF Research Database (Denmark)

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

2016-01-01

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

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

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

2017-02-01

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

A study on the ethics of microallocation of scarce resources in health care.

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Fortes, P A de Carvalho; Zoboli, E L C P

2002-08-01

This study attempts to analyse the ethical dilemmas arising from the microallocation of scarce health care resources, in terms of deontology and utilitarianism. A group of 395 people were interviewed in the region of Diadema, greater San Paulo, Brazil, while visiting patients in the only state hospital in town. Each interviewee was given a list of eight simulated emergencies (see appendix). In each of the eight cases the interviewee had to choose which of the two patients described, both of whom suffered from exactly the same problem, should receive the only hospital bed currently available. The differences between the hypothetical patients were as follows: age, gender, family dependency, and lifestyle. Each interviewee was asked to justify one of their responses. These responses were then analysed. The results pointed to the co-existence of deontological and utilitarian orientations among the people interviewed. A tendency to give priority to the destitute was revealed throughout the research, contradicting the idea that society, valuing only productive people, wishes only such people to receive the most resources, thus maximising the benefits to be gained from resources. The results showed that people's disapproval of the alcoholic was stronger than that of the nicotine abuser.

Role of telephone triage in obstetrics.

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

2012-12-01

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

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

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Hunter, Julie

2015-01-01

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

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

NARCIS (Netherlands)

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

2017-01-01

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

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

OpenAIRE

Safari, Sixtus Ruyumbu

2012-01-01

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

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

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

2010-01-01

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

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

Directory of Open Access Journals (Sweden)

Adeloye A. Adeniji

2016-06-01

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

The community speaks: understanding ethical values in allocation of scarce lifesaving resources during disasters.

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Daugherty Biddison, Elizabeth L; Gwon, Howard; Schoch-Spana, Monica; Cavalier, Robert; White, Douglas B; Dawson, Timothy; Terry, Peter B; London, Alex John; Regenberg, Alan; Faden, Ruth; Toner, Eric S

2014-06-01

Pandemic influenza or other crises causing mass respiratory failure could easily overwhelm current North American critical care capacity. This threat has generated large-scale federal, state, and local efforts to prepare for a public health disaster. Few, however, have systematically engaged the public regarding which values are most important in guiding decisions about how to allocate scarce healthcare resources during such crises. The aims of this pilot study were (1) to test whether deliberative democratic methods could be used to promote engaged discussion about complex, ethically challenging healthcare-related policy issues and (2) to develop specific deliberative democratic procedures that could ultimately be used in a statewide process to inform a Maryland framework for allocating scarce healthcare resources during disasters. Using collaboratively developed focus group materials and multiple metrics for assessing outcomes, we held 5-hour pilot community meetings with a combined total of 68 community members in two locations in Maryland. The key outcomes used to assess the project were (1) the comprehensibility of the background materials and ethical principles, (2) the salience of the ethical principles, (3) the perceived usefulness of the discussions, (4) the degree to which participants' opinions evolved as a result of the discussions, and (5) the quality of participant engagement. Most participants were thoughtful, reflective, and invested in this pilot policy-informing process. Throughout the pilot process, changes were made to background materials, the verbal introduction, and pre- and post-surveys. Importantly, by holding pilot meetings in two distinct communities (an affluent suburb and inner city neighborhood), we discerned that participants' ethical reflections were framed in large part by their place-based life experiences. This pilot process, coupled with extensive feedback from participants, yielded a refined methodology suitable for wider

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

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

2012-08-01

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

Inter-rater and intrarater reliability of the South African Triage Scale in low-resource settings of Haiti and Afghanistan.

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Dalwai, Mohammed; Tayler-Smith, Katie; Twomey, Michèle; Nasim, Masood; Popal, Abdul Qayum; Haqdost, Waliul Haq; Gayraud, Olivia; Cheréstal, Sophia; Wallis, Lee; Valles, Pola

2018-03-16

The South African Triage Scale (SATS) has demonstrated good validity in the EDs of Médecins Sans Frontières (MSF)-supported sites in Afghanistan and Haiti; however, corresponding reliability in these settings has not yet been reported on. This study set out to assess the inter-rater and intrarater reliability of the SATS in four MSF-supported EDs in Afghanistan and Haiti (two trauma-only EDs and two mixed (including both medical and trauma cases) EDs). Under classroom conditions between December 2013 and February 2014, ED nurses at each site assigned triage ratings to a set of context-specific vignettes (written case reports of ED patients). Inter-rater reliability was assessed by comparing triage ratings among nurses; intrarater reliability was assessed by asking the nurses to retriage 10 random vignettes from the original set and comparing these duplicate ratings. Inter-rater reliability was calculated using the unweighted kappa, linearly weighted kappa and quadratically weighted kappa (QWK) statistics, and the intraclass correlation coefficient (ICC). Intrarater reliability was calculated according to the percentage of exact agreement and the percentage of agreement allowing for one level of discrepancy in triage ratings. The correlation between years of nursing experience and reliability of the SATS was assessed based on comparison of ICCs and the respective 95% CIs. A total of 67 nurses agreed to participate in the study: In Afghanistan there were 19 nurses from Kunduz Trauma Centre and nine from Ahmed Shah Baba; in Haiti, there were 20 nurses from Martissant Emergency Centre and 19 from Tabarre Surgical and Trauma Centre. Inter-rater agreement was moderate across all sites (ICC range: 0.50-0.60; QWK range: 0.50-0.59) apart from the trauma ED in Haiti where it was moderate to substantial (ICC: 0.58; QWK: 0.61). Intrarater agreement was similar across the four sites (68%-74% exact agreement); when allowing for a one-level discrepancy in triage ratings

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

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Kaposy, Chris

2010-01-01

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

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

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

2018-06-13

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

Triage level assignment and nurse characteristics and experience.

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

2018-06-01

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

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

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Vassallo, James; Smith, Jason

2017-12-01

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

Mental health triage in emergency medicine.

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Smart, D; Pollard, C; Walpole, B

1999-02-01

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

Triage in psychiatric emergency services in Copenhagen

DEFF Research Database (Denmark)

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

2017-01-01

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

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

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

2014-03-20

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

Valuing lives and allocating resources: a defense of the modified youngest first principle of scarce resource distribution.

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Tallman, Ruth

2014-06-01

In this paper, I argue that the 'modified youngest first' principle provides a morally appropriate criterion for making decisions regarding the distribution of scarce medical resources, and that it is morally preferable to the simple 'youngest first' principle. Based on the complete lives system's goal of maximizing complete lives rather than individual life episodes, I argue that essential to the value we see in complete lives is the first person value attributed by the experiencer of that life. For a life to be 'complete' or 'incomplete,' the subject of that life must be able to understand the concept of a complete life, to have started goals and projects, and to know what it would be for that life to be complete. As the very young are not able to do this, it can reasonably be said that their characteristically human lives have not yet begun, giving those accepting a complete lives approach good reason to accept the modified youngest first principle over a simple 'youngest first' approach. © 2012 John Wiley & Sons Ltd.

Do prehospital providers and emergency nurses agree on triage assignment?

DEFF Research Database (Denmark)

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

2018-01-01

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

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

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

2017-10-01

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

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

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

2018-01-01

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

Identifying the core competencies of mental health telephone triage.

Science.gov (United States)

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

2013-11-01

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

Adaptive process triage system cannot identify patients with gastrointestinal perforation

DEFF Research Database (Denmark)

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

2017-01-01

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

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

Science.gov (United States)

Hitchings, Samantha; Barter, Janet

2009-10-01

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

[Emergency department triage: independent nursing intervention?].

Science.gov (United States)

Corujo Fontes, Sergio José

2014-03-01

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

Pronunciation dictionary development in resource-scarce environments

CSIR Research Space (South Africa)

Davel, M

2009-09-01

Full Text Available The deployment of speech technology systems in the developing world is often hampered by the lack of appropriate linguistic resources. A suitable pronunciation dictionary is one such resource that can be difficult to obtain for lesser...

How to Fairly Allocate Scarce Medical Resources: Ethical Argumentation under Scrutiny by Health Professionals and Lay People.

Directory of Open Access Journals (Sweden)

Pius Krütli

Full Text Available Societies are facing medical resource scarcities, inter alia due to increased life expectancy and limited health budgets and also due to temporal or continuous physical shortages of resources like donor organs. This makes it challenging to meet the medical needs of all. Ethicists provide normative guidance for how to fairly allocate scarce medical resources, but legitimate decisions require additionally information regarding what the general public considers to be fair. The purpose of this study was to explore how lay people, general practitioners, medical students and other health professionals evaluate the fairness of ten allocation principles for scarce medical resources: 'sickest first', 'waiting list', 'prognosis', 'behaviour' (i.e., those who engage in risky behaviour should not be prioritized, 'instrumental value' (e.g., health care workers should be favoured during epidemics, 'combination of criteria' (i.e., a sequence of the 'youngest first', 'prognosis', and 'lottery' principles, 'reciprocity' (i.e., those who provided services to the society in the past should be rewarded, 'youngest first', 'lottery', and 'monetary contribution'.1,267 respondents to an online questionnaire were confronted with hypothetical situations of scarcity regarding (i donor organs, (ii hospital beds during an epidemic, and (iii joint replacements. Nine allocation principles were evaluated in terms of fairness for each type of scarcity along 7-point Likert scales. The relationship between demographic factors (gender, age, religiosity, political orientation, and health status and fairness evaluations was modelled with logistic regression.Medical background was a major predictor of fairness evaluations. While general practitioners showed different response patterns for all three allocation situations, the responses by lay people were very similar. Lay people rated 'sickest first' and 'waiting list' on top of all allocation principles-e.g., for donor organs 83

How to Fairly Allocate Scarce Medical Resources: Ethical Argumentation under Scrutiny by Health Professionals and Lay People.

Science.gov (United States)

Krütli, Pius; Rosemann, Thomas; Törnblom, Kjell Y; Smieszek, Timo

2016-01-01

Societies are facing medical resource scarcities, inter alia due to increased life expectancy and limited health budgets and also due to temporal or continuous physical shortages of resources like donor organs. This makes it challenging to meet the medical needs of all. Ethicists provide normative guidance for how to fairly allocate scarce medical resources, but legitimate decisions require additionally information regarding what the general public considers to be fair. The purpose of this study was to explore how lay people, general practitioners, medical students and other health professionals evaluate the fairness of ten allocation principles for scarce medical resources: 'sickest first', 'waiting list', 'prognosis', 'behaviour' (i.e., those who engage in risky behaviour should not be prioritized), 'instrumental value' (e.g., health care workers should be favoured during epidemics), 'combination of criteria' (i.e., a sequence of the 'youngest first', 'prognosis', and 'lottery' principles), 'reciprocity' (i.e., those who provided services to the society in the past should be rewarded), 'youngest first', 'lottery', and 'monetary contribution'. 1,267 respondents to an online questionnaire were confronted with hypothetical situations of scarcity regarding (i) donor organs, (ii) hospital beds during an epidemic, and (iii) joint replacements. Nine allocation principles were evaluated in terms of fairness for each type of scarcity along 7-point Likert scales. The relationship between demographic factors (gender, age, religiosity, political orientation, and health status) and fairness evaluations was modelled with logistic regression. Medical background was a major predictor of fairness evaluations. While general practitioners showed different response patterns for all three allocation situations, the responses by lay people were very similar. Lay people rated 'sickest first' and 'waiting list' on top of all allocation principles-e.g., for donor organs 83.8% (95% CI

The management of scarce water resources using GNSS, InSAR and in-situ micro gravity measurements as monitoring tools

CSIR Research Space (South Africa)

Wonnacott, R

2015-08-01

Full Text Available of Geomatics, Vol. 4, No. 3, August 2015 213  The management of scarce water resources using GNSS, InSAR and in-situ micro gravity measurements as monitoring tools Richard Wonnacott1, Chris Hartnady1, Jeanine Engelbrecht2 1Umvoto Africa (Pty) Ltd... shown to provide a useful tool for the measurement and monitoring of ground subsidence resulting from numerous natural and anthropogenic causes including the abstraction of groundwater and gas. Zerbini et al (2007) processed and combined data from a...

Triage Drift:

DEFF Research Database (Denmark)

Bjørn, Pernille; Rødje, Kjetil

2008-01-01

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

Selecting Candidates for Liver Transplantation: A Medical Ethics Perspective on the Microallocation of a Scarce and Rationed Resource

Directory of Open Access Journals (Sweden)

Eric M Yoshida

1998-01-01

Full Text Available Liver transplantation has evolved over the past 35 years from an experimental procedure with high perioperative mortality to an accepted form of treatment with an approximate 85% one-year and 80% three-year patient survival rate. Following the success and acceptance of transplantation in the treatment of end-stage liver disease, there has been a progressive increase in the number of patients seeking a limited supply of donor organs. The ethical focus, on a microallocation level, has therefore changed from that of the 1960s, when the question was whether the procedure should be offered at all, to that of the 1990s and beyond, when the focus is on the proper allocation of a scarce, life-saving resource. The ethical issues concerning fair allocation surrounding liver transplantation are explored, from both the referring physician's perspective and the perspective of the transplant physician. In particular, the contrasting viewpoints of bioethicists Nicholas Rescher and James Childress, with respect to nonmedical and social criteria in the selection of patients for scarce, life-saving therapies, are explored. Lastly, some alternative ethical models for patient selection are reviewed.

Do poison center triage guidelines affect healthcare facility referrals?

Science.gov (United States)

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

2001-01-01

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

The value of holding scarce wind resource—A cause of overinvestment in wind power capacity in China

International Nuclear Information System (INIS)

Liu, Xuemei

2013-01-01

China's wind power capacity has increased dramatically in recent years, but about 30% of the installed capacity sits idle, so overinvestment in wind power capacity seems to be a serious problem. This paper explores reasons for the overinvestment. The economic analysis shows that, given uncertain future policy on wind power, it is optimal for power companies to invest more than the amount in a certain world. A part of the “overinvestment” has a real value, which can be interpreted as the value of holding scarce wind resource. This value exists because the wind-rich sites with convenient locations to connect to the grids are scarce resource, and also because the specific government policies that are essential for promoting wind power are uncertain in the future. This value should be taken into account in the investment decision, but it results in the phenomenon of “overinvestment”. The concept of the value of holding scarce resource can be generally applied to the resources that are scarce and for which the future policy is uncertain

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

DEFF Research Database (Denmark)

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

2012-01-01

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

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

Directory of Open Access Journals (Sweden)

Janine Bezem

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

Mass casualty triage after an airplane crash near Amsterdam

NARCIS (Netherlands)

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

2013-01-01

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

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

Science.gov (United States)

Badiali, Stefano; Giugni, Aimone; Marcis, Lucia

2017-06-01

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

Working with Manchester triage -- job satisfaction in nursing.

Science.gov (United States)

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

2009-10-01

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

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

Directory of Open Access Journals (Sweden)

Mahboub Pouraghaei

2017-06-01

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

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

Science.gov (United States)

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

2017-06-01

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

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

Science.gov (United States)

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

2003-03-01

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

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

Science.gov (United States)

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

2003-01-01

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

Optimal allocation of physical water resources integrated with virtual water trade in water scarce regions: A case study for Beijing, China.

Science.gov (United States)

Ye, Quanliang; Li, Yi; Zhuo, La; Zhang, Wenlong; Xiong, Wei; Wang, Chao; Wang, Peifang

2018-02-01

This study provides an innovative application of virtual water trade in the traditional allocation of physical water resources in water scarce regions. A multi-objective optimization model was developed to optimize the allocation of physical water and virtual water resources to different water users in Beijing, China, considering the trade-offs between economic benefit and environmental impacts of water consumption. Surface water, groundwater, transferred water and reclaimed water constituted the physical resource of water supply side, while virtual water flow associated with the trade of five major crops (barley, corn, rice, soy and wheat) and three livestock products (beef, pork and poultry) in agricultural sector (calculated by the trade quantities of products and their virtual water contents). Urban (daily activities and public facilities), industry, environment and agriculture (products growing) were considered in water demand side. As for the traditional allocation of physical water resources, the results showed that agriculture and urban were the two predominant water users (accounting 54% and 28%, respectively), while groundwater and surface water satisfied around 70% water demands of different users (accounting 36% and 34%, respectively). When considered the virtual water trade of eight agricultural products in water allocation procedure, the proportion of agricultural consumption decreased to 45% in total water demand, while the groundwater consumption decreased to 24% in total water supply. Virtual water trade overturned the traditional components of water supplied from different sources for agricultural consumption, and became the largest water source in Beijing. Additionally, it was also found that environmental demand took a similar percentage of water consumption in each water source. Reclaimed water was the main water source for industrial and environmental users. The results suggest that physical water resources would mainly satisfy the consumption

Level I center triage and mass casualties.

Science.gov (United States)

Hoey, Brian A; Schwab, C William

2004-05-01

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

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

African Journals Online (AJOL)

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

Resource allocation on the frontlines of public health preparedness and response: report of a summit on legal and ethical issues.

Science.gov (United States)

Barnett, Daniel J; Taylor, Holly A; Hodge, James G; Links, Jonathan M

2009-01-01

In the face of all-hazards preparedness challenges, local and state health department personnel have to date lacked a discrete set of legally and ethically informed public health principles to guide the distribution of scarce resources in crisis settings. To help address this gap, we convened a Summit of academic and practice experts to develop a set of principles for legally and ethically sound public health resource triage decision-making in emergencies. The invitation-only Summit, held in Washington, D.C., on June 29, 2006, assembled 20 experts from a combination of academic institutions and nonacademic leadership, policy, and practice settings. The Summit featured a tabletop exercise designed to highlight resource scarcity challenges in a public health infectious disease emergency. This exercise served as a springboard for Summit participants' subsequent identification of 10 public health emergency resource allocation principles through an iterative process. The final product of the Summit was a set of 10 principles to guide allocation decisions involving scarce resources in public health emergencies. The principles are grouped into three categories: obligations to community; balancing personal autonomy and community well-being/benefit; and good preparedness practice. The 10 Summit-derived principles represent an attempt to link law, ethics, and real-world public health emergency resource allocation practices, and can serve as a useful starting framework to guide further systematic approaches and future research on addressing public health resource scarcity in an all-hazards context.

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

Science.gov (United States)

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

2013-11-04

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

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

Science.gov (United States)

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

2014-03-01

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

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

OpenAIRE

Estebaranz Santamaría, Cristina

2014-01-01

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

An exploration of clinical decision making in mental health triage.

Science.gov (United States)

Sands, Natisha

2009-08-01

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

Reliability and validity of emergency department triage systems

NARCIS (Netherlands)

van der Wulp, I.

2010-01-01

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

How Triage Nurses Use Discretion: a Literature Review

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Lars Emil Fagernes Johannessen

2016-02-01

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

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

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Gray, R; Fawcett, T

2014-05-01

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

Using robotic telecommunications to triage pediatric disaster victims.

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

2012-01-01

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

Adoption of the 2006 Field Triage Decision Scheme for Injured Patients

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Sasser, Scott

2011-07-01

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

Improvements of Paediatric Triage at the Emergency Department

NARCIS (Netherlands)

N. Seiger (Nienke)

2014-01-01

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

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

African Journals Online (AJOL)

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

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

DEFF Research Database (Denmark)

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

2017-01-01

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

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

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

2015-04-10

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

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

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

2016-05-01

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

Triage and mortality in 2875 consecutive trauma patients

DEFF Research Database (Denmark)

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

2010-01-01

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

Determining paths by which farmers can adapt effectively to scarce freshwater resources

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Watson, R.; Hornberger, G.; Carrico, A. R.

2012-12-01

Stress on freshwater resources is a significant risk associated with climatic change. The risk is even greater given the expected changes in overall resource use as the developing world develops, as the world's population continues to grow, and as land use changes dramatically. Effective water management has implications for food security, health, and political stability worldwide. This is particularly true in developing regions heavily dependent on agriculture, and where agriculture depends on irrigation. Adaptation to water stress requires both managing water allocation among competing users and ensuring that each user is efficient in his or her use of a limited allotment: the problem is a quintessential common-pool resource (CPR) dilemma. In the future even more so than in the past, adaptation will be essential as the world evolves. The problem that we identify—determining paths by which farmers can adapt effectively to increasingly scarce freshwater resources—is one of great scientific and societal importance. The issue lies at the intersection of water-cycle processes and social-psychological processes that influence and are influenced by water availability and use. This intersection harbors intriguing unresolved scientific questions; advances in natural and social sciences will stem from attacks on the overall problem. The issue is societally compelling because the ability of the world to supply adequate food for a population expected to grow to over 9 billion by 2050 may well be determined by how farmers, consumers, and government institutions adapt to changing conditions of water availability. Major strides have been made in recent decades in understanding why Hardin's envisioned "tragedy of the commons" is avoided under certain circumstances, in some cases through self-organization rather than government intervention originally considered a necessity. Furthermore, we now know that the impacts of decisions about allocation and use of water can be

Therapeutic Assessment in Psychological Triage Using the PAI.

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Brown, Joshua D; Morey, Leslie C

2016-01-01

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

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

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Gary D Cantrell

2012-12-01

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

No Child Overlooked: Mental Health Triage in the Schools

Science.gov (United States)

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

2009-01-01

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

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

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

2017-11-01

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

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

Science.gov (United States)

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

2016-01-01

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

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

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Saeed Safari

2015-02-01

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

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

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

2015-11-01

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

The Impact of Telemedicine on Pediatric Critical Care Triage.

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

2017-11-01

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

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

Science.gov (United States)

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

2017-08-01

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

Triage medfører hurtigere behandling af de mest syge

DEFF Research Database (Denmark)

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

2011-01-01

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

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

Science.gov (United States)

Cady, Rhonda G.; Finkelstein, Stanley M.

2015-01-01

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

Scarce skills expatriates in South African universities: Rhetoric and realities of the “Messianic” academics

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Mokoko Sebola

2015-12-01

Full Text Available This article investigates the reason for the continued scarce skills shortage, despite the recruitment of expatriates in academic institutions as an intervention measure. It argues that while the Human Resources Departments in South African universities motivate for the appointment of expatriates in the development of scarce skills, little monitoring is done to determine the effectiveness of this objective and, often, no performance instrument exists for such personnel. As such, the scarce skills to be developed continue to be wanting in the country. This article is conceptual and uses literature to argue about the hypothetical relation between the lack of a monitoring tool for expatriates and the continued scarce skills problems that universities cannot address. It concludes that the continued lack of a performance-monitoring instrument in South African universities for contracted expatriates will not solve the skills shortage problem experienced in South Africa.

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

International Nuclear Information System (INIS)

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

2011-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2011-09-15

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

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

Science.gov (United States)

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

2018-02-01

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

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

African Journals Online (AJOL)

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

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

Directory of Open Access Journals (Sweden)

Madsen, Tracy E.

2014-12-01

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

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

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

2011-05-01

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

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

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

2015-01-01

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

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

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

2015-06-01

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

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

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

2012-10-01

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

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

Science.gov (United States)

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

2009-06-01

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

Parental satisfaction with paediatric care, triage and waiting times.

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

2014-04-01

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

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

Science.gov (United States)

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

2010-09-01

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

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

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

2016-02-11

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

Leveraging Scarce Resources With Bone Health TeleECHO to Improve the Care of Osteoporosis.

Science.gov (United States)

Lewiecki, E Michael; Rochelle, Rachelle; Bouchonville, Matthew F; Chafey, David H; Olenginski, Thomas P; Arora, Sanjeev

2017-12-01

Osteoporosis is a common condition with serious consequences because of fractures. Despite availability of treatments to reduce fracture risk, there is a large osteoporosis treatment gap that has reached crisis proportions. There are too few specialists to provide services for patients who need them. Bone Health Extension for Community Health Care Outcomes (TeleECHO) is a strategy using real-time ongoing videoconferencing technology to mentor health care professionals in rural and underserved communities to achieve an advanced level of knowledge for the care of patients with skeletal diseases. Over the first 21 months of weekly Bone Health TeleECHO programs, there were 263 registered health care professionals in the United States and several other countries, with 221 attending at least 1 online clinic and typically 35 to 40 attendees at each session at the end of the reported period. Assessment of self-confidence in 20 domains of osteoporosis care showed substantial improvement with the ECHO intervention ( P = 0.005). Bone Health TeleECHO can contribute to mitigating the crisis in osteoporosis care by leveraging scarce resources, providing motivated practitioners with skills to provide better skeletal health care, closer to home, with greater convenience, and lower cost than referral to a specialty center. Bone Health TeleECHO can be replicated in any location worldwide to reach anyone with Internet access, allowing access in local time zones and languages. The ECHO model of learning can be applied to other aspects of bone care, including the education of fracture liaison service coordinators, residents and fellows, and physicians with an interest in rare bone diseases.

Reliability of the primary triage process after the volendam fire disaster

NARCIS (Netherlands)

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

2008-01-01

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

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

Science.gov (United States)

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

2017-01-01

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

Crisis Team Management in a Scarce Resource Setting: Angkor Hospital for Children in Siem Reap, Cambodia

Directory of Open Access Journals (Sweden)

Richard Alynn Henker

2017-07-01

Full Text Available IntroductionA crisis team management (CTM simulation course was developed by volunteers from Health Volunteers Overseas for physicians and nurses at Angkor Hospital for Children (AHC in Siem Reap, Cambodia. The framework for the course was adapted from crisis resource management (1, 2, crisis team training (3, and TeamSTEPPs© models (4. The CTM course focused on teaching physicians and nurses on the development of team performance knowledge, skills, and attitudes. Challenges to providing this course at AHC included availability of simulation equipment, cultural differences in learning, and language barriers. The purpose of this project was to evaluate the impact of a CTM simulation course at AHC on attitudes and perceptions of participants on concepts related to team performance.MethodsEach of the CTM courses consisted of three lectures, including team performance concepts, communication, and debriefing followed by rotation through four simulation scenarios. The evaluation instrument used to evaluate the AHC CTM course was developed for Cambodian staff at AHC based on TeamSTEPPs© instruments evaluating attitude and perceptions of team performance (5. CTM team performance concepts included in lectures, debriefing sessions, and the evaluation instrument were: team structure, leadership, situation monitoring, mutual support, and communication. The Wilcoxon signed-rank test was used to analyze pre- and post-test paired data from participants in the course.ResultsOf the 54 participants completing the three CTM courses at AHC, 27 were nurses, 6 were anesthetists, and 21 were physicians. Attitude and perception scores were found to significantly improve (p < 0.05 for team structure, leadership, situation monitoring, and communication. Team performance areas that improved the most were: discussion of team performance, communication, and exchange of information.ConclusionTeaching of non-technical skills can be effective in a setting with scarce

Crisis Team Management in a Scarce Resource Setting: Angkor Hospital for Children in Siem Reap, Cambodia.

Science.gov (United States)

Henker, Richard Alynn; Henker, Hiroko; Eng, Hor; O'Donnell, John; Jirativanont, Tachawan

2017-01-01

A crisis team management (CTM) simulation course was developed by volunteers from Health Volunteers Overseas for physicians and nurses at Angkor Hospital for Children (AHC) in Siem Reap, Cambodia. The framework for the course was adapted from crisis resource management (1, 2), crisis team training (3), and TeamSTEPPs© models (4). The CTM course focused on teaching physicians and nurses on the development of team performance knowledge, skills, and attitudes. Challenges to providing this course at AHC included availability of simulation equipment, cultural differences in learning, and language barriers. The purpose of this project was to evaluate the impact of a CTM simulation course at AHC on attitudes and perceptions of participants on concepts related to team performance. Each of the CTM courses consisted of three lectures, including team performance concepts, communication, and debriefing followed by rotation through four simulation scenarios. The evaluation instrument used to evaluate the AHC CTM course was developed for Cambodian staff at AHC based on TeamSTEPPs© instruments evaluating attitude and perceptions of team performance (5). CTM team performance concepts included in lectures, debriefing sessions, and the evaluation instrument were: team structure, leadership, situation monitoring, mutual support, and communication. The Wilcoxon signed-rank test was used to analyze pre- and post-test paired data from participants in the course. Of the 54 participants completing the three CTM courses at AHC, 27 were nurses, 6 were anesthetists, and 21 were physicians. Attitude and perception scores were found to significantly improve ( p  < 0.05) for team structure, leadership, situation monitoring, and communication. Team performance areas that improved the most were: discussion of team performance, communication, and exchange of information. Teaching of non-technical skills can be effective in a setting with scarce resources in a Southeastern Asian country.

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

Science.gov (United States)

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

2013-01-01

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

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

Science.gov (United States)

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

2018-06-01

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

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

Directory of Open Access Journals (Sweden)

M. Dalwai*

2013-12-01

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

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

Science.gov (United States)

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

2016-01-01

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

Allocation of ventilators in a public health disaster.

Science.gov (United States)

Powell, Tia; Christ, Kelly C; Birkhead, Guthrie S

2008-03-01

In a public health emergency, many more patients could require mechanical ventilators than can be accommodated. To plan for such a crisis, the New York State Department of Health and the New York State Task Force on Life and the Law convened a workgroup to develop ethical and clinical guidelines for ventilator triage. The workgroup crafted an ethical framework including the following components: duty to care, duty to steward resources, duty to plan, distributive justice, and transparency. Incorporating the ethical framework, the clinical guidelines propose both withholding and withdrawing ventilators from patients with the highest probability of mortality to benefit patients with the highest likelihood of survival. Triage scores derive from the sepsis-related organ failure assessment system, which assigns points based on function in 6 basic medical domains. Triage may not be implemented by a facility without clear permission from public health authorities. New York State released the draft guidelines for public comment, allowing for revision to reflect both community values and medical innovation. This ventilator triage system represents a radical shift from ordinary standards of care, and may serve as a model for allocating other scarce resources in disasters.

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

Science.gov (United States)

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

2015-04-01

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

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

Science.gov (United States)

Ekins, Kylie; Morphet, Julia

2015-11-01

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

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

Science.gov (United States)

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

2018-06-01

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

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

African Journals Online (AJOL)

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

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

Science.gov (United States)

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

2014-07-01

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

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

Science.gov (United States)

MacDonald, D

1995-01-01

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

A New Triage Support Tool in Case of Explosion.

Science.gov (United States)

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

2018-04-01

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

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

NARCIS (Netherlands)

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

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

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

Directory of Open Access Journals (Sweden)

Jean E. Augustyn

2009-09-01

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

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

Science.gov (United States)

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

2018-04-11

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

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

Science.gov (United States)

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

2018-04-01

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

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

Science.gov (United States)

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

2017-05-15

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

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

African Journals Online (AJOL)

S Soogun

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

Paediatric triage in South Africa

African Journals Online (AJOL)

2013-05-07

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

Use of biomarkers in triage of patients with suspected stroke.

Science.gov (United States)

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

2011-05-01

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

A designated centre for people with disabilities operated by RehabCare, Longford

LENUS (Irish Health Repository)

Davoren, Mary

2015-01-01

Patients admitted to a secure forensic hospital are at risk of a long hospital stay. Forensic hospital beds are a scarce and expensive resource and ability to identify the factors predicting length of stay at time of admission would be beneficial. The DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale are designed to assess need for therapeutic security and urgency of that need while the HCR-20 predicts risk of violence. We hypothesized that items on the DUNDRUM-1 and DUNDRUM-2 scales, rated at the time of pre-admission assessment, would predict length of stay in a medium secure forensic hospital setting.

A designated centre for people with disabilities operated by Brothers of Charity Services Clare, Clare

LENUS (Irish Health Repository)

Davoren, Mary

2015-01-01

Patients admitted to a secure forensic hospital are at risk of a long hospital stay. Forensic hospital beds are a scarce and expensive resource and ability to identify the factors predicting length of stay at time of admission would be beneficial. The DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale are designed to assess need for therapeutic security and urgency of that need while the HCR-20 predicts risk of violence. We hypothesized that items on the DUNDRUM-1 and DUNDRUM-2 scales, rated at the time of pre-admission assessment, would predict length of stay in a medium secure forensic hospital setting.

Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission.

LENUS (Irish Health Repository)

Davoren, Mary

2015-01-01

Patients admitted to a secure forensic hospital are at risk of a long hospital stay. Forensic hospital beds are a scarce and expensive resource and ability to identify the factors predicting length of stay at time of admission would be beneficial. The DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale are designed to assess need for therapeutic security and urgency of that need while the HCR-20 predicts risk of violence. We hypothesized that items on the DUNDRUM-1 and DUNDRUM-2 scales, rated at the time of pre-admission assessment, would predict length of stay in a medium secure forensic hospital setting.

Interrogating scarcity: how to think about ‘resource-scarce settings’

Science.gov (United States)

Schrecker, Ted

2013-01-01

The idea of resource scarcity permeates health ethics and health policy analysis in various contexts. However, health ethics inquiry seldom asks—as it should—why some settings are ‘resource-scarce’ and others not. In this article I describe interrogating scarcity as a strategy for inquiry into questions of resource allocation within a single political jurisdiction and, in particular, as an approach to the issue of global health justice in an interconnected world. I demonstrate its relevance to the situation of low- and middle-income countries (LMICs) with brief descriptions of four elements of contemporary globalization: trade agreements; the worldwide financial marketplace and capital flight; structural adjustment; imperial geopolitics and foreign policy. This demonstration involves not only health care, but also social determinants of health. Finally, I argue that interrogating scarcity provides the basis for a new, critical approach to health policy at the interface of ethics and the social sciences, with specific reference to market fundamentalism as the value system underlying contemporary globalization. PMID:22899597

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

LENUS (Irish Health Repository)

Cronin, J G

2012-02-03

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

Triage Simulation in a Virtual Environment

NARCIS (Netherlands)

Dumay, A.C.M.

1995-01-01

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

Cost analysis and provider satisfaction with pediatrician in triage.

Science.gov (United States)

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

2012-10-01

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

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

Science.gov (United States)

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

2017-07-01

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

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

Science.gov (United States)

1984-02-06

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

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

Science.gov (United States)

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

2018-01-27

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

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

NARCIS (Netherlands)

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

2016-01-01

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

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

Science.gov (United States)

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

2016-02-01

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

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

Science.gov (United States)

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

2018-05-01

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

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

Science.gov (United States)

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

2017-04-03

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

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

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

2018-04-12

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

Rationing of resources: ethical issues in disasters and epidemic situations.

Science.gov (United States)

Lin, Janet Y; Anderson-Shaw, Lisa

2009-01-01

In an epidemic situation or large-scale disaster, medical and human resources may be stretched to the point of exhaustion. Appropriate planning must incorporate plans of action that minimize public health morbidity and mortality while maximizing the appropriate use of medical and human healthcare resources. While the current novel H1N1 influenza has spread throughout the world, the severity of this strain of influenza appears to be relatively less virulent and lethal compared to the 1918 influenza pandemic. However, the presence of this new influenza strain has reignited interest in pandemic planning. Amongst other necessary resources needed to combat pandemic influenza, a major medical resource concern is the limited number of mechanical ventilators that would be available to be used to treat ill patients. Recent reported cases of avian influenza suggest that mechanical ventilation will be required for the successful recovery of many individuals ill with this strain of virus. However, should the need for ventilators exceed the number of available machines, how will care providers make the difficult ethical decisions as to who should be placed or who should remain on these machines as more influenza patients arrive in need of care? This paper presents a decision-making model for clinicians that is based upon the bioethical principles of beneficence and justice. The model begins with the basic assumptions of triage and progresses into a useful algorithm based upon utilitarian principles. The model is intended to be used as a guide for clinicians in making decisions about the allocation of scarce resources in a just manner and to serve as an impetus for institutions to create or adapt plans to address resource allocation issues should the need arise.

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

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Rehman, Salma Abdul; Ali, Parveen Azam

2016-11-01

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

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

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Yuwares Sittichanbuncha

2015-01-01

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

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

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L N Goldstein

2017-03-01

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

Low compliance with a validated system for emergency department triage

DEFF Research Database (Denmark)

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

2011-01-01

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

El triage en enfermería

OpenAIRE

Macías de Plasencia, Guillermo

2013-01-01

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

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

Science.gov (United States)

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

2017-02-01

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

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

Science.gov (United States)

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

2014-01-01

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

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

Directory of Open Access Journals (Sweden)

Roberta Stofeles Cecon

2017-01-01

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

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

Science.gov (United States)

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

2016-02-01

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

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

Science.gov (United States)

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

2017-01-01

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

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

Directory of Open Access Journals (Sweden)

Sumanth Swaminathan

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

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

Science.gov (United States)

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

2016-01-01

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

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

Science.gov (United States)

Tominaga, Mariko; Michiue, Tomomi; Maeda, Hitoshi

2015-11-01

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

Self-rated worry in acute care telephone triage

DEFF Research Database (Denmark)

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

2018-01-01

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

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

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

2016-11-11

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

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

Science.gov (United States)

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

2012-11-01

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

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

Directory of Open Access Journals (Sweden)

Ke Yu

2011-06-01

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

Plasticity of rhizosphere hydraulic properties as a key for efficient utilization of scarce resources

Science.gov (United States)

Carminati, Andrea; Vetterlein, Doris

2013-01-01

experimental methods need to be developed and applied to different plant species and soil types, in order to understand whether such dualism in rhizosphere properties is an important mechanism for efficient utilization of scarce resources and drought tolerance. PMID:23235697

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

Science.gov (United States)

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

2018-02-01

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

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

Science.gov (United States)

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

2017-06-01

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

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

Science.gov (United States)

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

2018-04-19

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

Managing resource revenues in developing economies

NARCIS (Netherlands)

Collier, Paul; Van Der Ploeg, Rick; Spence, Michael; Venables, Anthony J.

2010-01-01

This paper addresses the efficient management of natural resource revenues in capital-scarce developing economies. It departs from usual prescriptions based on the permanent income hypothesis and argues that capital-scarce countries should prioritize domestic investment. Because revenue streams are

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

Science.gov (United States)

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

2015-07-31

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

When the news crew descends: a media triage plan.

Science.gov (United States)

Larson, Laurie

2002-01-01

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

Geriatric resources in acute care hospitals and trauma centers: a scarce commodity.

Science.gov (United States)

Maxwell, Cathy A; Mion, Lorraine C; Minnick, Ann

2013-12-01

The number of older adults admitted to acute care hospitals with traumatic injury is rising. The purpose of this study was to examine the location of five prominent geriatric resource programs in U.S. acute care hospitals and trauma centers (N = 4,865). As of 2010, 5.8% of all U.S. hospitals had at least one of these programs. Only 8.8% of trauma centers were served by at least one program; the majorities were in level I trauma centers. Slow adoption of geriatric resource programs in hospitals may be due to lack of champions who will advocate for these programs, lack of evidence of their impact on outcomes, or lack of a business plan to support adoption. Future studies should focus on the benefits of geriatric resource programs from patients' perspectives, as well as from business case and outcomes perspectives. Copyright 2013, SLACK Incorporated.

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

Science.gov (United States)

Lee, James S; Franc, Jeffrey M

2015-08-01

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

Measuring scarce water saving from interregional virtual water flows in China

Science.gov (United States)

Zhao, X.; Li, Y. P.; Yang, H.; Liu, W. F.; Tillotson, M. R.; Guan, D.; Yi, Y.; Wang, H.

2018-05-01

Trade of commodities can lead to virtual water flows between trading partners. When commodities flow from regions of high water productivity to regions of low water productivity, the trade has the potential to generate water saving. However, this accounting of water saving does not account for the water scarcity status in different regions. It could be that the water saving generated from this trade occurs at the expense of the intensified water scarcity in the exporting region, and exerts limited effect on water stress alleviation in importing regions. In this paper, we propose an approach to measure the scarce water saving associated with virtual water trade (measuring in water withdrawal/use). The scarce water is quantified by multiplying the water use in production with the water stress index (WSI). We assessed the scarce water saving/loss through interprovincial trade within China using a multi-region input-output table from 2010. The results show that interprovincial trade resulted in 14.2 km3 of water loss without considering water stress, but only 0.4 km3 scarce water loss using the scarce water concept. Among the 435 total connections of virtual water flows, 254 connections contributed to 20.2 km3 of scarce water saving. Most of these connections are virtual water flows from provinces with lower WSI to that with higher WSI. Conversely, 175 connections contributed to 20.6 km3 of scarce water loss. The virtual water flow connections between Xinjiang and other provinces stood out as the biggest contributors, accounting for 66% of total scarce water loss. The results show the importance of assessing water savings generated from trade with consideration of both water scarcity status and water productivity across regions. Identifying key connections of scarce water saving is useful in guiding interregional economic restructuring towards water stress alleviation, a major goal of China’s sustainable development strategy.

Earthquakes and trauma: review of triage and injury-specific, immediate care.

Science.gov (United States)

Gautschi, Oliver P; Cadosch, Dieter; Rajan, Gunesh; Zellweger, René

2008-01-01

Earthquakes present a major threat to mankind. Increasing knowledge about geophysical interactions, progressing architectural technology, and improved disaster management algorithms have rendered modern populations less susceptible to earthquakes. Nevertheless, the mass casualties resulting from earthquakes in Great Kanto (Japan), Ancash (Peru), Tangshan (China), Guatemala, Armenia, and Izmit (Turkey) or the recent earthquakes in Bhuj (India), Bam (Iran), Sumatra (Indonesia) and Kashmir (Pakistan) indicate the devastating effect earthquakes can have on both individual and population health. Appropriate preparation and implementation of crisis management algorithms are of utmost importance to ensure a large-scale medical-aid response is readily available following a devastating event. In particular, efficient triage is vital to optimize the use of limited medical resources and to effectively mobilize these resources so as to maximize patient salvage. However, the main priorities of disaster rescue teams are the rescue and provision of emergency care for physical trauma. Furthermore, the establishment of transport evacuation corridors, a feature often neglected, is essential in order to provide the casualties with a chance for survival. The optimal management of victims under such settings is discussed, addressing injuries of the body and psyche by means of simple diagnostic and therapeutic procedures globally applicable and available.

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

DEFF Research Database (Denmark)

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

2014-01-01

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

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

African Journals Online (AJOL)

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

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

OpenAIRE

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

2017-01-01

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

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

Directory of Open Access Journals (Sweden)

Stephane T. Tshitenge

2016-07-01

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

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

Science.gov (United States)

Waller, Edward J

2015-08-01

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

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

Directory of Open Access Journals (Sweden)

Crespo de Carvalho J

2013-12-01

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

The impact of using computer decision-support software in primary care nurse-led telephone triage: interactional dilemmas and conversational consequences.

Science.gov (United States)

Murdoch, Jamie; Barnes, Rebecca; Pooler, Jillian; Lattimer, Valerie; Fletcher, Emily; Campbell, John L

2015-02-01

Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Sustainable governance of scarce metals: the case of lithium.

Science.gov (United States)

Prior, Timothy; Wäger, Patrick A; Stamp, Anna; Widmer, Rolf; Giurco, Damien

2013-09-01

Minerals and metals are finite resources, and recent evidence suggests that for many, primary production is becoming more difficult and more expensive. Yet these resources are fundamentally important for society--they support many critical services like infrastructure, telecommunications and energy generation. A continued reliance on minerals and metals as service providers in modern society requires dedicated and concerted governance in relation to production, use, reuse and recycling. Lithium provides a good example to explore possible sustainable governance strategies. Lithium is a geochemically scarce metal (being found in a wide range of natural systems, but in low concentrations that are difficult to extract), yet recent studies suggest increasing future demand, particularly to supply the lithium in lithium-ion batteries, which are used in a wide variety of modern personal and commercial technologies. This paper explores interventions for sustainable governance and handling of lithium for two different supply and demand contexts: Australia as a net lithium producer and Switzerland as a net lithium consumer. It focuses particularly on possible nation-specific issues for sustainable governance in these two countries' contexts, and links these to the global lithium supply chain and demand scenarios. The article concludes that innovative business models, like 'servicizing' the lithium value chain, would hold sustainable governance advantages for both producer and consumer countries. Copyright © 2013 Elsevier B.V. All rights reserved.

Evaluation of an advanced-practice physiotherapist in triaging patients with lumbar spine pain: surgeon-physiotherapist level of agreement and patient satisfaction.

Science.gov (United States)

Robarts, Susan; Stratford, Paul; Kennedy, Deborah; Malcolm, Barry; Finkelstein, Joel

2017-08-01

Surgery for lumbar spine pain is indicated for specific etiologies. Given the majority of individuals referred to spine surgeons are not surgical candidates, care delivery is inefficient, with consultations being of limited value for most. Using specially trained physiotherapists in triage is a human resource strategy that may optimize surgeons' time and the patient experience. An advanced-practice physiotherapist (APP) and a surgeon assessed consecutive patients with lumbar spine pain presenting at an academic health centre's spine surgery clinic. The second assessor was blinded to the outcome of the first. We used the κ statistic to evaluate surgeon-APP level of chance-corrected agreement concerning patients' need for a surgical consultation. To assess satisfaction with the APP, patients completed a modified version of the validated Visit-specific Questionnaire. The sample included 102 participants (54 women) with a mean age of 54.3 ± 14.3 years and a mean Oswestry Disability Index score of 35.4 ± 16.6. The assessors' overall agreement was 86%. The κ coefficient for the need for a surgical consultation was 0.69 (95% confidence interval 0.54-0.84). The APP identified that 77% of patients did not require a surgical consultation. Twenty-one patients underwent surgery. Satisfaction scores for the APP were very high (mean score 92 out of 100). In triaging patients with lumbar spine pain, the APP and surgeon had a high level of agreement. An APP performing triage at a surgical centre can effectively reduce wait lists by 70%, reserving surgical consultations for those patients in whom they are indicated.

Higher Education: A Time for Triage?

Science.gov (United States)

Lagowski, J. J.

1995-10-01

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

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

Science.gov (United States)

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

2014-01-01

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

Triage for suspected acute Pulmonary Embolism: Think before opening Pandora's Box

Energy Technology Data Exchange (ETDEWEB)

Levin, David [Department of Radiology, Mayo Clinic, Rochester, MN (United States); Seo, Joon Beom [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kiely, David G. [Sheffield Pulmonary Vascular Disease Unit, M-15, M-Floor, Royal Hallamshire Hospital, Sheffield (United Kingdom); Hatabu, Hiroto [Department of Radiology, Brigham and Women' s Hospital and Harvard Medical School Boston, MA (United States); Gefter, Warren [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA (United States); Beek, Edwin J.R. van [Clinical Research Imaging Centre, University of Edinburgh, Scotland (United Kingdom); Schiebler, Mark L., E-mail: mschiebler@uwhealth.org [Department of Radiology, UW-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252 (United States)

2015-06-15

This is a review of the current strengths and weaknesses of the various imaging modalities available for the diagnosis of suspected non-massive Pulmonary Embolism (PE). Without careful consideration for the clinical presentation, and the timely application of clinical decision support (CDS) methodology, the current overutilization of imaging resources for this disease will continue. For a patient with a low clinical risk profile and a negative D-dimer there is no reason to consider further workup with imaging; as the negative predictive value in this scenario is the same as imaging. While the current efficacy and effectiveness data support the continued use of Computed Tomographic angiography (CTA) as the imaging golden standard for the diagnosis of PE; this test does have the unintended consequences of radiation exposure, possible overdiagnosis and overuse. There is a persistent lack of appreciation on the part of ordering physicians for the effectiveness of the alternatives to CTA (ventilation–perfusion imaging and contrast enhanced magnetic resonance angiography) in these patients. Careful use of standardized protocols for patient triage and the application of CDS will allow for a better use of imaging resources.

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

African Journals Online (AJOL)

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

Development of statewide geriatric patients trauma triage criteria.

Science.gov (United States)

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

2011-06-01

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

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

DEFF Research Database (Denmark)

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

2017-01-01

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

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

Science.gov (United States)

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

2018-02-08

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

Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa.

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Chowdhury, Sharfuddin; Nicol, Andrew John; Moydien, Mahammed Riyaad; Navsaria, Pradeep Harkison; Montoya-Pelaez, Luis Felipe

2018-01-01

The optimal timing for emergency surgical interventions and implementation of protocols for trauma surgery is insufficient in the literature. The Groote Schuur emergency surgery triage (GSEST) system, based on Cape Triaging Score (CTS), is followed at Groote Schuur Hospital (GSH) for triaging emergency surgical cases including trauma cases. The study aimed to look at the effect of delay in surgery after scheduling based on the GSEST system has an impact on outcome in terms of postoperative complications and death. Prospective audit of patients presenting to GSH trauma center following penetrating or blunt chest, abdominal, neck and peripheral vascular trauma who underwent surgery over a 4-month period was performed. Post-operative complications were graded according to Clavien-Dindo classification of surgical complications. One-hundred six patients underwent surgery during the study period. One-hundred two (96.2%) cases were related to penetrating trauma. Stab wounds comprised 71 (67%) and gunshot wounds (GSW) 31 (29.2%) cases. Of the 106 cases, 6, 47, 40, and 13 patients were booked as red, orange, yellow, and green, respectively. The median delay for green, yellow, and orange cases was within the expected time. The red patients took unexpectedly longer (median delay 48 min, IQR 35-60 min). Thirty-one (29.3%) patients developed postoperative complications. Among the booked red, orange, yellow, and green cases, postoperative complications developed in 3, 18, 9, and 1 cases, respectively. Only two (1.9%) postoperative deaths were documented during the study period. There was no statistically significant association between operative triage and post-operative complications ( p  = 0.074). Surgical case categorization has been shown to be useful in prioritizing emergency trauma surgical cases in a resource constraint high-volume trauma center.

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

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Boakye O

2016-05-01

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

'Smart card' speeds triage, boosts safety.

Science.gov (United States)

2008-10-01

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

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

African Journals Online (AJOL)

2013-12-03

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

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

Science.gov (United States)

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

2010-10-01

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

Virtual scarce water embodied in inter-provincial electricity transmission in China

International Nuclear Information System (INIS)

Zhang, Chao; Zhong, Lijin; Liang, Sai; Sanders, Kelly T.; Wang, Jiao; Xu, Ming

2017-01-01

Highlights: • Virtual water in inter-provincial electricity transmission in China is calculated. • A Water Stress Index is used to reflect relative scarcity of water consumption. • West Inner Mongolia is the largest exporter of scarce water. • Hebei, Beijing and Shandong are the three largest receivers of scarce water. - Abstract: Intra-national electricity transmission drives virtual water transfer from electricity production regions to electricity consumption regions. In China, the water-intensive thermoelectric power industry is expanding quickly in many water-scarce energy production hubs in northern and northwestern provinces. This study constructed a node-flow model of inter-provincial electricity transmission to investigate the virtual water and scarcity-adjusted virtual water (or virtual scarce water) embodied in the electricity transmission network. It is revealed that total inter-provincial virtual water transfer embodied in electricity transmission was 623 million m"3 in 2011, equivalent to 12.7% of the national total thermoelectric water consumption. The top three largest single virtual water flows are West Inner Mongolia-to-Beijing (44 million m"3), East Inner Mongolia-to-Liaoning (39 million m"3), and Guizhou-to-Guangdong (37 million m"3). If the actual volumes of consumptive water use are translated into scarcity-adjusted water consumption based on Water Stress Index, West Inner Mongolia (81 million m"3), Shanxi (63 million m"3) and Ningxia (30 million m"3) become the top three exporters of virtual scarce water. Many ongoing long-distance electricity transmission projects in China will enlarge the scale of scarce water outflows from northwestern regions and potentially increase their water stress.

Triage of means: options for conserving tiger corridors beyond designated protected lands in India

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Indranil Mondal

2016-11-01

Full Text Available The latest tiger census conducted in India during the year 2014 shows that it harbours 57% of the global tiger population in 7% of their historic global range. At the same time, India has 1.25 billion people growing at a rate of 1.7% per year. Protected tiger habitats in India are geographically isolated and collectively holds this tiger population under tremendous anthropogenic pressure. These protected lands are in itself not enough to sustain the growing tiger population, intensifying human-tiger conflict as dispersing individuals enter human occupied areas. These factors – isolation and inadequate size of the protected lands harbouring tiger meta-populations, highlight the need to connect tiger habitats and the importance of corridors beyond protected lands. It is imperative to conserve such corridors passing through private lands to safeguard the long-term survival of the tigers in India. The goal of long-term tiger conservation in India lies in smartly integrating tiger conservation concerns in various sectors where tiger conservation is not the priority. To effectively tap into all these resources, we propose a Triage of Means strategy. Here we do not prioritize species, populations or sites due to the non-availability of conservation resources. Instead, we aim to prioritize from available resources (means to achieve conservation from other sectors where tiger conservation is not the focus. We outline how to prioritise resources available from various sectors into conservation by prioritizing issues hampering tiger conservation beyond protected habitats.

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

International Nuclear Information System (INIS)

Safdar, C. A.

2010-01-01

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

Self-Replication of Localized Vegetation Patches in Scarce Environments

Science.gov (United States)

Bordeu, Ignacio; Clerc, Marcel G.; Couteron, Piere; Lefever, René; Tlidi, Mustapha

2016-09-01

Desertification due to climate change and increasing drought periods is a worldwide problem for both ecology and economy. Our ability to understand how vegetation manages to survive and propagate through arid and semiarid ecosystems may be useful in the development of future strategies to prevent desertification, preserve flora—and fauna within—or even make use of scarce resources soils. In this paper, we study a robust phenomena observed in semi-arid ecosystems, by which localized vegetation patches split in a process called self-replication. Localized patches of vegetation are visible in nature at various spatial scales. Even though they have been described in literature, their growth mechanisms remain largely unexplored. Here, we develop an innovative statistical analysis based on real field observations to show that patches may exhibit deformation and splitting. This growth mechanism is opposite to the desertification since it allows to repopulate territories devoid of vegetation. We investigate these aspects by characterizing quantitatively, with a simple mathematical model, a new class of instabilities that lead to the self-replication phenomenon observed.

Sample triage : an overview of Environment Canada's program

Energy Technology Data Exchange (ETDEWEB)

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

2006-07-01

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

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

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Josh Hanson

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

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

Directory of Open Access Journals (Sweden)

Elizabeth M Azzato

2014-01-01

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

Triage of Women with Low-Grade Cervical Lesions - HPV mRNA Testing versus Repeat Cytology

Science.gov (United States)

Sørbye, Sveinung Wergeland; Arbyn, Marc; Fismen, Silje; Gutteberg, Tore Jarl; Mortensen, Elin Synnøve

2011-01-01

Background In Norway, women with low-grade squamous intraepithelial lesions (LSIL) are followed up after six months in order to decide whether they should undergo further follow-up or be referred back to the screening interval of three years. A high specificity and positive predictive value (PPV) of the triage test is important to avoid unnecessary diagnostic and therapeutic procedures. Materials and Methods At the University Hospital of North Norway, repeat cytology and the HPV mRNA test PreTect HPV-Proofer, detecting E6/E7 mRNA from HPV types 16, 18, 31, 33 and 45, are used in triage of women with ASC-US and LSIL. In this study, women with LSIL cytology in the period 2005–2008 were included (n = 522). Two triage methods were evaluated in two separate groups: repeat cytology only (n = 225) and HPV mRNA testing in addition to repeat cytology (n = 297). Histologically confirmed cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) was used as the study endpoint. Results Of 522 women with LSIL, 207 had biopsies and 125 of them had CIN2+. The sensitivity and specificity of repeat cytology (ASC-US or worse) were 85.7% (95% confidence interval (CI): 72.1, 92.2) and 54.4 % (95% CI: 46.9, 61.9), respectively. The sensitivity and specificity of the HPV mRNA test were 94.2% (95% CI: 88.7, 99.7) and 86.0% (95% CI: 81.5, 90.5), respectively. The PPV of repeat cytology was 38.4% (95% CI: 29.9, 46.9) compared to 67.0% (95% CI: 57.7, 76.4) of the HPV mRNA test. Conclusion HPV mRNA testing was more sensitive and specific than repeat cytology in triage of women with LSIL cytology. In addition, the HPV mRNA test showed higher PPV. These data indicate that the HPV mRNA test is a better triage test for women with LSIL than repeat cytology. PMID:21918682

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

Science.gov (United States)

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

2016-01-01

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

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

Science.gov (United States)

Ram-Tiktin, Efrat

2017-07-01

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

Radiation protection - Performance criteria for laboratories performing cytogenetic triage for assessment of mass casualties in radiological or nuclear emergencies - General principles and application to dicentric assay

International Nuclear Information System (INIS)

2008-01-01

The potential for nuclear and radiological emergencies involving mass casualties from accidental or malicious acts or terrorism requires generic procedures for emergency dose assessment to help the development of medical response capabilities. A mass-casualties incident is defined here as an event that exceeds the local medical resources. Biological dosimetry, based on cytogenetic analysis using the dicentric assay, typically applied for accidental dose assessment, has been defined in ISO 19238. Cytogenetic triage is the use of chromosome damage to evaluate and assess approximately and rapidly radiation doses received by individuals in order to supplement the clinical categorization of casualties. This International Standard focuses on the use of the dicentric assay for rapid cytogenetic triage involving mass-casualty incidents. The primary purpose of this International Standard is to provide a guideline to all laboratories in order to perform the dicentric-bioassay - cytogenetic triage for dose assessment using documented and validated procedures. Secondly, it can facilitate the application of cytogenetic biodosimetry networks to permit comparison of results obtained in different laboratories. Finally, it is expected that laboratories newly commissioned to carry out the cytogenetic triage conform to this International Standard in order to perform the triage reproducibly and accurately. This International Standard is written in the form of procedures to adopt for dicentric-bioassay - cytogenetic triage biological dosimetry for overexposures involving mass radiological casualties. The criteria required for such measurements usually depend on the application of the results: medical management when appropriate, radiation-protection management, record keeping and medical/legal requirements. For example, selected cases can be analysed to produce a more accurate evaluation of high partial-body exposure; secondly, doses can be estimated for persons exposed below the

Computer Forensics Field Triage Process Model

Directory of Open Access Journals (Sweden)

Marcus K. Rogers

2006-06-01

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

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

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Seyedhossein Seyyedhoseini Davaraani

2014-07-01

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

Development of a Mass Casualty Triage Performance Assessment Tool

Science.gov (United States)

2015-02-01

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

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

DEFF Research Database (Denmark)

Hertzum, Morten

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

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

DEFF Research Database (Denmark)

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

2009-01-01

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

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

NARCIS (Netherlands)

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

2010-01-01

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

Sustainable governance of scarce metals: The case of lithium

International Nuclear Information System (INIS)

Prior, Timothy; Wäger, Patrick A.; Stamp, Anna; Widmer, Rolf; Giurco, Damien

2013-01-01

Minerals and metals are finite resources, and recent evidence suggests that for many, primary production is becoming more difficult and more expensive. Yet these resources are fundamentally important for society—they support many critical services like infrastructure, telecommunications and energy generation. A continued reliance on minerals and metals as service providers in modern society requires dedicated and concerted governance in relation to production, use, reuse and recycling. Lithium provides a good example to explore possible sustainable governance strategies. Lithium is a geochemically scarce metal (being found in a wide range of natural systems, but in low concentrations that are difficult to extract), yet recent studies suggest increasing future demand, particularly to supply the lithium in lithium-ion batteries, which are used in a wide variety of modern personal and commercial technologies. This paper explores interventions for sustainable governance and handling of lithium for two different supply and demand contexts: Australia as a net lithium producer and Switzerland as a net lithium consumer. It focuses particularly on possible nation-specific issues for sustainable governance in these two countries' contexts, and links these to the global lithium supply chain and demand scenarios. The article concludes that innovative business models, like ‘servicizing’ the lithium value chain, would hold sustainable governance advantages for both producer and consumer countries. - Highlights: • Lithium is a geochemically scare metal, but demand is forecast to increase in future • We explore sustainable lithium governance implications for Australia and Switzerland • One governance mechanism is the ‘servicization’ of the lithium value chain • We explore one actual, and two hypothetical lithium service business models • ‘Servicizing’ a commodity would require fundamental innovations in minerals policy

Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study

Directory of Open Access Journals (Sweden)

Barfod Charlotte

2012-04-01

Full Text Available Abstract Background Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT system and the outcome measures; Admission to Intensive Care Unit (ICU and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures. Methods The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, Tvitals, and presenting complaint, Tcomplaint. The more urgent of the two determines the final triage category, Tfinal. We retrieved 6279 unique adult patients admitted through the Emergency Department (ED from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures. Results The covariates, Tvitals, Tcomplaint and Tfinal were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO2, respiratory rate (RR, systolic blood pressure (BP and Glasgow Coma Score (GCS. Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5% and 'altered level of consciousness' (10.6%. More than half of the patients had a Tcomplaint more urgent than Tvitals

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

Science.gov (United States)

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

2013-07-01

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

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

OpenAIRE

Choi, Young Cheol; Hwang, Seong Youn

2008-01-01

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

Leader-Follower Effects in Resource Dilemmas: The Roles of Leadership Selection and Social Responsibility

OpenAIRE

Cremer, David de; Dijk, Eric van

2008-01-01

Abstract Previous research on the allocation of scarce resources shows that when people are assigned labels of leader or follower in their group, leaders allocate more of the scarce resources to themselves than followers do. In three laboratory studies, we examine the idea that how people are selected for the leader role (i.e. election or appointment) determines whether leaders take more or equal shares (relative to followers) from a common resource. In a first experiment, we show ...

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

Science.gov (United States)

Sheng, Yu-Hsiang; Chang, Polun

2006-01-01

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

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

Science.gov (United States)

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

2018-01-01

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

Uncovering genes and ploidy involved in the high diversity in root hair density, length and response to local scarce phosphate in Arabidopsis thaliana.

Directory of Open Access Journals (Sweden)

Markus G Stetter

Full Text Available Plant root hairs increase the root surface to enhance the uptake of sparingly soluble and immobile nutrients, such as the essential nutrient phosphorus, from the soil. Here, root hair traits and the response to scarce local phosphorus concentration were studied in 166 accessions of Arabidopsis thaliana using split plates. Root hair density and length were correlated, but highly variable among accessions. Surprisingly, the well-known increase in root hair density under low phosphorus was mostly restricted to genotypes that had less and shorter root hairs under P sufficient conditions. By contrast, several accessions with dense and long root hairs even had lower hair density or shorter hairs in local scarce phosphorus. Furthermore, accessions with whole-genome duplications developed more dense but phosphorus-insensitive root hairs. The impact of genome duplication on root hair density was confirmed by comparing tetraploid accessions with their diploid ancestors. Genome-wide association mapping identified candidate genes potentially involved in root hair responses tp scarce local phosphate. Knock-out mutants in identified candidate genes (CYR1, At1g32360 and RLP48 were isolated and differences in root hair traits in the mutants were confirmed. The large diversity in root hair traits among accessions and the diverse response when local phosphorus is scarce is a rich resource for further functional analyses.

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

Science.gov (United States)

Demelo, Jonathan; Parsons, Paul; Sedig, Kamran

2017-02-02

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

Development of rapid high throughput biodosimetry tools for radiological triage

International Nuclear Information System (INIS)

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

2018-01-01

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

A physiotherapy triage assessment service for people with low back disorders: evaluation of short-term outcomes

Directory of Open Access Journals (Sweden)

Bath B

2012-06-01

Full Text Available Brenna Bath, Punam PahwaCollege of Medicine, University of Saskatchewan, Saskatoon, CanadaPurpose: To determine the short-term effects of physiotherapy triage assessments on self-reported pain, functioning, and general well-being and quality of life in people with low back-related disorders.Methods: Participants with low back–related complaints were recruited from those referred to a spinal triage assessment program delivered by physiotherapists (PTs. Before undergoing the triage assessment, the participants completed a battery of questionnaires covering a range of sociodemographic, clinical, and psychosocial features. The study used the Numeric Pain Rating Scale (NPRS, the Oswestry Disability Index (ODI, and the Medical Outcomes Survey 36-item short-form version 2 (SF-36v2 to assess self-reported pain, function, and quality of life. Baseline measures and variables were analyzed using a descriptive analysis method (ie, proportions, means, medians. Paired samples t-tests or Wilcoxon matched-pair signed-rank tests were used to analyze the overall group differences between the pretest and posttest outcome measures where appropriate.Results: A total of 108 out of 115 (93.9% participants completed the posttest survey. The Physical Component Summary of the SF36v2 was the only measure that demonstrated significant improvement (P < 0.001.Conclusion: A spinal triage assessment program delivered by PTs can be viewed as a complex intervention that may have the potential to affect a wide range of patient-related outcomes. Further research is needed to examine the long-term outcomes and explore potential mechanisms of improvement using a biopsychosocial framework.Keywords: interprofessional practice, quality of life, back pain, orthopedics

Processing scarce biological samples for light and transmission electron microscopy

Directory of Open Access Journals (Sweden)

P Taupin

2008-06-01

Full Text Available Light microscopy (LM and transmission electron microscopy (TEM aim at understanding the relationship structure-function. With advances in biology, isolation and purification of scarce populations of cells or subcellular structures may not lead to enough biological material, for processing for LM and TEM. A protocol for preparation of scarce biological samples is presented. It is based on pre-embedding the biological samples, suspensions or pellets, in bovine serum albumin (BSA and bis-acrylamide (BA, cross-linked and polymerized. This preparation provides a simple and reproducible technique to process biological materials, present in limited quantities that can not be amplified, for light and transmission electron microscopy.

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

NARCIS (Netherlands)

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

2009-01-01

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

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

NARCIS (Netherlands)

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

2009-01-01

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

Developing a methodological framework for estimating water productivity indicators in water scarce regions

Science.gov (United States)

Mubako, S. T.; Fullerton, T. M.; Walke, A.; Collins, T.; Mubako, G.; Walker, W. S.

2014-12-01

Water productivity is an area of growing interest in assessing the impact of human economic activities on water resources, especially in arid regions. Indicators of water productivity can assist water users in evaluating sectoral water use efficiency, identifying sources of pressure on water resources, and in supporting water allocation rationale under scarcity conditions. This case study for the water-scarce Middle Rio Grande River Basin aims to develop an environmental-economic accounting approach for water use in arid river basins through a methodological framework that relates water use to human economic activities impacting regional water resources. Water uses are coupled to economic transactions, and the complex but mutual relations between various water using sectors estimated. A comparison is made between the calculated water productivity indicators and representative cost/price per unit volume of water for the main water use sectors. Although it contributes very little to regional economic output, preliminary results confirm that Irrigation is among the sectors with the largest direct water use intensities. High economic value and low water use intensity economic sectors in the study region include Manufacturing, Mining, and Steam Electric Power. Water accounting challenges revealed by the study include differences in water management regimes between jurisdictions, and little understanding of the impact of major economic activities on the interaction between surface and groundwater systems in this region. A more comprehensive assessment would require the incorporation of environmental and social sustainability indicators to the calculated water productivity indicators.

Exploring deep potential aquifer in water scarce crystalline rocks

Indian Academy of Sciences (India)

out to explore deep groundwater potential zone in a water scarce granitic area. As existing field condi- ... Decision support tool developed in granitic ter- .... cially in terms of fracture system, the aquifer char- acteristics ... Methodologies used.

Sustainable governance of scarce metals: The case of lithium

Energy Technology Data Exchange (ETDEWEB)

Prior, Timothy, E-mail: tim.prior@sipo.gess.ethz.ch [Center for Security Studies (CSS), ETH Zürich (Switzerland); Institute for Sustainable Futures, University of Technology, Sydney (Australia); Wäger, Patrick A. [Technology and Society Laboratory, Empa - Swiss Federal Laboratories for Materials Science and Technology, St. Gallen (Switzerland); Stamp, Anna [Technology and Society Laboratory, Empa - Swiss Federal Laboratories for Materials Science and Technology, St. Gallen (Switzerland); Institute for Environmental Decisions, ETH Zürich (Switzerland); Widmer, Rolf [Technology and Society Laboratory, Empa - Swiss Federal Laboratories for Materials Science and Technology, St. Gallen (Switzerland); Giurco, Damien [Institute for Sustainable Futures, University of Technology, Sydney (Australia)

2013-09-01

Minerals and metals are finite resources, and recent evidence suggests that for many, primary production is becoming more difficult and more expensive. Yet these resources are fundamentally important for society—they support many critical services like infrastructure, telecommunications and energy generation. A continued reliance on minerals and metals as service providers in modern society requires dedicated and concerted governance in relation to production, use, reuse and recycling. Lithium provides a good example to explore possible sustainable governance strategies. Lithium is a geochemically scarce metal (being found in a wide range of natural systems, but in low concentrations that are difficult to extract), yet recent studies suggest increasing future demand, particularly to supply the lithium in lithium-ion batteries, which are used in a wide variety of modern personal and commercial technologies. This paper explores interventions for sustainable governance and handling of lithium for two different supply and demand contexts: Australia as a net lithium producer and Switzerland as a net lithium consumer. It focuses particularly on possible nation-specific issues for sustainable governance in these two countries' contexts, and links these to the global lithium supply chain and demand scenarios. The article concludes that innovative business models, like ‘servicizing’ the lithium value chain, would hold sustainable governance advantages for both producer and consumer countries. - Highlights: • Lithium is a geochemically scare metal, but demand is forecast to increase in future • We explore sustainable lithium governance implications for Australia and Switzerland • One governance mechanism is the ‘servicization’ of the lithium value chain • We explore one actual, and two hypothetical lithium service business models • ‘Servicizing’ a commodity would require fundamental innovations in minerals policy.

Serological biomarkers in triage of FIT-positive subjects?

DEFF Research Database (Denmark)

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

2017-01-01

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

Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults.

Science.gov (United States)

Ichwan, Brian; Darbha, Subrahmanyam; Shah, Manish N; Thompson, Laura; Evans, David C; Boulger, Creagh T; Caterino, Jeffrey M

2015-01-01

We evaluate the sensitivity of Ohio's 2009 emergency medical services (EMS) geriatric trauma triage criteria compared with the previous adult triage criteria in identifying need for trauma center care among older adults. We studied a retrospective cohort of injured patients aged 16 years or older in the 2006 to 2011 Ohio Trauma Registry. Patients aged 70 years or older were considered geriatric. We identified whether each patient met the geriatric and the adult triage criteria. The outcome measure was need for trauma center care, defined by surrogate markers: Injury Severity Score greater than 15, operating room in fewer than 48 hours, any ICU stay, and inhospital mortality. We calculated sensitivity and specificity of both triage criteria for both age groups. We included 101,577 patients; 33,379 (33%) were geriatric. Overall, 57% of patients met adult criteria and 68% met geriatric criteria. Using Injury Severity Score, for older adults geriatric criteria were more sensitive for need for trauma center care (93%; 95% confidence interval [CI] 92% to 93%) than adult criteria (61%; 95% CI 60% to 62%). Geriatric criteria decreased specificity in older adults from 61% (95% CI 61% to 62%) to 49% (95% CI 48% to 49%). Geriatric criteria in older adults (93% sensitivity, 49% specificity) performed similarly to the adult criteria in younger adults (sensitivity 87% and specificity 44%). Similar patterns were observed for other outcomes. Standard adult EMS triage guidelines provide poor sensitivity in older adults. Ohio's geriatric trauma triage guidelines significantly improve sensitivity in identifying Injury Severity Score and other surrogate markers of the need for trauma center care, with modest decreases in specificity for older adults. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Swallowable fluorometric capsule for wireless triage of gastrointestinal bleeding.

Science.gov (United States)

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

2015-12-07

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

Monitor Soil Degradation or Triage for Soil Security? An Australian Challenge

Directory of Open Access Journals (Sweden)

Andrea Koch

2015-04-01

Full Text Available The Australian National Soil Research, Development and Extension Strategy identifies soil security as a foundation for the current and future productivity and profitability of Australian agriculture. Current agricultural production is attenuated by soil degradation. Future production is highly dependent on the condition of Australian soils. Soil degradation in Australia is dominated in its areal extent by soil erosion. We reiterate the use of soil erosion as a reliable indicator of soil condition/quality and a practical measure of soil degradation. We describe three key phases of soil degradation since European settlement, and show a clear link between inappropriate agricultural practices and the resultant soil degradation. We demonstrate that modern agricultural practices have had a marked effect on reducing erosion. Current advances in agricultural soil management could lead to further stabilization and slowing of soil degradation in addition to improving productivity. However, policy complacency towards soil degradation, combined with future climate projections of increased rainfall intensity but decreased volumes, warmer temperatures and increased time in drought may once again accelerate soil degradation and susceptibility to erosion and thus limit the ability of agriculture to advance without further improving soil management practices. Monitoring soil degradation may indicate land degradation, but we contend that monitoring will not lead to soil security. We propose the adoption of a triaging approach to soil degradation using the soil security framework, to prioritise treatment plans that engage science and agriculture to develop practices that simultaneously increase productivity and improve soil condition. This will provide a public policy platform for efficient allocation of public and private resources to secure Australia’s soil resource.

Sharing a common resource with concave benefits

OpenAIRE

Ambec, S.

2006-01-01

A group of agents enjoy concave and single-peak benefit functions from consuming a shared resource. They also value money (transfers). The resource is scarce in the sense that not everybody can consume its peak. The paper characterizes the unique (resource and money) allocation that is efficient, incentive compatible and equal-sharing individual rational. It can be implemented (i) by selling the resource or taxing extraction and redistributing the money collected equally, or (ii) by assigning...

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

Science.gov (United States)

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

2006-06-01

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

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

Science.gov (United States)

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

2015-08-01

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

Gender differences and social ties effects in resource sharing

NARCIS (Netherlands)

d'Exelle, Ben; Riedl, Arno

2016-01-01

In rural areas in developing countries gender inequality tends to be severe which might have substantial welfare implications if it determines how scarce economic resources are shared between men and women. Therefore, it is important to know how gender influences resource sharing and - given the

Resources planning for radiological incidents management

Science.gov (United States)

Hamid, Amy Hamijah binti Ab.; Rozan, Mohd Zaidi Abd; Ibrahim, Roliana; Deris, Safaai; Yunus, Muhd. Noor Muhd.

2017-01-01

Disastrous radiation and nuclear meltdown require an intricate scale of emergency health and social care capacity planning framework. In Malaysia, multiple agencies are responsible for implementing radiological and nuclear safety and security. This research project focused on the Radiological Trauma Triage (RTT) System. This system applies patient's classification based on their injury and level of radiation sickness. This classification prioritizes on the diagnostic and treatment of the casualties which include resources estimation of the medical delivery system supply and demand. Also, this system consists of the leading rescue agency organization and disaster coordinator, as well as the technical support and radiological medical response teams. This research implemented and developed the resources planning simulator for radiological incidents management. The objective of the simulator is to assist the authorities in planning their resources while managing the radiological incidents within the Internal Treatment Area (ITA), Reception Area Treatment (RAT) and Hospital Care Treatment (HCT) phases. The majority (75%) of the stakeholders and experts, who had been interviewed, witnessed and accepted that the simulator would be effective to resolve various types of disaster and resources management issues.

Systematic Review of Real-time Remote Health Monitoring System in Triage and Priority-Based Sensor Technology: Taxonomy, Open Challenges, Motivation and Recommendations.

Science.gov (United States)

Albahri, O S; Albahri, A S; Mohammed, K I; Zaidan, A A; Zaidan, B B; Hashim, M; Salman, Omar H

2018-03-22

The new and ground-breaking real-time remote monitoring in triage and priority-based sensor technology used in telemedicine have significantly bounded and dispersed communication components. To examine these technologies and provide researchers with a clear vision of this area, we must first be aware of the utilised approaches and existing limitations in this line of research. To this end, an extensive search was conducted to find articles dealing with (a) telemedicine, (b) triage, (c) priority and (d) sensor; (e) comprehensively review related applications and establish the coherent taxonomy of these articles. ScienceDirect, IEEE Xplore and Web of Science databases were checked for articles on triage and priority-based sensor technology in telemedicine. The retrieved articles were filtered according to the type of telemedicine technology explored. A total of 150 articles were selected and classified into two categories. The first category includes reviews and surveys of triage and priority-based sensor technology in telemedicine. The second category includes articles on the three-tiered architecture of telemedicine. Tier 1 represents the users. Sensors acquire the vital signs of the users and send them to Tier 2, which is the personal gateway that uses local area network protocols or wireless body area network. Medical data are sent from Tier 2 to Tier 3, which is the healthcare provider in medical institutes. Then, the motivation for using triage and priority-based sensor technology in telemedicine, the issues related to the obstruction of its application and the development and utilisation of telemedicine are examined on the basis of the findings presented in the literature.

A pivot nurse at triage.

Science.gov (United States)

Martin, Marie

2012-01-01

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

An Ecological Paradox: The African Wild Dog (Lycaon Pictus Is Not Attracted to Water Points When Water Is Scarce in Hwange National Park, Zimbabwe.

Directory of Open Access Journals (Sweden)

Henry Ndaimani

Full Text Available In dry biomes, spatio-temporal variation in surface water resource stocks is pervasive, with unknown effects on the ranging behaviour of large predators. This study assessed the effect of spatial variation in surface water resources on the ranging behaviour of the African wild dog (Lycaon pictus. We analyzed data for 1992 (dry year with 20 water points and 2000 (wet year with 30 water points against presence-only data for five packs of L. pictus in a part of Hwange National Park and adjacent smallholder communal farming areas in western Zimbabwe. Modelling the potential habitat for L. pictus using Maxent with distance from water points (Dw and Normalized Difference Vegetation Index (NDVI as predictor variables was successful for 2000 (AUC = 0.793 but not successful for 1992 (AUC = 0.423, with L. pictus probability of occurrence near water points being more for year 2000 than for year 1992. The predicted L. pictus range was wider in 1992 (~13888.1 km2 than in 2000 (~958.4 km2 (Test of Proportions, χ2 = 124.52, df = 1, P = 0.00. Using the 2nd order Multitype Nearest Neighbour Distance Function (Gcross, we also observed significant attraction between L. pictus and water points within only ~1km radius for 1992 but up to ~8km radius for 2000. Our study reinforced the notion that surface water resources attract wild dogs in the savannahs but paradoxically less so when water resources are scarce. In particular, our study furthers current understanding of the effects of changing water availability regimes on the endangered L. pictus, providing evidence that the endangered predator's home range encroaches into potential ecological traps (i.e., smallholder communal farming areas when water resources are scarce.

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

Science.gov (United States)

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

2017-06-01

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

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

DEFF Research Database (Denmark)

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

2017-01-01

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

The design and implementation of an obstetric triage system for unscheduled pregnancy related attendances: a mixed methods evaluation.

Science.gov (United States)

Kenyon, Sara; Hewison, Alistair; Dann, Sophie-Anna; Easterbrook, Jolene; Hamilton-Giachritsis, Catherine; Beckmann, April; Johns, Nina

2017-09-18

No standardised system of triage exists in Maternity Care and local audit identified this to be problematic. We designed, implemented and evaluated an Obstetric Triage System in a large UK maternity unit. This includes a standard clinical triage assessment by a midwife, within 15 min of attendance, leading to assignment to a category of clinical urgency (on a 4-category scale). This guides timing of subsequent standardised immediate care for the eight most common reasons for attendance. A training programme was integral to the introduction. A mixed methods evaluation was conducted. A structured audit of 994 sets of maternity notes before and after implementation identified the number of women seen within 15 min of attendance. Secondary measures reviewed included time to subsequent care and attendance. An inter-operator reliability study using scenarios was completed by midwives. A focus group and two questionnaire studies were undertaken to explore midwives' views of the system and to evaluate the training. In addition a national postal survey of practice in UK maternity units was undertaken in 2015. The structured audit of 974/992 (98%) of notes demonstrated an increase in the number of women seen within 15 min of attendance from 39% before implementation to 54% afterwards (RR (95% CI) 1.4 (1.2, 1.7) p = reliability (ICC 0.961 (95% CI 0.91-0.99)) was demonstrated with breakdown showing consistently good rates. Thematic analysis of focus group data (n = 12) informed the development of the questionnaire which was sent to all appropriate midwives. The response rate was 53/79 (67%) and the midwives reported that the new system helped them manage the department and improved safety. The National Survey (response rate 85/135 [63%]) demonstrated wide variation in where women are seen and staffing models in place. The majority of units 69/85 (81%) did not use a triage system based on clinical assessment to prioritise care. This obstetric triage system has excellent

Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Clinical Practice Guideline.

Science.gov (United States)

Jeronimo, Jose; Castle, Philip E; Temin, Sarah; Denny, Lynette; Gupta, Vandana; Kim, Jane J; Luciani, Silvana; Murokora, Daniel; Ngoma, Twalib; Qiao, Youlin; Quinn, Michael; Sankaranarayanan, Rengaswamy; Sasieni, Peter; Schmeler, Kathleen M; Shastri, Surendra S

2017-10-01

To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally. ASCO convened a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus. Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, one to three times per lifetime. For basic settings, visual assessment is recommended as triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results are present; in other settings, colposcopy is recommended for abnormal triage results. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation) is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in

Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Clinical Practice Guideline

Directory of Open Access Journals (Sweden)

Jose Jeronimo

2017-10-01

Full Text Available Purpose: To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally. Methods: ASCO convened a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus. Results: Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Recommendations: Human papillomavirus (HPV DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, one to three times per lifetime. For basic settings, visual assessment is recommended as triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results are present; in other settings, colposcopy is recommended for abnormal triage results. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general

Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises

Energy Technology Data Exchange (ETDEWEB)

Koerner, Markus; Kroetz, Michael M.; Wirth, Stefan; Boehm, Holger F.; Reiser, Maximilian; Linsenmaier, Ulrich [University Hospital Munich, Department of Clinical Radiology, Munich (Germany); Huber-Wagner, Stefan; Kanz, Karl-Georg [University Hospital Munich, Department of Surgery, Munich (Germany)

2009-08-15

The purpose of this study was to evaluate the feasibility, stability, and reproducibility of a dedicated CT protocol for the triage of patients in two separate large-scale exercises that simulated a mass casualty incident (MCI). In both exercises, a bomb explosion at the local soccer stadium that had caused about 100 casualties was simulated. Seven casualties who were rated ''critical'' by on-site field triage were admitted to the emergency department and underwent whole-body CT. The CT workflow was simulated with phantoms. The history of the casualties was matched to existing CT examinations that were used for evaluation of image reading under MCI conditions. The times needed for transfer and preparation of patients, examination, image reconstruction, total time in the CT examination room, image transfer to PACS, and image reading were recorded, and mean capacities were calculated and compared using the Mann-Whitney U test. We found no significant time differences in transfer and preparation of patients, duration of CT data acquisition, image reconstruction, total time in the CT room, and reading of the images. The calculated capacities per hour were 9.4 vs. 9.8 for examinations completed, and 8.2 vs. 7.2 for reports completed. In conclusion, CT triage is feasible and produced constant results with this dedicated and fast protocol. (orig.)

Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises

International Nuclear Information System (INIS)

Koerner, Markus; Kroetz, Michael M.; Wirth, Stefan; Boehm, Holger F.; Reiser, Maximilian; Linsenmaier, Ulrich; Huber-Wagner, Stefan; Kanz, Karl-Georg

2009-01-01

The purpose of this study was to evaluate the feasibility, stability, and reproducibility of a dedicated CT protocol for the triage of patients in two separate large-scale exercises that simulated a mass casualty incident (MCI). In both exercises, a bomb explosion at the local soccer stadium that had caused about 100 casualties was simulated. Seven casualties who were rated ''critical'' by on-site field triage were admitted to the emergency department and underwent whole-body CT. The CT workflow was simulated with phantoms. The history of the casualties was matched to existing CT examinations that were used for evaluation of image reading under MCI conditions. The times needed for transfer and preparation of patients, examination, image reconstruction, total time in the CT examination room, image transfer to PACS, and image reading were recorded, and mean capacities were calculated and compared using the Mann-Whitney U test. We found no significant time differences in transfer and preparation of patients, duration of CT data acquisition, image reconstruction, total time in the CT room, and reading of the images. The calculated capacities per hour were 9.4 vs. 9.8 for examinations completed, and 8.2 vs. 7.2 for reports completed. In conclusion, CT triage is feasible and produced constant results with this dedicated and fast protocol. (orig.)

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

Energy Technology Data Exchange (ETDEWEB)

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

2011-09-15

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

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

African Journals Online (AJOL)

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

Using Multi Criteria Evaluation in Forest resource conservation in ...

African Journals Online (AJOL)

The research attempts to propose technology in managing scarce forest resources through the use of GIS techniques. It contributes to the discourse on forest management, ecological mapping and inventory of forest resources in Ghana. It provides an information base to tackle the threat of deforestation on a location by ...

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

Science.gov (United States)

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

2015-06-01

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

Multibiodose radiation emergency triage categorization software.

Science.gov (United States)

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

2014-07-01

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

Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma: 110 is the new 90.

Science.gov (United States)

Brown, Joshua B; Gestring, Mark L; Forsythe, Raquel M; Stassen, Nicole A; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

2015-02-01

Undertriage is a concern in geriatric patients. The National Trauma Triage Protocol (NTTP) recognized that systolic blood pressure (SBP) less than 110 mm Hg may represent shock in those older than 65 years. The objective was to evaluate the impact of substituting an SBP of less than 110 mm Hg for the current SBP of less than 90 mm Hg criterion within the NTTP on triage performance and mortality. Subjects undergoing scene transport in the National Trauma Data Bank (2010-2012) were included. The outcome of trauma center need was defined as Injury Severity Score (ISS) greater than 15, intensive care unit admission, urgent operation, or emergency department death. Geriatric (age > 65 years) and adult (age, 16-65 years) cohorts were compared. Triage characteristics and area under the curve (AUC) were compared between SBP of less than 110 mm Hg and SBP of less than 90 mm Hg. Hierarchical logistic regression was used to determine whether geriatric patients newly triaged positive under this change (SBP, 90-109 mm Hg) have a risk of mortality similar to those triaged positive with SBP of less than 90 mm Hg. There were 1,555,944 subjects included. SBP of less than 110 mm Hg had higher sensitivity but lower specificity in geriatric (13% vs. 5%, 93% vs. 99%) and adult (23% vs. 10%, 90% vs. 98%) cohorts. AUC was higher for SBP of less than 110 mm Hg individually in both geriatric and adult (p AUC was similar for SBP of less than 110 mm Hg and SBP of less than 90 mm Hg in geriatric subjects but was higher for SBP of less than 90 mm Hg in adult subjects (p < 0.01). Substituting SBP of less than 110 mm Hg resulted in an undertriage reduction of 4.4% with overtriage increase of 4.3% in the geriatric cohort. Geriatric subjects with SBP of 90 mm Hg to 109 mm Hg had an odds of mortality similar to those of geriatric patients with SBP of less than 90 mm Hg (adjusted odds ratio, 1.03; 95% confidence interval, 0.88-1.20; p = 0.71). SBP of less than 110 mm Hg increases sensitivity. SBP of

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

NARCIS (Netherlands)

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

2009-01-01

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

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

Science.gov (United States)

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

1979-04-01

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

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

Science.gov (United States)

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

2017-01-01

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

Video2vec Embeddings Recognize Events when Examples are Scarce

NARCIS (Netherlands)

Habibian, A.; Mensink, T.; Snoek, C.G.M.

2017-01-01

This paper aims for event recognition when video examples are scarce or even completely absent. The key in such a challenging setting is a semantic video representation. Rather than building the representation from individual attribute detectors and their annotations, we propose to learn the entire

Triage (2009: la ética en tiempos de guerra

Directory of Open Access Journals (Sweden)

María Teresa ICART ISERN

2016-09-01

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

Physiotherapy in Primary Care Triage - the effects on utilization of medical services at primary health care clinics by patients and sub-groups of patients with musculoskeletal disorders: a case-control study.

Science.gov (United States)

Bornhöft, Lena; Larsson, Maria E H; Thorn, Jörgen

2015-01-01

Primary Care Triage is a patient sorting system used in some primary health care clinics (PHCCs) in Sweden where patients with musculoskeletal disorders (MSD) are triaged directly to physiotherapists. The purpose of this study was to investigate whether sorting/triaging patients seeking a PHCC for MSD directly to physiotherapists affects their utilization of medical services at the clinic for the MSD and to determine whether the effects of the triaging system vary for different sub-groups of patients. A retrospective case-control study design was used at two PHCCs. At the intervention clinic, 656 patients with MSD were initially triaged to physiotherapists. At the control clinic, 1673 patients were initially assessed by general practitioners (GPs). The main outcome measures were the number of patients continuing to visit GPs after the initial assessment, the number of patients receiving referrals to specialists/external examinations, doctors' notes for sick-leave or prescriptions for analgesics during one year, all for the original MSD. Significantly fewer patients triaged to physiotherapists required multiple GP visits for the MSD or received MSD-related referrals to specialists/external examinations, sick-leave recommendations or prescriptions during the following year compared to the GP-assessed group. This applies to all sub-groups except for the group with lower extremity disorders, which did not reach significance for either multiple GP visits or sick-leave recommendations. The reduced utilization of medical services by patients with MSD who were triaged to physiotherapists at a PHCC is likely due to altered management of MSD with initial assessment by physiotherapists.

Participatory Water Resources Modeling in a Water-Scarce Basin (Rio Sonora, Mexico) Reveals Uncertainty in Decision-Making

Science.gov (United States)

Mayer, A. S.; Vivoni, E. R.; Halvorsen, K. E.; Kossak, D.

2014-12-01

The Rio Sonora Basin (RSB) in northwest Mexico has a semi-arid and highly variable climate along with urban and agricultural pressures on water resources. Three participatory modeling workshops were held in the RSB in spring 2013. A model of the water resources system, consisting of a watershed hydrology model, a model of the water infrastructure, and groundwater models, was developed deliberatively in the workshops, along with scenarios of future climate and development. Participants were asked to design water resources management strategies by choosing from a range of supply augmentation and demand reduction measures associated with water conservation. Participants assessed water supply reliability, measured as the average daily supply divided by daily demand for historical and future periods, by probing with the climate and development scenarios. Pre- and post-workshop-surveys were developed and administered, based on conceptual models of workshop participants' beliefs regarding modeling and local water resources. The survey results indicate that participants believed their modeling abilities increased and beliefs in the utility of models increased as a result of the workshops. The selected water resources strategies varied widely among participants. Wastewater reuse for industry and aquifer recharge were popular options, but significant numbers of participants thought that inter-basin transfers and desalination were viable. The majority of participants indicated that substantial increases in agricultural water efficiency could be achieved. On average, participants chose strategies that produce reliabilities over the historical and future periods of 95%, but more than 20% of participants were apparently satisfied with reliabilities lower than 80%. The wide range of strategies chosen and associated reliabilities indicate that there is a substantial degree of uncertainty in how future water resources decisions could be made in the region.

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

Science.gov (United States)

Bath, Brenna; Janzen, Bonnie

2012-01-01

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

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

Science.gov (United States)

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

2018-02-01

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

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

Science.gov (United States)

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

2018-03-01

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

Electronic sorting of radioactive ores; Triage electronique des minerais radioactifs

Energy Technology Data Exchange (ETDEWEB)

Sandier, J.

1958-01-15

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

Improving Flood Predictions in Data-Scarce Basins

Science.gov (United States)

Vimal, Solomon; Zanardo, Stefano; Rafique, Farhat; Hilberts, Arno

2017-04-01

Flood modeling methodology at Risk Management Solutions Ltd. has evolved over several years with the development of continental scale flood risk models spanning most of Europe, the United States and Japan. Pluvial (rain fed) and fluvial (river fed) flood maps represent the basis for the assessment of regional flood risk. These maps are derived by solving the 1D energy balance equation for river routing and 2D shallow water equation (SWE) for overland flow. The models are run with high performance computing and GPU based solvers as the time taken for simulation is large in such continental scale modeling. These results are validated with data from authorities and business partners, and have been used in the insurance industry for many years. While this methodology has been proven extremely effective in regions where the quality and availability of data are high, its application is very challenging in other regions where data are scarce. This is generally the case for low and middle income countries, where simpler approaches are needed for flood risk modeling and assessment. In this study we explore new methods to make use of modeling results obtained in data-rich contexts to improve predictive ability in data-scarce contexts. As an example, based on our modeled flood maps in data-rich countries, we identify statistical relationships between flood characteristics and topographic and climatic indicators, and test their generalization across physical domains. Moreover, we apply the Height Above Nearest Drainage (HAND)approach to estimate "probable" saturated areas for different return period flood events as functions of basin characteristics. This work falls into the well-established research field of Predictions in Ungauged Basins.

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

NARCIS (Netherlands)

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

2010-01-01

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

Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda.

Directory of Open Access Journals (Sweden)

Celestin Hategeka

Full Text Available Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+-a locally adapted pediatric advanced life support management program-in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children.A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children.Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services. However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated.Our assessment provides evidence to inform new strategies to enhance the capacity of

Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda

Science.gov (United States)

Shoveller, Jean; Tuyisenge, Lisine; Kenyon, Cynthia; Cechetto, David F.; Lynd, Larry D.

2017-01-01

Background Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+)–a locally adapted pediatric advanced life support management program–in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children. Methods A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children. Results Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services). However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated. Conclusions Our assessment provides evidence to inform new strategies

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

LENUS (Irish Health Repository)

Fennelly, Orna

2018-06-01

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

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

International Nuclear Information System (INIS)

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

2011-01-01

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

Inter-laboratory comparison to validate the dicentric assay as a cytogenetic triage tool for medical management of radiation accidents

Energy Technology Data Exchange (ETDEWEB)

Beinke, Christina, E-mail: christinabeinke@bundeswehr.org [Bundeswehr Institute of Radiobiology Affiliated to the University of Ulm, Neuherbergstrasse 11, 80937 Munich (Germany); Oestreicher, Ursula [Federal Office for Radiation Protection, Neuherberg (Germany); Riecke, Armin [Department for Internal Medicine, Federal Armed Forces Hospital, Ulm (Germany); Kulka, Ulrike [Federal Office for Radiation Protection, Neuherberg (Germany); Meineke, Viktor [Bundeswehr Institute of Radiobiology Affiliated to the University of Ulm, Neuherbergstrasse 11, 80937 Munich (Germany); Romm, Horst [Federal Office for Radiation Protection, Neuherberg (Germany)

2011-09-15

Radiation accidents with exposure of human beings can assume huge dimensions concerning occurring health impairments and essential medical resources such as personnel, patient care management and appropriate medical facilities. Particularly in mass-casualty events, a rapid sorting and allocation of victims to treatment is needed and their classification in medical treatment groups has to be conducted as fast as possible. For triage purposes several approaches can be considered. Clinical signs and symptoms are extremely helpful in estimating radiation effects on an organ-based level, whereas the assessment of radiation effects based on cytogenetic biodosimetry tools is the alternative approach. For both systems there are pros and cons with respect to the usefulness for specific applications, such as individual cases versus mass-casualty screening or whole- versus partial-body exposures. Among the biodosimetry tools the dicentric chromosome assay (DCA) is considered as the 'gold standard' for biodosimetry after an acute radiation exposure. Recently, steady progress in standardization and harmonization of the DCA has occurred, in order to enable the validated performance of the DCA in the frame of cooperative response of biodosimetry networks during a large scale radiological scenario. Using the DCA in triage mode which allows the stratification of radiation exposed victims into broad 1.0 Gy categories only 20-50 metaphase cells per subject are scored instead of the 500-1000 scored for routine analysis. Our data show that there are significant differences between the dicentric yields after 1.0 Gy and 3.0 Gy {gamma}-ray ex vivo exposure of blood suggesting this assay as suitable for the distinction between high and low dosed exposed individuals. These preliminary findings indicate the usefulness of the DCA also for therapeutic decision making.

Triage in an adult emergency service: patient satisfaction

Directory of Open Access Journals (Sweden)

Pollyane Liliane Silva

2016-06-01

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

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

NARCIS (Netherlands)

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

2014-01-01

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

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

NARCIS (Netherlands)

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

2014-01-01

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

"MedTRIS" (Medical Triage and Registration Informatics System): A Web-based Client Server System for the Registration of Patients Being Treated in First Aid Posts at Public Events and Mass Gatherings.

Science.gov (United States)

Gogaert, Stefan; Vande Veegaete, Axel; Scholliers, Annelies; Vandekerckhove, Philippe

2016-10-01

First aid (FA) services are provisioned on-site as a preventive measure at most public events. In Flanders, Belgium, the Belgian Red Cross-Flanders (BRCF) is the major provider of these FA services with volunteers being deployed at approximately 10,000 public events annually. The BRCF has systematically registered information on the patients being treated in FA posts at major events and mass gatherings during the last 10 years. This information has been collected in a web-based client server system called "MedTRIS" (Medical Triage and Registration Informatics System). MedTRIS contains data on more than 200,000 patients at 335 mass events. This report describes the MedTRIS architecture, the data collected, and how the system operates in the field. This database consolidates different types of information with regards to FA interventions in a standardized way for a variety of public events. MedTRIS allows close monitoring in "real time" of the situation at mass gatherings and immediate intervention, when necessary; allows more accurate prediction of resources needed; allows to validate conceptual and predictive models for medical resources at (mass) public events; and can contribute to the definition of a standardized minimum data set (MDS) for mass-gathering health research and evaluation. Gogaert S , Vande veegaete A , Scholliers A , Vandekerckhove P . "MedTRIS" (Medical Triage and Registration Informatics System): a web-based client server system for the registration of patients being treated in first aid posts at public events and mass gatherings. Prehosp Disaster Med. 2016;31(5):557-562.

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

Science.gov (United States)

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

2017-12-12

To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. Randomized clinical trial. Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game v traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low v high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. 149 (81%) physicians in the game arm and 148 (80%) in the traditional education arm completed the trial. Of these, 64/100 (64%) and 58/100 (58%), respectively

Advances in a framework to compare bio-dosimetry methods for triage in large-scale radiation events

International Nuclear Information System (INIS)

Flood, Ann Barry; Boyle, Holly K.; Du, Gaixin; Demidenko, Eugene; Williams, Benjamin B.; Swartz, Harold M.; Nicolalde, Roberto J.

2014-01-01

Planning and preparation for a large-scale nuclear event would be advanced by assessing the applicability of potentially available bio-dosimetry methods. Using an updated comparative framework the performance of six bio-dosimetry methods was compared for five different population sizes (100-1 000 000) and two rates for initiating processing of the marker (15 or 15 000 people per hour) with four additional time windows. These updated factors are extrinsic to the bio-dosimetry methods themselves but have direct effects on each method's ability to begin processing individuals and the size of the population that can be accommodated. The results indicate that increased population size, along with severely compromised infrastructure, increases the time needed to triage, which decreases the usefulness of many time intensive dosimetry methods. This framework and model for evaluating bio-dosimetry provides important information for policy-makers and response planners to facilitate evaluation of each method and should advance coordination of these methods into effective triage plans. (authors)

War time experiences of triage and resuscitation: Australian Army nurses in the Vietnam War, 1967-1971.

Science.gov (United States)

Biedermann, N E; Harvey, N R

2001-07-01

The experiences of nurses in war is prolifically described in the North American scholarly literature, and in the Australian nursing literature to a lesser extent. The literature describes the plights and achievements of nurses caring for soldiers and civilians often under the most undesirable of circumstances. A central focus of war time nursing is the resuscitation of critically wounded soldiers. This paper addresses the experiences of the Australian Army nurses who were involved in the triage and resuscitation of critically wounded allied and enemy soldiers in the Vietnam War between 1967 and 1971. As part of a research study to explore and analyse the nature of nursing work in the Vietnam War, seventeen Vietnam veteran nurses were interviewed about their experiences. This paper explores the progression of the triage department in the Australian military hospital in Vung Tau, and it highlights that the majority of the nurses who took part in this study were clinically unprepared, particularly as emergency nurses.

Evaluación comparativa de Oportunidad y Pertinencia del Triage en el Servicio de Urgencias Adulto del Hospital Meissen en los periodos octubre 2011-marzo 2012 versus octubre 2012-marzo 2013

OpenAIRE

Sánchez Díaz, Jorge Eliecer

2014-01-01

Introducción: en la presente investigación se hace un análisis retrospectivo, descriptivo y comparativo de 2441 historias clínicas, donde se evalúan dos características de calidad contempladas en el Sistema Obligatorio de Garantía de Calidad de Atención en Salud Colombiano -SOGCS-: Oportunidad y Pertinencia en el Triage y la Atención Inicial de Urgencias (AIU) a pacientes del servicio de urgencias adulto (mayores de 14 años), en dos modelos de Triage, Triage Tradicional (TT), realizado por pr...

VideoStory Embeddings Recognize Events when Examples are Scarce

OpenAIRE

Habibian, Amirhossein; Mensink, Thomas; Snoek, Cees G. M.

2015-01-01

This paper aims for event recognition when video examples are scarce or even completely absent. The key in such a challenging setting is a semantic video representation. Rather than building the representation from individual attribute detectors and their annotations, we propose to learn the entire representation from freely available web videos and their descriptions using an embedding between video features and term vectors. In our proposed embedding, which we call VideoStory, the correlati...

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

Science.gov (United States)

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

2015-04-01

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

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

International Nuclear Information System (INIS)

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

2013-06-01

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

Structure analysis and core community detection of embodied resources networks among regional industries

Science.gov (United States)

He, Xijun; Dong, Yanbo; Wu, Yuying; Wei, Guodan; Xing, Lizhi; Yan, Jia

2017-08-01

To address the double pressure of scarce resources and regional industrial isomorphism, this paper applied the concepts of exergy and embodied resources based on economic input-output (I-O) data. We constructed the embodied resources networks among the regional industries of Beijing-Tianjin-Hebei (also known as Jing-Jin-Ji) in China. We analyzed the rules of embodied resources consumption in the area's industries, identified the core community structures, and studied the characteristics of industrial homogeneity through regional comparisons. The results showed that the dependence on scarce resources of industrial operations in Beijing was less than in Jin-Ji, while the dependence on finance, technology, information, and other service resources in Beijing was higher than in Jin-Ji. The I-O efficiency of embodied resources among industries and the agglomeration of correlation relationships in industries with large embodied resources were higher than in Jin-Ji. The industrial coincidence degree in the ;bridge; industries and in the core community in Jin-Ji was higher than in Jing-Jin and Jing-Ji, which means the industrial homogeneous competition of Jin-Ji was higher, too. This study makes a significant contribution toward promoting the dislocation development of regional industries, accelerating the coordination of resources, and reducing homogeneity competition.

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

Directory of Open Access Journals (Sweden)

Bath B

2011-12-01

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

Crowdsourcing Stream Stage in Data Scarce Regions: Applications of CrowdHydrology

Science.gov (United States)

Lowry, C.; Fienen, M. N.

2013-12-01

Crowdsourced data collection using citizen scientists and mobile phones is a promising way to collect supplemental information in data scarce or remote regions. The research presented here explore the possibilities and pitfalls of crowdsourcing hydrologic data via mobile phone text messaging through the example of CrowdHydrology, a distributed network of over 40 stream gages in four states. Signage at the CrowdHydrology gages ask citizen scientists to answer to a simple question via text message: 'What is the water height?'. While these data in no way replace more traditional measurements of stream stage, they do provide low cost supplemental measurements in data scarce regions. Results demonstrate the accuracy of crowdsourced data and provide insight for successful future crowdsourced data collection efforts. A less recognized benefit is that even in data rich areas, crowdsourced data collection is a cost-effective way to perform quality assurance on more sophisticated, and costly, data collection efforts.

Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

Directory of Open Access Journals (Sweden)

Kantonen Jarmo

2012-01-01

Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital. A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month as compared to the three previous years in the EDs

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

Energy Technology Data Exchange (ETDEWEB)

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

2017-08-01

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

Prehospital triage of patients diagnosed with perforated peptic ulcer or peptic ulcer bleeding: an observational study of patients calling 1-1-2.

Science.gov (United States)

Bonnesen, Kasper; Friesgaard, Kristian D; Boetker, Morten T; Nikolajsen, Lone

2018-04-05

Triage systems are used in emergency medical services to systematically prioritize prehospital resources according to individual patient conditions. Previous studies have shown cases of preventable deaths in emergency medical services even when triage systems are used, indicating a potential undertriage among some conditions. The aim of this study was to investigate the triage level among patients diagnosed with perforated peptic ulcer (PPU) or peptic ulcer bleeding (PUB). In a three-year period in Central Denmark Region, all patients hospitalized within 24 h after a 1-1-2 emergency call and who subsequently received either a PPU or a PUB (hereinafter combined and referred to as PPU/PUB) or a First Hour Quintet (FHQ: respiratory failure, stroke, trauma, cardiac chest pain, and cardiac arrest) diagnosis were investigated. A modified Poisson regression was used to estimate the relative risk of receiving the highest and lowest prehospital response level. Also, a linear regression analysis was used to estimate the relative risk of 30-day mortality. Of 8658 evaluated patients, 263 were diagnosed with PPU/PUB. After adjusting for relevant confounding variables, patients diagnosed with PPU/PUB were less likely to receive ambulance transportation compared to patients diagnosed with stroke, RR = 1.41 (CI: 1.28-1.56); trauma, RR = 1.28 (CI: 1.15-1.42); cardiac chest pain, RR = 1.47 (CI: 1.33-1.62); and cardiac arrest, RR = 1.44 (CI: 1.31-1.42). Among patients diagnosed with PPU/PUB, 6.5% (CI: 3.3-9.7) did not receive ambulance transportation. The proportion of patients not receiving ambulance transportation was higher among patients diagnosed with PPU/PUB compared to patients diagnosed with an FHQ diagnosis. The 30-day mortality rate among patients diagnosed with PPU/PUB was 7.8% (CI: 4.2-11.1). This was lower than the 30-day mortality rate among patients diagnosed with respiratory failure (P = 0.010), stroke (P = 0.001), and cardiac arrest (P�

ASR corpus design for resource-scarce languages

CSIR Research Space (South Africa)

Barnard, E

2009-09-01

Full Text Available little effect (top to bottom). This same behaviour is observed for all eleven languages, and is confirmed by repre- sentations such as that shown in Fig 2 (which shows the phone accuracy as a function of the number of training speakers, when about a... computed from the fit. ever, the more straightforward design employed here is repre- sentative of current standard practice. For this approach, the limited effect that additional speakers (above 50) has on system accuracy, was unexpected. High...

Processing spoken lectures in resource-scarce environments

CSIR Research Space (South Africa)

Van Heerden, CJ

2011-11-01

Full Text Available and then adapting or training new models using the segmented spoken lectures. The eventual systems perform quite well, aligning more than 90% of a selected set of target words successfully....

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

OpenAIRE

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

2018-01-01

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

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

LENUS (Irish Health Repository)

Emmanuel, Andrew

2010-11-01

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

Controlling percolation with limited resources

Science.gov (United States)

Schröder, Malte; Araújo, Nuno A. M.; Sornette, Didier; Nagler, Jan

2017-12-01

Connectivity, or the lack thereof, is crucial for the function of many man-made systems, from financial and economic networks over epidemic spreading in social networks to technical infrastructure. Often, connections are deliberately established or removed to induce, maintain, or destroy global connectivity. Thus, there has been a great interest in understanding how to control percolation, the transition to large-scale connectivity. Previous work, however, studied control strategies assuming unlimited resources. Here, we depart from this unrealistic assumption and consider the effect of limited resources on the effectiveness of control. We show that, even for scarce resources, percolation can be controlled with an efficient intervention strategy. We derive such an efficient strategy and study its implications, revealing a discontinuous transition as an unintended side effect of optimal control.

Descripción del triage en la zona de impacto realizado por personal del área de la salud a partir de ejercicios de simulación

Directory of Open Access Journals (Sweden)

Andrés Felipe Palacio Sánchez

2008-11-01

Full Text Available INTRODUCCIÓN: no existen en la literatura datos concretos acerca de la manera como se realiza el triage de multitud de lesionados en la zona de impacto, ni de los principales determinantes de sus resultados. Se realizó la simulación de un evento en masa y de la clasificación de los lesionados con la idea de describir la manera como se efectúa el triage y tratar de identificar determinantes importantes de sus resultados. OBJETIVO: describir la manera como el personal del área de la salud con distinto nivel de formación lleva a cabo el triage de multitud de lesionados en la zona de impacto, a partir de un ejercicio de simulación. MATERIALES Y MÉTODOS: se diseñaron 100 casos simulados de pacientes lesionados en un atentado dinamitero. Se conformaron grupos de 4 personas pertenecientes al área de la salud con distinto nivel de formación para que realizaran el triage en la zona de impacto de 20 casos simulados por cada grupo. Se hicieron 1.000 clasificaciones (50 grupos de 20 casos distribuidos así: 25 grupos de rescate (500 casos, 10 grupos de médicos graduados (200 casos y 15 grupos de estudiantes de último año de medicina (300 casos. No se hizo un análisis estadístico formal de los resultados por la heterogeneidad de los grupos, su tamaño y las condiciones del ejercicio para cada caso. RESULTADOS: se observaron proporciones de acierto globales similares a las reportadas en la literatura mundial (aproximadamente 50%; se observó una proporción de subtriage (11,8% mayor que la reportada en la literatura la cual tiende a cero. Se halló una proporción de sobretriage menor que la aceptada en la literatura, a expensas del aumento en el subtriage. Hay signos de desconocimiento de las herramientas del triage por parte del personal del área de la salud. Las proporciones de acierto y desacierto no parecen estar determinadas por el sexo y la edad; la tendencia es hacia que están determinadas mayormente por el tipo de lesi

Video2vec Embeddings Recognize Events when Examples are Scarce

OpenAIRE

Habibian, A.; Mensink, T.; Snoek, C.G.M.

2017-01-01

This paper aims for event recognition when video examples are scarce or even completely absent. The key in such a challenging setting is a semantic video representation. Rather than building the representation from individual attribute detectors and their annotations, we propose to learn the entire representation from freely available web videos and their descriptions using an embedding between video features and term vectors. In our proposed embedding, which we call Video2vec, the correlatio...

Effects of Water Management Strategies on Water Balance in a Water Scarce Region: A Case Study in Beijing by a Holistic Model

Directory of Open Access Journals (Sweden)

Zhigong Peng

2016-08-01

Full Text Available Irrigation is facing increasing pressure from other competitive water users to reduce water consumption in a water scarce region. Based on the Basin-wide Holistic Integrated Water Assessment (BHIWA model, the effects of water management strategies on water balance in the dry regions of North China were analyzed. The results show that, with the decrease of irrigation water supply reliability (IWSR and the increase of irrigation water use efficiency (WUE, irrigation water use decreased significantly, leading to reduced agriculture water consumption, and sustained ground water levels. Compared with the increase of WUE, the decrease of IWSR contributes more to reducing irrigation water consumption and protecting groundwater. Sensitivity tests show that among various water cycle components, irrigation water use is most sensitive to changes, followed by agriculture water consumption, and then groundwater level. Reducing IWSR is an effective strategy to reduce irrigation water consumption and promote sustainable water resources management, which could be the support of basic data and theory for regional water resources planning.

Mapping Stormwater Retention in the Cities: A Flexible Model for Data-Scarce Environments

Science.gov (United States)

Hamel, P.; Keeler, B.

2014-12-01

There is a growing demand for understanding and mapping urban hydrological ecosystem services, including stormwater retention for flood mitigation and water quality improvement. Progress in integrated urban water management and low impact development in Western countries increased our understanding of how grey and green infrastructure interact to enhance these services. However, valuation methods that account for a diverse group of beneficiaries are typically not made explicit in urban water management models. In addition, the lack of spatial data on the stormwater network in developing countries makes it challenging to apply state-of-the-art models needed to understand both the magnitude and spatial distribution of the stormwater retention service. To fill this gap, we designed the Urban InVEST stormwater retention model, a tool that complements the suite of InVEST software models to quantify and map ecosystem services. We present the model structure emphasizing the data requirements from a user's perspective and the representation of services and beneficiaries. We illustrate the model application with two case studies in a data-rich (New York City) and data-scarce environment. We discuss the difference in the level of information obtained when less resources (data, time, or expertise) are available, and how this affects multiple ecosystem service assessments that the tool is ultimately designed for.

Comparison of the Triage Micro Parasite Panel and Microscopy for the Detection of Entamoeba histolytica/Entamoeba dispar, Giardia lamblia, and Cryptosporidium parvum in Stool Samples Collected in Kenya

Directory of Open Access Journals (Sweden)

Brett Swierczewski

2012-01-01

Full Text Available Entamoeba histolytica, Giardia lamblia, and Cryptosporidium parvum are three of the most important parasitic causes of acute diarrhea worldwide. Laboratory diagnosis of these parasites is usually done by ova and parasite examination (O&P examination via microscopy. The sensitivity and specificity of O&P examination varies among laboratories and can be labor intensive and time consuming. The Triage Micro Parasite Panel (BioSite, San Diego, California is an enzyme immunoassay kit that can detect E. histolytica/E. dispar, G. lamblia, and C. parvum simultaneously using fresh or frozen stool. The present study evaluated the Triage Micro Parasite Panel in detecting E. histolytica/E. dispar, G. lamblia, and C. parvum compared to O&P examination in 266 stool samples collected at medical facilities in Kenya. The sensitivity and specificity results for the Triage Micro Parasite Panel were: for E. histolytica/E. dispar: 100%, 100%, G. lamblia: 100%, 100% and C. parvum: 73%, 100%. There was no evidence of cross reactivity using the kit with other parasites identified in the stool specimens. These results indicate that the Triage Micro Parasite Panel is a highly sensitive kit that can be used for screening purposes in large scale studies or outbreak investigations or as a possible alternative to O&P examination.

High-throughput microfluidics automated cytogenetic processing for effectively lowering biological process time and aid triage during radiation accidents

International Nuclear Information System (INIS)

Ramakumar, Adarsh

2016-01-01

Nuclear or radiation mass casualties require individual, rapid, and accurate dose-based triage of exposed subjects for cytokine therapy and supportive care, to save life. Radiation mass casualties will demand high-throughput individual diagnostic dose assessment for medical management of exposed subjects. Cytogenetic techniques are widely used for triage and definitive radiation biodosimetry. Prototype platform to demonstrate high-throughput microfluidic micro incubation to support the logistics of sample in miniaturized incubators from the site of accident to analytical labs has been developed. Efforts have been made, both at the level of developing concepts and advanced system for higher throughput in processing the samples and also implementing better and efficient methods of logistics leading to performance of lab-on-chip analyses. Automated high-throughput platform with automated feature extraction, storage, cross platform data linkage, cross platform validation and inclusion of multi-parametric biomarker approaches will provide the first generation high-throughput platform systems for effective medical management, particularly during radiation mass casualty events

Must producers earn a resource rent?

International Nuclear Information System (INIS)

Austvik, Ole Gunnar

2003-01-01

In petroleum producing countries it has been a prevailing opinion that a resource rent should be earned by petroleum producers due to the commodities' non-renewable nature. An important element in this logic is that the supply of oil and natural gas is limited to relatively few places in the world. As the resources are exploited, the remaining reserves are reduced. What is extracted today cannot be extracted tomorrow. Rationing of the scarce resource takes place through pricing mechanisms. Due to the scarcity the consumers must pay a higher price than the marginal production costs, so that the amounts supplied and demanded become equal. Most producers of oil and gas and not just the ones that produce the cheapest, have therefore until now earned an economic rent

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

Science.gov (United States)

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

2017-12-01

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

The sequential organ failure assessment (SOFA) score is an effective triage marker following staggered paracetamol (acetaminophen) overdose.

Science.gov (United States)

Craig, D G; Zafar, S; Reid, T W D J; Martin, K G; Davidson, J S; Hayes, P C; Simpson, K J

2012-06-01

The sequential organ failure assessment (SOFA) score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, but has not been evaluated following staggered (multiple supratherapeutic doses over >8 h, resulting in cumulative dose of >4 g/day) overdoses. To evaluate the prognostic accuracy of the SOFA score following staggered paracetamol overdose. Time-course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual timed laboratory samples were correlated with corresponding clinical parameters and the daily SOFA scores were calculated. A total of 39/50 (78%) patients developed hepatic encephalopathy. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2-95.7), 94.3 (95% CI 82.5-99.1), and 98.4 (95% CI 84.3-100.0) at 0, 24 and 48 h, respectively, postadmission. A SOFA score of paracetamol overdose, is associated with a good prognosis. Both the SOFA and APACHE II scores could improve triage of high-risk staggered paracetamol overdose patients. © 2012 Blackwell Publishing Ltd.

Impact of policies designed to enhance efficiency of water and nutrients on farm households varying in resource endowments in south India

NARCIS (Netherlands)

Senthilkumar, K.; Bindraban, P.S.; Ridder, de N.; Thiyagarajan, T.M.; Giller, K.E.

2012-01-01

Livelihoods of rice farmers depend on the efficient use of scarcely available agricultural resources. Farmers tend to maximize economic output of farming activities that may not necessarily coincide with the optimal use of resources from an ecological perspective. However, improving resource use

Factors Influencing Water Resource Governance among Pastoral Community at Mkondoa Sub-Catchment Morogoro Region Tanzania

OpenAIRE

Yeremia Yohana Masifia; Sarone Ole Sena

2017-01-01

The importance of proper Water Resource Management with greater emphasis on ensuring sustainability quality accountability and community participation has become imminent as water resources increasingly become scarce Harvey et al 2007. Water resources management in Tanzania is governed under the National Water Policy of 2002 and Water Resources Management Act No.11 of year 2009. Other related legislations include Environmental Management Act No. 20 of year 2004 Forest Policy and Forest Act No...

The Effect of Education on the Knowledge and Practice of Emergency Department’s Nurses Regarding the Patients’ Triage

Directory of Open Access Journals (Sweden)

Mohammad Kalantarimeibidi

2014-09-01

Full Text Available Introduction: Emergency department as one of the most important wards of the hospital confronts with lots of referring patients. Timely service presentation in this ward depends on efficient and effective functions of its personnel. Thus, this study was aimed to evaluate the effect of education on the knowledge and practice of emergency department’s nurses in the patients’ triage field. Methods: In this cross-sectional study, the knowledge and practice of 50 nurses was evaluated before and after of 9 hours educational workshop regarding patients’ triage based on the emergency severity index (ESI. Persons who had at least six months work experience in the emergency department and did not participate in any triage workshop during the six years before starting the project were entered to the study. Data gathering was performed through preparing three questionnaires separately included demographic information as well as assessment of knowledge and practice. Evaluated demographic characteristics were age, gender, marital status, work history, academic degree, type of employment, work shift, and average of work shift weekly. To assess the knowledge and practice, two separate questionnaires were used that their reliability and validity were confirmed before. Data was analyzed using SPSS 16 and appropriate analytic tests. P<0.05 was considered as statistically significant. Results: The average knowledge scores of nurses reached from 7.5±2.1 to 14±1.6 (p= 0.001, r=0.49 after education. Also the average scores of participants increased from 31.8±9.9 to 69.7±8.1 (p= 0.001, r=0.87.  There was no significant relationship between characteristics of nurses and their knowledge scores in six weeks after education (p>0.05. While it was seen between the work history of nursing (p=0.038, working in emergency department (p=0.001, as well as type of employment (p=0.019 and average scores of practice within six weeks after education. No significant

HPV DNA testing improves CIN2+ risk stratification and detection of CIN2+ in delayed triage of ASCUS and LSIL. A population-based follow-up study from Western Norway

Energy Technology Data Exchange (ETDEWEB)

Budal, Elisabeth B; Haugland, Hans K; Skar, Robert [Department of Pathology, Haukeland University Hospital, N-2021, Bergen (Norway); Mæhle, Bjørn O [Department of Pathology, Haukeland University Hospital, N-2021, Bergen (Norway); Section for Pathology, Department of Clinical Medicine, University of Bergen, N-5021, Bergen (Norway); Bjørge, Tone [Department of Global Public Health and Primary Care, University of Bergen, Bergen (Norway); Norwegian Institute of Public Health, Bergen (Norway); Vintermyr, Olav K, E-mail: olav.vintermyr@helse-bergen.no [Department of Pathology, Haukeland University Hospital, N-2021, Bergen (Norway); Section for Pathology, Department of Clinical Medicine, University of Bergen, N-5021, Bergen (Norway)

2014-02-01

In Norway, Pap smears with atypical squamous cells of uncertain significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) are triaged after 6 months. The aim of the study was to evaluate effects of implementing human papillomavirus (HPV) test (2005) in delayed triage of ASCUS and LSIL in a cohort of women from Western Norway. After a survey of 119,469 cervical Pap smears during 2005–2007, a total of 1055 women with an index ASCUS or LSIL were included in the study and followed up for 3–6 years with respect to progression into cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Overall sensitivity for detection of CIN2+ with HPV testing and cytology was 96% and 72%, respectively. The sensitivity for detection of CIN2+ was not affected by age, but the specificity of the HPV test increased with age. Thus, for the age groups <34 years, 34–50 years, and >50 years, the specificity of a positive HPV test to detect CIN2+ was 47%, 71%, and 82%, respectively. Positive predictive values for CIN2+ in women with positive cytology, positive HPV test, negative cytology, negative HPV test, or negative HPV and cytology tests were 52%, 41%, 8%, 1.5%, and 0.4%, respectively. HPV testing resulted in a net 22% increased detection of CIN2+. Fifty-six percent of CIN2+ was detected at an earlier time point with HPV testing in triage. Implementation of HPV testing in delayed triage of ASCUS and LSIL improved the stratification of CIN2+ risk and increased CIN2+ detection and at an earlier time point than with triage by cytology alone.

HPV DNA testing improves CIN2+ risk stratification and detection of CIN2+ in delayed triage of ASCUS and LSIL. A population-based follow-up study from Western Norway.

Science.gov (United States)

Budal, Elisabeth B; Haugland, Hans K; Skar, Robert; Maehle, Bjørn O; Bjørge, Tone; Vintermyr, Olav K

2014-02-01

In Norway, Pap smears with atypical squamous cells of uncertain significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) are triaged after 6 months. The aim of the study was to evaluate effects of implementing human papillomavirus (HPV) test (2005) in delayed triage of ASCUS and LSIL in a cohort of women from Western Norway. After a survey of 119,469 cervical Pap smears during 2005-2007, a total of 1055 women with an index ASCUS or LSIL were included in the study and followed up for 3-6 years with respect to progression into cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Overall sensitivity for detection of CIN2+ with HPV testing and cytology was 96% and 72%, respectively. The sensitivity for detection of CIN2+ was not affected by age, but the specificity of the HPV test increased with age. Thus, for the age groups 50 years, the specificity of a positive HPV test to detect CIN2+ was 47%, 71%, and 82%, respectively. Positive predictive values for CIN2+ in women with positive cytology, positive HPV test, negative cytology, negative HPV test, or negative HPV and cytology tests were 52%, 41%, 8%, 1.5%, and 0.4%, respectively. HPV testing resulted in a net 22% increased detection of CIN2+. Fifty-six percent of CIN2+ was detected at an earlier time point with HPV testing in triage. Implementation of HPV testing in delayed triage of ASCUS and LSIL improved the stratification of CIN2+ risk and increased CIN2+ detection and at an earlier time point than with triage by cytology alone. © 2013 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

HPV DNA testing improves CIN2+ risk stratification and detection of CIN2+ in delayed triage of ASCUS and LSIL. A population-based follow-up study from Western Norway

International Nuclear Information System (INIS)

Budal, Elisabeth B; Haugland, Hans K; Skar, Robert; Mæhle, Bjørn O; Bjørge, Tone; Vintermyr, Olav K

2014-01-01

In Norway, Pap smears with atypical squamous cells of uncertain significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) are triaged after 6 months. The aim of the study was to evaluate effects of implementing human papillomavirus (HPV) test (2005) in delayed triage of ASCUS and LSIL in a cohort of women from Western Norway. After a survey of 119,469 cervical Pap smears during 2005–2007, a total of 1055 women with an index ASCUS or LSIL were included in the study and followed up for 3–6 years with respect to progression into cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Overall sensitivity for detection of CIN2+ with HPV testing and cytology was 96% and 72%, respectively. The sensitivity for detection of CIN2+ was not affected by age, but the specificity of the HPV test increased with age. Thus, for the age groups <34 years, 34–50 years, and >50 years, the specificity of a positive HPV test to detect CIN2+ was 47%, 71%, and 82%, respectively. Positive predictive values for CIN2+ in women with positive cytology, positive HPV test, negative cytology, negative HPV test, or negative HPV and cytology tests were 52%, 41%, 8%, 1.5%, and 0.4%, respectively. HPV testing resulted in a net 22% increased detection of CIN2+. Fifty-six percent of CIN2+ was detected at an earlier time point with HPV testing in triage. Implementation of HPV testing in delayed triage of ASCUS and LSIL improved the stratification of CIN2+ risk and increased CIN2+ detection and at an earlier time point than with triage by cytology alone

Groundwater footprint methodology as policy tool for balancing water needs (agriculture & tourism) in water scarce islands - The case of Crete, Greece.

Science.gov (United States)

Kourgialas, Nektarios N; Karatzas, George P; Dokou, Zoi; Kokorogiannis, Andreas

2018-02-15

In many Mediterranean islands with limited surface water resources, the growth of agricultural and touristic sectors, which are the main water consumers, highly depends on the sustainable water resources management. This work highlights the crucial role of groundwater footprint (GF) as a tool for the sustainable management of water resources, especially in water scarce islands. The groundwater footprint represents the water budget between inflows and outflows in an aquifer system and is used as an index of the effect of groundwater use in natural resources and environmental flows. The case study presented in this paper is the island of Crete, which consists of 11 main aquifer systems. The data used for estimating the groundwater footprint in each system were groundwater recharges, abstractions through 412 wells, environmental flows (discharges) from 76 springs and 19 streams present in the area of study. The proposed methodology takes into consideration not only the water quantity but also the water quality of the aquifer systems and can be used as an integrated decision making tool for the sustainable management of groundwater resources. This methodology can be applied in any groundwater system. The results serve as a tool for assessing the potential of sustainable use and the optimal distribution of water needs under the current and future climatic conditions, considering both quantitative and qualitative factors. Adaptation measures and water policies that will effectively promote sustainable development are also proposed for the management of the aquifer systems that exhibit a large groundwater footprint. Copyright © 2017 Elsevier B.V. All rights reserved.

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

Science.gov (United States)

Silverloo, Iréne; Andrae, Bengt; Wilander, Erik

2009-01-01

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

Resource scarcity, effort, and performance in physically demanding jobs: An evolutionary explanation.

Science.gov (United States)

Pitesa, Marko; Thau, Stefan

2018-03-01

Based on evolutionary theory, we predicted that cues of resource scarcity in the environment (e.g., news of droughts or food shortages) lead people to reduce their effort and performance in physically demanding work. We tested this prediction in a 2-wave field survey among employees and replicated it experimentally in the lab. In Study 1, employees who perceived resources in the environment to be scarce reported exerting less effort when their jobs involved much (but not little) physical work. In Study 2, participants who read that resources in the environment were scarce performed worse on a task demanding more (carrying books) but not less (transcribing book titles) physical work. This result was found even though better performance increased participants' chances of additional remuneration, and even though scarcity cues did not affect individuals' actual ability to meet their energy needs. We discuss implications for managing effort and performance, and the potential of evolutionary psychology to explain core organizational phenomena. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The utility of focused assessment with sonography for trauma as a triage tool in multiple-casualty incidents during the second Lebanon war.

Science.gov (United States)

Beck-Razi, Nira; Fischer, Doron; Michaelson, Moshe; Engel, Ahuva; Gaitini, Diana

2007-09-01

The purpose of this study was to evaluate the role of focused assessment with sonography for trauma (FAST) as a triage tool in multiple-casualty incidents (MCIs) for a single international conflict. The charts of 849 casualties that arrived at our level 1 trauma referral center were reviewed. Casualties were initially triaged according to the Injury Severity Score at the emergency department gate. Two-hundred eighty-one physically injured patients, 215 soldiers (76.5%) and 66 civilians (23.5%), were admitted. Focused assessment with sonography for trauma was performed in 102 casualties suspected to have an abdominal injury. Sixty-eight underwent computed tomography (CT); 12 underwent laparotomy; and 28 were kept under clinical observation alone. We compared FAST results against CT, laparotomy, and clinical observation records. Focused assessment with sonography for trauma results were positive in 17 casualties and negative in 85. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FAST were 75%, 97.6%, 88.2%, 94.1%, and 93.1%, respectively. A strong correlation between FAST and CT results, laparotomy, and clinical observation was obtained (P war conflict-related MCI, FAST enabled immediate triage of casualties to laparotomy, CT, or clinical observation. Because of its moderate sensitivity, a negative FAST result with strong clinical suspicion demands further evaluation, especially in an MCI.

Analyses of impacts of China's international trade on its water resources and uses

Science.gov (United States)

Zhang, Z. Y.; Yang, H.; Shi, M. J.; Zehnder, A. J. B.; Abbaspour, K. C.

2011-04-01

This study provides an insight into the impact of China's international trade of goods and services on its water resources and uses. Virtual water flows associated with China's international trade are quantified in an input-output framework. The analysis is scaled down to the sectoral and provincial levels to trace the origins and destinations of virtual water flows associated with the international trade. The results reveal that China is a net virtual water exporter of 4.7 × 1010 m3 year-1, accounting for 2.1% of its total water resources and 8.9% of the total water use. Water scarce regions tend to have higher percentages of virtual water export relative to their water resources and water uses. In the water scarce Huang-Huai-Hai region, the net virtual water export accounts for 7.9% of the region's water resources and 11.2% of its water uses. For individual sectors, major net virtual water exporters are those where agriculture provides raw materials in the initial process of the production chain and/or pollution intensity is high. The results suggest that China's economic gains from being a world "manufacture factory" have come at a high cost to its water resources and through pollution to its environment.

Redeye: A Digital Library for Forensic Document Triage

Energy Technology Data Exchange (ETDEWEB)

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

2013-01-01

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

Coping with hygiene in South Africa, a water scarce country.

Science.gov (United States)

Duse, A G; da Silva, M P; Zietsman, I

2003-06-01

The burden of infectious diseases may be reduced by adopting effective infection control measures. Some of these are dependent on the provision of adequate and safe water supplies for maintenance of basic standards of personal, domestic and healthcare hygiene. Consequences of scarce, and sometimes unsafe, waters supplies in South Africa are highlighted with reference to healthcare-associated infections, community acquired infectious intestinal diseases and domestic practices as infection sources. Availability of water in more than 67% of South African municipal hospitals and primary health care facilities (delivered by water tanker in 12.5% of satellite clinics, 5% from river or dam sources, 12.4% relying on rainwater) does not necessarily guarantee that it's quality is safe for utilisation. In the Northern Province and Mpumalanga, water needs to be purified prior to usage in 14.4 and 33% of satellite clinics respectively. Simple, low maintenance and low-cost interventions to maximise use and safety of limited water resources may be implemented: micro-organism (S. dysenteriae) inactivation by direct UV-exposure in sunlight abundant environments, water purification by filtration mechanisms and making use of iron pots in the community for pasteurisation, decontamination and boiling procedures. Education is paramount in promoting healthy domestic food handling practices, changing cultural perceptions of hygiene, hand-washing technique and mechanisms of domestic environmental decontamination. Water provision cannot be separated from other inter-related factors such as sanitation. Although the present government has taken initiatives to reduce the number of people not having access to water by 50% in 2002, provision of sanitation has been slower (>38% inadequate sanitation in 2002). Adoption of integrated environmental management approaches in conjunction with community participation (WASH Campaign--2002), by the government, aims to address the sanitation problems.

Access Point Backhaul Resource Aggregation as a Many-to-One Matching Game in Wireless Local Area Networks

Directory of Open Access Journals (Sweden)

Kawther Hassine

2017-01-01

Full Text Available This paper studies backhaul bandwidth aggregation in the context of a wireless local area network composed of two different types of access points: those with spare backhaul capacity (which we term providers and those in shortage of it (beneficiaries; the aim is to transfer excess capacity from providers to beneficiaries. We model the system as a matching game with many-to-one setting wherein several providers can be matched to one beneficiary and adopt the so-called deferred acceptance algorithm to reach an optimal and stable solution. We consider two flavors, when the beneficiaries are limited in their resource demands and when they are not, and two scenarios, when resources are abundant and when they are scarce. Our results show that the many-to-one setting outperforms the one-to-one case in terms of overall throughput gain, resource usage, and individual beneficiaries satisfaction by up to 50%, whether resources are scarce or abundant. As of the limited versus nonlimited case, the former ensures more fair sharing of spectral resources and higher satisfaction percentage between beneficiaries.

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

Directory of Open Access Journals (Sweden)

Abdulaziz Bin Saeed

2017-01-01

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

Event-based nonpoint source pollution prediction in a scarce data catchment

Science.gov (United States)

Chen, Lei; Sun, Cheng; Wang, Guobo; Xie, Hui; Shen, Zhenyao

2017-09-01

Quantifying the rainfall-runoff-pollutant (R-R-P) process is key to regulating non-point source (NPS) pollution; however, the impacts of scarce measured data on R-R-P simulations have not yet been reported. In this study, we conducted a comprehensive study of scarce data that addressed both rainfall-runoff and runoff-pollutant processes, whereby the impacts of data scarcity on two commonly used methods, including Unit Hydrograph (UH) and Loads Estimator (LOADEST), were quantified. A case study was performed in a typical small catchment of the Three Gorges Reservoir Region (TGRR) of China. Based on our results, the classification of rainfall patterns should be carried out first when analyzing modeling results. Compared to data based on a missing rate and a missing location, key information generates more impacts on the simulated flow and NPS loads. When the scarcity rate exceeds a certain threshold (20% in this study), measured data scarcity level has clear impacts on the model's accuracy. As the model of total nitrogen (TN) always performs better under different data scarcity conditions, researchers are encouraged to pay more attention to continuous the monitoring of total phosphorus (TP) for better NPS-TP predictions. The results of this study serve as baseline information for hydrologic forecasting and for the further control of NPS pollutants.

The mobilization of supplier resources for complex projects

DEFF Research Database (Denmark)

Lutz, Salla; Ellegaard, Chris

2015-01-01

. Therefore, buying companies also need to influence supplier actors to prioritize and optimize resource flows into their specific exchange. Based on a theoretical basis comprising the literature on buyer-seller relationship, including resource based research of the Industrial Marketing and Purchasing (IMP......) group, as well as Dynamic Capabilities theory and the project management literature, this paper presents the results from a study of applied buying company resource mobilization routines. We report on a qualitative investigation of routines applied in complex construction projects in the North European...... offshore wind turbine industry. Complex construction/production projects are widespread global business phenomena, but knowledge of resource mobilization routines in this context is scarce in the literature. We find that the complex project owner (buying company) applies a series of 11 particular routines...

A comparative study of the effect of triage training by role-playing and educational video on the knowledge and performance of emergency medical service staffs in Iran.

Science.gov (United States)

Aghababaeian, Hamidreza; Sedaghat, Soheila; Tahery, Noorallah; Moghaddam, Ali Sadeghi; Maniei, Mohammad; Bahrami, Nosrat; Ahvazi, Ladan Araghi

2013-12-01

Educating emergency medical staffs in triage skills is an important aspect of disaster preparedness. The aim of the study was to compare the effect of role-playing and educational video presentation on the learning and performance of the emergency medical service staffs in Khozestan, Iran A total of 144 emergency technicians were randomly classified into two groups. A researcher trained the first group using an educational video method and the second group with a role-playing method. Data were collected before, immediately, and 15 days after training using a questionnaire covering the three domains of demographic information, triage knowledge, and triage performance. The data were analyzed using defined knowledge and performance parameters. There was no significant difference between the two training methods on performance and immediate knowledge (P = .2), lasting knowledge (P=.05) and immediate performance (P = .35), but there was a statistical advantage for the role-playing method on lasting performance (P = .02). The two educational methods equally increase knowledge and performance, but the role-playing method may have a more desirable and lasting effect on performance.

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

Science.gov (United States)

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

2018-07-01

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

HPV DNA testing improves CIN2+ risk stratification and detection of CIN2+ in delayed triage of ASCUS and LSIL. A population-based follow-up study from Western Norway

OpenAIRE

Budal, Elisabeth Berge; Haugland, Hans Kristian; Skar, Robert; Mæhle, Bjørn Ove; Bjørge, Tone; Vintermyr, Olav Karsten

2014-01-01

In Norway, Pap smears with atypical squamous cells of uncertain significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) are triaged after 6 months. The aim of the study was to evaluate effects of implementing human papillomavirus (HPV) test (2005) in delayed triage of ASCUS and LSIL in a cohort of women from Western Norway. After a survey of 119,469 cervical Pap smears during 2005–2007, a total of 1055 women with an index ASCUS or LSIL were included in the study and followe...

Faecal immunochemical tests to triage patients with lower abdominal symptoms for suspected colorectal cancer referrals in primary care: a systematic review and cost-effectiveness analysis.

Science.gov (United States)

Westwood, Marie; Corro Ramos, Isaac; Lang, Shona; Luyendijk, Marianne; Zaim, Remziye; Stirk, Lisa; Al, Maiwenn; Armstrong, Nigel; Kleijnen, Jos

2017-05-01

Colorectal cancer (CRC) is the third most common cancer in the UK. Presenting symptoms that can be associated with CRC usually have another explanation. Faecal immunochemical tests (FITs) detect blood that is not visible to the naked eye and may help to select patients who are likely to benefit from further investigation. To assess the effectiveness of FITs [OC-Sensor (Eiken Chemical Co./MAST Diagnostics, Tokyo, Japan), HM-JACKarc (Kyowa Medex/Alpha Laboratories Ltd, Tokyo, Japan), FOB Gold (Sentinel/Sysmex, Sentinel Diagnostics, Milan, Italy), RIDASCREEN Hb or RIDASCREEN Hb/Hp complex (R-Biopharm, Darmstadt, Germany)] for primary care triage of people with low-risk symptoms. Twenty-four resources were searched to March 2016. Review methods followed published guidelines. Summary estimates were calculated using a bivariate model or a random-effects logistic regression model. The cost-effectiveness analysis considered long-term costs and quality-adjusted life-years (QALYs) that were associated with different faecal occult blood tests and direct colonoscopy referral. Modelling comprised a diagnostic decision model, a Markov model for long-term costs and QALYs that were associated with CRC treatment and progression, and a Markov model for QALYs that were associated with no CRC. We included 10 studies. Using a single sample and 10 µg Hb/g faeces threshold, sensitivity estimates for OC-Sensor [92.1%, 95% confidence interval (CI) 86.9% to 95.3%] and HM-JACKarc (100%, 95% CI 71.5% to 100%) indicated that both may be useful to rule out CRC. Specificity estimates were 85.8% (95% CI 78.3% to 91.0%) and 76.6% (95% CI 72.6% to 80.3%). Triage using FITs could rule out CRC and avoid colonoscopy in approximately 75% of symptomatic patients. Data from our systematic review suggest that 22.5-93% of patients with a positive FIT and no CRC have other significant bowel pathologies. The results of the base-case analysis suggested minimal difference in QALYs between all of the

An electronic screen for triaging adolescent substance use by risk levels.

Science.gov (United States)

Levy, Sharon; Weiss, Roger; Sherritt, Lon; Ziemnik, Rosemary; Spalding, Allegra; Van Hook, Shari; Shrier, Lydia A

2014-09-01

Screening adolescents for substance use and intervening immediately can reduce the burden of addiction and substance-related morbidity. Several screening tools have been developed to identify problem substance use for adolescents, but none have been calibrated to triage adolescents into clinically relevant risk categories to guide interventions. To describe the psychometric properties of an electronic screen and brief assessment tool that triages adolescents into 4 actionable categories regarding their experience with nontobacco substance use. Adolescent patients (age range, 12-17 years) arriving for routine medical care at 2 outpatient primary care centers and 1 outpatient center for substance use treatment at a pediatric hospital completed an electronic screening tool from June 1, 2012, through March 31, 2013, that consisted of a question on the frequency of using 8 types of drugs in the past year (Screening to Brief Intervention). Additional questions assessed severity of any past-year substance use. Patients completed a structured diagnostic interview (Composite International Diagnostic Interview-Substance Abuse Module), yielding Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) substance use diagnoses. For the entire screen and the Screening to Brief Intervention, sensitivity and specificity for identifying nontobacco substance use, substance use disorders, severe substance use disorders, and tobacco dependence were calculated using the Composite International Diagnostic Interview-Substance Abuse Module as the criterion standard. Of 340 patients invited to participate, 216 (63.5%) enrolled in the study. Sensitivity and specificity were 100% and 84% (95% CI, 76%-89%) for identifying nontobacco substance use, 90% (95% CI, 77%-96%) and 94% (95% CI, 89%-96%) for substance use disorders, 100% and 94% (95% CI, 90%-96%) for severe substance use disorders, and 75% (95% CI, 52%-89%) and 98% (95% CI, 95%-100%) for nicotine dependence. No significant

First evaluation of the NHS direct online clinical enquiry service: A nurse-led web chat triage service for the public

NARCIS (Netherlands)

Eminovic, Nina; Wyatt, Jeremy C.; Tarpey, Aideen M.; Murray, Gerard; Ingrams, Grant J.

2004-01-01

Background: NHS Direct is a telephone triage service used by the UK public to contact a nurse for any kind of health problem. NHS Direct Online (NHSDO) extends NHS Direct, allowing the telephone to be replaced by the Internet, and introducing new opportunities for informing patients about their

Is safe surgery possible when resources are scarce?

Science.gov (United States)

O'Hara, Nathan N

2015-07-01

The greatest burden of surgical disease exists in low- and middle-income countries, where the quality and safety of surgical treatment cause major challenges. Securing necessary and appropriate medical supplies and infrastructure remains a significant and under-recognised limitation to providing safe and high-quality surgical care in these settings. The majority of surgical instruments are sold in high-income countries. Limited market pressures lead to superfluous designs and inflated costs for these devices. This context creates an opportunity for frugal innovation-the search for designs that will enable low-cost care without compromising quality. Although progressive examples of frugal surgical innovations exist, policy innovation is required to augment design pathways while fostering appropriate safety controls for prospective devices. Many low-cost, high-quality medical technologies will increase access to safe surgical care in low-income countries and have widespread applicability as all countries look to reduce the cost of providing care, without compromising quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The allocation of scarce resources in miscellaneous cases

NARCIS (Netherlands)

Hamsvoort, van der C.P.C.M.

2006-01-01

Key words: sustainable development, environmental utilization space (EUS),      auctions, conservation contracting, information asymmetry, agricultural land

Information technology systems for critical care triage and medical response during an influenza pandemic: a review of current systems.

Science.gov (United States)

Bandayrel, Kristofer; Lapinsky, Stephen; Christian, Michael

2013-06-01

To assess local, state, federal, and global pandemic influenza preparedness by identifying pandemic plans at the local, state, federal, and global levels, and to identify any information technology (IT) systems in these plans to support critical care triage during an influenza pandemic in the Canadian province of Ontario. The authors used advanced MEDLINE and Google search strategies and conducted a comprehensive review of key pandemic influenza Web sites. Descriptive data extraction and analysis for IT systems were conducted on all of the included pandemic plans. A total of 155 pandemic influenza plans were reviewed: 29 local, 62 state, 63 federal, and 1 global. We found 70 plans that examined IT systems (10 local, 33 state, 26 federal, 1 global), and 85 that did not (19 local, 29 state, 37 federal). Of the 70 plans, 64 described surveillance systems (10 local, 32 state, 21 federal, 1 global), 2 described patient data collection systems (1 state, 1 federal); 4 described other types of IT systems (4 federal), and none were intended for triage. Although several pandemic plans have been drafted, the majority are high-level general documents that do not describe IT systems. The plans that discuss IT systems focus strongly on surveillance, which fails to recognize the needs of a health care system responding to an influenza pandemic. The best examples of the types of IT systems to guide decision making during a pandemic were found in the Kansas and the Czech Republic pandemic plans, because these systems were designed to collect both patient and surveillance data. Although Ontario has yet to develop such an IT system, several IT systems are in place that could be leveraged to support critical care triage and medical response during an influenza pandemic.

Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios.

Science.gov (United States)

Hansen, Elisabeth Holm; Hunskaar, Steinar

2011-05-01

The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n = 18, response rate 90%) as a test-retest assessment. Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Correct classification of acute and non-urgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage.

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

Science.gov (United States)

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

2017-01-01

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

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

Science.gov (United States)

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

2012-03-01

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

Classification of human- and automated resource allocation approaches in multi-project management

NARCIS (Netherlands)

Ponsteen, A.; Kusters, R.J.; Pasian, B.; Storm, P.

2015-01-01

Managing a multi-project environment requires a different method than managing a single project. The main challenge of managing a multi-project environment is the allocation of scarce human resources over the projects in execution. As part of a broader research on this topic, the aim of this paper

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

Science.gov (United States)

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

2017-09-01

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

Integrated resource planning - a long and winding road

International Nuclear Information System (INIS)

Reuter, A.L.

1995-01-01

The separation of Croatia from former Yugoslavia and the military turbulence at its borders during the last years caused a number of problems in the Croatian energy system. Resources for improving the situation are scarce. So it is necessary to plan the rehabilitation and modernization of the Croatian energy system in a way which includes all national resources and allocates these resources where they lead to the highest benefits to the national economy. In this paper it is shown that Integrated Resource Planning (IRP) is such a method which enables the rational use of national resources. Also presented in this paper is a transparent and rational procedure which allows the energy planner to support the decision maker in developing an energy policy under consideration of interests of affected groups. This procedure is called Structured Analysis Procedure and step by step leads from the problem formulation to the decision on which action is to be applied to solve the problem. (author)

Quest for Quality : Interventions to Improve Human Resources for Health among Faith-Based Organizations

NARCIS (Netherlands)

Adjei, S; Maniple, E; I, Dokotala; Mpoza, K; PM, Pamba; Pearl, E; Dieleman, M.A.; Hilhorst, Thea

2009-01-01

ATraditionally, faith-based health organisations have been important health care providers in many remote and other under-serviced areas. Currently, these facilities bear the brunt of the competition for scarce human resources. It is important for faith-based organisations to learn from recent

Periorbital edema: a puzzle no more?

Science.gov (United States)

Sobel, Rachel K; Carter, Keith D; Allen, Richard C

2012-09-01

Periorbital edema is a common problem that deserves scrutiny. Although a variety of healthcare providers may see this clinical entity, ophthalmologists are often consulted along the way toward diagnosis. It can challenge even the most astute clinicians. A diagnosis may reveal merely a bothersome issue or potentially a sight-threatening or life-threatening problem. Comprehensive reviews on this topic are scarce. Textbooks are brief. There are, however, many studies in the scientific literature of notable cases of periorbital edema. The causes generally fall into the categories of infectious, inflammatory or tumors, medication related, and postsurgical or trauma. This article synthesizes the current literature on the topic with a case series from our institution. It aims to provide a thorough resource for all practitioners to make the prospect of triaging, diagnosing, and treating periorbital edema less daunting.

Video-Based Learning vs Traditional Lecture for Instructing Emergency Medicine Residents in Disaster Medicine Principles of Mass Triage, Decontamination, and Personal Protective Equipment.

Science.gov (United States)

Curtis, Henry A; Trang, Karen; Chason, Kevin W; Biddinger, Paul D

2018-02-01

Introduction Great demands have been placed on disaster medicine educators. There is a need to develop innovative methods to educate Emergency Physicians in the ever-expanding body of disaster medicine knowledge. The authors sought to demonstrate that video-based learning (VBL) could be a promising alternative to traditional learning methods for teaching disaster medicine core competencies. Hypothesis/Problem The objective was to compare VBL to traditional lecture (TL) for instructing Emergency Medicine residents in the American College of Emergency Physicians (ACEP; Irving, Texas USA) disaster medicine core competencies of patient triage and decontamination. A randomized, controlled pilot study compared two methods of instruction for mass triage, decontamination, and personal protective equipment (PPE). Emergency Medicine resident learning was measured with a knowledge quiz, a Likert scale measuring comfort, and a practical exercise. An independent samples t-test compared the scoring of the VBL with the TL group. Twenty-six residents were randomized to VBL (n=13) or TL (n=13). Knowledge score improvement following video (14.9%) versus lecture (14.1%) did not differ significantly between the groups (P=.74). Comfort score improvement also did not differ (P=.64) between video (18.3%) and lecture groups (15.8%). In the practical skills assessment, the VBL group outperformed the TL group overall (70.4% vs 55.5%; Plearning vs traditional lecture for instructing emergency medicine residents in disaster medicine principles of mass triage, decontamination, and personal protective equipment. Prehosp Disaster Med. 2018;33(1):7-12.

Data collection for cooperative water resources modeling in the Lower Rio Grande Basin, Fort Quitman to the Gulf of Mexico.

Energy Technology Data Exchange (ETDEWEB)

Passell, Howard David; Pallachula, Kiran (GRAM, Inc., Albuquerque, NM); Tidwell, Vincent Carroll; Villalobos, Joshua (Texas A& M University); Piccinni, Giovanni (Texas A& M University); Brainard, James Robert; Gerik, Thomas (Texas A& M University); Morrison, Wendy (Texas A& M University); Serrat-Capdevila, Aleix (University of Arizona); Valdes, Juan (University of Arizona); Sheng, Zhuping (Texas A& M University); Lovato, Rene (Instituto Mexicano de Tecnologia del Agua); Guitron, Alberto (Instituto Mexicano de Tecnologia del Agua); Ennis, Martha Lee; Aparicio, Javier (Instituto Mexicano de Tecnologia del Agua); Newman, Gretchen Carr (GRAM, Inc., Albuquerque, NM); Michelsen, Ari M. (Texas A& M University)

2004-10-01

Water resource scarcity around the world is driving the need for the development of simulation models that can assist in water resources management. Transboundary water resources are receiving special attention because of the potential for conflict over scarce shared water resources. The Rio Grande/Rio Bravo along the U.S./Mexican border is an example of a scarce, transboundary water resource over which conflict has already begun. The data collection and modeling effort described in this report aims at developing methods for international collaboration, data collection, data integration and modeling for simulating geographically large and diverse international watersheds, with a special focus on the Rio Grande/Rio Bravo. This report describes the basin, and the data collected. This data collection effort was spatially aggregated across five reaches consisting of Fort Quitman to Presidio, the Rio Conchos, Presidio to Amistad Dam, Amistad Dam to Falcon Dam, and Falcon Dam to the Gulf of Mexico. This report represents a nine-month effort made in FY04, during which time the model was not completed.

Relationships between regional economic sectors and water use in a water-scarce area in China: A quantitative analysis

Science.gov (United States)

Wang, Weiping; Gao, Lei; Liu, Pin; Hailu, Atakelty

2014-07-01

Northern China has been facing severe water scarcity as a result of vigorous economic growth, population expansion and changing lifestyles. A typical case is Shandong province whose water resources per capita is approximately only a sixth of the national average and a twentieth of the global average. It is useful to assess the implications of the province’s growth and trade patterns for water use and water conservation strategies. This study quantitatively analyses relationships between regional economic sectors and water use in Shandong using an input-output model for virtual water resources. The changes in key indicators for 1997-2007 are tracked and the effects of water-saving policies on these changes are examined. The results highlight the benefits of applying a virtual water trade analysis on a water-scarce region where water resources exhibit highly heterogeneous temporal and geographical distributions. The net export of virtual water in Shandong was initially large, but this declined over the years and the province has recently become a net importer. Between 1997 and 2002, water use in most sectors increased due to rapid urbanisation and industrialisation. Since then, water use in all Shandong economic sectors exhibit a downward trend despite continued increases in goods and services net exports, a trend which can be attributed to the vigorous implementation of water-saving policies and measures, especially water use quotas. Economic sectors consume water directly and indirectly and understanding the pattern of virtual water trade implied by sectoral relationships is important for managing water scarcity problems. This study fills the knowledge gap in the existing literature created by the lack of case studies that dynamically assess virtual water trade and analyse the effects of water-saving policies and measures. The study draws policy recommendations that are relevant for future water planning in Shandong and other regions in northern China.

Predicting Posttraumatic Stress Symptom Prevalence and Local Distribution after an Earthquake with Scarce Data.

Science.gov (United States)

Dussaillant, Francisca; Apablaza, Mauricio

2017-08-01

After a major earthquake, the assignment of scarce mental health emergency personnel to different geographic areas is crucial to the effective management of the crisis. The scarce information that is available in the aftermath of a disaster may be valuable in helping predict where are the populations that are in most need. The objectives of this study were to derive algorithms to predict posttraumatic stress (PTS) symptom prevalence and local distribution after an earthquake and to test whether there are algorithms that require few input data and are still reasonably predictive. A rich database of PTS symptoms, informed after Chile's 2010 earthquake and tsunami, was used. Several model specifications for the mean and centiles of the distribution of PTS symptoms, together with posttraumatic stress disorder (PTSD) prevalence, were estimated via linear and quantile regressions. The models varied in the set of covariates included. Adjusted R2 for the most liberal specifications (in terms of numbers of covariates included) ranged from 0.62 to 0.74, depending on the outcome. When only including peak ground acceleration (PGA), poverty rate, and household damage in linear and quadratic form, predictive capacity was still good (adjusted R2 from 0.59 to 0.67 were obtained). Information about local poverty, household damage, and PGA can be used as an aid to predict PTS symptom prevalence and local distribution after an earthquake. This can be of help to improve the assignment of mental health personnel to the affected localities. Dussaillant F , Apablaza M . Predicting posttraumatic stress symptom prevalence and local distribution after an earthquake with scarce data. Prehosp Disaster Med. 2017;32(4):357-367.

Sensitivity, Specificity, and Clinical Value of Human Papillomavirus (HPV) E6/E7 mRNA Assay as a Triage Test for Cervical Cytology and HPV DNA Test ▿

Science.gov (United States)

Benevolo, Maria; Vocaturo, Amina; Caraceni, Donatella; French, Deborah; Rosini, Sandra; Zappacosta, Roberta; Terrenato, Irene; Ciccocioppo, Lucia; Frega, Antonio; Rossi, Paolo Giorgi

2011-01-01

There is evidence that testing for human papillomavirus (HPV) E6/E7 mRNA is more specific than testing for HPV DNA. A retrospective study was carried out to evaluate the performance of the PreTect HPV-Proofer E6/E7 mRNA assay (Norchip) as a triage test for cytology and HPV DNA testing. This study analyzed 1,201 women, 688 of whom had a colposcopy follow-up and 195 of whom had histology-confirmed high-grade intraepithelial neoplasia or worse (CIN2+). The proportion of positive results and the sensitivity and specificity for CIN2+ were determined for HPV mRNA in comparison to HPV DNA and cytology. All data were adjusted for follow-up completeness. Stratified by cytological grades, the HPV mRNA sensitivity was 83% (95% confidence interval [CI] = 63 to 94%) in ASC-US (atypical squamous cells of undetermined significance), 62% (95% CI = 47 to 75%) in L-SIL (low-grade squamous intraepithelial lesion), and 67% (95% CI = 57 to 76%) in H-SIL (high-grade squamous intraepithelial lesion). The corresponding figures were 99, 91, and 96%, respectively, for HPV DNA. The specificities were 82, 76, and 45%, respectively, for HPV mRNA and 29, 13, and 4%, respectively, for HPV DNA. Used as a triage test for ASC-US and L-SIL, mRNA reduced colposcopies by 79% (95% CI = 74 to 83%) and 69% (95% CI = 65 to 74%), respectively, while HPV DNA reduced colposcopies by 38% (95% CI = 32 to 44%) and by 15% (95% CI = 12 to 19%), respectively. As a HPV DNA positivity triage test, mRNA reduced colposcopies by 63% (95% CI = 60 to 66%), having 68% sensitivity (95% CI = 61 to 75%), whereas cytology at the ASC-US+ threshold reduced colposcopies by 23% (95% CI = 20 to 26%), showing 92% sensitivity (95% CI = 87 to 95%). In conclusion, PreTect HPV-Proofer mRNA can serve as a better triage test than HPV DNA to reduce colposcopy referral in both ASC-US and L-SIL. It is also more efficient than cytology for the triage of HPV DNA-positive women. Nevertheless, its low sensitivity demands a strict follow-up of

The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study.

LENUS (Irish Health Repository)

Flynn, Grainne

2011-01-01

The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity.

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

Science.gov (United States)

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

2008-01-01

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

Equity in health care in Namibia: developing a needs-based resource allocation formula using principal components analysis

OpenAIRE

Mutirua Kauto; Shangula Kalumbi; Mbeeli Thomas; Mandlhate Custodia; Zere Eyob; Kapenambili William

2007-01-01

Abstract Background The pace of redressing inequities in the distribution of scarce health care resources in Namibia has been slow. This is due primarily to adherence to the historical incrementalist type of budgeting that has been used to allocate resources. Those regions with high levels of deprivation and relatively greater need for health care resources have been getting less than their fair share. To rectify this situation, which was inherited from the apartheid system, there is a need t...

Great ape skeletal collections: making the most of scarce and irreplaceable resources in the digital age.

Science.gov (United States)

Gordon, Adam D; Marcus, Emily; Wood, Bernard

2013-12-01

Information about primate genomes has re-emphasized the importance of the great apes (Pan, Gorilla, and Pongo) as, for most purposes, the appropriate comparators when generating hypotheses about the most recent common ancestor of the hominins and panins, or the most recent common ancestor of the hominin clade. Great ape skeletal collections are thus an important and irreplaceable resource for researchers conducting these types of comparative analyses, yet the integrity of these collections is threatened by unnecessary use and their availability is threatened by financial pressures on the institutions in which the collections reside. We discuss the general history of great ape skeletal collections, and in order to get a better sense of the utility and potential of these important sources of data we assemble the equivalent of a biography of the Powell-Cotton Collection. We explore the history of how this collection of chimpanzee and gorilla skeletons was accumulated, how it came to be recognized as a potentially important source of comparative information, who has made use of it, and what types of data have been collected. We present a protocol for collecting information about each individual animal (e.g., which bones are preserved, their condition, etc.) and have made that information about the Powell-Cotton Collection freely available in an online relational database (Human Origins Database, www.humanoriginsdatabase.org). As an illustration of the practical application of these data, we developed a tabular summary of ontogenetic information about each individual (see Appendices A and B). Collections like the Powell-Cotton are irreplaceable sources of material regarding the hard-tissue evidence and recent history of the closest living relatives of modern humans. We end this contribution by suggesting ways that curators and the researchers who use and rely on these reference collections could work together to help preserve and protect them so that future generations

A handbook for the triage, monitoring and treatment of people exposed to a malevolent use of radiation

International Nuclear Information System (INIS)

Rojas-Palma, Carlos; Meer, Klaas van der; Liland, Astrid; Jaworska, Alicja; Jerstad, Ane; Kruse, Phil; Smith, Karen; Rahola, Tua; Muikku, Maarit; Etherington, George; Perez, Maria del R.; Carr, Zhanat; Smagala, Genowefa

2008-01-01

In the aftermath of the Chernobyl accident European national emergency response plans have been tailored to deal with accidents at nuclear power plants. Several terrorist acts (World Trade Center, New York; Atocha train station, Madrid; suicide bombings) carried out by disaffected groups have shifted the focus to malevolent use of radiation. The radiation exposure can range from very low to substantial, possibly combined with conventional injuries. Therefore practicable tools are needed for an adequate response to such acts and more specifically to address European guidelines covering triage to treatment and long term follow up of exposed people. The European Commission through the EURATOM 6th Framework Programme is co-sponsoring the specific targeted research project TMT handbook. The main objective of this project is to produce a practicable handbook for the effective and timely triage, monitoring and treatment of people exposed to radiation following a malevolent act. This paper elaborates on the work being carried out and outlines the progress achieved prior to the deployment of the handbook in European national emergency response organizations, which are in the process of testing and evaluating the material through targeted emergency response exercises. The end of this paper includes some remarks on the challenges that need to be dealt with in order to achieve a sustainable development of what has been achieved through the lifetime of this project. (author)

Resource-loaded planning for ALICE

CERN Document Server

Gastal, M

2005-01-01

The ALICE experimental area management team faces various challenges when it comes to sharing scarce resources, indispensable to any efficient installation in a category one worksite. Space, cranes, jigs, and personnel with key competences have to be carefully allocated to activities so as to avoid slowing down work progress. To this intent, a resource loaded planning has been developed that allows highlighting coactivities and prioritizing critical tasks. It uses the built-in capabilities of Microsoft Project. The use of this scheduling tool leads to a more efficient use of time and a safer work environment. The installation sequence resulting from this schedule is presented in this paper. The first part of the sequence focuses on the revision of the coils in the SX2 building. The dipole has then to be installed in the RB26 side of the UX25 cavern. This complex and resource intensive activity has to be performed in parallel with the services installation inside the L3 magnet. On the RB24 side of the cavern t...

Environmental safety issues for semiconductors (research on scarce materials recycling)

International Nuclear Information System (INIS)

Izumi, Shigekazu

2004-01-01

In the 21st century, in the fabrication of various industrial parts, particularly, current and future electronics devices in the semiconductor industry, environmental safety issues should be carefully considered. We coined a new term, environmental safety issues for semiconductors, considering our semiconductor research and technology which include environmental and ecological factors. The main object of this analysis is to address the present situation of environmental safety problems in the semiconductor industry; some of which are: (1) the generation and use of hazardous toxic gases in the crystal growth procedure such as molecular beam epitaxy (MBE) and metalorganic chemical vapor deposition (MOCVD), (2) the generation of industrial toxic wastes in the semiconductor process and (3) scarce materials recycling from wastes in the MBE and MOCVD growth procedure

HPV16/18 genotyping for the triage of HPV positive women in primary cervical cancer screening in Chile.

Science.gov (United States)

Lagos, Marcela; Van De Wyngard, Vanessa; Poggi, Helena; Cook, Paz; Viviani, Paola; Barriga, María Isabel; Pruyas, Martha; Ferreccio, Catterina

2015-01-01

We previously conducted a population-based screening trial of high-risk human papillomavirus (hrHPV) testing and conventional cytology, demonstrating higher sensitivity (92.7 % vs 22.1 % for CIN2+) but lower positive predictive value (10.5 % vs 23.9 %) of hrHPV testing. Here we report the performance of HPV16/18 genotyping to triage the hrHPV positive participants. Women aged 25 years and older received hrHPV (Hybrid Capture 2) and Papanicolaou testing; positives by either test underwent colposcopy and directed biopsy, as did a sample of double-negatives. hrHPV positive women were reflex-tested with HPV16/18 genotyping (Digene HPV Genotyping PS Test). Among the 8,265 participants, 10.7 % were hrHPV positive, 1.7 % had ASCUS+ cytology, 1.2 % had CIN2+; 776 (88 %) hrHPV positive women had complete results, of whom 38.8 % were positive for HPV16 (24.0 %), HPV18 (9.7 %) or both (5.1 %). CIN2+ prevalence in HPV16/18 positive women (16.3 %, 95 % CI 12.3-20.9) was twice that of HPV16/18 negative women (8.0 %, 95 % CI 5.7-10.8). HPV16/18 genotyping identified 40.5 % of CIN2, 66.7 % of CIN3 and 75.0 % of cancers. Compared to hrHPV screening alone, HPV16/18 triage significantly reduced the referral rate (10.7 % vs 3.7 %) and the number of colposcopies required to detect one CIN2+ (9 vs 6). When HPV16/18 negative women with baseline ASCUS+ cytology were also colposcopied, an additional 14 % of CIN2+ was identified; referral increased slightly to 4.2 %. HPV16/18 triage effectively stratified hrHPV positive women by their risk of high-grade lesions. HPV16/18 positive women must be referred immediately; referral could be deferred in HPV16/18 negative women given the slower progression of non-HPV16/18 lesions, however, they will require active follow-up.

A decision-making tool for exchange transfusions in infants with severe hyperbilirubinemia in resource-limited settings.

Science.gov (United States)

Olusanya, B O; Iskander, I F; Slusher, T M; Wennberg, R P

2016-05-01

Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange transfusions (ETs) in many low- and middle-income countries. Several system-based constraints sometimes limit the ability to provide timely ETs for all infants at risk of kernicterus, thus necessitating a treatment triage to optimize available resources. This article proposes a practical priority-setting model for term and near-term infants requiring ET after the first 48 h of life. The proposed model combines plasma/serum bilirubin estimation, clinical signs of acute bilirubin encephalopathy and neurotoxicity risk factors for predicting the risk of kernicterus based on available evidence in the literature.

Water : a commodity or resource?

International Nuclear Information System (INIS)

Pomeroy, G.

2003-01-01

Over the past several years, natural gas demand has increased significantly, as it is seen as an environmentally friendly, convenient and cost effective fuel. As a result, Alberta should experience the development of a sustainable resource in the form of natural gas from coal, provided adequate management of associated water is in place. The environmental impact and volume of water produced with natural gas from coal can be significant. Water is scarce and demand is growing. Gas producers are faced with the challenge of high water production and disposal costs, and often choose the deep disposal option as the most economical solution. However, environmentalists and agriculture groups who view water as a valuable resource, warrant the costs associated with the treatment of produced water. The author proposed a conceptual solution to this dilemma concerning produced water. It was suggested that producers of water should be connected with consumers, while allowing free market supply and demand dynamics to price out the inefficient use of the resource. The author also discussed the related regulatory, environmental, technological, economic, and commercial issues. It was concluded that water is both a resource and a commodity. Alberta should implement measures to promote water conservation, pollute less, and manage supply and demand. figs

Factors Affecting Human Resource Management Practices of Foreign Subsidiaries: Acase study of Japanese Multinational Companies in Malaysia

OpenAIRE

Iberahim, Hadijah

2008-01-01

This study investigates how firm-level human resources management (HRM) practices are transformed to fit the organization's needs of developing skilled workers as core competence, in a changing environment where resources are scarce. This paper deals with the issue of factors influencing HRM practices in the development of competent workforce at two Japanese multinational companies (JMNCs)of Malaysian electric and electrical industry. This qualitative study applied longitudinal and comparat...

Adaptation to the International Business Environment: A Resource Advantage Perspective

Directory of Open Access Journals (Sweden)

Manuel Portugal Ferreira

2008-01-01

Full Text Available This paper discusses the importance of the adaptation of the firm to the International Business Environment. Using concepts from the literature on resource advantage, we posit that the firms' adaptation capability to different International Business Environments is a valuable, difficult to imitate, non-tradeable, rare butnot scarce and path dependent resource. We further suggest that adaptation to International Business Environment is a non-substitutable core source of competitive advantage for the multinational enterprises, developed over time through the firms experiences and built into their routines. In line with this argument, some propositions are formulated. We conclude with a broad discussion and suggesting some avenues for future research\\.

A cohort study of cervical screening using partial HPV typing and cytology triage.

Science.gov (United States)

Schiffman, Mark; Hyun, Noorie; Raine-Bennett, Tina R; Katki, Hormuzd; Fetterman, Barbara; Gage, Julia C; Cheung, Li C; Befano, Brian; Poitras, Nancy; Lorey, Thomas; Castle, Philip E; Wentzensen, Nicolas

2016-12-01

HPV testing is more sensitive than cytology for cervical screening. However, to incorporate HPV tests into screening, risk-stratification ("triage") of HPV-positive women is needed to avoid excessive colposcopy and overtreatment. We prospectively evaluated combinations of partial HPV typing (Onclarity, BD) and cytology triage, and explored whether management could be simplified, based on grouping combinations yielding similar 3-year or 18-month CIN3+ risks. We typed ∼9,000 archived specimens, taken at enrollment (2007-2011) into the NCI-Kaiser Permanente Northern California (KPNC) HPV Persistence and Progression (PaP) cohort. Stratified sampling, with reweighting in the statistical analysis, permitted risk estimation of HPV/cytology combinations for the 700,000+-woman KPNC screening population. Based on 3-year CIN3+ risks, Onclarity results could be combined into five groups (HPV16, else HPV18/45, else HPV31/33/58/52, else HPV51/35/39/68/56/66/68, else HPV negative); cytology results fell into three risk groups ("high-grade," ASC-US/LSIL, NILM). For the resultant 15 HPV group-cytology combinations, 3-year CIN3+ risks ranged 1,000-fold from 60.6% to 0.06%. To guide management, we compared the risks to established "benchmark" risk/management thresholds in this same population (e.g., LSIL predicted 3-year CIN3+ risk of 5.8% in the screening population, providing the benchmark for colposcopic referral). By benchmarking to 3-year risk thresholds (supplemented by 18-month estimates), the widely varying risk strata could be condensed into four action bands (very high risk of CIN3+ mandating consideration of cone biopsy if colposcopy did not find precancer; moderate risk justifying colposcopy; low risk managed by intensified follow-up to permit HPV "clearance"; and very low risk permitting routine screening.) Overall, the results support primary HPV testing, with management of HPV-positive women using partial HPV typing and cytology. © 2016 UICC.

38 CFR 17.142 - Authority to approve sharing agreements, contracts for scarce medical specialist services and...

Science.gov (United States)

2010-07-01

... sharing agreements, contracts for scarce medical specialist services and contracts for other medical... medical specialist services and contracts for other medical services. The Under Secretary for Health is... specialist services at Department of Veterans Affairs health care facilities (including, but not limited to...

Greenhouse gas mitigation with scarce land

DEFF Research Database (Denmark)

Meyer-Aurich, A; Olesen, Jørgen E; Prochnow, A

2013-01-01

Agricultural lands have been identified to mitigate greenhouse gas (GHG) emissions primarily by production of energy crops and substituting fossil energy resources and through carbon sequestration in soils. Increased fertilizer input resulting in increased yields may reduce the area needed for crop...

Chapter 7. Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster

NARCIS (Netherlands)

Christian, Michael D.; Joynt, Gavin M.; Hick, John L.; Colvin, John; Danis, Marion; Sprung, Charles L.; Christian, Micahel D.; Camargo, Ruben; Ceraso, Daniel; Azoulay, Elie; Duguet, Alexandre; Guery, Benoit; Reinhart, Konrad; Adini, Bruria; Barlavie, Yaron; Benin-Goren, Odeda; Cohen, Robert; Klein, Motti; Leoniv, Yuval; Margalit, Gila; Rubinovitch, Bina; Sonnenblick, Moshe; Steinberg, Avraham; Weissman, Charles; Wolff, Donna; Kesecioglu, Jozef; de Jong, Menno; Moreno, Rui; An, Youzhong; Du, Bin; Loo, Shi; Richards, Guy; Artigas, Antonio; Pugin, Jerome; Amundson, Dennis; Devereaux, Asha; Beigel, John; Farmer, Chris; Maki, Dennis; Masur, Henry; Rubinson, Lewis; Sandrock, Christian; Talmor, Daniel; Truog, Robert; Zimmerman, Janice; Brett, Steve; Montgomery, Hugh; Rhodes, Andrew; Sanderson, Frances; Taylor, Bruce

2010-01-01

To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on critical care triage. Based on a literature review and expert opinion, a Delphi process was used to define the

Managing a scarce resource: addressing critical health workforce challenges.

NARCIS (Netherlands)

Giepmans. P.; Dussault, G.; Batenburg, R.; Frich, J.; Olivers, R.; Sermeus, W.

2013-01-01

With health care services significantly changing, the challenge is to initiate innovative, situational and integrated workforce forecasting and planning. Many health systems require a shift in mindset to move to the planning of skill mixes for health care professionals. This implies great challenges

Management of scarce water resources: a Middle Eastern experience

National Research Council Canada - National Science Library

El-Naser, H

2009-01-01

.... Research in these regions has long supported the necessity of delivering life sustaining access and availability to water while being inherently linked to several inter-related factors, including...

Speech-based emotion detection in a resource-scarce environment

CSIR Research Space (South Africa)

Martirosian, O

2007-11-01

Full Text Available , happiness and frustration; passive emotion encompasses sadness and dis- appointment, and neutral encompasses speech with a negligible amount of emotional content. Because a study on the expression of emotion in speech has not been done in the South... seconds long and the segments labelled with the dominant emotion of the speech contained in them. The fine emotional labels used were angry, frustrated, happy, friendly, neutral, sad and depressed. These fine labels were combined into three broad...

Efficient harvesting of Internet audio for resource-scarce ASR

CSIR Research Space (South Africa)

Davel, MH

2011-08-01

Full Text Available accurate ASR system, which is generally not available when working with resourcescarce languages. In this work, the authors define a process whereby an ASR corpus is bootstrapped using unmatched ASR models in conjunction with speech and approximate...

First-void urine: A potential biomarker source for triage of high-risk human papillomavirus infected women.

Science.gov (United States)

Van Keer, Severien; Pattyn, Jade; Tjalma, Wiebren A A; Van Ostade, Xaveer; Ieven, Margareta; Van Damme, Pierre; Vorsters, Alex

2017-09-01

Great interest has been directed towards the use of first-void urine as a liquid biopsy for high-risk human papillomavirus DNA testing. Despite the high correlations established between urinary and cervical infections, human papillomavirus testing is unable to distinguish between productive and transforming high-risk infections that have the tendency to progress to cervical cancer. Thus far, investigations have been primarily confined to the identification of biomarkers for triage of high-risk human papillomavirus-positive women in cervicovaginal specimens and tissue biopsies. This paper reviews urinary biomarkers for cervical cancer and triage of high-risk human papillomavirus infections and elaborates on the opportunities and challenges that have emerged regarding the use of first-void urine as a liquid biopsy for the analysis of both morphological- (conventional cytology and novel immunohistochemical techniques) and molecular-based (HPV16/18 genotyping, host/viral gene methylation, RNA, and proteins) biomarkers. A literature search was performed in PubMed and Web of Science for studies investigating the use of urine as a biomarker source for cervical cancer screening. Five studies were identified reporting on biomarkers that are still in preclinical exploratory or clinical assay development phases and on assessments of non-invasive (urine) samples. Although large-scale validation studies are still needed, we conclude that methylation of both host and viral genes in urine has been proven feasible for use as a molecular cervical cancer triage and screening biomarker in phase two studies. This is especially promising and underscores our hypothesis that human papillomavirus DNA and candidate human and viral biomarkers are washed away with the initial, first-void urine, together with exfoliated cells, debris and impurities that line the urethra opening. Similar to the limitations of self-collected cervicovaginal samples, first-void urine will likely not fulfil the

Implementation of a Prehospital Triage System for Patients With Chest Pain and Logistics for Primary Percutaneous Coronary Intervention in the Region of Amsterdam, The Netherlands

NARCIS (Netherlands)

Adams, Rob; Appelman, Yolande; Bronzwaer, Jean G.; Slagboom, Ton; Amoroso, Giovanni; van Exter, Pieternel; Tijssen, G. P. Jan; de Winter, Robbert J.

2010-01-01

We aimed to describe the logistics of a prehospital triage system for patients with acute chest pain in the region of Amsterdam, The Netherlands. Ambulance electrocardiograms (ECGs) were evaluated immediately in 1 of the percutaneous coronary intervention (PCI)-capable centers. Patients accepted for

The formation and design of the 'Acute Admission Database'- a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital

Directory of Open Access Journals (Sweden)

Barfod Charlotte

2012-04-01

Full Text Available Abstract Background Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1 to describe the formation and design of the 'Acute Admission Database', and 2 to characterize the cohort included. Methods All adult patients triaged at the Emergency Department at Hillerød Hospital and admitted either to the observationary unit or to a general ward in-hospital were prospectively included during a period of 22 weeks. The triage system used was a Danish adaptation of the Swedish triage system, ADAPT. Data from 3 different data sources was merged using a unique identifier, the Central Personal Registry number; 1 Data from patient admission; time and date, vital signs, presenting complaint and triage category, 2 Blood sample results taken at admission, including a venous acid-base status, and 3 Outcome measures, e.g. length of stay, admission to Intensive Care Unit, and mortality within 7 and 28 days after admission. Results In primary triage, patients were categorized as red (4.4%, orange (25.2%, yellow (38.7% and green (31.7%. Abnormal vital signs were present at admission in 25% of the patients, most often temperature (10.5%, saturation of peripheral oxygen (9.2%, Glasgow Coma Score (6.6% and respiratory rate (4.8%. A venous acid-base status was obtained in 43% of all patients. The majority (78% had a pH within the normal range (7.35-7.45, 15% had acidosis (pH 7.45. Median length of stay was 2 days (range 1-123. The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0, 1.8% (95% CI 1.5-2.2 died within 7 days, and 4.2% (95% CI 3.7-4.7 died within 28 days after admission

Perceived Power Resources in Situations of Collective Action

Directory of Open Access Journals (Sweden)

Insa Theesfeld

2011-02-01

Full Text Available This paper discusses various concepts of power. Its goal is to shed light on a better method for implementing the power concept. The case of Bulgaria’s water user associations’ failure shows the abuse of power by local actors who fear they will lose their influence and the private benefits that they have enjoyed under the former system. The paper provides an empirical study of power resources verified by actors’ perceptions rather than having resource endowments quantified. It also illustrates the contrast between empirically revealed perceived power resources in a local context and their theoretical examination in the distributional theory of institutional change. Studies that set power resources in relation to one another are scarce. Therefore, in this study an innovative, interactive method is used that leads to a ranking of perceived power resources, which is robust against the impact of belonging to different territorial, social, and agricultural producer groups: 1 unrestricted access to information, 2 personal relationships, 3 trustworthiness, 4 cash resources for bribing, 5 menace, and 6 physical power and violence. The implication of this gradation of power resources on collective action solutions addresses complementary measures to disseminate information and compensation measures for those who fear losing their benefits and may therefore oppose the new institutions.

Virologic versus cytologic triage of women with equivocal Pap smears: a meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia.

Science.gov (United States)

Arbyn, Marc; Buntinx, Frank; Van Ranst, Marc; Paraskevaidis, Evangelos; Martin-Hirsch, Pierre; Dillner, Joakim

2004-02-18

The appropriate management of women with minor cytologic lesions in their cervix is unclear. We performed a meta-analysis to assess the accuracy of human papillomavirus (HPV) DNA testing as an alternative to repeat cytology in women who had equivocal results on a previous Pap smear. Data were extracted from articles published between 1992 and 2002 that contained results of virologic and cytologic testing followed by colposcopically directed biopsy in women with an index smear showing atypical cells of undetermined significance (ASCUS). Fifteen studies were identified in which HPV triage and the histologic outcome (presence or absence of a cervical intraepithelial neoplasia of grade II or worse [CIN2+]) was documented. Nine, seven, and two studies also documented the accuracy of repeat cytology when the cutoff for abnormal cytology was set at a threshold of ASCUS or worse, low-grade squamous intraepithelial lesion (LSIL) or worse, or high-grade squamous intraepithelial lesion (HSIL) or worse, respectively. Random-effects models were used for pooling of accuracy parameters in case of interstudy heterogeneity. Differences in accuracy were assessed by pooling the ratio of the sensitivity (or specificity) of HPV testing to that of repeat cytology. The sensitivity and specificity were 84.4% (95% confidence interval [CI] = 77.6% to 91.1%) and 72.9% (95% CI = 62.5% to 83.3%), respectively, for HPV testing overall and 94.8% (95% CI = 92.7% to 96.9%) and 67.3% (95% CI = 58.2% to 76.4%), respectively, for HPV testing in the eight studies that used the Hybrid Capture II assay. Sensitivity and specificity of repeat cytology at a threshold for abnormal cytology of ASCUS or worse was 81.8% (95% CI = 73.5% to 84.3%) and 57.6% (95% CI = 49.5% to 65.7%), respectively. Repeat cytology that used higher cytologic thresholds yielded substantially lower sensitivity but higher specificity than triage with the Hybrid Capture II assay. The ratio of the sensitivity of the Hybrid Capture II

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

Science.gov (United States)

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

2015-02-01

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

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

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Salvatore Di Somma

2013-06-01

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

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

Science.gov (United States)

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

2013-02-01

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

Modelling impacts of climate change on water resources in ungauged and data-scarce watersheds. Application to the Siurana catchment (NE Spain).

Science.gov (United States)

Candela, Lucila; Tamoh, Karim; Olivares, Gonzalo; Gomez, Manuel

2012-12-01

Gaining knowledge on potential climate change impacts on water resources is a complex process which depends on numerical models capable of describing these processes in quantitative terms. Under limited data or ungauged basin conditions, which constrain the modelling approach, a physically based coherent methodological approach is required. The traditional approach to assess flow regime and groundwater recharge impacts, based on coupling general atmosphere-ocean circulation models (GCM) and hydrologic models, has been investigated in the Siurana ungauged catchment (NE Spain). The future A2 (medium-high) and B1 (medium-low) greenhouse gas scenarios and time slices 2013-2037 (2025) and 2038-2062 (2050), developed by the Intergovernmental Panel on Climate Change (IPCC, 2001), have been selected. For scenario simulations, coupled GCM ECHAM5 scenarios, stochastically downscaled outputs and surface-subsurface modelling to simulate changes in water resources were applied to the catchment. Flow regime analysis was assessed by HEC-HMS, a physically based hydrologic model to assess rainfall-runoff in a catchment, while recharge was estimated with VisualBALAN, a distributed model for natural recharge estimation. Simulations show that the projected climate change at the catchment will affect the entire hydrological system with a maximum of 56% reduction of water resources. While subtle changes are observed for the 2025 time slice, the temperature and precipitation forecast for 2050 shows a maximum increase of 2.2 °C and a decreased precipitation volume of 11.3% in relation to historical values. Regarding historical values, runoff output shows a maximum 20% decrease, and 18% decrease of natural recharge with a certain delay in relation to runoff and rainfall data. According to the results, the most important parameters conditioning future water resources are changes in climatic parameters, but they are highly dependent on soil moisture conditions. Copyright © 2012 Elsevier B

Mapping and assessment of ecosystem services to improve resource management and human wellbeing in data-scarce peri-urban ecosystems

OpenAIRE

Wangai, Peter Waweru

2017-01-01

The ecosystem service (ES) approach acknowledges the fundamental interactions between biodiversity, ecosystems, natural resources and human wellbeing, while substantiating both tangible and intangible benefits of ecosystems to humans. Reflecting on the challenges of rapid population growth and land use changes in Africa’s urban areas on the one hand, and the opportunities provided by the ES approach on the other hand, the thesis adopts suitable ES mapping and assessment methodologies, framewo...

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

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Eltahir A.G. Khalil

2013-06-01

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

A common-pool resource experiment in acequia communities

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Nejem Raheem

2015-03-01

Full Text Available Farmers and rural advocates in New Mexico assert that traditional irrigators are better adapted to water scarcity and variability than other communities. Data to actually test this are often scarce, but such information could be useful for planning the state’s water future, especially as climate change predictions tend toward less reliable supplies. This paper reports results from a common pool resource (CPR experiment that simulates irrigating behavior using two groups: rural irrigators and undergraduate students. Despite predictions to the opposite, there was no significant difference between mean withdrawals or predictions of other players’ behavior. On average, both groups withdrew above the social optimum but below the Nash equilibrium. This work appears to be the first example of a common pool resource experiment conducted with traditional New Mexican irrigators.

Coexistence and community structure in a consumer resource model with implicit stoichiometry.

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Orlando, Paul A; Brown, Joel S; Wise, David H

2012-09-01

We combine stoichiometry theory and optimal foraging theory into the MacArthur consumer-resource model. This generates predictions for diet choice, coexistence, and community structure of heterotroph communities. Tradeoffs in consumer resource-garnering traits influence community outcomes. With scarce resources, consumers forage opportunistically for complementary resources and may coexist via tradeoffs in resource encounter rates. In contrast to single currency models, stoichiometry permits multiple equilibria. These alternative stable states occur when tradeoffs in resource encounter rates are stronger than tradeoffs in elemental conversion efficiencies. With abundant resources consumers exhibit partially selective diets for essential resources and may coexist via tradeoffs in elemental conversion efficiencies. These results differ from single currency models, where adaptive diet selection is either opportunistic or selective. Interestingly, communities composed of efficient consumers share many of the same properties as communities based on substitutable resources. However, communities composed of relatively inefficient consumers behave similarly to plant communities as characterized by Tilman's consumer resource theory. The results of our model indicate that the effects of stoichiometry theory on community ecology are dependent upon both consumer foraging behavior and the nature of resource garnering tradeoffs. Copyright © 2012 Elsevier Inc. All rights reserved.

Three years experience with forward-site mass casualty triage-, evacuation-, operating room-, ICU-, and radiography-enabled disaster vehicles: development of usage strategies from drills and deployments.

Science.gov (United States)

Griffiths, Jane L; Kirby, Neil R; Waterson, James A

2014-01-01

Delineation of the advantages and problems related to the use of forward-site operating room-, Intensive Care Unit (ICU)-, radiography-, and mass casualty-enabled disaster vehicles for site evacuation, patient stabilization, and triage. The vehicles discussed have six ventilated ICU spaces, two ORs, on-site radiography, 21 intermediate acuity spaces with stretchers, and 54 seated minor acuity spaces. Each space has piped oxygen with an independent vehicle-loaded supply. The vehicles are operated by the Dubai Corporate Ambulance Services. Their support hospital is the main trauma center for the Emirate of Dubai and provides the vehicles' surgical, intensivist, anesthesia, and nursing staff. The disaster vehicles have been deployed 264 times in the last 5 years (these figures do not include deployments for drills). Introducing this new service required extensive initial planning and ongoing analysis of the performance of the disaster vehicles that offer ambulance services and receiving hospitals a large array of possibilities in terms of triage, stabilization of priority I and II patients, and management of priority III patients. In both drills and in disasters, the vehicles were valuable in forward triage and stabilization and in the transport of large numbers of priority III patients. This has avoided the depletion of emergency transport available for priority I and II patients. The successful utilization of disaster vehicles requires seamless cooperation between the hospital staffing the vehicles and the ambulance service deploying them. They are particularly effective during preplanned deployments to high-risk situations. These vehicles also potentially provide self-sufficient refuges for forward teams in hostile environments.

More than Target 6.3: A Systems Approach to Rethinking Sustainable Development Goals in a Resource-Scarce World

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Qiong Zhang

2016-12-01

Full Text Available The 2030 Agenda for Sustainable Development outlines 17 individual Sustainable Development Goals (SDGs that guide the needs of practice for many professional disciplines around the world, including engineering, research, policy, and development. The SDGs represent commitments to reduce poverty, hunger, ill health, gender inequality, environmental degradation, and lack of access to clean water and sanitation. If a typical reductionist approach is employed to address and optimize individual goals, it may lead to a failure in technological, policy, or managerial development interventions through unintended consequences in other goals. This study uses a systems approach to understand the fundamental dynamics between the SDGs in order to identify potential synergies and antagonisms. A conceptual system model was constructed to illustrate the causal relationships between SDGs, examine system structures using generic system archetypes, and identify leverage points to effectively influence intentional and minimize unintentional changes in the system. The structure of interactions among the SDGs reflects three archetypes of system behavior: Reinforcing Growth, Limits to Growth, and Growth and Underinvestment. The leverage points identified from the conceptual model are gender equality, sustainable management of water and sanitation, alternative resources, sustainable livelihood standards, and global partnerships. Such a conceptual system analysis of SDGs can enhance the likelihood that the development community will broaden its understanding of the potential synergistic benefits of their projects on resource management, environmental sustainability, and climate change. By linking the interactions and feedbacks of those projects with economic gains, women’s empowerment, and educational equality, stakeholders can recognize holistic improvements that can be made to the quality of life of many of the world’s poor.

Colposcopic triage methods for detecting cervical intraepithelial neoplasia grade 3 after cytopathological diagnosis of low-grade squamous intraepithelial lesion: a systematic review on diagnostic tests

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Flávia de Miranda Corrêa

Full Text Available CONTEXT AND OBJECTIVE: The age-stratified performance of the oncogenic HPV-DNA (human papillomavirus deoxyribonucleic acid test for triage of low-grade squamous intraepithelial lesions (LSIL requires investigation. The objective of this study was to evaluate and compare the age-stratified performance (cutoff point: 35 years of oncogenic HPV-DNA testing and repeated cytological tests, for detecting cervical intraepithelial neoplasia grade 3 (CIN3, in order to triage for LSIL. DESIGN AND SETTING: Systematic review. Studies were identified in nine electronic databases and in the reference lists of the articles retrieved. METHODS: The eligibility criteria consisted of initial cytological findings of LSIL; subsequent oncogenic HPV-DNA testing and repeated cytological tests; and CIN3 detection. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS guidelines were used for quality assessment. Qualitative information synthesis was performed. RESULTS: Out of 7,776 studies, 284 were identified as pertinent and three fulfilled the eligibility criteria. The CIN3 prevalence ranged from 6% to 12%. The HPV-DNA positivity rate ranged from 64% to 83%; sensitivity for CIN3 detection ranged from 95.2% to 100%; and specificity was available in two studies (27% and 52%. The sensitivity of repeated cytological tests, in relation to the threshold for atypical squamous cells of undetermined significance (ASCUS, was available in two studies (33% and 90.8%; and specificity was available in one study (53%. CONCLUSIONS: Currently, there is no scientific evidence available that would prove that colposcopic triage using oncogenic HPV-DNA testing to detect CIN3 performs better than repeated cytological tests, among women with LSIL aged 35 years and over.

Modelling impacts of climate change on water resources in ungauged and data-scarce watersheds. Application to the Siurana catchment (NE Spain)

International Nuclear Information System (INIS)

Candela, Lucila; Tamoh, Karim; Olivares, Gonzalo; Gomez, Manuel

2012-01-01

Gaining knowledge on potential climate change impacts on water resources is a complex process which depends on numerical models capable of describing these processes in quantitative terms. Under limited data or ungauged basin conditions, which constrain the modelling approach, a physically based coherent methodological approach is required. The traditional approach to assess flow regime and groundwater recharge impacts, based on coupling general atmosphere–ocean circulation models (GCM) and hydrologic models, has been investigated in the Siurana ungauged catchment (NE Spain). The future A2 (medium-high) and B1 (medium-low) greenhouse gas scenarios and time slices 2013–2037 (2025) and 2038–2062 (2050), developed by the Intergovernmental Panel on Climate Change (IPCC, 2001), have been selected. For scenario simulations, coupled GCM ECHAM5 scenarios, stochastically downscaled outputs and surface–subsurface modelling to simulate changes in water resources were applied to the catchment. Flow regime analysis was assessed by HEC-HMS, a physically based hydrologic model to assess rainfall–runoff in a catchment, while recharge was estimated with VisualBALAN, a distributed model for natural recharge estimation. Simulations show that the projected climate change at the catchment will affect the entire hydrological system with a maximum of 56% reduction of water resources. While subtle changes are observed for the 2025 time slice, the temperature and precipitation forecast for 2050 shows a maximum increase of 2.2 °C and a decreased precipitation volume of 11.3% in relation to historical values. Regarding historical values, runoff output shows a maximum 20% decrease, and 18% decrease of natural recharge with a certain delay in relation to runoff and rainfall data. According to the results, the most important parameters conditioning future water resources are changes in climatic parameters, but they are highly dependent on soil moisture conditions. -- Highlights: �

Modelling impacts of climate change on water resources in ungauged and data-scarce watersheds. Application to the Siurana catchment (NE Spain)

Energy Technology Data Exchange (ETDEWEB)

Candela, Lucila, E-mail: lucila.candela@upc.edu [Department of Geotechnical Engineering and Geoscience, Technical University of Catalonia-UPC, 08034, Barcelona (Spain); Tamoh, Karim [Department of Geotechnical Engineering and Geoscience, Technical University of Catalonia-UPC, 08034, Barcelona (Spain); Olivares, Gonzalo; Gomez, Manuel [Flumen Research Institute, UPC Gran Capitan s.n. Barcelona (Spain)

2012-12-01

Gaining knowledge on potential climate change impacts on water resources is a complex process which depends on numerical models capable of describing these processes in quantitative terms. Under limited data or ungauged basin conditions, which constrain the modelling approach, a physically based coherent methodological approach is required. The traditional approach to assess flow regime and groundwater recharge impacts, based on coupling general atmosphere-ocean circulation models (GCM) and hydrologic models, has been investigated in the Siurana ungauged catchment (NE Spain). The future A2 (medium-high) and B1 (medium-low) greenhouse gas scenarios and time slices 2013-2037 (2025) and 2038-2062 (2050), developed by the Intergovernmental Panel on Climate Change (IPCC, 2001), have been selected. For scenario simulations, coupled GCM ECHAM5 scenarios, stochastically downscaled outputs and surface-subsurface modelling to simulate changes in water resources were applied to the catchment. Flow regime analysis was assessed by HEC-HMS, a physically based hydrologic model to assess rainfall-runoff in a catchment, while recharge was estimated with VisualBALAN, a distributed model for natural recharge estimation. Simulations show that the projected climate change at the catchment will affect the entire hydrological system with a maximum of 56% reduction of water resources. While subtle changes are observed for the 2025 time slice, the temperature and precipitation forecast for 2050 shows a maximum increase of 2.2 Degree-Sign C and a decreased precipitation volume of 11.3% in relation to historical values. Regarding historical values, runoff output shows a maximum 20% decrease, and 18% decrease of natural recharge with a certain delay in relation to runoff and rainfall data. According to the results, the most important parameters conditioning future water resources are changes in climatic parameters, but they are highly dependent on soil moisture conditions. -- Highlights

Performance of High Resolution Satellite Rainfall Products over Data Scarce Parts of Eastern Ethiopia

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Shimelis B. Gebere

2015-09-01

Full Text Available Accurate estimation of rainfall in mountainous areas is necessary for various water resource-related applications. Though rain gauges accurately measure rainfall, they are rarely found in mountainous regions and satellite rainfall data can be used as an alternative source over these regions. This study evaluated the performance of three high-resolution satellite rainfall products, the Tropical Rainfall Measuring Mission (TRMM 3B42, the Global Satellite Mapping of Precipitation (GSMaP_MVK+, and the Precipitation Estimation from Remotely-Sensed Information using Artificial Neural Networks (PERSIANN at daily, monthly, and seasonal time scales against rain gauge records over data-scarce parts of Eastern Ethiopia. TRMM 3B42 rain products show relatively better performance at the three time scales, while PERSIANN did much better than GSMaP. At the daily time scale, TRMM correctly detected 88% of the rainfall from the rain gauge. The correlation at the monthly time scale also revealed that the TRMM has captured the observed rainfall better than the other two. For Belg (short rain and Kiremt (long rain seasons, the TRMM did better than the others by far. However, during Bega (dry season, PERSIANN showed a relatively good estimate. At all-time scales, noticing the bias, TRMM tends to overestimate, while PERSIANN and GSMaP tend to underestimate the rainfall. The overall result suggests that monthly and seasonal TRMM rainfall performed better than daily rainfall. It has also been found that both GSMaP and PERSIANN performed better in relatively flat areas than mountainous areas. Before the practical use of TRMM, the RMSE value needs to be improved by considering the topography of the study area or adjusting the bias.

Two African woodfuel markets: urban demand, resource depletion, and environmental degradation

International Nuclear Information System (INIS)

Hosier, R.H.; Milukas, M.V.

1992-01-01

This paper examines charcoal markets in two African cities: Mogadishu, Somalia and Kigali, Rwanda. Economic theory dictates that if woodfuel resources become scarce, their real price will increase commensurately with the interest rate. Although Rwanda and Somalia represent drastically different physical environments, both are considered to be wood-scarce. But neither market has demonstrated straightforward depletion effects. In Mogadishu, the price first rose and then fell in reaction to shifts in the structure of the charcoal market, relaxed regulations, and economic contraction. In Rwanda, the price began rising only after the closing of the Bugasera Region to charcoal producers. Charcoal must be increasingly produced from private farmland. These two case studies highlight the importance of agricultural land clearance, conflicting government regulations, and shifts in market structure in determining whether or not charcoal prices will demonstrate depletion effects, and whether or not charcoal production will lead to local environmental degradation. (author)

Reconceptualizing Value Creation with Limited Resources

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Jim Hazy

2008-09-01

Full Text Available In traditional economics and finance the notion of value creation is virtually synonymous with the net present value of cash flows. Such a characterization implies that all of the uses of resource inputs, such as raw material and energy, are known and that their value is priced into commodities markets. It also fails to allow for the opportunity cost associated with the depletion of resources which, with advancing technology, might reasonably have future uses far greater in value than can be achieved at present with current technology. Stated differently, in traditional valuation analysis the option value associated with scarce resources—when new technology or knowledge can be applied to them—is not addressed. In the present work, we define technology leverage as representative of this effect. We then address the problem of sustainability of organizations by stating four propositions and examining their implications for government policy and for firm governance.

Service innovation in glaucoma management: using a Web-based electronic patient record to facilitate virtual specialist supervision of a shared care glaucoma programme.

Science.gov (United States)

Wright, Heathcote R; Diamond, Jeremy P

2015-03-01

To assess the importance of specialist supervision in a new model of glaucoma service delivery. An optometrist supported by three technicians managed each glaucoma clinic. Patients underwent testing and clinical examination before the optometrist triaged them into one of five groups: 'normal', 'stable', 'low risk', 'unstable' and 'high risk'. Patient data were uploaded to an electronic medical record to facilitate virtual review by a glaucoma specialist. 24 257 glaucoma reviews at three glaucoma clinics during a 31-month period were analysed. The clinic optometrists and glaucoma specialists had substantial agreement (κ 0.69). 13 patients were identified to be high risk by the glaucoma specialist that had not been identified as such by the optometrist. Glaucoma specialists amended 13% of the optometrists' interim decisions resulting in an overall reduction in review appointments by 2.4%. Employing technicians and optometrists to triage glaucoma patients into groups defined by risk of blindness allows higher risk patients to be directed to a glaucoma specialist. Virtual review allows the glaucoma specialist to remain in overall control while reducing the risk that patients are treated or followed-up unnecessarily. Demand for glaucoma appointments can be reduced allowing scarce medical resources to be directed to patients most in need. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Climatic changes and water resources in the Middle East and North Africa

Energy Technology Data Exchange (ETDEWEB)

Zereini, Fathi [Frankfurt Univ. (Germany). Inst. for Atmospheric and Environmental Sciences; Hoetzl, Heinz (eds.) [Karlsruhe Univ. (Germany). Inst. Geologie

2008-07-01

''Climatic Change and Water Resources in the Middle East and North Africa'' is dedicated to high-priority topics related to the impact of climate change on water resources in a water scarce region. The subject is described and discussed in three main chapters and different case studies. The three main chapters are (1) Climatic changes - sources and effects on the water cycle, (2) Impact of climate change on water resources, (3) Water resources and water management. These chapters are split up into further 26 sections. A total of 64 individuals from many countries have made contributions to this book. All topics in this book are complimentary and contribute to a comprehensive understanding of the interactions between global climate change, world water cycle and water resources. A valuable and meaningful interdisciplinary mixture of topics is combined in this book which will be of great interest to many scientists. (orig.)

Proposal for the establishment of an International Centre for Resource Management (ICRM)

International Nuclear Information System (INIS)

Islam, S.

1999-01-01

Energy and physical resources are necessary for development. These resources are not scarce. What is scarce is Technology. Technology is not only machines, it is also knowledge to run these machines. Most of the developing countries waste whatever resources they do have because of a lack of scientists, technologists and modern management. The main reason for underdevelopment of the poor countries is their weak linkage to modern science and technology. The scientists in the developing countries are isolated. Science cannot survive, let alone flourish, in isolation. The International Centre for Theoretical Physics in Trieste, Italy (ICTP) was established to end scientific isolation and to stop brain drain. The centre was established in 1964 under the auspices of the International Atomic Energy Agency (IAEA). Now the centre's Management is run by the United Nations Educational, Scientific and Cultural Organization (UNESCO), ICTP in Trieste started in 1964 with a budget of US$ 355,000. The building was donated by the Government of Italy. Now its budget is about US$ 20 million (90 per cent from Italy). About 4,000 scientists visit the centre every year. Since its establishment about 40,000 scientists from developing countries and 20,000 from developed countries have visited ICTP. The principal purpose of the proposed International Centre for Resource Management will be to foster through seminars, conferences, teaching and research the advancement of better resource utilization and environmental protection in the less developed countries. An international teaching and research institute dealing in energy policy, research and project management, electronic communication, hydrology, water resource management, soil science, climatology, meteorology, oceanography and desertification will provide the developing countries with expertise needed for successful development policy. Since it happens that the major advance in these fields have relevance for development, aid giving

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

Science.gov (United States)

Chan, Joanne C Y; Hamamura, Takeshi

2015-08-01

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

Allocating Scarce Resources Strategically - An Evaluation and Discussion of the Global Fund's Pattern of Disbursements

Science.gov (United States)

McCoy, David; Kinyua, Kelvin

2012-01-01

Background The Global Fund is under pressure to improve its rationing of financial support. This study describes the GF's pattern of disbursements in relation to total health expenditure (THE), government health expenditure (GHE), income status and the burden of HIV/AIDS, TB and malaria. It also examines the potential for recipient countries to increase domestic public financing for health. Methods This is a cross-sectional study of 104 countries that received Global Fund disbursements in 2009. It analyses data on Global Fund disbursements; health financing indicators; government revenue and expenditure; and burden of disease. Findings Global Fund disbursements made up 0.37% of THE across all 104 countries; but with considerable country variation ranging from 0.002% to 53.4%. Global Fund disbursements to government amounted to 0.47% of GHE across the 104 countries, but again with considerable variation (in three countries more than half of GHE was based on Global Fund support). Although the Global Fund provides progressively more funding for lower income countries on average, there is much variation at the country such that here was no correlation between per capita GF disbursements and per capita THE, nor between per capita GF disbursement to government and per capita GHE. There was only a slight positive correlation between per capita GF disbursement and burden of disease. Several countries with a high degree of 'financial dependency' upon the Fund have the potential to increase levels of domestic financing for health. Discussion The Global Fund can improve its targeting of resources so that it better matches the pattern of global need. To do this it needs to: a) reduce the extent to which funds are allocated on a demand-driven basis; and b) align its funding model to broader health systems financing and patterns of health expenditure beyond the three diseases. PMID:22590496

Allocating scarce resources strategically--an evaluation and discussion of the Global Fund's pattern of disbursements.

Directory of Open Access Journals (Sweden)

David McCoy

Full Text Available BACKGROUND: The Global Fund is under pressure to improve its rationing of financial support. This study describes the GF's pattern of disbursements in relation to total health expenditure (THE, government health expenditure (GHE, income status and the burden of HIV/AIDS, TB and malaria. It also examines the potential for recipient countries to increase domestic public financing for health. METHODS: This is a cross-sectional study of 104 countries that received Global Fund disbursements in 2009. It analyses data on Global Fund disbursements; health financing indicators; government revenue and expenditure; and burden of disease. FINDINGS: Global Fund disbursements made up 0.37% of THE across all 104 countries; but with considerable country variation ranging from 0.002% to 53.4%. Global Fund disbursements to government amounted to 0.47% of GHE across the 104 countries, but again with considerable variation (in three countries more than half of GHE was based on Global Fund support. Although the Global Fund provides progressively more funding for lower income countries on average, there is much variation at the country such that here was no correlation between per capita GF disbursements and per capita THE, nor between per capita GF disbursement to government and per capita GHE. There was only a slight positive correlation between per capita GF disbursement and burden of disease. Several countries with a high degree of 'financial dependency' upon the Fund have the potential to increase levels of domestic financing for health. DISCUSSION: The Global Fund can improve its targeting of resources so that it better matches the pattern of global need. To do this it needs to: a reduce the extent to which funds are allocated on a demand-driven basis; and b align its funding model to broader health systems financing and patterns of health expenditure beyond the three diseases.

The Swine Flu Triage (SwiFT) study: development and ongoing refinement of a triage tool to provide regular information to guide immediate policy and practice for the use of critical care services during the H1N1 swine influenza pandemic.

Science.gov (United States)

Rowan, K M; Harrison, D A; Walsh, T S; McAuley, D F; Perkins, G D; Taylor, B L; Menon, D K

2010-12-01

To use, existing critical care and early pandemic, data to inform care during the pandemic influenza A 2009 (H1N1) pandemic (with a possible use for triage - if the demand for critical care seriously exceeded supply). To monitor the impact of the H1N1 pandemic on critical care services, in real time, with regular feedback to critical care clinicians and other relevant jurisdictions to inform ongoing policy and practice. Modelling of data and cohort study. Modelling - 148 adult, general critical care units in England, Wales and Northern Ireland in the Intensive Care National Audit & Research Centre Case Mix Programme. Cohort study - 192 acute hospitals in England, Wales, Northern Ireland, Scotland and the Republic of Ireland. Modelling - 105,397 admissions to adult, general critical care units. Cohort study - 1728 H1N1 pandemic-related admissions referred and assessed as requiring critical care. Modelling - requirement for organ support and acute hospital mortality. Cohort study - survival to the end of critical care. Modelling - cancelled or postponed, elective or scheduled surgery resulted in savings in calendar days of critical, Level 3 and advanced respiratory care of 17, 11 and 10%, respectively. These savings varied across units. Using routine, physiological variables, the best triage models, for all and for acute respiratory admissions, achieved only satisfactory concordance of 0.79 and 0.75, respectively. Application of the best model on all admissions indicated that approximately 12.5% of calendar days of critical care could be saved. Cohort study - research governance approvals were achieved for 192 acute hospitals, for 91 within 1 day of central research and development approval across the five countries. A total of 1725 cases (562 confirmed) were reported. Confirmed cases were young (mean age of 40 years), had low severity of acute illness on presentation [61% CURB-65 (confusion, urea, respiratory rate, blood pressure, age over 65 years) 0-1], but had

The Potential Role of Neglected and Underutilised Crop Species as Future Crops under Water Scarce Conditions in Sub-Saharan Africa

Science.gov (United States)

Chivenge, Pauline; Mabhaudhi, Tafadzwanashe; Modi, Albert T.; Mafongoya, Paramu

2015-01-01

Modern agricultural systems that promote cultivation of a very limited number of crop species have relegated indigenous crops to the status of neglected and underutilised crop species (NUCS). The complex interactions of water scarcity associated with climate change and variability in sub-Saharan Africa (SSA), and population pressure require innovative strategies to address food insecurity and undernourishment. Current research efforts have identified NUCS as having potential to reduce food and nutrition insecurity, particularly for resource poor households in SSA. This is because of their adaptability to low input agricultural systems and nutritional composition. However, what is required to promote NUCS is scientific research including agronomy, breeding, post-harvest handling and value addition, and linking farmers to markets. Among the essential knowledge base is reliable information about water utilisation by NUCS with potential for commercialisation. This commentary identifies and characterises NUCS with agronomic potential in SSA, especially in the semi-arid areas taking into consideration inter alia: (i) what can grow under water-scarce conditions, (ii) water requirements, and (iii) water productivity. Several representative leafy vegetables, tuber crops, cereal crops and grain legumes were identified as fitting the NUCS category. Agro-biodiversity remains essential for sustainable agriculture. PMID:26016431

The Potential Role of Neglected and Underutilised Crop Species as Future Crops under Water Scarce Conditions in Sub-Saharan Africa

Directory of Open Access Journals (Sweden)

Pauline Chivenge

2015-05-01

Full Text Available Modern agricultural systems that promote cultivation of a very limited number of crop species have relegated indigenous crops to the status of neglected and underutilised crop species (NUCS. The complex interactions of water scarcity associated with climate change and variability in sub-Saharan Africa (SSA, and population pressure require innovative strategies to address food insecurity and undernourishment. Current research efforts have identified NUCS as having potential to reduce food and nutrition insecurity, particularly for resource poor households in SSA. This is because of their adaptability to low input agricultural systems and nutritional composition. However, what is required to promote NUCS is scientific research including agronomy, breeding, post-harvest handling and value addition, and linking farmers to markets. Among the essential knowledge base is reliable information about water utilisation by NUCS with potential for commercialisation. This commentary identifies and characterises NUCS with agronomic potential in SSA, especially in the semi-arid areas taking into consideration inter alia: (i what can grow under water-scarce conditions, (ii water requirements, and (iii water productivity. Several representative leafy vegetables, tuber crops, cereal crops and grain legumes were identified as fitting the NUCS category. Agro-biodiversity remains essential for sustainable agriculture.

Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department.

Science.gov (United States)

Cheng, Ivy; Castren, Maaret; Kiss, Alex; Zwarenstein, Merrick; Brommels, Mats; Mittmann, Nicole

2016-05-01

The purpose of this study was to evaluate the cost-effectiveness of physician-nurse supplementary triage assistance team (MDRNSTAT) from a hospital and patient perspective. This was a cost-effectiveness evaluation of a cluster randomized control trial comparing the MDRNSTAT with nurse-only triage in the emergency department (ED) between the hours of 0800 and 1500. Cost was MDRNSTAT salary. Revenue was from Ontario's Pay-for-Results and patient volume-case mix payment programs. The incremental cost-effectiveness ratio was based on MDRNSTAT cost and three consequence assessments: 1) per additional patient-seen; 2) per physician initial assessment (PIA) hour saved; and 3) per ED length of stay (EDLOS) hour saved. Patient opportunity cost was determined. Patient satisfaction was quantified by a cost-benefit ratio. A sensitivity analysis extrapolating MDRNSTAT to different working hours, salary, and willingness-to-pay data was performed. The added cost of the MDRNSTAT was $3,597.27 [$1,729.47 to ∞] per additional patient-seen, $75.37 [$67.99 to $105.30] per PIA hour saved, and $112.99 [$74.68 to $251.43] per EDLOS hour saved. From the hospital perspective, the cost-benefit ratio was 38.6 [19.0 to ∞] and net present value of -$447,996 [-$435,646 to -$459,900]. For patients, the cost-benefit ratio for satisfaction was 2.8 [2.3 to 4.6]. If MDRNSTAT performance were consistently implemented from noon to midnight, it would be more cost-effective. The MDRNSTAT is not a cost-effective daytime strategy but appears to be more feasible during time periods with higher patient volume, such as late morning to evening.

The TriAGe+ Score for Vertigo or Dizziness: A Diagnostic Model for Stroke in the Emergency Department.

Science.gov (United States)

Kuroda, R; Nakada, T; Ojima, T; Serizawa, M; Imai, N; Yagi, N; Tasaki, A; Aoki, M; Oiwa, T; Ogane, T; Mochizuki, K; Kobari, M; Miyajima, H

2017-05-01

Vertigo or dizziness is a common occurrence, but it remains a challenging symptom when encountered in the emergency department (ED). A diagnostic score for stroke with high accuracy is therefore required. A single-center observational study (498 patients) was conducted. The predictor variables were derived from a multivariate logistic regression analysis with Akaike information criterion. The outcome was the occurrence of stroke. We evaluated the utility of a new diagnostic score (TriAGe+) and compared it with the ABCD2 score. The cohorts included 498 patients (147 with stroke [29.4%]). Eight variables were included: triggers, atrial fibrillation, male gender, blood pressure ≥140/90 mm Hg, brainstem or cerebellar dysfunction, focal weakness or speech impairment, dizziness, and no history of vertigo or dizziness or labyrinth or vestibular disease. We derived the TriAGe+ score from these variables. In the cohort, the prevalence of stroke increased significantly using the diagnostic score: 5.9% for a score of 0-4; 9.1% for 5-7; 24.7% for 8-9; and 57.3% for 10-17. At a cutoff value of 10 points, the sensitivity of the score was 77.5%, the specificity was 72.1%, and the positive likelihood ratio was 3.2. When the cutoff was defined as 5 points, the score obtained a high sensitivity (96.6%) with a good negative likelihood ratio (.15). The new score outperformed the ABCD2 score for the occurrence of stroke (C statistic, .818 versus .726; P vertigo or dizziness presenting to the ED. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Water resources in the Klein Karoo: the challenge of sustainable development in a water-scarce area

Directory of Open Access Journals (Sweden)

Ashton Maherry

2009-12-01

Full Text Available The Klein Karoo is situated in the Western Cape, South Africa, and is characterised by low rainfall (100–450 mm yr^–1. The Klein Karoo is situated in the primary catchment of the Gouritz River. The mean annual runoff (MAR for the three major tributaries of the Gouritz River arising in or feeding the Klein Karoo (Touws, Gamka, Olifants is 540 Mm³ yr^–1. Groundwater recharge in the three Klein Karoo catchments is ±257 Mm³ yr^–1, but only a portion of this reaches the rivers. The very variable flows result in low 1:50 year yield of 161 Mm³ (30% of MAR. The current demand for water in these catchments is 182 Mm³ yr^–1, which exceeds the yield, and demand is projected to increase between 23% and 150% by 2025. Changes in the approach to water management are required, including improving the efficiency of irrigation and land restoration to improve water infiltration and reduce soil erosion. We believe that it is time to change to a water management approach that is designed to anticipate and manage the inherent variability in water resources in the Klein Karoo, thereby placing the region on a path to sustainable development.

Service guidelines based on Resource Utilization Groups Version III for Home Care provide decision-making support for case managers.

Science.gov (United States)

Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila

2012-01-01

Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.

Observation and Estimation of Evapotranspiration from an Irrigated Green Roof in a Rain-Scarce Environment

Directory of Open Access Journals (Sweden)

Youcan Feng

2018-03-01

Full Text Available While the rain-driven evapotranspiration (ET process has been well-studied in the humid climate, the mixed irrigation and rain-driven ET process is less understood for green roof implementations in dry regions, where empirical observations and model parameterizations are lacking. This paper presents an effort of monitoring and simulating the ET process for an irrigated green roof in a rain-scarce environment. Annual ET rates for three weighing lysimeter test units with non-vegetated, sedums, and grass covers were 2.01, 2.52, and 2.69 mm d−1, respectively. Simulations based on the three Penman–Monteith equation-derived models achieved accuracy within the reported range of previous studies. Compared to the humid climate, the overestimation of high ET rates by existing models is expected to cause a larger error in dry environments, where the enhanced ET process caused by repeated irrigations overlapped with hot, dry conditions often occurs during summer. The studied sedum species did not show significantly lower ET rates than native species, and could not effectively take advantage of the deep moisture storage. Therefore, native species, instead of the shallow-rooted species commonly recommended in humid climates, might be a better choice for green roofs in rain-scarce environments.

Research Ethics 2.0 : New Perspectives on Norms, Values, and Integrity in Genomic Research in Times of Even Scarcer Resources

NARCIS (Netherlands)

Brall, Caroline; Maeckelberghe, Els; Porz, Rouven; Makhoul, Jihad; Schröder-Bäck, Peter

Research ethics anew gained importance due to the changing scientific landscape and increasing demands and competition in the academic field. These changes are further exaggerated because of scarce(r) resources in some countries on the one hand and advances in genomics on the other. In this paper,

Los sistemas de triage: respuesta a la saturación en las salas de urgencias

Directory of Open Access Journals (Sweden)

Consuelo Cubero Alpízar

2014-10-01

Full Text Available Antecedentes. Las estrategias para la atención de usuarios en las salas de urgencias a nivel hospitalario se han vuelto imprescindibles para el buen funcionamiento de estos servicios, debido al incremento de en la demanda cada vez mayor de prestación de servicios en. En este contexto, se plantea un proyecto de investigación cuyo objetivo se centró en analizar la efectividad de los sistemas de atención de urgencias hospitalarias a nivel mundial.Método. Se revisó toda aquella evidencia publicada durante los últimos 15 años, y que incluya observación del personal que los aplica, los tipos de sistema de triage, así como los tiempos de espera antes de la atención y la calidad de la atención brindada al paciente. La estrategia de búsqueda se utilizó para identificar estudios clínicos en diferentes bases de datos como Pubmed, Cochrane library, EBSCO y google académico.Resultado. Entre los resultados más relevantes se identificó la saturación en las salas de urgencias como un problema real originado del aumento en la demanda de tales servicios a nivel mundial, lo cual redunda en una menor calidad en el servicio que se presta y también en un aumento en la mortalidad por los tiempos de espera. Se identificó que no se compara la atención aleatoria por llegada y los sistemas estructurados, además de que históricamente son las enfermeras las que mejor cumplen dicha tarea.Conclusión. Es urgente revisar los sistemas de clasificación de pacientes en el momento en el que llegan al área de urgencias del sistema hospitalario, con el objetivo de adaptar los sistemas de triage a las necesidades reales del país.

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

Science.gov (United States)

Knight, Erin; Morris, Margaret; Heaman, Maureen

2014-03-01

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

Mapping evapotranspiration trends using MODIS and SEBAL model in a data scarce and heterogeneous landscape in Eastern Africa

NARCIS (Netherlands)

Kiptala, J.K.; Mohamedi, Y.; Mul, M.L.; Van der Zaag, P.

2013-01-01

Evapotranspiration (ET) accounts for a substantial amount of the water use in river basins particular in the tropics and arid regions. However, accurate estimation still remains a challenge especially in large spatially heterogeneous and data scarce areas including the Upper Pangani River Basin in

Resource allocation for epidemic control in metapopulations.

Science.gov (United States)

Ndeffo Mbah, Martial L; Gilligan, Christopher A

2011-01-01

Deployment of limited resources is an issue of major importance for decision-making in crisis events. This is especially true for large-scale outbreaks of infectious diseases. Little is known when it comes to identifying the most efficient way of deploying scarce resources for control when disease outbreaks occur in different but interconnected regions. The policy maker is frequently faced with the challenge of optimizing efficiency (e.g. minimizing the burden of infection) while accounting for social equity (e.g. equal opportunity for infected individuals to access treatment). For a large range of diseases described by a simple SIRS model, we consider strategies that should be used to minimize the discounted number of infected individuals during the course of an epidemic. We show that when faced with the dilemma of choosing between socially equitable and purely efficient strategies, the choice of the control strategy should be informed by key measurable epidemiological factors such as the basic reproductive number and the efficiency of the treatment measure. Our model provides new insights for policy makers in the optimal deployment of limited resources for control in the event of epidemic outbreaks at the landscape scale.

Resource allocation for epidemic control in metapopulations.

Directory of Open Access Journals (Sweden)

Martial L Ndeffo Mbah

Full Text Available Deployment of limited resources is an issue of major importance for decision-making in crisis events. This is especially true for large-scale outbreaks of infectious diseases. Little is known when it comes to identifying the most efficient way of deploying scarce resources for control when disease outbreaks occur in different but interconnected regions. The policy maker is frequently faced with the challenge of optimizing efficiency (e.g. minimizing the burden of infection while accounting for social equity (e.g. equal opportunity for infected individuals to access treatment. For a large range of diseases described by a simple SIRS model, we consider strategies that should be used to minimize the discounted number of infected individuals during the course of an epidemic. We show that when faced with the dilemma of choosing between socially equitable and purely efficient strategies, the choice of the control strategy should be informed by key measurable epidemiological factors such as the basic reproductive number and the efficiency of the treatment measure. Our model provides new insights for policy makers in the optimal deployment of limited resources for control in the event of epidemic outbreaks at the landscape scale.

Development of Load Duration Curve System in Data Scarce Watersheds Based on a Distributed Hydrological Model

Science.gov (United States)

WANG, J.

2017-12-01

In stream water quality control, the total maximum daily load (TMDL) program is very effective. However, the load duration curves (LDC) of TMDL are difficult to be established because no sufficient observed flow and pollutant data can be provided in data-scarce watersheds in which no hydrological stations or consecutively long-term hydrological data are available. Although the point sources or a non-point sources of pollutants can be clarified easily with the aid of LDC, where does the pollutant come from and to where it will be transported in the watershed cannot be traced by LDC. To seek out the best management practices (BMPs) of pollutants in a watershed, and to overcome the limitation of LDC, we proposed to develop LDC based on a distributed hydrological model of SWAT for the water quality management in data scarce river basins. In this study, firstly, the distributed hydrological model of SWAT was established with the scarce-hydrological data. Then, the long-term daily flows were generated with the established SWAT model and rainfall data from the adjacent weather station. Flow duration curves (FDC) was then developed with the aid of generated daily flows by SWAT model. Considering the goal of water quality management, LDC curves of different pollutants can be obtained based on the FDC. With the monitored water quality data and the LDC curves, the water quality problems caused by the point or non-point source pollutants in different seasons can be ascertained. Finally, the distributed hydrological model of SWAT was employed again to tracing the spatial distribution and the origination of the pollutants of coming from what kind of agricultural practices and/or other human activities. A case study was conducted in the Jian-jiang river, a tributary of Yangtze river, of Duyun city, Guizhou province. Results indicate that this kind of method can realize the water quality management based on TMDL and find out the suitable BMPs for reducing pollutant in a watershed.

The H,G_1,G_2 photometric system with scarce observational data

Science.gov (United States)

Penttilä, A.; Granvik, M.; Muinonen, K.; Wilkman, O.

2014-07-01

The H,G_1,G_2 photometric system was officially adopted at the IAU General Assembly in Beijing, 2012. The system replaced the H,G system from 1985. The 'photometric system' is a parametrized model V(α; params) for the magnitude-phase relation of small Solar System bodies, and the main purpose is to predict the magnitude at backscattering, H := V(0°), i.e., the (absolute) magnitude of the object. The original H,G system was designed using the best available data in 1985, but since then new observations have been made showing certain features, especially near backscattering, to which the H,G function has troubles adjusting to. The H,G_1,G_2 system was developed especially to address these issues [1]. With a sufficient number of high-accuracy observations and with a wide phase-angle coverage, the H,G_1,G_2 system performs well. However, with scarce low-accuracy data the system has troubles producing a reliable fit, as would any other three-parameter nonlinear function. Therefore, simultaneously with the H,G_1,G_2 system, a two-parameter version of the model, the H,G_{12} system, was introduced [1]. The two-parameter version ties the parameters G_1,G_2 into a single parameter G_{12} by a linear relation, and still uses the H,G_1,G_2 system in the background. This version dramatically improves the possibility to receive a reliable phase-curve fit to scarce data. The amount of observed small bodies is increasing all the time, and so is the need to produce estimates for the absolute magnitude/diameter/albedo and other size/composition related parameters. The lack of small-phase-angle observations is especially topical for near-Earth objects (NEOs). With these, even the two- parameter version faces problems. The previous procedure with the H,G system in such circumstances has been that the G-parameter has been fixed to some constant value, thus only fitting a single-parameter function. In conclusion, there is a definitive need for a reliable procedure to produce

Using OSG Computing Resources with (iLC)Dirac

CERN Document Server

AUTHOR|(SzGeCERN)683529; Petric, Marko

2017-01-01

CPU cycles for small experiments and projects can be scarce, thus making use of all available resources, whether dedicated or opportunistic, is mandatory. While enabling uniform access to the LCG computing elements (ARC, CREAM), the DIRAC grid interware was not able to use OSG computing elements (GlobusCE, HTCondor-CE) without dedicated support at the grid site through so called 'SiteDirectors', which directly submit to the local batch system. This in turn requires additional dedicated effort for small experiments on the grid site. Adding interfaces to the OSG CEs through the respective grid middleware is therefore allowing accessing them within the DIRAC software without additional sitespecific infrastructure. This enables greater use of opportunistic resources for experiments and projects without dedicated clusters or an established computing infrastructure with the DIRAC software. To allow sending jobs to HTCondor-CE and legacy Globus computing elements inside DIRAC the required wrapper classes were develo...

Molecular Triage of Premalignant Lesions in Liquid-Based Cervical Cytology and Circulating Cell-Free DNA from Urine, Using a Panel of Methylated Human Papilloma Virus and Host Genes

NARCIS (Netherlands)

Guerrero-Preston, Rafael; Valle, Blanca L.; Jedlicka, Anne; Turaga, Nitesh; Folawiyo, Oluwasina; Pirini, Francesca; Lawson, Fahcina; Vergura, Angelo; Noordhuis, Maartje; Dziedzic, Amanda; Perez, Gabriela; Renehan, Marisa; Guerrero-Diaz, Carolina; Rodriguez, Edgar De Jesus; Diaz-Montes, Teresa; Orengo, Jose Rodriguez; Mendez, Keimari; Romaguera, Josefina; Trock, Bruce J.; Florea, Liliana; Sidransky, David

2016-01-01

Clinically useful molecular tools to triage women for a biopsy upon referral to colposcopy are not available. We aimed to develop a molecular panel to detect cervical intraepithelial neoplasia (CIN) grade 2 or higher lesions (CIN2(+)) in women with abnormal cervical cytology and high-risk HPV

Comparison of the clinical performance of an HPV mRNA test and an HPV DNA test in triage of atypical squamous cells of undetermined significance (ASC-US)

DEFF Research Database (Denmark)

Waldstrom, M; Ornskov, D

2012-01-01

The effect of triaging women with atypical squamous cells of undetermined significance (ASC-US) with human papillomavirus (HPV) DNA testing has been well documented. New tests detecting HPV E6/E7 mRNA are emerging, claiming to be more specific for detecting high-grade disease. We evaluated the cl...

The formation and design of the TRIAGE study--baseline data on 6005 consecutive patients admitted to hospital from the emergency department

DEFF Research Database (Denmark)

Plesner, Louis Lind; Iversen, Anne Kristine Servais; Langkjær, Sandra

2015-01-01

the Danish Emergency Proces Triage (DEPT) which categorizes patients as green (not urgent), yellow (urgent), orange (emergent) or red (rescusitation). Presenting complaints, admission diagnoses, comorbidities, length of stay, and 'events' during admission (any of 20 predefined definitive treatments......BACKGROUND: Patient crowding in emergency departments (ED) is a common challenge and associated with worsened outcome for the patients. Previous studies on biomarkers in the ED setting has focused on identification of high risk patients, and and the ability to use biomarkers to identify low...

Statistical translation with scarce resources: a South African case study

CSIR Research Space (South Africa)

Ronald, K

2006-11-01

Full Text Available Statistical machine translation techniques offer great promise for the development of automatic translation systems. However, the realization of this potential requires the availability of significant amounts of parallel bilingual texts. This paper...

Setting priorities for safe motherhood interventions in resource-scarce settings.

Science.gov (United States)

Prata, Ndola; Sreenivas, Amita; Greig, Fiona; Walsh, Julia; Potts, Malcolm

2010-01-01

Guide policy-makers in prioritizing safe motherhood interventions. Three models (LOW, MED, HIGH) were constructed based on 34 sub-Saharan African countries to assess the relative cost-effectiveness of available safe motherhood interventions. Cost and effectiveness data were compiled and inserted into the WHO Mother Baby Package Costing Spreadsheet. For each model we assessed the percentage in maternal mortality reduction after implementing all interventions, and optimal combinations of interventions given restricted budgets of US$ 0.50, US$ 1.00, US$ 1.50 per capital maternal health expenditures respectively for LOW, MED, and HIGH models. The most cost-effective interventions were family planning and safe abortion (fpsa), antenatal care including misoprostol distribution for postpartum hemorrhage prevention at home deliveries (anc-miso), followed by sepsis treatment (sepsis) and facility-based postpartum hemorrhage management (pph). The combination of interventions that avert the greatest number of maternal deaths should be prioritized and expanded to cover the greatest number of women at risk. Those which save the most number of lives in each model are 'fpsa, anc-miso' and 'fpsa, sepsis, safe delivery' for LOW; 'fpsa, anc-miso' and 'fpsa, sepsis, safe delivery' for MED; and 'fpsa, anc-miso, sepsis, eclampsia treatment, safe delivery' for HIGH settings. Safe motherhood interventions save a significant number of newborn lives.

The management of scarce water resources using GNSS, InSAR ...

African Journals Online (AJOL)

GNSS receivers were run continuously for a period of 133 days between March and August 2014 to detect possible surface subsidence during pumping and artesian free flow extraction of water in the wellfield. Two InSAR scenes were processed, one during the peak period of water extraction from the wellfield and the other ...

Allocation of scarce resources in health care: values and concepts

Directory of Open Access Journals (Sweden)

Per-Erik Liss

2006-01-01

Full Text Available En muchos países existe un vacío entre la necesidad de cuidados de salud de la población y los recursos disponibles para realizar esos cuidados. Esas naciones han procurado eliminar o reducir el vacío existente a través de la realización de actividades, como, por ejemplo: la mejoría de la eficacia y la atribución de responsabilidades. Puesto que esas medidas han probado que son insuficientes, las decisiones deben ser tomadas considerando el mejor uso de los escasos recursos. El establecimiento de prioridades y el proceso de racionalización implica decisiones claves, ya que ellas tienen consecuencias para la salud y la calidad de vida de la población, y por ello, deben ser racionales y basadas en argumentos sólidos. Eso significa que las decisiones a ser tomadas engloban tres cuestiones: hechos, conceptos y valores. En el presente artículo, el foco es sobre las cuestiones conceptuales y valorativas. Es presentada una plataforma ética básica que sirve como guía para la toma de decisiones. Los principios éticos que constituyen la plataforma contienen conceptos centrales, tales como: necesidad de cuidado de salud, costo-eficacia, salud y objetivo del cuidado de salud. Una breve presentación de esos conceptos es realizada, finalizando con el concepto de objetivo del cuidado de salud y su importancia para la toma de decisiones.

Diagnosing and Managing Adult Diabetes with Scarce Resources in Uganda

DEFF Research Database (Denmark)

Nielsen, Jannie; Whyte, Susan Reynolds

testing to be provided for a fee at the hospital, in the private wing or through the services of a patient organization. Because the glucometer strips are relatively expensive, many patients went for months without testing their glucose levels. An additional problem was the need to obtain strips...... that matched the available glucometer (about 30 types were found in the areas visited). Economic constraints were exacerbated by costs for transport to the limited number of diabetes treatment facilities. Conclusion There is a severe lack of free diabetes testing and treatment possibilities in Uganda. Health...

Children's Programs in an Era of Scarce Resources [Chapter Five].

Science.gov (United States)

Van Horn, Carl E.; And Others

This analysis is the fifth of a series of seven reports on the ways that the urban fiscal crisis has affected children. Children's services in New Jersey have not suffered unduly from recent Federal budget cuts, but the combination of depressed revenues, continuing inflation, state aid reductions and Federal budget cuts have had a negative…

Court’s Precious Time: Transparency, Honor and Judicial Scarce Resources

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Boaz Shnoor

2017-12-01

Full Text Available While many judicial systems in the Western World are coping with a shortage of judges, the public is not always aware of the overload and its reasons. Our claim is that the reason for this, is the fact that the judicial system preferred to preserve an ideal image of the judiciary and control all information about it, rather than to publicize the judicial overload problem. In this paper, we aim to show that until recently, the issue of “judicial overload” was hidden from the public eye. We deal with the importance and advantageous of presenting the relevant facts to the public. We shall empirically show, that the judicial system has begun to legitimize the exposure of judicial overload to the public.Si bien es cierto que muchos sistemas judiciales del mundo occidental están lidiando con la escasez de jueces, también lo es que el público no siempre es consciente de la sobrecarga de trabajo y de sus razones. Nosotros afirmamos que la razón de ello es que el sistema judicial ha preferido preservar una imagen ideal de la judicatura y controlar toda la información acerca de ella antes que hacer público el problema de la sobrecarga de trabajo de los jueces. En este artículo, pretendemos mostrar que, hasta hace poco, la cuestión de la "sobrecarga de los jueces" ha permanecido oculta a ojos del público. Tratamos el tema de la importancia y la ventaja que supone presentar los hechos relevantes al público, y demostraremos empíricamente que el sistema judicial ha comenzado a aprobar la exposición de la sobrecarga judicial al público. DOWNLOAD THIS PAPER FROM SSRN: http://ssrn.com/abstract=3039584

Scarce information about breast cancer screening: An Italian websites analysis.

Science.gov (United States)

Attena, Francesco; Cancellieri, Mariagrazia; Pelullo, Concetta Paola

2016-12-01

Although the public should have complete and correct information about risk/benefit ratio of breast cancer screening, public knowledge appears generally scarce and oriented to overestimate benefits, with little awareness of possible disadvantages of the screening.We evaluated any document specifically addressed to the general female public and posted on internet by Italian public health services. The presence of false positive, false positive after biopsy, false negative, interval cancer, overdiagnosis, lead-time bias, exposure to irradiation, and mortality reduction was analyzed.Of the 255 websites consulted, 136 (53.3%) had sites addressed to the female public. The most commonly reported information points were the false-positive (30.8% of sites) and radiation exposure (29.4%) rates. Only 11 documents mentioned overdiagnosis, 2 mentioned risk of false positive with biopsy, and only 1 mentioned lead-time bias. Moreover, only 15 sites (11.0%) reported quantitative data for any risk variables.Most documents about breast cancer screening published on the web for the female public contained little or no information about risk/benefit ratio and were biased in favor of screening.

Hospital triage system for adult patients using an influenza-like illness scoring system during the 2009 pandemic--Mexico.

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Eduardo Rodriguez-Noriega

2010-05-01

Full Text Available Pandemic influenza A (H1N1 virus emerged during 2009. To help clinicians triage adults with acute respiratory illness, a scoring system for influenza-like illness (ILI was implemented at Hospital Civil de Guadalajara, Mexico.A medical history, laboratory and radiology results were collected on emergency room (ER patients with acute respiratory illness to calculate an ILI-score. Patients were evaluated for admission by their ILI-score and clinicians' assessment of risk for developing complications. Nasal and throat swabs were collected from intermediate and high-risk patients for influenza testing by RT-PCR. The disposition and ILI-score of those oseltamivir-treated versus untreated, clinical characteristics of 2009 pandemic influenza A (H1N1 patients versus test-negative patients were compared by Pearson's Chi(2, Fisher's Exact, and Wilcoxon rank-sum tests.Of 1840 ER patients, 230 were initially hospitalized (mean ILI-score = 15, and the rest were discharged, including 286 ambulatory patients given oseltamivir (median ILI-score = 11, and 1324 untreated (median ILI-score = 5. Fourteen (1% untreated patients returned, and 3 were hospitalized on oseltamivir (median ILI-score = 19. Of 371 patients tested by RT-PCR, 104 (28% had pandemic influenza and 42 (11% had seasonal influenza A detected. Twenty (91% of 22 imaged hospitalized pandemic influenza patients had bilateral infiltrates compared to 23 (38% of 61 imaged hospital test-negative patients (p<0.001. One patient with confirmed pandemic influenza presented 6 days after symptom onset, required mechanical ventilation, and died.The triaging system that used an ILI-score complimented clinicians' judgment of who needed oseltamivir and inpatient care and helped hospital staff manage a surge in demand for services.

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

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

2012-08-01

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

[Ethical Debates Related to the Allocation of Medical Resources During the Response to the Mass Casualty Incident at Formosa Fun Coast Water Park].

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Tang, Jing-Shia; Chen, Chia-Jung; Huang, Mei-Chih

2017-02-01

Disasters are unpredictable and often result in mass casualties. Limited medical resources often affect the response to mass casualty incidents, undermining the ability of responders to adequately protect all of the casualties. Thus, the injuries of casualties are classified in hopes of fully utilizing medical resources efficiently in order to save the maximum possible number of people. However, as opinions on casualty prioritization are subjective, disagreements and disputes often arise regarding allocating medical resources. The present article focused on the 2015 explosion at Formosa Fun Coast, a recreational water park in Bali, New Taipei City, Taiwan as a way to explore the dilemma over the triage and resource allocation for casualties with burns over 90% and 50-60% of their bodies. The principles of utilitarianism and deontology in Western medicine were used to discuss the reasons and rationale behind the allocation of medical resources during this incident. Confucianism, a philosophical mindset that significantly influences Taiwanese society today, was then discussed to describe the "miracles" that happened during the incident, including the acquisition of assistance from the public and medical professionals. External supplies and professional help (social resources) were provided voluntarily after this incident, which had a profound impact on both the immediate response and the longer-term recovery efforts.

Values, participatory democracy, and healthcare resource allocation: an application to a campus community.

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Bentley, J P; Larson, L N; Brenton, M A

1995-03-01

As healthcare reform is debated, it is important that decision makers consider the values of all citizens, that is, what people find desirable or useful about healthcare services. Several states have used town meetings in an effort to determine their citizens' views on the values in the realm of healthcare. In this article, the authors describe a process in which individuals actively participate in an open discussion about issues surrounding allocation of healthcare resources in a university setting. Three different groups from the university community participated in separate, structured meetings to discuss their values concerning the allocation of scarce healthcare resources. Such meetings give participants opportunities to learn about their values and those of other persons in the community.

γ-H2AX foci analysis in human lymphocytes: a biological tool for assessment of early triage during mass exposure of radiation

International Nuclear Information System (INIS)

Nayak, Akshay Kumar A.; Mumbrekar, Kamalesh D.; Satish Rao, B.S.

2014-01-01

Emergence of nuclear terrorism and increased use of nuclear technology for industry, energy production, and defence purpose has also increased the risk of mass exposure to radiation. During these scenarios of mass exposure to radiation, an efficient system which would measure the dose absorbed by an individual is required for early triage management. The present study aims to establish γ-H2AX as a biomarker for management of early triage. Radiation induced DNA DSB studied in lymphocytes isolated from 10 healthy individuals and challenged with 2 Gy of X-rays in vitro showed a gradual decrease in number of foci signals. As the persistence of foci signals is important for biodosimetry, phosphatase inhibitors like Calyculin A, Fostriecin and Okadiac Acid were used. Calyculin A was found to be the better inhibitor showing a 2 fold increase in retention of foci signals at 6 hours. The dose response curve was performed in lymphocytes isolated from healthy individuals by fluorescent microscopy and flow cytometry. Although both the methods indicated a linear increase in foci signals, microscopic analysis was found to be more sensitive. Influence of age and gender on dose response curve was studied and no significant difference was found. The effect of confounding factors like genetic factors and smoking habits on the dose response curve is being investigated. (author)

Integration of mental health resources in a primary care setting leads to increased provider satisfaction and patient access.

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Vickers, Kristin S; Ridgeway, Jennifer L; Hathaway, Julie C; Egginton, Jason S; Kaderlik, Angela B; Katzelnick, David J

2013-01-01

This evaluation assessed the opinions and experiences of primary care providers and their support staff before and after implementation of expanded on-site mental health services and related system changes in a primary care clinic. Individual semistructured interviews, which contained a combination of open-ended questions and rating scales, were used to elicit opinions about mental health services before on-site system and resource changes occurred and repeated following changes that were intended to improve access to on-site mental health care. In the first set of interviews, prior to expanding mental health services, primary care providers and support staff were generally dissatisfied with the availability and scheduling of on-site mental health care. Patients were often referred outside the primary care clinic for mental health treatment, to the detriment of communication and coordinated care. Follow-up interviews conducted after expansion of mental health services, scheduling refinements and other system changes revealed improved provider satisfaction in treatment access and coordination of care. Providers appreciated immediate and on-site social worker availability to triage mental health needs and help access care, and on-site treatment was viewed as important for remaining informed about patient care the primary care providers are not delivering directly. Expanding integrated mental health services resulted in increased staff and provider satisfaction. Our evaluation identified key components of satisfaction, including on-site collaboration and assistance triaging patient needs. The sustainability of integrated models of care requires additional study. © 2013.

Resource Constrained Project Scheduling Subject to Due Dates: Preemption Permitted with Penalty

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Behrouz Afshar-Nadjafi

2014-01-01

Full Text Available Extensive research works have been carried out in resource constrained project scheduling problem. However, scarce researches have studied the problems in which a setup cost must be incurred if activities are preempted. In this research, we investigate the resource constrained project scheduling problem to minimize the total project cost, considering earliness-tardiness and preemption penalties. A mixed integer programming formulation is proposed for the problem. The resulting problem is NP-hard. So, we try to obtain a satisfying solution using simulated annealing (SA algorithm. The efficiency of the proposed algorithm is tested based on 150 randomly produced examples. Statistical comparison in terms of the computational times and objective function indicates that the proposed algorithm is efficient and effective.

Establishing a health outcomes and economics center in radiology: strategies and resources required

International Nuclear Information System (INIS)

Medina, Santiago L.; Altman, Nolan R.

2002-01-01

To describe the resources and strategies required to establish a health outcomes and economics center in radiology.Methods. Human and nonhuman resources required to perform sound outcomes and economics studies in radiology are reviewed.Results. Human resources needed include skilled medical and nonmedical staff. Nonhuman resources required are: (1) communication and information network; (2) education tools and training programs; (3) budgetary strategies; and (4) sources of income. Effective utilization of these resources allows the performance of robust operational and clinical research projects in decision analysis, cost-effectiveness, diagnostic performance (sensitivity, specificity, and ROC curves), and clinical analytical and experimental studies.Conclusion. As new radiologic technology and techniques are introduced in medicine, society is increasingly demanding sound clinical studies that will determine the impact of radiologic studies on patient outcome. Health-care funding is scarce, and therefore third-party payers and hospitals are demanding more efficiency and productivity from radiologic service providers. To meet these challenges, radiology departments could establish health outcomes and economics centers to study the clinical effectiveness of imaging and its impact on patient outcome. (orig.)

Data Resources for Conducting Health Services and Policy Research.

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Blewett, Lynn A; Call, Kathleen Thiede; Turner, Joanna; Hest, Robert

2018-04-01

Rich federal data resources provide essential data inputs for monitoring the health and health care of the US population and are essential for conducting health services policy research. The six household surveys we document in this article cover a broad array of health topics, including health insurance coverage (American Community Survey, Current Population Survey), health conditions and behaviors (National Health Interview Survey, Behavioral Risk Factor Surveillance System), health care utilization and spending (Medical Expenditure Panel Survey), and longitudinal data on public program participation (SIPP). New federal activities are linking federal surveys with administrative data to reduce duplication and response burden. In the private sector, vendors are aggregating data from medical records and claims to enhance our understanding of treatment, quality, and outcomes of medical care. Federal agencies must continue to innovate to meet the continuous challenges of scarce resources, pressures for more granular data, and new multimode data collection methodologies.

Policies to support economic and environmental goals at farm and regional scales: Outcomes for rice farmers in Southern India depend on their resource endowment

NARCIS (Netherlands)

Senthilkumar, K.; Lubbers, M.T.M.H.; Ridder, de N.; Bindraban, P.S.; Thiyagarajan, T.M.; Giller, K.E.

2011-01-01

Improving water use and nitrogen efficiencies is of overall importance to society at large - to conserve scarce water resources and prevent environmental pollution. Efficient cultivation practices for rice which had no yield penalty were not adopted by farmers because of the open access to water

Admission, discharge and triage guidelines for paediatric intensive care units in Spain.

Science.gov (United States)

de la Oliva, Pedro; Cambra-Lasaosa, Francisco José; Quintana-Díaz, Manuel; Rey-Galán, Corsino; Sánchez-Díaz, Juan Ignacio; Martín-Delgado, María Cruz; de Carlos-Vicente, Juan Carlos; Hernández-Rastrollo, Ramón; Holanda-Peña, María Soledad; Pilar-Orive, Francisco Javier; Ocete-Hita, Esther; Rodríguez-Núñez, Antonio; Serrano-González, Ana; Blanch, Luis

2018-05-01

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Copyright © 2017. Publicado por Elsevier España, S.L.U.

REFLECTIONS ON PSYCHO-LEGAL PRACTICES IN THE TRIAGE OF THE PUBLIC DEFENDER’S OFFICE OF SÃO PAULO

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Renata Ghisleni de Oliveira

2016-11-01

Full Text Available In this article, we presented some developments of the doctoral research in which were studied psycho-legal encounters at the Defensoria Pública do Estado de São Paulo (Public Defender’s Office of the State of São Paulo, taking the experience of the Centros de Atendimento Multidisciplinar (Multidisciplinary Assistance Centers – CAMs, acronym in Portuguese as subject. Through a qualitative intervention-research methodology based on diaries and narrative construction, we have monitored professional practices involving the joint work of defenders, social workers and psychologists at the Public Defender’s Office, between 2011 and 2013. Here, we decided to focus on the triage, space where the first assistance to people who look for legal help is performed, which allowed us to get in contact with the management of requests and the way they become legal, non-legal and psycho-social demands. In order to do that, we used information from referral forms sent to a CAM in the years 2010 and 2011, along with situations experienced in the course of this research. The theoretical references of this study are Foucault’s thought and French Institutional Analysis. The triage showed that a traditional division between knowledges is utilized, which tends to (reproduce an “unintegrated” and disciplined legal assistance, providing a familialist mode of response to the problems presented by the population. However, mental health issues emerge as something that escapes divisions, producing shifts in the work process. We believe these ways of knowing-how-to-do generate a legal assistance that tends to be more oriented to comprehensive care, constituting an experience of thinking-knowing-doing between professions that does not submit to protocols and divisions already established.

Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to ''triage'' patients' treatment

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Agid, R.; Lee, S.K.; Willinsky, R.A.; Farb, R.I.; TerBrugge, K.G. [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

2006-11-15

To evaluate the clinical role of CT angiography (CTA) in patients with acute subarachnoid hemorrhage (SAH) for treatment decision-making. Consecutive patients with acute SAH had CTA using a 64-slice scanner for initial clinical decision-making. Image processing included multiplanar volume reformatted (MPVR) maximum intensity projections (MIP) and 3D volume-rendered reconstructions. CTAs were used for (1) evaluating the cause of SAH, and (2) triaging aneurysm-bearing patients to the more appropriate management, either surgical clipping or endovascular coiling. CTA findings were confirmed by neurosurgical exploration or catheter angiography (digital subtraction angiography, DSA). Successful coiling provided evidence that triaging to endovascular treatment was correct. Included in the study were 73 patients. CTA findings were confirmed by DSA or neurosurgical operation in 65 patients, and of these 65, 47 had aneurysmal SAH, 3 had vasculitis, 1 had arterial dissection and 14 had no underlying arterial abnormality. The cause of SAH was detected with CTA in 62 out of the 65 patients (95.4%, sensitivity 94%, specificity 100%). CTA revealed the aneurysm in 46 of 47 patients (98%, sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 82.3%), 1 of 3 vasculitides and 1 of 1 dissection. Of the 46 patients with aneurysm, 44 (95.7%) were referred for treatment based on CTA. In 2 patients (2 of 46, 4.4%) CTA was not informative enough to choose treatment requiring DSA. Of the 44 patients, 27 (61.4%) were referred to endovascular treatment and successful coiling was achieved in 25 (25 of 27, 92.6%). CTA using a 64-slice scanner is an accurate tool for detecting and characterizing aneurysms in acute SAH. CTA is useful in the decision process whether to coil or clip an aneurysm. (orig.)

Resource Allocation and Outpatient Appointment Scheduling Using Simulation Optimization

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Carrie Ka Yuk Lin

2017-01-01

Full Text Available This paper studies the real-life problems of outpatient clinics having the multiple objectives of minimizing resource overtime, patient waiting time, and waiting area congestion. In the clinic, there are several patient classes, each of which follows different treatment procedure flow paths through a multiphase and multiserver queuing system with scarce staff and limited space. We incorporate the stochastic factors for the probabilities of the patients being diverted into different flow paths, patient punctuality, arrival times, procedure duration, and the number of accompanied visitors. We present a novel two-stage simulation-based heuristic algorithm to assess various tactical and operational decisions for optimizing the multiple objectives. In stage I, we search for a resource allocation plan, and in stage II, we determine a block appointment schedule by patient class and a service discipline for the daily operational level. We also explore the effects of the separate strategies and their integration to identify the best possible combination. The computational experiments are designed on the basis of data from a study of an ophthalmology clinic in a public hospital. Results show that our approach significantly mitigates the undesirable outcomes by integrating the strategies and increasing the resource flexibility at the bottleneck procedures without adding resources.

Availability of resources for emergency care at a second-level hospital in Ghana: A mixed methods assessment

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Kennedy B. Japiong

2016-03-01

Conclusion: This study identified opportunities to improve the care of patients with emergency conditions at the Police Hospital in Ghana. Low-cost improvements in training, organization and planning could improve item and service availability, such as: developing a continuing education curriculum for staff in all areas of the emergency centre; holding in-service training on existing protocols for triage and emergency care; adding checklists to guide appropriate triage and safe transfer of patients; and perform a root cause analysis of item non-availability to develop targeted interventions.

Is subjective well-being a useful parameter for allocating resources among public interventions?

Science.gov (United States)

Gandjour, A

2001-01-01

Scarce public resources require trade-offs between competing programs in different sectors, and the careful allocation of fixed resources within a single sector. This paper argues that a general quality of life instrument encompassing health-related and non-health-related components is suitable for determining the best trade-offs between sectors. Further, this paper suggests that subjective well-being shows the properties crucial to a general quality of life measure and has additional advantages that makes it particularly useful for the allocation of public and health care resources. The paper argues that Western societies are in an unusually prosperous situation today which allows to concentrate efforts not only on reducing harm but also on improving positive states of health. Further, subjective well-being can be evaluated from the patient's perspective and incorporates a valuation of life expectancy. Criteria required for an appropriate questionnaire that measures subjective well-being are presented.

Social Support in the Structure of Personality Resources in Individuals with Disabilities

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D.A. Leontiev

2015-10-01

Full Text Available The paper focuses on the issues of social support of individuals with disabilities and describes its role in the development and maintenance of subjective well-being of persons in situations of disability. A special external resource for overcoming unfavorable developmental conditions, social support is interlocked in a continuous relationship with psychological resources of personality. One of its distinctive features is that it implies the subject's activity aimed at overcoming difficult life situation on his/her own. When the person's bodily resources are insufficient (as it happens in situations of physical disabilities, the role of macro- and microsocial resources in supporting his/her well-being naturally increases. However, when both social and bodily resources are scarce, it is the individual's personality that stands in the gap. The research described in the paper explored the relationship between microsocial resources (support of family and friends, satisfaction with this support and psychological resources of resistance and self-regulation of personality. The sample consisted of 210 subjects (48 students with disabilities, 162 healthy subjects. The outcomes revealed certain differences between the subsamples with low and high rates of social support which suggest that the subjects' perceptions and evaluations of the support contribute to their psychological resources of coping and self-regulation, activating and/or reinforcing the existing potential of their personalities.

NASA Water Resources Program

Science.gov (United States)

Toll, David L.

2011-01-01

With increasing population pressure and water usage coupled with climate variability and change, water issues are being reported by numerous groups as the most critical environmental problems facing us in the 21st century. Competitive uses and the prevalence of river basins and aquifers that extend across boundaries engender political tensions between communities, stakeholders and countries. In addition to the numerous water availability issues, water quality related problems are seriously affecting human health and our environment. The potential crises and conflicts especially arise when water is competed among multiple uses. For example, urban areas, environmental and recreational uses, agriculture, and energy production compete for scarce resources, not only in the Western U.S. but throughout much of the U.S. and also in numerous parts of the world. Mitigating these conflicts and meeting water demands and needs requires using existing water resources more efficiently. The NASA Water Resources Program Element works to use NASA products and technology to address these critical water issues. The primary goal of the Water Resources is to facilitate application of NASA Earth science products as a routine use in integrated water resources management for the sustainable use of water. This also includes the extreme events of drought and floods and the adaptation to the impacts from climate change. NASA satellite and Earth system observations of water and related data provide a huge volume of valuable data in both near-real-time and extended back nearly 50 years about the Earth's land surface conditions such as precipitation, snow, soil moisture, water levels, land cover type, vegetation type, and health. NASA Water Resources Program works closely to use NASA and Earth science data with other U.S. government agencies, universities, and non-profit and private sector organizations both domestically and internationally. The NASA Water Resources Program organizes its

Modeling Multi-Event Non-Point Source Pollution in a Data-Scarce Catchment Using ANN and Entropy Analysis

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Lei Chen

2017-06-01

Full Text Available Event-based runoff–pollutant relationships have been the key for water quality management, but the scarcity of measured data results in poor model performance, especially for multiple rainfall events. In this study, a new framework was proposed for event-based non-point source (NPS prediction and evaluation. The artificial neural network (ANN was used to extend the runoff–pollutant relationship from complete data events to other data-scarce events. The interpolation method was then used to solve the problem of tail deviation in the simulated pollutographs. In addition, the entropy method was utilized to train the ANN for comprehensive evaluations. A case study was performed in the Three Gorges Reservoir Region, China. Results showed that the ANN performed well in the NPS simulation, especially for light rainfall events, and the phosphorus predictions were always more accurate than the nitrogen predictions under scarce data conditions. In addition, peak pollutant data scarcity had a significant impact on the model performance. Furthermore, these traditional indicators would lead to certain information loss during the model evaluation, but the entropy weighting method could provide a more accurate model evaluation. These results would be valuable for monitoring schemes and the quantitation of event-based NPS pollution, especially in data-poor catchments.

Integrated hydrologic and hydrodynamic modeling to assess water exchange in a data-scarce reservoir

Science.gov (United States)

Wu, Binbin; Wang, Guoqiang; Wang, Zhonggen; Liu, Changming; Ma, Jianming

2017-12-01

Integrated hydrologic and hydrodynamic modeling is useful in evaluating hydrodynamic characteristics (e.g. water exchange processes) in data-scarce water bodies, however, most studies lack verification of the hydrologic model. Here, water exchange (represented by water age) was investigated through integrated hydrologic and hydrodynamic modeling of the Hongfeng Reservoir, a poorly gauged reservoir in southwest China. The performance of the hydrologic model and parameter replacement among sub-basins with hydrological similarity was verified by historical data. Results showed that hydrological similarity based on the hierarchical cluster analysis and topographic index probability density distribution was reliable with satisfactory performance of parameter replacement. The hydrodynamic model was verified using daily water levels and water temperatures from 2009 and 2010. The water exchange processes in the Hongfeng Reservoir are very complex with temporal, vertical, and spatial variations. The temporal water age was primarily controlled by the variable inflow and outflow, and the maximum and minimum ages for the site near the dam were 406.10 d (15th June) and 90.74 d (3rd August), respectively, in 2010. Distinct vertical differences in water age showed that surface flow, interflow, and underflow appeared alternately, depending on the season and water depth. The worst water exchange situation was found in the central areas of the North Lake with the highest water ages in the bottom on both 15th June and 3rd August, in 2010. Comparison of the spatial water ages revealed that the more favorable hydraulic conditions on 3rd August mainly improved the water exchange in the dam areas and most areas of the South Lake, but had little effect on the bottom layers of the other deepest areas in the South and North Lakes. The presented framework can be applied in other data-scarce waterbodies worldwide to provide better understanding of water exchange processes.

Ethical issues in pediatric emergency mass critical care.

Science.gov (United States)

Antommaria, Armand H Matheny; Powell, Tia; Miller, Jennifer E; Christian, Michael D

2011-11-01

As a result of recent events, including natural disasters and pandemics, mass critical care planning has become a priority. In general, planning involves limiting the scope of disasters, increasing the supply of medical resources, and allocating scarce resources. Entities at varying levels have articulated ethical frameworks to inform policy development. In spite of this increased focus, children have received limited attention. Children require special attention because of their unique vulnerabilities and needs. In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations.Steering Committee members established subgroups by topic area and performed literature reviews of MEDLINE and Ovid databases. Draft documents were subsequently developed and revised based on the feedback from the Task Force. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. This document reflects expert input from the Task Force in addition to the most current medical literature. The Ethics Subcommittee recommends that surge planning seek to provide resources for children in proportion to their percentage of the population or preferably, if data are available, the percentage of those affected by the disaster. Generally, scarce resources should be allocated on the basis of need, benefit, and the conservation of resources. Estimates of need, benefit, and resource utilization may be more subjective or objective. While the

Population growth and economic growth.

Science.gov (United States)

Narayana, D L

1984-01-01

This discussion of the issues relating to the problem posed by population explosion in the developing countries and economic growth in the contemporary world covers the following: predictions of economic and social trends; the Malthusian theory of population; the classical or stationary theory of population; the medical triage model; ecological disaster; the Global 2000 study; the limits to growth; critiques of the Limits to Growth model; nonrenewable resources; food and agriculture; population explosion and stabilization; space and ocean colonization; and the limits perspective. The Limits to Growth model, a general equilibrium anti-growth model, is the gloomiest economic model ever constructed. None of the doomsday models, the Malthusian theory, the classical stationary state, the neo-Malthusian medical triage model, the Global 2000 study, are so far reaching in their consequences. The course of events that followed the publication of the "Limits to Growth" in 1972 in the form of 2 oil shocks, food shock, pollution shock, and price shock seemed to bear out formally the gloomy predictions of the thesis with a remarkable speed. The 12 years of economic experience and the knowledge of resource trends postulate that even if the economic pressures visualized by the model are at work they are neither far reaching nor so drastic. Appropriate action can solve them. There are several limitations to the Limits to Growth model. The central theme of the model, which is overshoot and collapse, is unlikely to be the course of events. The model is too aggregative to be realistic. It exaggerates the ecological disaster arising out of the exponential growth of population and industry. The gross underestimation of renewable resources is a basic flaw of the model. The most critical weakness of the model is its gross underestimation of the historical trend of technological progress and the technological possiblities within industry and agriculture. The model does correctly emphasize

Analyzing potential effects of migration on coastal resource conservation in Southeastern Ghana.

Science.gov (United States)

Goldbach, Carina; Schlüter, Achim; Fujitani, Marie

2018-03-01

Coastal areas are under increasing pressure from rapid human population growth, yet empirical research on the effect of migration on coastal and marine resources is scarce. We contribute to this understudied literature by conducting an original household survey in a coastal region of Southeastern Ghana. This study employs two proxies for pro-environmental behavior that have not, to our knowledge, been used in the context of coastal migration, to explicitly compare migrant and non-migrant populations. Environmental attitudes toward coastal resources and individual extraction behavior in common-pool resource (CPR) experiments have shown broad relevance in the literature to understand natural resource decision making. We found that migrants in general did not differ significantly from non-migrants in relation to their environmental attitudes or their extraction behavior in the CPR game. However, when focusing on migrant fishers only, results suggested that this subgroup was less concerned about the utilization of coastal resources than non-migrant fishers and behaved less cooperatively in the CPR experiment. These findings, though, held true only for the subgroup of fishers, and could not be found for other occupational groups. Therefore, we conclude that migrants do not per se value coastal resources less or cooperate less in CPR situations, but that socioeconomic characteristics, and particularly their occupational status and their relation to the resource, matter. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Admission, discharge and triage guidelines for paediatric intensive care units in Spain].

Science.gov (United States)

de la Oliva, Pedro; Cambra-Lasaosa, Francisco José; Quintana-Díaz, Manuel; Rey-Galán, Corsino; Sánchez-Díaz, Juan Ignacio; Martín-Delgado, María Cruz; de Carlos-Vicente, Juan Carlos; Hernández-Rastrollo, Ramón; Holanda-Peña, María Soledad; Pilar-Orive, Francisco Javier; Ocete-Hita, Esther; Rodríguez-Núñez, Antonio; Serrano-González, Ana; Blanch, Luis

2018-05-01

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Rethinking transitions of care: An interprofessional transfer triage protocol in post-acute care.

Science.gov (United States)

Patel, Radha V; Wright, Lauri; Hay, Brittany

2017-09-01

Readmissions to hospitals from post-acute care (PAC) units within long-term care settings have been rapidly increasing over the past decade, and are drivers of increased healthcare costs. With an average of $11,000 per admission, there is a need for strategies to reduce 30-day preventable hospital readmission rates. In 2018, incentives and penalties will be instituted for long-term care facilities failing to meet all-cause, all-condition hospital readmission rate performance measures. An interprofessional team (IPT) developed and implemented a Transfer Triage Protocol used in conjunction with the INTERACT programme to enhance clinical decision-making and assess the potential to reduce the facility's 30-day preventable hospital readmission rates by 10% within 6 weeks of implementation. Results from quantitative analysis demonstrated an overall 35.2% reduction in the 30-day preventable hospital readmission rate. Qualitative analysis revealed the need for additional staff education, improved screening and communication upon admission and prior to hospital transfer, and the need for more IPT on-site availability. This pilot study demonstrates the benefits and implications for practice of an IPT to improve the quality of care within PAC and decrease 30-day preventable hospital readmissions.

Isotope techniques in water resources development 1991

International Nuclear Information System (INIS)

1992-01-01

Water resources are scarce in many parts of the world. Often, the only water resource is groundwater. Overuse usually invites a rapid decline in groundwater resources which are recharged insufficiently, or not at all, by prevailing climatic conditions. These and other problems currently encountered in hydrology and associated environmental fields have prompted an increasing demand for the utilization of isotope methods. Such methods have been recognized as being indispensable for solving problems such as the identification of pollution sources, characterization of palaeowater resources, evaluation of recharge and evaporative discharge under arid and semi-arid conditions, reconstruction of past climates, study of the interrelationships between surface and groundwater, dating of groundwater and validation of contaminant transport models. Moreover, in combination with other hydrogeological and geochemical methods, isotope techniques can provide useful hydrological information, such as data on the origin, replenishment and dynamics of groundwater. It was against this background that the International Atomic Energy Agency, in co-operation with the United Nations Educational, Scientific and Cultural Organization and the International Association of Hydrological Sciences, organized this symposium on the Use of Isotope Techniques in Water Resources Development, which took place in Vienna from 11 to 15 March 1991. The main themes of the symposium were the use of isotope techniques in solving practical problems of water resources assessment and development, particularly with respect to groundwater protection, and in studying environmental problems related to water, including palaeohydrological and palaeoclimatological problems. A substantial part of the oral presentations was concerned with the present state and trends in groundwater dating, and with some methodological aspects. These proceedings contain the papers of 37 oral and the extended synopses of 47 poster

Women and energy resources management. A UNIFEM perspective

International Nuclear Information System (INIS)

Marks, I.

1996-01-01

Women need access to energy resources in order to meet their basic needs for food, shelter, clean water, health care and employment and to improve their family's living conditions. Due to population growth and economic development the demand for the main energy sources in low-income rural areas, biomass, is far greater than the supply, and women have no choice but to overexploit the increasingly scarce resources just to survive. Improvements in energy efficiency and an increased use of renewable energy sources could help women to balance their immediate livelihood needs and the long-term ecological needs. However, women generally lack access to these improved energy technologies. This article explores the causes of women's limited access to improved energy technologies and why energy polices and programmes often fail to address women's specific needs and concerns. Strategies of the United Nations Development Fund for Women (UNIFEM) are outlined as examples of approaches aiming at improving women's access to information and sustainable technologies and promoting women's full participation in environmental decision and policy making. (author). 23 refs

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

Science.gov (United States)

Daniel, Michelle

2012-01-01

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

Another Way to Manage Installations: Safeguarding Scarce Resources for the Future

National Research Council Canada - National Science Library

Hood, Wesley

1998-01-01

.... This research paper will propose and analyze two controversial measures that will, if implemented, release senior leaders to more pressing duties and also help to make the Department of Defense...

Optimizing the Quality of Dynamic Context Subscriptions for Scarce Network Resources

DEFF Research Database (Denmark)

Shawky, Ahmed; Olsen, Rasmus Løvenstein; Pedersen, Jens Myrup

2012-01-01

Scalable access to dynamic context information is a key challenge for future context-sensitive systems. When increasing the access frequency, the information accuracy can improve but at the same time the additional context management traffic may reduce network performance, which creates...... the opposite effect on information reliability. In order to understand and control this trade-off, this paper develops a model that allows to calculate context reliability, captured by the so-called mismatch probability, in relation to the network load. The model is subsequently used for a real time algorithm...

The Supply of Judicial Labour: Optimising a Scarce Resource in Australia

Directory of Open Access Journals (Sweden)

Brian Opeskin

2017-12-01

Full Text Available Developed societies generate a multitude of controversies between their members, which need to be resolved fairly if society is to function well. Judicial officers play a central role in that process by hearing and determining disputes according to law, but they are costly and their long tenure entrenches labour market rigidities. This is an inconvenience for modern governments, as they attempt to keep the wheels of justice turning, while facing budgetary constraints that drive them to seek ever greater cost-efficiencies. This article surveys the ways in which governments in Australia have sought to optimise the judicial labour force by creating a more flexible and cost-effective supply. The system of justice that has evolved in response to these developments is a complex one, with many complementary parts. There is no unique solution to the question of how many judicial officers society needs to quell disputes because this goal can be achieved in different ways. But great care needs to be taken to ensure that government action to find flexible sources of labour to meet the demand for judicial dispute resolution does not come at too high a price in terms of respect for the rule of law. Las sociedades desarrolladas generan multitud de polémicas entre sus miembros, y éstas deben ser solucionadas de forma justa para que la sociedad funcione bien. Los agentes judiciales desempeñan un papel esencial en ese proceso, dado que atienden y solucionan disputas de acuerdo con el derecho, pero son agentes costosos y sus largas permanencias en el puesto perpetúan la rigidez del mercado laboral. Ello es un inconveniente para los gobernantes actuales, que intentan asegurar que el ejercicio de la justicia siga su curso, al tiempo que se enfrentan a limitaciones presupuestarias que los empujan a buscar una eficiencia en relación a los costes cada vez mayor. Este artículo estudia las maneras en las que los gobiernos de Australia han procurado optimizar la fuerza de trabajo judicial mediante la creación de un suministro más flexible y más eficaz con respecto al coste. El sistema de justicia que ha evolucionado en respuesta a estos desarrollos es complejo, con muchas partes complementarias. No hay una única respuesta a la pregunta de cuántos agentes judiciales necesita la sociedad para mitigar disputas, porque este objetivo se puede conseguir de diferentes formas. Pero hace falta ser más prudentes para asegurar que la acción gubernamental centrada en encontrar fuentes de trabajo flexibles para satisfacer la demanda de resolución de disputas judiciales no implique un precio demasiado alto en términos de respeto al imperio de la ley. DOWNLOAD THIS PAPER FROM SSRN: https://ssrn.com/abstract=2928388 

Water ethics - a substitute for over-regulation of a scarce resource

DEFF Research Database (Denmark)

Harremoës, Poul

2002-01-01

is problematic and no easy solutions are in sight, but attention and awareness are essential. The ethical community has been expanded from a human dimension to include an ecological dimension, which aggravates the dilemma. There have been too many surprises in water quality development, due to unforeseen......” and more recently by “economical instruments”. Water ethics is an important, but frequently ignored element in regulation. Equity in availability and applicability of water is the important ethical issue at all levels, from local community to the global scale. The distribution of rights and duties...

Balancing water resource conservation and food security in China.

Science.gov (United States)

Dalin, Carole; Qiu, Huanguang; Hanasaki, Naota; Mauzerall, Denise L; Rodriguez-Iturbe, Ignacio

2015-04-14

China's economic growth is expected to continue into the next decades, accompanied by sustained urbanization and industrialization. The associated increase in demand for land, water resources, and rich foods will deepen the challenge of sustainably feeding the population and balancing agricultural and environmental policies. We combine a hydrologic model with an economic model to project China's future food trade patterns and embedded water resources by 2030 and to analyze the effects of targeted irrigation reductions on this system, notably on national agricultural water consumption and food self-sufficiency. We simulate interprovincial and international food trade with a general equilibrium welfare model and a linear programming optimization, and we obtain province-level estimates of commodities' virtual water content with a hydrologic model. We find that reducing irrigated land in regions highly dependent on scarce river flow and nonrenewable groundwater resources, such as Inner Mongolia and the greater Beijing area, can improve the efficiency of agriculture and trade regarding water resources. It can also avoid significant consumption of irrigation water across China (up to 14.8 km(3)/y, reduction by 14%), while incurring relatively small decreases in national food self-sufficiency (e.g., by 3% for wheat). Other researchers found that a national, rather than local, water policy would have similar effects on food production but would only reduce irrigation water consumption by 5%.

MiRTE: Mixed Reality Triage and Evacuation game for Mass Casualty information systems design, testing and training.

Science.gov (United States)

Yu, Xunyi; Ganz, Aura

2011-01-01

In this paper we introduce a Mixed Reality Triage and Evacuation game, MiRTE, that is used in the development, testing and training of Mass Casualty Incident (MCI) information systems for first responders. Using the Source game engine from Valve software, MiRTE creates immersive virtual environments to simulate various incident scenarios, and enables interactions between multiple players/first responders. What distinguishes it from a pure computer simulation game is that it can interface with external mass casualty incident management systems, such as DIORAMA. The game will enable system developers to specify technical requirements of underlying technology, and test different alternatives of design. After the information system hardware and software are completed, the game can simulate various algorithms such as localization technologies, and interface with an actual user interface on PCs and Smartphones. We implemented and tested the game with the DIORAMA system.

Sustainability assessment of regional water resources under the DPSIR framework

Science.gov (United States)

Sun, Shikun; Wang, Yubao; Liu, Jing; Cai, Huanjie; Wu, Pute; Geng, Qingling; Xu, Lijun

2016-01-01

Fresh water is a scarce and critical resource in both natural and socioeconomic systems. Increasing populations combined with an increasing demand for water resources have led to water shortages worldwide. Current water management strategies may not be sustainable, and comprehensive action should be taken to minimize the water budget deficit. Sustainable water resources management is essential because it ensures the integration of social, economic, and environmental issues into all stages of water resources management. This paper establishes the indicators to evaluate the sustainability of water utilization based on the Drive-Pressure-Status-Impact-Response (DPSIR) model. Based on the analytic hierarchy process (AHP) method, a comprehensive assessment of changes to the sustainability of the water resource system in the city of Bayannur was conducted using these indicators. The results indicate that there is an increase in the driving force of local water consumption due to changes in society, economic development, and the consumption structure of residents. The pressure on the water system increased, whereas the status of the water resources continued to decrease over the study period due to the increasing drive indicators. The local government adopted a series of response measures to relieve the decreasing water resources and alleviate the negative effects of the increasing driver in demand. The response measures improved the efficiency of water usage to a large extent, but the large-scale expansion in demands brought a rebounding effect, known as ;Jevons paradox; At the same time, the increasing emissions of industrial and agriculture pollutants brought huge pressures to the regional water resources environment, which caused a decrease in the sustainability of regional water resources. Changing medium and short-term factors, such as regional economic pattern, technological levels, and water utilization practices, can contribute to the sustainable utilization of

Impact of variations in triage cytology interpretation on human papillomavirus-based cervical screening and implications for screening algorithms.

Science.gov (United States)

Ronco, Guglielmo; Zappa, Marco; Franceschi, Silvia; Tunesi, Sara; Caprioglio, Adele; Confortini, Massimo; Del Mistro, Annarosa; Carozzi, Francesca; Segnan, Nereo; Zorzi, Manuel; Giorgi-Rossi, Paolo

2016-11-01

Women positive to human papillomavirus (HPV+) testing at cervical screening need triage, typically cytology and immediate colposcopy in case of atypical squamous cells of undetermined significance (ASCUS) or worse (ASCUS+) or, in cytology-normal HPV+ women, HPV test repeat after 1 year and colposcopy referral if still HPV+. Our hypothesis was that substantial variations in triage positivity and sensitivity may produce little variation in overall referral to colposcopy and on sensitivity of the entire screening process. Centre- and age-aggregated data from 72,869 women aged 35-64 years were derived from 10 organised screening programmes which have piloted HPV screening in Italy since 2012. Overall colposcopy referral was evaluated as a function of immediate colposcopy referral and overall CIN2+ detection as a function of the proportion of all CIN2+ detected by immediate referral (a proxy of cytology's sensitivity). We fitted additive regression models, adjusted for centre, age, compliance to HPV retesting and to colposcopy, by generalised estimation equations. The proportion of HPV+ women directly referred to colposcopy varied across programmes (20-57%; average 37%) and so did CIN2+ detection (49-94%; average 77%). Overall, 63% (range 41-75%) of HPV+ were referred to colposcopy either immediately or at HPV repeat. An absolute 10% increase in immediate colposcopy referral resulted in 4.2% (95% CI: 3.3-5.1%) increase in overall referral. An absolute 10% increase in cytology's sensitivity resulted in a 1.1% (95% CI: 0.1-2.0%) increase in overall CIN2+ detection. Repeat HPV testing limits the effect of subjectivity of cytology interpretation on overall referral and sensitivity. These will change only slightly when replacing cytology with another test if the interval to HPV repeat remains unchanged. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Role of dicentric analysis in an overarching biodosimetry strategy for use following a nuclear detonation in an urban environment.

Science.gov (United States)

Blumenthal, Daniel J; Sugarman, Stephen L; Christensen, Doran M; Wiley, Albert L; Livingston, Gordon K; Glassman, Erik S; Koerner, John F; Sullivan, Julie M; Hinds, Sidney

2014-04-01

In the moments immediately following a nuclear detonation, casualties with a variety of injuries including trauma, burns, radiation exposure, and combined injuries would require immediate assistance. Accurate and timely radiation dose assessments, based on patient history and laboratory testing, are absolutely critical to support adequately the triage and treatment of those affected. This capability is also essential for ensuring the proper allocation of scarce resources and will support longitudinal evaluation of radiation-exposed individuals and populations. To maximize saving lives, casualties must be systematically triaged to determine what medical interventions are needed, the nature of those interventions, and who requires intervention immediately. In the National Strategy for Improving the Response and Recovery for an Improvised Nuclear Device (IND) Attack, the U.S. Department of Homeland Security recognized laboratory capacity for radiation biodosimetry as having a significant gap for performing mass radiation dose assessment. The anticipated demand for radiation biodosimetry exceeds its supply, and this gap is partly linked to the limited number and analytical complexity of laboratory methods for determining radiation doses within patients. The dicentric assay is a key component of a cytogenetic biodosimetry response asset, as it has the necessary sensitivity and specificity for assessing medically significant radiation doses. To address these shortfalls, the authors have developed a multimodal strategy to expand dicentric assay capacity. This strategy includes the development of an internet-based cytogenetics network that would address immediately the labor intensive burden of the dicentric chromosome assay by increasing the number of skilled personnel to conduct the analysis. An additional option that will require more time includes improving surge capabilities by combining resources available within the country's 150 clinical cytogenetics laboratories

The reliability of the Manchester Triage System (MTS): a meta-analysis.

Science.gov (United States)

Mirhaghi, Amir; Mazlom, Reza; Heydari, Abbas; Ebrahimi, Mohsen

2017-05-01

Although the Manchester Triage System (MTS) was first developed two decades ago, the reliability of the MTS has not been questioned through comparison with a moderating variable; therefore, the aim of this study is to determine the extent of the reliability of MTS using a meta-analytic review. Electronic databases were searched up to 1 March 2014. Studies were only included if they had reported sample sizes, reliability coefficients, and adequate description of the reliability assessment. The Guidelines for Reporting Reliability and Agreement Studies was used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was performed based on the method-of-moments estimator. Seven studies were included. The pooled coefficient for the MTS was substantial at 0.751 (CI 95%: 0.677 to 0.810); the incidence of mistriage is greater than 50%. Agreement is higher for the latest version of MTS (for adults) among nurse-experts and in countries in closer proximity to the country of MTS origin (the UK, in Manchester) than for the oldest (pediatric) version, nurse-nurse raters, and countries at a greater distance from the UK. The MTS showed an acceptable level of overall reliability in the emergency department, but more development is required to attain almost perfect agreement. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

Nuclear energy prospects and uranium resources in Latin America

International Nuclear Information System (INIS)

Polliart, A.J.; Barretto, P.M.C.

1976-01-01

Nuclear power and other major technological applications of nuclear energy will become of interest to a growing number of Latin American countries as their demand for electricity rises because of the expansion of industry. Nevertheless, for many years to come, the chief benefits that atomic energy can bring to Latin America will take the form of applying nuclear science techniques in medicine, water resources development and agricultural research. The medical applications are widely known and the water resources applications are highly specialized. The agricultural applications are many, but generally less well known, and this is one reason why the Agency is devoting a special meeting of the Conference to a review of the use of nuclear science techniques in agricultural research, food production and food preservation. Latin America is the only region of the world in which substantial progress has been made towards what is now known as a nuclear-weapon-free zone - in other words, a zone in which no country possesses or seeks to possess the capacity to make nuclear weapons or other nuclear explosive devices, or permits such weapons on its territory. This has been achieved partly by the operation of Treaties and partly by the policy of individual Governments. The nuclear-weapon-free status is partly reflected in safeguards agreements with the Agency. In this way, the countries of the region are avoiding the vast waste of scarce resources that a nuclear weapons programme entails and, particularly, of scarce scientific manpower and technological skill, which they urgently need for their own peaceful development. The Agency safeguards thus provide international assurance that the nuclear programmes of the countries concerned will not be diverted to nuclear weapons or other nuclear explosives. In this way the Agency's safeguards contribute to security and peace in the region. It is obviously of interest to all countries in the region that this de facto nuclear

Modeling landslide susceptibility in data-scarce environments using optimized data mining and statistical methods

Science.gov (United States)

Lee, Jung-Hyun; Sameen, Maher Ibrahim; Pradhan, Biswajeet; Park, Hyuck-Jin

2018-02-01

This study evaluated the generalizability of five models to select a suitable approach for landslide susceptibility modeling in data-scarce environments. In total, 418 landslide inventories and 18 landslide conditioning factors were analyzed. Multicollinearity and factor optimization were investigated before data modeling, and two experiments were then conducted. In each experiment, five susceptibility maps were produced based on support vector machine (SVM), random forest (RF), weight-of-evidence (WoE), ridge regression (Rid_R), and robust regression (RR) models. The highest accuracy (AUC = 0.85) was achieved with the SVM model when either the full or limited landslide inventories were used. Furthermore, the RF and WoE models were severely affected when less landslide samples were used for training. The other models were affected slightly when the training samples were limited.

Establishing a library of resources to help people understand key concepts in assessing treatment claims-The "Critical thinking and Appraisal Resource Library" (CARL).

Science.gov (United States)

Castle, John C; Chalmers, Iain; Atkinson, Patricia; Badenoch, Douglas; Oxman, Andrew D; Austvoll-Dahlgren, Astrid; Nordheim, Lena; Krause, L Kendall; Schwartz, Lisa M; Woloshin, Steven; Burls, Amanda; Mosconi, Paola; Hoffmann, Tammy; Cusack, Leila; Albarqouni, Loai; Glasziou, Paul

2017-01-01

People are frequently confronted with untrustworthy claims about the effects of treatments. Uncritical acceptance of these claims can lead to poor, and sometimes dangerous, treatment decisions, and wasted time and money. Resources to help people learn to think critically about treatment claims are scarce, and they are widely scattered. Furthermore, very few learning-resources have been assessed to see if they improve knowledge and behavior. Our objectives were to develop the Critical thinking and Appraisal Resource Library (CARL). This library was to be in the form of a database containing learning resources for those who are responsible for encouraging critical thinking about treatment claims, and was to be made available online. We wished to include resources for groups we identified as 'intermediaries' of knowledge, i.e. teachers of schoolchildren, undergraduates and graduates, for example those teaching evidence-based medicine, or those communicating treatment claims to the public. In selecting resources, we wished to draw particular attention to those resources that had been formally evaluated, for example, by the creators of the resource or independent research groups. CARL was populated with learning-resources identified from a variety of sources-two previously developed but unmaintained inventories; systematic reviews of learning-interventions; online and database searches; and recommendations by members of the project group and its advisors. The learning-resources in CARL were organised by 'Key Concepts' needed to judge the trustworthiness of treatment claims, and were made available online by the James Lind Initiative in Testing Treatments interactive (TTi) English (www.testingtreatments.org/category/learning-resources).TTi English also incorporated the database of Key Concepts and the Claim Evaluation Tools developed through the Informed Healthcare Choices (IHC) project (informedhealthchoices.org). We have created a database of resources called CARL

Equity in health care in Namibia: developing a needs-based resource allocation formula using principal components analysis

Directory of Open Access Journals (Sweden)

Mutirua Kauto

2007-03-01

Full Text Available Abstract Background The pace of redressing inequities in the distribution of scarce health care resources in Namibia has been slow. This is due primarily to adherence to the historical incrementalist type of budgeting that has been used to allocate resources. Those regions with high levels of deprivation and relatively greater need for health care resources have been getting less than their fair share. To rectify this situation, which was inherited from the apartheid system, there is a need to develop a needs-based resource allocation mechanism. Methods Principal components analysis was employed to compute asset indices from asset based and health-related variables, using data from the Namibia demographic and health survey of 2000. The asset indices then formed the basis of proposals for regional weights for establishing a needs-based resource allocation formula. Results Comparing the current allocations of public sector health car resources with estimates using a needs based formula showed that regions with higher levels of need currently receive fewer resources than do regions with lower need. Conclusion To address the prevailing inequities in resource allocation, the Ministry of Health and Social Services should abandon the historical incrementalist method of budgeting/resource allocation and adopt a more appropriate allocation mechanism that incorporates measures of need for health care.

Equity in health care in Namibia: developing a needs-based resource allocation formula using principal components analysis.

Science.gov (United States)

Zere, Eyob; Mandlhate, Custodia; Mbeeli, Thomas; Shangula, Kalumbi; Mutirua, Kauto; Kapenambili, William

2007-03-29

The pace of redressing inequities in the distribution of scarce health care resources in Namibia has been slow. This is due primarily to adherence to the historical incrementalist type of budgeting that has been used to allocate resources. Those regions with high levels of deprivation and relatively greater need for health care resources have been getting less than their fair share. To rectify this situation, which was inherited from the apartheid system, there is a need to develop a needs-based resource allocation mechanism. Principal components analysis was employed to compute asset indices from asset based and health-related variables, using data from the Namibia demographic and health survey of 2000. The asset indices then formed the basis of proposals for regional weights for establishing a needs-based resource allocation formula. Comparing the current allocations of public sector health car resources with estimates using a needs based formula showed that regions with higher levels of need currently receive fewer resources than do regions with lower need. To address the prevailing inequities in resource allocation, the Ministry of Health and Social Services should abandon the historical incrementalist method of budgeting/resource allocation and adopt a more appropriate allocation mechanism that incorporates measures of need for health care.

Comparison of CATs, CURB-65 and PMEWS as triage tools in pandemic influenza admissions to UK hospitals: case control analysis using retrospective data.

Directory of Open Access Journals (Sweden)

Puja R Myles

Full Text Available Triage tools have an important role in pandemics to identify those most likely to benefit from higher levels of care. We compared Community Assessment Tools (CATs, the CURB-65 score, and the Pandemic Medical Early Warning Score (PMEWS; to predict higher levels of care (high dependency--Level 2 or intensive care--Level 3 and/or death in patients at or shortly after admission to hospital with A/H1N1 2009 pandemic influenza. This was a case-control analysis using retrospectively collected data from the FLU-CIN cohort (1040 adults, 480 children with PCR-confirmed A/H1N1 2009 influenza. Area under receiver operator curves (AUROC, sensitivity, specificity, positive predictive values and negative predictive values were calculated. CATs best predicted Level 2/3 admissions in both adults [AUROC (95% CI: CATs 0.77 (0.73, 0.80; CURB-65 0.68 (0.64, 0.72; PMEWS 0.68 (0.64, 0.73, p<0.001] and children [AUROC: CATs 0.74 (0.68, 0.80; CURB-65 0.52 (0.46, 0.59; PMEWS 0.69 (0.62, 0.75, p<0.001]. CURB-65 and CATs were similar in predicting death in adults with both performing better than PMEWS; and CATs best predicted death in children. CATs were the best predictor of Level 2/3 care and/or death for both adults and children. CATs are potentially useful triage tools for predicting need for higher levels of care and/or mortality in patients of all ages.

Regional variability of farmer decision making and irrigation water use: insights from a data-scarce region of North India

Science.gov (United States)

O'Keeffe, Jimmy; Buytaert, Wouter; Brozović, Nick; Mijic, Ana

2014-05-01

Over the last fifty years, changes in agriculture brought about by the Green Revolution have transformed India from a famine-prone, drought-susceptible country into the worlds' third largest grain producer and one of the most intensively irrigated parts of the globe. Regionally, cheap energy, subsidised seeds and fertilisers, and in some areas Government purchase guarantees for grain promote the intensification of farming. While this allows farmers to survive, it also aggravates the drain agriculture is having on resources, particularly energy and water. Analysis at a regional scale, however, masks the considerable spatial variability that exists on a more localised level and must be taken into consideration to understand correctly aggregate system response to policy, hydrologic, and climatic change. In this study we present and analyse the results from over 100 farmer interviews conducted in the data-scarce districts of Jalaun and Sitapur on the Gangetic Plains of Uttar Pradesh during the post monsoon period of 2013. Variables such as the volumes and timing of irrigation water applied, sources of water, methods of abstraction and irrigation, and costs incurred are mapped, using qualitative data analysis and GIS. Large differences between the districts emerge, for instance in the region of Jalaun where cheaper canal water is available in addition to groundwater. This has enabled farmers to afford more water efficient technologies such as sprinklers, a practice not found in Sitapur which depends almost exclusively on more expensive diesel pumps. Results are used to delineate the spatial variability in water use practices, along with farmer behaviour and decision making. The primary data are compared with socio-economic information taken from regionally produced statistical abstracts. The combined data are used to identify the main drivers that influence farmer decision-making, which is in turn leading to groundwater overdraught in many parts of North India. Finally

Use of Drying Technologies for Resource Recovery from Solid Wastes and Brines

Science.gov (United States)

Wignarajah, Kanapathipillai; Alba, Ric; Fisher, John W.; Hogan, John A.; Polonsky, Alex

2010-01-01

Long term storage of unprocessed biological wastes and human wastes can present major health issues and a loss of potential resources. Space vehicles and planetary habitats are typically resource-scarce or resource-limited environments for long-term human habitation. To-date, most of the resources will need to be supplied from Earth, but this may not be possible for long duration human exploration. Based on present knowledge, there is only very limited in-situ resources on planetary habitats. Hence, the opportunity to "live off the land" in a planetary habitat is limited. However, if we assume that wastes generated by human explorers are viewed as resources, there is great potential to utilize and recycle them, thereby reducing the requirements for supply Earth and enabling the "live off the land" exploration scenario. Technologies used for the recovery of resources from wastes should be reliable, safe, easy to operate, fail-proof, modular, automated and preferably multifunctional in being capable of handling mixed solid and liquid wastes. For a lunar habitat, energy does not appear to be the major driving factor amongst the technologies studied. Instead, reliability appears to be more important[1] . This paper reports studies to date on drying technologies to remove water from solid wastes and brines. Experimental performance data obtained for recovery water from wastes and brine are presented. Simplicity of operation of hardware and energy efficiency are discussed. Some improvements and modifications to hardware were performed. Hopefully, this information will assist in future efforts in the "downselection" of technologies for recovery of water and resources from solid wastes and brines.

Medical Evaluation and Triage of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Medical Evaluation Workgroup

Science.gov (United States)

Nordstrom, Kimberly; Zun, Leslie S; Wilson, Michael P; MD, Victor Stiebel; Ng, Anthony T; Bregman, Benjamin; Anderson, Eric L

2012-01-01

Numerous medical and psychiatric conditions can cause agitation; some of these causes are life threatening. It is important to be able to differentiate between medical and nonmedical causes of agitation so that patients can receive appropriate and timely treatment. This article aims to educate all clinicians in nonmedical settings, such as mental health clinics, and medical settings on the differing levels of severity in agitation, basic triage, use of de-escalation, and factors, symptoms, and signs in determining whether a medical etiology is likely. Lastly, this article focuses on the medical workup of agitation when a medical etiology is suspected or when etiology is unclear. PMID:22461915

RAPID, MACHINE-LEARNED RESOURCE ALLOCATION: APPLICATION TO HIGH-REDSHIFT GAMMA-RAY BURST FOLLOW-UP

Energy Technology Data Exchange (ETDEWEB)

Morgan, A N; Richards, Joseph W; Butler, Nathaniel R; Bloom, Joshua S [Department of Astronomy, University of California, Berkeley, CA 94720-3411 (United States); Long, James; Broderick, Tamara [Department of Statistics, University of California, Berkeley, CA 94720-3860 (United States)

2012-02-20

As the number of observed gamma-ray bursts (GRBs) continues to grow, follow-up resources need to be used more efficiently in order to maximize science output from limited telescope time. As such, it is becoming increasingly important to rapidly identify bursts of interest as soon as possible after the event, before the afterglows fade beyond detectability. Studying the most distant (highest redshift) events, for instance, remains a primary goal for many in the field. Here, we present our Random Forest Automated Triage Estimator for GRB redshifts (RATE GRB-z ) for rapid identification of high-redshift candidates using early-time metrics from the three telescopes onboard Swift. While the basic RATE methodology is generalizable to a number of resource allocation problems, here we demonstrate its utility for telescope-constrained follow-up efforts with the primary goal to identify and study high-z GRBs. For each new GRB, RATE GRB-z provides a recommendation-based on the available telescope time-of whether the event warrants additional follow-up resources. We train RATE GRB-z using a set consisting of 135 Swift bursts with known redshifts, only 18 of which are z > 4. Cross-validated performance metrics on these training data suggest that {approx}56% of high-z bursts can be captured from following up the top 20% of the ranked candidates, and {approx}84% of high-z bursts are identified after following up the top {approx}40% of candidates. We further use the method to rank 200 + Swift bursts with unknown redshifts according to their likelihood of being high-z.

The allocation of resources for animal health.

Science.gov (United States)

Howe, K S

2017-04-01

Economics is too important to be left to the experts. This paper is therefore mainly for animal health policy-makers who are not economists but want a better appreciation of how economics can contribute to resource allocation decisions. First, the methodology of economic analysis is outlined with the objective of dispelling criticisms of its simplifying assumption of rationality. Then, unusual in economics but more familiar to biological and veterinary scientists, the technical aspects of transforming resources into products are discussed. Economics' unique contribution is to establish criteria enabling society to obtain maximum value from the production and distribution of goods and services (products) from scarce resources. Animal disease reduces the efficiency of this process. Value is intangible, but people reveal how much they value (i.e. feel a want or need for) products by what they actually consume, in quality and quantity. Animal products, and so implicitly animals themselves, are an example. The strength of people's preferences is reflected both in the prices they pay for market goods and services, and by their political votes where markets do not exist. Importantly, there is a difference between financial value (what the consumer pays for a good or service) and economic value (the maximum amount of money they would be prepared to pay for it). Allocating resources for animal health creates both costs and benefits, financial and economic. Moreover, costs and benefits are both private and social because of externalities, a major consideration in infectious diseases. Where production decisions with animal health implications are made exclusively for private benefit, government has a role in providing incentives for animal sectors to act in ways that result in socially efficient outcomes.

A comparative analysis of ecosystem services valuation approaches for application at the local scale and in data scarce regions

OpenAIRE

Pandeya, B.; Buytaert, W.; Zulkafli, Z.; Karpouzoglou, T.; Mao, F.; Hannah, D.M.

2016-01-01

Despite significant advances in the development of the ecosystem services concept across the science and policy arenas, the valuation of ecosystem services to guide sustainable development remains challenging, especially at a local scale and in data scarce regions. In this paper, we review and compare major past and current valuation approaches and discuss their key strengths and weaknesses for guiding policy decisions. To deal with the complexity of methods used in different valuation approa...

Hydrological Modeling in Data-Scarce Catchments: The Kilombero Floodplain in Tanzania

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Kristian Näschen

2018-05-01

Full Text Available Deterioration of upland soils, demographic growth, and climate change all lead to an increased utilization of wetlands in East Africa. This considerable pressure on wetland resources results in trade-offs between those resources and their related ecosystem services. Furthermore, relationships between catchment attributes and available wetland water resources are one of the key drivers that might lead to wetland degradation. To investigate the impacts of these developments on catchment-wetland water resources, the Soil and Water Assessment Tool (SWAT was applied to the Kilombero Catchment in Tanzania, which is like many other East African catchments, as it is characterized by overall data scarcity. Due to the lack of recent discharge data, the model was calibrated for the period from 1958–1965 (R2 = 0.86, NSE = 0.85, KGE = 0.93 and validated from 1966–1970 (R2 = 0.80, NSE = 0.80, KGE = 0.89 with the sequential uncertainty fitting algorithm (SUFI-2 on a daily resolution. Results show the dependency of the wetland on baseflow contribution from the enclosing catchment, especially in dry season. Main contributions with regard to overall water yield arise from the northern mountains and the southeastern highlands, which are characterized by steep slopes and a high share of forest and savanna vegetation, respectively. Simulations of land use change effects, generated with Landsat images from the 1970s up to 2014, show severe shifts in the water balance components on the subcatchment scale due to anthropogenic activities. Sustainable management of the investigated catchment should therefore account for the catchment–wetland interaction concerning water resources, with a special emphasis on groundwater fluxes to ensure future food production as well as the preservation of the wetland ecosystem.

Shuffled Frog Leaping Algorithm for Preemptive Project Scheduling Problems with Resource Vacations Based on Patterson Set

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Yi Han

2013-01-01

Full Text Available This paper presents a shuffled frog leaping algorithm (SFLA for the single-mode resource-constrained project scheduling problem where activities can be divided into equant units and interrupted during processing. Each activity consumes 0–3 types of resources which are renewable and temporarily not available due to resource vacations in each period. The presence of scarce resources and precedence relations between activities makes project scheduling a difficult and important task in project management. A recent popular metaheuristic shuffled frog leaping algorithm, which is enlightened by the predatory habit of frog group in a small pond, is adopted to investigate the project makespan improvement on Patterson benchmark sets which is composed of different small and medium size projects. Computational results demonstrate the effectiveness and efficiency of SFLA in reducing project makespan and minimizing activity splitting number within an average CPU runtime, 0.521 second. This paper exposes all the scheduling sequences for each project and shows that of the 23 best known solutions have been improved.

Novel Human Radiation Exposure Biomarker Panel Applicable for Population Triage

Energy Technology Data Exchange (ETDEWEB)

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

2014-11-01

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

An Empirical Study on Low-Carbon: Human Resources Performance Evaluation

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Quan Chen

2018-01-01

Full Text Available Low-carbon logistics meets the requirements of a low-carbon economy and is the most effective operating model for logistic development to achieve sustainability by coping with severe energy consumption and global warming. Low-carbon logistics aims to reduce carbon intensity rather than simply reduce energy consumption and carbon emissions. Human resources are an important part of the great competition in the logistics market and significantly affect the operations of enterprises. Performance evaluations of human resources are particularly important for low-carbon logistics enterprises with scarce talents. Such evaluations in these enterprises are of great significance for their strategic development. This study constructed a human resource performance evaluation system to assess non-managerial employees’ low-carbon job capacity, job performance, and job attitude in the low-carbon logistics sector. The case study results revealed that the investigated company enjoyed initial success after having promoted low-carbon concepts and values to its non-managerial employees, and the success was demonstrated by excellent performance in its employees’ job attitude and knowledge. This study adopts the AHP method to reasonably determine an indicator system of performance evaluation and its weight to avoid certain human-caused bias. This study not only fills the gap in the related literature, but can also be applied to industrial practice.

An Empirical Study on Low-Carbon: Human Resources Performance Evaluation

Science.gov (United States)

Chen, Quan; Tsai, Sang-Bing; Zhou, Jie; Yu, Jian; Chang, Li-Chung; Li, Guodong; Zheng, Yuxiang; Wang, Jiangtao

2018-01-01

Low-carbon logistics meets the requirements of a low-carbon economy and is the most effective operating model for logistic development to achieve sustainability by coping with severe energy consumption and global warming. Low-carbon logistics aims to reduce carbon intensity rather than simply reduce energy consumption and carbon emissions. Human resources are an important part of the great competition in the logistics market and significantly affect the operations of enterprises. Performance evaluations of human resources are particularly important for low-carbon logistics enterprises with scarce talents. Such evaluations in these enterprises are of great significance for their strategic development. This study constructed a human resource performance evaluation system to assess non-managerial employees’ low-carbon job capacity, job performance, and job attitude in the low-carbon logistics sector. The case study results revealed that the investigated company enjoyed initial success after having promoted low-carbon concepts and values to its non-managerial employees, and the success was demonstrated by excellent performance in its employees’ job attitude and knowledge. This study adopts the AHP method to reasonably determine an indicator system of performance evaluation and its weight to avoid certain human-caused bias. This study not only fills the gap in the related literature, but can also be applied to industrial practice. PMID:29301375

An Empirical Study on Low-Carbon: Human Resources Performance Evaluation.

Science.gov (United States)

Chen, Quan; Tsai, Sang-Bing; Zhai, Yuming; Zhou, Jie; Yu, Jian; Chang, Li-Chung; Li, Guodong; Zheng, Yuxiang; Wang, Jiangtao

2018-01-03

Low-carbon logistics meets the requirements of a low-carbon economy and is the most effective operating model for logistic development to achieve sustainability by coping with severe energy consumption and global warming. Low-carbon logistics aims to reduce carbon intensity rather than simply reduce energy consumption and carbon emissions. Human resources are an important part of the great competition in the logistics market and significantly affect the operations of enterprises. Performance evaluations of human resources are particularly important for low-carbon logistics enterprises with scarce talents. Such evaluations in these enterprises are of great significance for their strategic development. This study constructed a human resource performance evaluation system to assess non-managerial employees' low-carbon job capacity, job performance, and job attitude in the low-carbon logistics sector. The case study results revealed that the investigated company enjoyed initial success after having promoted low-carbon concepts and values to its non-managerial employees, and the success was demonstrated by excellent performance in its employees' job attitude and knowledge. This study adopts the AHP method to reasonably determine an indicator system of performance evaluation and its weight to avoid certain human-caused bias. This study not only fills the gap in the related literature, but can also be applied to industrial practice.

Critical Resources for Emerging Battery Technologies for Hybrid and Electric Vehicles. Proceedings of the International Conference “ISWA World Solid Waste Congress”, 17th - 19th September 2012, Florence, Italy

DEFF Research Database (Denmark)

Habib, Komal; Nyander, Nils Christian; Wenzel, Henrik

2012-01-01

such as photovoltaics, wind turbines, electric and hybrid cars are, however, in turn dependent on other non- renewable resources such as metals which may become scarce in the future. The concept of ‘critical resources’ is in this context is an expression of how limited or constrained the supply of a resource......-manganese spinel Titanate (LMO – T)) for electric cars in a proposed scenario of 2050, in which a scale of 100 % global conversion of passenger cars to battery cars is modeled. Potential resource supply constraints for these emerging battery technologies in electric cars have been analyzed and assessed...

The quality, safety and governance of telephone triage and advice services - an overview of evidence from systematic reviews.

Science.gov (United States)

Lake, Rebecca; Georgiou, Andrew; Li, Julie; Li, Ling; Byrne, Mary; Robinson, Maureen; Westbrook, Johanna I

2017-08-30

Telephone triage and advice services (TTAS) are increasingly being implemented around the world. These services allow people to speak to a nurse or general practitioner over the telephone and receive assessment and healthcare advice. There is an existing body of research on the topic of TTAS, however the diffuseness of the evidence base makes it difficult to identify key lessons that are consistent across the literature. Systematic reviews represent the highest level of evidence synthesis. We aimed to undertake an overview of such reviews to determine the scope, consistency and generalisability of findings in relation to the governance, safety and quality of TTAS. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library for English language systematic reviews focused on key governance, quality and safety findings related to telephone based triage and advice services, published since 1990. The search was undertaken by three researchers who reached consensus on all included systematic reviews. An appraisal of the methodological quality of the systematic reviews was independently undertaken by two researchers using A Measurement Tool to Assess Systematic Reviews. Ten systematic reviews from a potential 291 results were selected for inclusion. TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Evidence of TTAS performance was reported across nine key indicators - access, appropriateness, compliance, patient satisfaction, cost, safety, health service utilisation, physician workload and clinical outcomes. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care. Taken as a whole, current evidence does not provide definitive answers to questions about the quality of care

The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study

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O'Neill Conor

2011-03-01

Full Text Available Abstract Background The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity. Methods All those assessed following screening over a three month period at a busy remand committals prison (n = 246 were rated in a retrospective cohort design blind to outcome. Similarly, all those admitted to a mental health service from the same prison in-reach service over an overlapping two year period were rated blind to outcome (n = 100. Results The 11 item scale had good internal consistency (Cronbach's alpha = 0.95 and inter-rater reliability. The scale score did not correlate with the HCR-20 'historical' score. For the three month sample, the receiver operating characteristic area under the curve (AUC for those admitted to hospital was 0.893 (95% confidence interval 0.843 to 0.943. For the two year sample, AUC distinguished at each level between those admitted to open wards, low secure units or a medium/high secure service. Open wards v low secure units AUC = 0.805 (95% CI 0.680 to 0.930; low secure v medium/high secure AUC = 0.866, (95% CI 0.784 to 0.949. Item to outcome correlations were significant for all 11 items. Conclusions The DUNDRUM-1 triage security scale and its items performed to criterion levels when tested against the real world outcome. This instrument can be used to ensure consistency in decision making when deciding who to admit to secure forensic hospitals. It can also be used to benchmark admission thresholds between services and jurisdictions. In this study we found some divergence between assessed need and actual placement

The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study

Science.gov (United States)

2011-01-01

Background The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity. Methods All those assessed following screening over a three month period at a busy remand committals prison (n = 246) were rated in a retrospective cohort design blind to outcome. Similarly, all those admitted to a mental health service from the same prison in-reach service over an overlapping two year period were rated blind to outcome (n = 100). Results The 11 item scale had good internal consistency (Cronbach's alpha = 0.95) and inter-rater reliability. The scale score did not correlate with the HCR-20 'historical' score. For the three month sample, the receiver operating characteristic area under the curve (AUC) for those admitted to hospital was 0.893 (95% confidence interval 0.843 to 0.943). For the two year sample, AUC distinguished at each level between those admitted to open wards, low secure units or a medium/high secure service. Open wards v low secure units AUC = 0.805 (95% CI 0.680 to 0.930); low secure v medium/high secure AUC = 0.866, (95% CI 0.784 to 0.949). Item to outcome correlations were significant for all 11 items. Conclusions The DUNDRUM-1 triage security scale and its items performed to criterion levels when tested against the real world outcome. This instrument can be used to ensure consistency in decision making when deciding who to admit to secure forensic hospitals. It can also be used to benchmark admission thresholds between services and jurisdictions. In this study we found some divergence between assessed need and actual placement. This provides fertile

Video2vec Embeddings Recognize Events When Examples Are Scarce.

Science.gov (United States)

Habibian, Amirhossein; Mensink, Thomas; Snoek, Cees G M

2017-10-01

This paper aims for event recognition when video examples are scarce or even completely absent. The key in such a challenging setting is a semantic video representation. Rather than building the representation from individual attribute detectors and their annotations, we propose to learn the entire representation from freely available web videos and their descriptions using an embedding between video features and term vectors. In our proposed embedding, which we call Video2vec, the correlations between the words are utilized to learn a more effective representation by optimizing a joint objective balancing descriptiveness and predictability. We show how learning the Video2vec embedding using a multimodal predictability loss, including appearance, motion and audio features, results in a better predictable representation. We also propose an event specific variant of Video2vec to learn a more accurate representation for the words, which are indicative of the event, by introducing a term sensitive descriptiveness loss. Our experiments on three challenging collections of web videos from the NIST TRECVID Multimedia Event Detection and Columbia Consumer Videos datasets demonstrate: i) the advantages of Video2vec over representations using attributes or alternative embeddings, ii) the benefit of fusing video modalities by an embedding over common strategies, iii) the complementarity of term sensitive descriptiveness and multimodal predictability for event recognition. By its ability to improve predictability of present day audio-visual video features, while at the same time maximizing their semantic descriptiveness, Video2vec leads to state-of-the-art accuracy for both few- and zero-example recognition of events in video.

Machine Learning or Information Retrieval Techniques for Bug Triaging: Which is better?

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Anjali Goyal

2017-07-01

Full Text Available Bugs are the inevitable part of a software system. Nowadays, large software development projects even release beta versions of their products to gather bug reports from users. The collected bug reports are then worked upon by various developers in order to resolve the defects and make the final software product more reliable. The high frequency of incoming bugs makes the bug handling a difficult and time consuming task. Bug assignment is an integral part of bug triaging that aims at the process of assigning a suitable developer for the reported bug who corrects the source code in order to resolve the bug. There are various semi and fully automated techniques to ease the task of bug assignment. This paper presents the current state of the art of various techniques used for bug report assignment. Through exhaustive research, the authors have observed that machine learning and information retrieval based bug assignment approaches are most popular in literature. A deeper investigation has shown that the trend of techniques is taking a shift from machine learning based approaches towards information retrieval based approaches. Therefore, the focus of this work is to find the reason behind the observed drift and thus a comparative analysis is conducted on the bug reports of the Mozilla, Eclipse, Gnome and Open Office projects in the Bugzilla repository. The results of the study show that the information retrieval based technique yields better efficiency in recommending the developers for bug reports.

Genome-Wide Analysis to Identify HLA Factors Potentially Associated With Severe Dengue

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Sudheer Gupta

2018-04-01

Full Text Available The pathogenesis of dengue hemorrhagic fever (DHF, following dengue virus (DENV infection, is a complex and poorly understood phenomenon. In view of the clinical need of identifying patients with higher likelihood of developing this severe outcome, we undertook a comparative genome-wide association analysis of epitope variants from sequences available in the ViPR database that have been reported to be differentially related to dengue fever and DHF. Having enumerated the incriminated epitope variants, we determined the corresponding HLA alleles in the context of which DENV infection could potentially precipitate DHF. Our analysis considered the development of DHF in three different perspectives: (a as a consequence of primary DENV infection, (b following secondary DENV infection with a heterologous serotype, (c as a result of DENV infection following infection with related flaviviruses like Zika virus, Japanese Encephalitis virus, West Nile virus, etc. Subject to experimental validation, these viral and host markers would be valuable in triaging DENV-infected patients for closer supervision owing to the relatively higher risk of poor prognostic outcome and also for the judicious allocation of scarce institutional resources during large outbreaks.

Glacier changes and climate trends derived from multiple sources in the data scarce Cordillera Vilcanota region, Southern Peruvian Andes

OpenAIRE

N. Salzmann; C. Huggel; M. Rohrer; W. Silverio; B. G. Mark; P. Burns; C. Portocarrero

2012-01-01

The role of glaciers as temporal water reservoirs is particularly pronounced in the (outer) tropics because of the very distinct wet/dry seasons. Rapid glacier retreat caused by climatic changes is thus a major concern, and decision makers demand urgently for regional/local glacier evolution trends, ice mass estimates and runoff assessments. However, in remote mountain areas, spatial and temporal data coverage is typically very scarce and this is further complicated by a high spatial and temp...

HPV16 RNA patterns defined by novel high-throughput RT-qPCR as triage marker in HPV-based cervical cancer precursor screening.

Science.gov (United States)

Höfler, Daniela; Böhmer, Gerd; von Wasielewski, Reinhard; Neumann, Heinrich; Halec, Gordana; Holzinger, Dana; Dondog, Bolormaa; Gissmann, Lutz; Pawlita, Michael; Schmitt, Markus

2015-09-01

Cervical cancer precursor screening by HPV testing has a low positive predictive value for advanced lesion. HPV16 RNA patterns characteristic for HPV16-transformed cells but based on laborious, cost-intensive singleplex NASBA reactions promised high value in triaging HPV16 DNA-positive women. We developed two high-throughput reverse transcriptase quantitative (RT-q) PCR assays for the HPV16 transcripts E6*I, E1^E4 and E1C and the cellular transcript ubiquitin C and analysed RNA of 158 singly HPV16 DNA-positive cervical cell samples archived in PreservCyt buffer for the presence of transformation-associated HPV16 RNA patterns, i.e., upregulation of E6*I relative to E1^E4 and/or presence of E1C. HPV16 RNA pattern analyses classified 85% of 58 samples diagnosed ≤CIN1 (no cytologically and histologically detectable cervical lesion or CIN grade 1) as negative and 90% of 59 samples diagnosed as ≥CIN3 (CIN grade 3 or invasive cancer) as positive. Among 41 CIN grade 2 samples representing an intermediate lesion group, 49% were HPV16 RNA patterns-positive. Interestingly, 3 of 4 HPV16 RNA patterns-positive lesions initially diagnosed as ≤CIN1 at follow-up 5-24 months later had progressed to ≥CIN2. We successfully developed and validated a second generation of HPV16 RNA patterns assay by rapid RT-qPCR as triage marker for HPV16 DNA-positive women offering clinical utility to distinguish between the need for immediate colposcopy and continued observation. Limited follow-up data suggests that HPV16 RNA patterns-positivity in ≤CIN1 lesions can predict disease progression. Copyright © 2015 Elsevier Inc. All rights reserved.

Adrenal incidentaloma triage with single source (fast kVp switch) dual energy CT

Science.gov (United States)

Glazer, Daniel I; Keshavarzi, Nahid R; Parker, Robert A; Kaza, Ravi K; Platt, Joel F; Francis, Isaac R

2015-01-01

Purpose To evaluate single source dual energy CT (DECT) for distinguishing benign and indeterminate adrenal nodules, with attention to effects of phase of intravenous contrast enhancement. Materials and methods An IRB-approved, HIPAA-compliant retrospective review revealed 273 contrast-enhanced abdominal DECTs from November 2009–March 2012. 50 adrenal nodules ≥ 0.8 cm were identified in 41 patients: 22 female, 19 male, average age 66 (range 36–88 years). CT post-processing and measurements were independently performed by two radiologists (R1 and R2) for each nodule: (1) HU on true non-contrast images; (2) post-contrast HU on monochromatic spectral images at 40, 75, and 140 keV; (3) post-contrast material density (mg/cc) on virtual non-contrast (VNC) images. Nodules were separated into benign (VNC images, benign nodules had significantly lower material density (R1: 992.4 mg/cc ± 9.9; R2: 992.7 mg/cc ±9.6) than indeterminate nodules (R1: 1001.1mg/cc ±20.5 (p .038); R2: 1007.6 HU ±13.4 (p <.0001). Conclusion DECT tools can mathematically subtract iodine or minimize its effects in high energy reconstructions, approximating non-contrast imaging and potentially reducing the need for additional studies to triage adrenal nodules detected on post-contrast DECT exams. PMID:25055267

HPV-Based Screening, Triage, Treatment, and Followup Strategies in the Management of Cervical Intraepithelial Neoplasia

Directory of Open Access Journals (Sweden)

Oscar Peralta-Zaragoza

2013-01-01

Full Text Available Cervical cancer is the second most common cause of death from cancer in women worldwide, and the development of new diagnostic, prognostic, and treatment strategies merits special attention. Many efforts have been made to design new drugs and develop immunotherapy and gene therapy strategies to treat cervical cancer. HPV genotyping has potentially valuable applications in triage of low-grade abnormal cervical cytology, assessment of prognosis and followup of cervical intraepithelial neoplasia, and in treatment strategies for invasive cervical cancer. It is known that during the development of cervical cancer associated with HPV infection, a cascade of abnormal events is induced, including disruption of cellular cycle control, alteration of gene expression, and deregulation of microRNA expression. Thus, the identification and subsequent functional evaluation of host proteins associated with HPV E6 and E7 oncoproteins may provide useful information in understanding cervical carcinogenesis, identifying cervical cancer molecular markers, and developing specific targeting strategies against tumor cells. Therefore, in this paper, we discuss the main diagnostic methods, management strategies, and followup of HPV-associated cervical lesions and review clinical trials applying gene therapy strategies against the development of cervical cancer.

Engaging Survivors of Human Trafficking: Complex Health Care Needs and Scarce Resources.

Science.gov (United States)

Judge, Abigail M; Murphy, Jennifer A; Hidalgo, Jose; Macias-Konstantopoulos, Wendy

2018-05-01

Human trafficking, also known as modern-day slavery, is an egregious human rights violation associated with wide-ranging medical and mental health consequences. Because of the extensive health problems related to trafficking, health care providers play a critical role in identifying survivors and engaging them in ongoing care. Although guidelines for recognizing affected patients and a framework for developing response protocols in health care settings have been described, survivors' ongoing engagement in health care services is very challenging. High rates of disengagement, lost contact, premature termination, and attrition are common outcomes. For interventions to be effective in this marginalized population, challenges in engaging survivors in long-term therapeutic primary and mental health care must be better understood and overcome. This article uses the socioecological model of public health to identify barriers to engagement; offers evidence- and practice-based recommendations for overcoming these barriers; and proposes an interdisciplinary call to action for developing more flexible, adaptable models of care.

Integrated Yard Space Allocation and Yard Crane Deployment Problem in Resource-Limited Container Terminals

Directory of Open Access Journals (Sweden)

Caimao Tan

2016-01-01

Full Text Available Yard storage space and yard crane equipment are the core resources in the container terminal yard area. This paper studies the integrated yard space allocation (outbound container space and yard crane deployment problem in resource-limited container terminals where yard space and yard cranes are extremely scarce. Two corresponding counterstrategies are introduced, respectively, and the integrated problem is solved as mixed integer programming. The model this paper formulated considers the container volume fluctuation of the service line, and the objective is a trade-off between yard sharing space and terminal operation cost. In numerical experiments, this paper tries to reveal the management meaning in practical operation of container terminal and provides decision support for terminal managers; therefore a series of scenarios are presented to analyze the relations among the yard sharing space, the number of yard cranes, the size of yard subblock, and the cost of terminal operation.

Establishing a library of resources to help people understand key concepts in assessing treatment claims—The “Critical thinking and Appraisal Resource Library” (CARL)

Science.gov (United States)

Chalmers, Iain; Atkinson, Patricia; Badenoch, Douglas; Oxman, Andrew D.; Austvoll-Dahlgren, Astrid; Nordheim, Lena; Krause, L. Kendall; Schwartz, Lisa M.; Woloshin, Steven; Burls, Amanda; Mosconi, Paola; Hoffmann, Tammy; Cusack, Leila; Albarqouni, Loai; Glasziou, Paul

2017-01-01

Background People are frequently confronted with untrustworthy claims about the effects of treatments. Uncritical acceptance of these claims can lead to poor, and sometimes dangerous, treatment decisions, and wasted time and money. Resources to help people learn to think critically about treatment claims are scarce, and they are widely scattered. Furthermore, very few learning-resources have been assessed to see if they improve knowledge and behavior. Objectives Our objectives were to develop the Critical thinking and Appraisal Resource Library (CARL). This library was to be in the form of a database containing learning resources for those who are responsible for encouraging critical thinking about treatment claims, and was to be made available online. We wished to include resources for groups we identified as ‘intermediaries’ of knowledge, i.e. teachers of schoolchildren, undergraduates and graduates, for example those teaching evidence-based medicine, or those communicating treatment claims to the public. In selecting resources, we wished to draw particular attention to those resources that had been formally evaluated, for example, by the creators of the resource or independent research groups. Methods CARL was populated with learning-resources identified from a variety of sources—two previously developed but unmaintained inventories; systematic reviews of learning-interventions; online and database searches; and recommendations by members of the project group and its advisors. The learning-resources in CARL were organised by ‘Key Concepts’ needed to judge the trustworthiness of treatment claims, and were made available online by the James Lind Initiative in Testing Treatments interactive (TTi) English (www.testingtreatments.org/category/learning-resources).TTi English also incorporated the database of Key Concepts and the Claim Evaluation Tools developed through the Informed Healthcare Choices (IHC) project (informedhealthchoices.org). Results We have

Development of processes allowing near real-time refinement and validation of triage tools during the early stage of an outbreak in readiness for surge: the FLU-CATs Study.

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Venkatesan, Sudhir; Myles, Puja R; McCann, Gerard; Kousoulis, Antonis A; Hashmi, Maimoona; Belatri, Rabah; Boyle, Emma; Barcroft, Alan; van Staa, Tjeerd Pieter; Kirkham, Jamie J; Nguyen Van Tam, Jonathan S; Williams, Timothy J; Semple, Malcolm G

2015-10-01

During pandemics of novel influenza and outbreaks of emerging infections, surge in health-care demand can exceed capacity to provide normal standards of care. In such exceptional circumstances, triage tools may aid decisions in identifying people who are most likely to benefit from higher levels of care. Rapid research during the early phase of an outbreak should allow refinement and validation of triage tools so that in the event of surge a valid tool is available. The overarching study aim is to conduct a prospective near real-time analysis of structured clinical assessments of influenza-like illness (ILI) using primary care electronic health records (EHRs) during a pandemic. This abstract summarises the preparatory work, infrastructure development, user testing and proof-of-concept study. (1) In preparation for conducting rapid research in the early phase of a future outbreak, to develop processes that allow near real-time analysis of general practitioner (GP) assessments of people presenting with ILI, management decisions and patient outcomes. (2) As proof of concept: conduct a pilot study evaluating the performance of the triage tools 'Community Assessment Tools' and 'Pandemic Medical Early Warning Score' to predict hospital admission and death in patients presenting with ILI to GPs during inter-pandemic winter seasons. Prospective near real-time analysis of structured clinical assessments and anonymised linkage to data from EHRs. User experience was evaluated by semistructured interviews with participating GPs. Thirty GPs in England, Wales and Scotland, participating in the Clinical Practice Research Datalink. All people presenting with ILI. None. Study outcome is proof of concept through demonstration of data capture and near real-time analysis. Primary patient outcomes were hospital admission within 24 hours and death (all causes) within 30 days of GP assessment. Secondary patient outcomes included GP decision to prescribe antibiotics and/or influenza

The Field Assessment Stroke Triage for Emergency Destination (FAST-ED): a Simple and Accurate Pre-Hospital Scale to Detect Large Vessel Occlusion Strokes

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Lima, Fabricio O.; Silva, Gisele S.; Furie, Karen L.; Frankel, Michael R.; Lev, Michael H.; Camargo, Érica CS; Haussen, Diogo C.; Singhal, Aneesh B.; Koroshetz, Walter J.; Smith, Wade S.; Nogueira, Raul G.

2016-01-01

Background and Purpose Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS. Methods The FAST-ED scale was based on items of the NIHSS with higher predictive value for LVOS and tested in the STOPStroke cohort, in which patients underwent CT angiography within the first 24 hours of stroke onset. LVOS were defined by total occlusions involving the intracranial-ICA, MCA-M1, MCA-2, or basilar arteries. Patients with partial, bi-hemispheric, and/or anterior + posterior circulation occlusions were excluded. Receiver operating characteristic (ROC) curve, sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of FAST-ED were compared with the NIHSS, Rapid Arterial oCclusion Evaluation (RACE) scale and Cincinnati Prehospital Stroke Severity Scale (CPSSS). Results LVO was detected in 240 of the 727 qualifying patients (33%). FAST-ED had comparable accuracy to predict LVO to the NIHSS and higher accuracy than RACE and CPSS (area under the ROC curve: FAST-ED=0.81 as reference; NIHSS=0.80, p=0.28; RACE=0.77, p=0.02; and CPSS=0.75, p=0.002). A FAST-ED ≥4 had sensitivity of 0.60, specificity 0.89, PPV 0.72, and NPV 0.82 versus RACE ≥5 of 0.55, 0.87, 0.68, 0.79 and CPSS ≥2 of 0.56, 0.85, 0.65, 0.78, respectively. Conclusions FAST-ED is a simple scale that if successfully validated in the field may be used by medical emergency professionals to identify LVOS in the pre-hospital setting enabling rapid triage of patients. PMID:27364531

Improving the performance of reflex Human Papilloma Virus (HPV) testing in triaging women with atypical squamous cells of undetermined significance (ASCUS): A restrospective study in a tertiary hospital in United Arab Emirates (UAE).

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Fakhreldin, Marwa; Elmasry, Karim

2016-02-03

Cervical cancer is the second commonest cancer in women worldwide. Infection with oncogenic types of human Papillomavirus (HPV) is the most important risk factor for developing cervical cancer. Reflex High risk HPV (HR-HPV) testing is of significant value in the assessment of Papanicolaou (Pap) smear results where ASCUS are identified. To improve the performance of reflex HR-HPV testing in triage of ASCUS and analyze the factors impacting it. In this study, we generated a database of 9641 women who had cervical smears collected during the study period from the cytopathology record in a large tertiary hospital in UAE. These included 297 smears with ASCUS diagnosis. All cases were retrospectively followed up with a mean duration of 2.44 years. We analyzed data according to the outcome based on several follow-up Pap smear analysis as the reference assessment. We detected HR-HPV infection in 17.9% of cases. 9.1% ASCUS cases can be more accurate in premenopausal women upon adding age group and presenting complaint as a triage item. This improves the performance of reflex HPV testing and the subsequent selection of high risk patients for colposcopy. Copyright © 2015 Elsevier Ltd. All rights reserved.

On the History of Cattle Genetic Resources

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Marleen Felius

2014-11-01

Full Text Available Cattle are our most important livestock species because of their production and role in human culture. Many breeds that differ in appearance, performance and environmental adaptation are kept on all inhabited continents, but the historic origin of the diverse phenotypes is not always clear. We give an account of the history of cattle by integrating archaeological record and pictorial or written sources, scarce until 300 years ago, with the recent contributions of DNA analysis. We describe the domestication of their wild ancestor, migrations to eventually all inhabited continents, the developments during prehistory, the antiquity and the Middle Ages, the relatively recent breed formation, the industrial cattle husbandry in the Old and New World and the current efforts to preserve the cattle genetic resources. Surveying the available information, we propose three main and overlapping phases during the development of the present genetic diversity: (i domestication and subsequent wild introgression; (ii natural adaptation to a diverse agricultural habitat; and (iii breed development.

Crew resource management in the ICU: the need for culture change.

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Haerkens, Marck Htm; Jenkins, Donald H; van der Hoeven, Johannes G

2012-08-22

Intensive care frequently results in unintentional harm to patients and statistics don't seem to improve. The ICU environment is especially unforgiving for mistakes due to the multidisciplinary, time-critical nature of care and vulnerability of the patients. Human factors account for the majority of adverse events and a sound safety climate is therefore essential. This article reviews the existing literature on aviation-derived training called Crew Resource Management (CRM) and discusses its application in critical care medicine. CRM focuses on teamwork, threat and error management and blame free discussion of human mistakes. Though evidence is still scarce, the authors consider CRM to be a promising tool for culture change in the ICU setting, if supported by leadership and well-designed follow-up.