WorldWideScience

Sample records for stronger-emotional pulls triage

  1. EMERGENCY TRIAGE

    OpenAIRE

    Renata Rajapakse

    2015-01-01

    This paper describes emergency triage. It presents the reasons for implementation of triage and its benefits. Focuses on the Manchester triage system, which is formally validated triage model in Slovenia.

  2. 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....... The paper provides in-depth empirical observations describing the situated work practices of triage work, and the complex collaborative nature of the triage process. We identify and conceptualize triage work practices as comprising patient trajectories, triage nurse activities, coordinative artefacts...... and exception handling; we also articulate how these four features of triage practices constitute and connect workflows, organize and re-organize time and space during the triage process. Finally we conceptualize these connections as an assessing and sorting mechanism in collaborative work. We argue...

  3. 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

  4. Ethics of conservation triage

    Directory of Open Access Journals (Sweden)

    Kerrie A Wilson

    2016-09-01

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

  5. The Copenhagen Triage Algorithm

    DEFF Research Database (Denmark)

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

    2016-01-01

    BACKGROUND: Crowding in the emergency department (ED) is a well-known problem resulting in an increased risk of adverse outcomes. Effective triage might counteract this problem by identifying the sickest patients and ensuring early treatment. In the last two decades, systematic triage has become...... the standard in ED's worldwide. However, triage models are also time consuming, supported by limited evidence and could potentially be of more harm than benefit. The aim of this study is to develop a quicker triage model using data from a large cohort of unselected ED patients and evaluate if this new model...... 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...

  6. Drawbar Pull

    Science.gov (United States)

    2017-01-26

    of vehicle stall (i.e. no forward motion) may be required. For tracked vehicles, it may be necessary, at times, to tie down the tracks of the test ...Final 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE Test Operations Procedure (TOP) 02-2-604 w/CN1 Drawbar Pull 5a. CONTRACT NUMBER...PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) U.S. Army Yuma Proving Ground Yuma Test Center 301 C Street Yuma, Arizona 85365-9498 Automotive

  7. Triage in military settings.

    Science.gov (United States)

    Falzone, E; Pasquier, P; Hoffmann, C; Barbier, O; Boutonnet, M; Salvadori, A; Jarrassier, A; Renner, J; Malgras, B; Mérat, S

    2017-02-01

    Triage, a medical term derived from the French word "trier", is the practical process of sorting casualties to rationally allocate limited resources. In combat settings with limited medical resources and long transportation times, triage is challenging since the objectives are to avoid overcrowding medical treatment facilities while saving a maximum of soldiers and to get as many of them back into action as possible. The new face of modern warfare, asymmetric and non-conventional, has led to the integrative evolution of triage into the theatre of operations. This article defines different triage scores and algorithms currently implemented in military settings. The discrepancies associated with these military triage systems are highlighted. The assessment of combat casualty severity requires several scores and each nation adopts different systems for triage on the battlefield with the same aim of quickly identifying those combat casualties requiring lifesaving and damage control resuscitation procedures. Other areas of interest for triage in military settings are discussed, including predicting the need for massive transfusion, haemodynamic parameters and ultrasound exploration. Copyright © 2016 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  8. Contemporary Obstetric Triage.

    Science.gov (United States)

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

    2016-03-01

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

  9. Ethics and triage.

    Science.gov (United States)

    Domres, B; Koch, M; Manger, A; Becker, H D

    2001-01-01

    A disaster is characterized by an imbalance between needs and supplies. In circumstances in which there occur mass casualties, it is not possible to provide care for all of the victims. Thus, it may be necessary to triage the casualties according to pre-established priorities. The performance of triage is associated with many ethical issues. Currently, no Europe-wide agreement on triage and ethics exists. One system based on a categorization into four groups is proposed. Triage should be avoided whenever possible, but, when it is required, there is an obligation to respect human rights and the humanitarian laws, especially with reference to the Geneva Convention of 1864 and the Universal Declaration of Human Rights of 1948. The condition of informed consent must be followed, even in mass casualty situations. Triage always must follow established medical criteria and cannot be based on any other principles. Triage implies constant re-evaluation of victims as conditions of the victims and of available resources change continuously. In order to facilitate international coordination and cooperation, a universal classification system must be adopted.

  10. Triage and the Modified Physiological Triage Tool-24 (MPTT-24).

    Science.gov (United States)

    Vassallo, James; Horne, S; Smith, J E

    2018-01-04

    Major incidents occur on a regular basis. So far in 2017, England has witnessed five terrorism-related major incidents, resulting in approximately 40 fatalities and 400 injured. Triage is a key principle in the effective management of a major incident and involves prioritising patients on the basis of their clinical acuity. This paper describes the limitations associated with existing methods of primary major incident triage and the process of developing a new and improved triage tool-the Modified Physiological Triage Tool-24 (MPTT-24). Whilst the MPTT-24 is likely to be the optimum physiological method for primary major incident triage, it needs to be accompanied by an appropriate secondary triage process. The existing UK military and civilian secondary triage tool, the Triage Sort, is described, which offers little advantage over primary methods for identifying patients who require life-saving intervention. Further research is required to identify the optimum method of secondary triage. © 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.

  11. Paediatric triage in South Africa

    African Journals Online (AJOL)

    2013-05-07

    May 7, 2013 ... are the World Health Organization Emergency Triage Assessment and Treatment (ETAT), the South African adaptation of this tool known as ETAT-SA, the ... in the early 19th century, but the word 'triage' to describe this practice only came into ... In recognition of the fact that emergency care for children at ...

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

    Centers for Disease Control (CDC) Podcasts

    2009-01-22

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

  13. PushPull++

    KAUST Repository

    Lipp, Markus

    2014-07-22

    PushPull tools are implemented in most commercial 3D modeling suites. Their purpose is to intuitively transform a face, edge, or vertex, and then to adapt the polygonal mesh locally. However, previous approaches have limitations: Some allow adjustments only when adjacent faces are orthogonal; others support slanted surfaces but never create new details. Moreover, self-intersections and edge-collapses during editing are either ignored or work only partially for solid geometry. To overcome these limitations, we introduce the PushPull++ tool for rapid polygonal modeling. In our solution, we contribute novel methods for adaptive face insertion, adjacent face updates, edge collapse handling, and an intuitive user interface that automatically proposes useful drag directions. We show that PushPull++ reduces the complexity of common modeling tasks by up to an order of magnitude when compared with existing tools. Copyright © ACM.

  14. Pushing and pulling

    CERN Document Server

    Bell, Samantha

    2018-01-01

    "Using the new Next Generation Science Standards (NGSS), the My World of Science series provides the earliest readers with background on key STEM concepts. Pushing and Pulling explores force and motion in physics in a simple, engaging way that will help readers develop word recognition and reading skills. Includes a glossary and index"-- Provided by publisher.

  15. Safety of telephone triage in general practitioner cooperatives: do triage nurses correctly estimate urgency?

    NARCIS (Netherlands)

    Giesen, P.H.J.; Ferwerda, R.; Tijssen, R.; Mokkink, H.G.A.; Drijver, R.; Bosch, W.J.H.M. van den; Grol, R.P.T.M.

    2007-01-01

    BACKGROUND: In recent years, there has been a growth in the use of triage nurses to decrease general practitioner (GP) workloads and increase the efficiency of telephone triage. The actual safety of decisions made by triage nurses has not yet been assessed. OBJECTIVES: To investigate whether triage

  16. Pull, feel, and run

    DEFF Research Database (Denmark)

    Johannsen, Bjørn Friis; Bruun, Jesper

    We investigate kinesthetic learning activities (KLAs) as a new learning technologies. Teachers may want to employ KLAs to have students use their own bodies in learning to construct an appropriate level of understanding of physics entities, interactions and representations. However, few studies...... have investigated what characterizes learning opportunities afforded through KLAs. Using a/v recordings, we investigate characteristics of two different KLAs: A pulling and a circular movement activity. In both activities, students enact Newtonian objects. Here we characterize typical levels...

  17. Triage in de huisartsenpraktijk : te zwaar geschut?

    NARCIS (Netherlands)

    Rutten, F H; Zwart, D L

    2016-01-01

    Based on triage during out-of-hours emergency services with physical contact with patients, the Dutch Triage Standard - a telephone triage algorithm - has been developed for use in primary care out-of-hours services. However, it is also used in the daytime setting. We argue that this tool should be

  18. Physicians, triage, and nuclear war.

    Science.gov (United States)

    Leaning, J

    1988-07-30

    Difficult ethical choices imposed by triage, the process of sorting casualties according to severity of illness (need) and priority for treatment (allocation), are discussed in the context of recent disasters such as an Amtrak collision and the Mexico city earthquake. The question of medical response to nuclear war raises issues of professional duty to assist in making plans for morally repugnant events such as mass destruction; the feasibility of triage, as a conscious professional act, during a time of extreme stress and carnage; and fundamental differences among physicians in their beliefs about themselves, their roles, and their moral obligation to the world.

  19. CT triage for lung malignancy

    DEFF Research Database (Denmark)

    Kusk, Martin Weber; Karstoft, Jens; Mussmann, Bo

    2015-01-01

    : To assess detection performance using only coronal multiplanar reformations (MPR) when triaging patients for lung malignancies with CT compared to images in three orthogonal planes, and to evaluate performance comparison of novice and experienced readers. Material and Methods: Retrospective study of 63...

  20. Acuity Assessment in Obstetrical Triage.

    Science.gov (United States)

    Gratton, Robert J; Bazaracai, Neila; Cameron, Ian; Watts, Nancy; Brayman, Colleen; Hancock, Gregg; Twohey, Rachel; AlShanteer, Suhair; Ryder, Jennifer E; Wodrich, Kathryn; Williams, Emily; Guay, Amélie; Basso, Melanie; Smithson, David S

    2016-02-01

    A five-category Obstetrical Triage Acuity Scale (OTAS) was developed with a comprehensive set of obstetrical determinants. The purposes of this study were: (1) to compare the inter-rater reliability (IRR) in tertiary and community hospital settings and measure the intra-rater reliability (ITR) of OTAS; (2) to establish the validity of OTAS; and (3) to present the first revision of OTAS from the National Obstetrical Triage Working Group. To assess IRR, obstetrical triage nurses were randomly selected from London Health Sciences Centre (LHSC) (n = 8), Stratford General Hospital (n = 11), and Chatham General Hospital (n= 7) to assign acuity levels to clinical scenarios based on actual patient visits. At LHSC, a group of nurses were retested at nine months to measure ITR. To assess validity, OTAS acuity level was correlated with measures of resource utilization. OTAS has significant and comparable IRR in a tertiary care hospital and in two community hospitals. Repeat assessment in a cohort of nurses demonstrated significant ITR. Acuity level correlated significantly with performance of routine and second order laboratory investigations, point of care ultrasound, nursing work load, and health care provider attendance. A National Obstetrical Triage Working Group was formed and guided the first revision. Four acuity modifiers were added based on hemodynamics, respiratory distress, cervical dilatation, and fetal well-being. OTAS is the first obstetrical triage scale with established reliability and validity. OTAS enables standardized assessments of acuity within and across institutions. Further, it facilitates assessment of patient care and flow based on acuity. Copyright © 2016 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  1. Role of telephone triage in obstetrics.

    Science.gov (United States)

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

    2012-12-01

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

  2. 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 if this is in...... of the service in PEUs. The need for PEUs out-of-daytime (when all Community Mental Health Centers are closed) has also been demonstrated....

  3. Emergency department triage: an ethical analysis

    Directory of Open Access Journals (Sweden)

    Gastmans Chris

    2011-10-01

    Full Text Available Abstract Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.

  4. Accountability Pressure, Academic Standards, and Educational Triage

    Science.gov (United States)

    Lauen, Douglas Lee; Gaddis, S. Michael

    2012-01-01

    This study aims to determine whether educational accountability promotes educational triage. This study exploits a natural experiment in North Carolina in which standards increased first in math in 2006 and second in reading in 2008 to determine whether an increase in educational standards caused an increase in educational triage at the expense of…

  5. Emergency department triage: an ethical analysis

    Science.gov (United States)

    2011-01-01

    Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach. PMID:21982119

  6. Pull Promotions and Channel Coordination

    OpenAIRE

    Eitan Gerstner; James D. Hess

    1995-01-01

    This paper recommends that manufacturers consider a pull price promotion as a coordination device in an independent channel of distribution. Uncoordinated decisions of both manufacturer and retailer to charge high prices can break down the effort to expand the market, resulting in losses to the channel as a whole. We show that manufacturers can enhance channel price coordination by designing pull price discounts that target price-conscious consumers. The increased price coordination improves ...

  7. Triaging suicidal patients: sifting through the evidence.

    Science.gov (United States)

    Clarke, Diana E; Brown, Anne-Marie; Giles-Smith, Lori

    2008-07-01

    The triaging of individuals who present to general hospital emergency departments with suicidal thoughts and behaviours is especially challenging and fraught with uncertainty. Although the suicide literature is vast, and risk factor research has a long history, there is a dearth of articles that address the "point of care" factors that need to be considered in triaging a suicidal patient. In order to address this dilemma for nurses performing the triage function, this paper is a targeted review of the suicide risk factor literature designed to discern factors that may have implications for making a triage determination with the intent of improving the accuracy and quality of triage for suicidal patients. Contextual and compositional factors suggesting long-term risk; situational, precipitating, factors that may impact one's immediate risk; and cues and clues to imminent risk are presented along with evidence-based suggestions for assessment and safety.

  8. What is orthopaedic triage? A systematic review.

    Science.gov (United States)

    Morris, Joanne H; James, Rebecca E; Davey, Rachel; Waddington, Gordon

    2015-02-01

    Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as 'triage' services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on 'best practice' to assist health care facilities. A comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken. 1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes. This systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics. © 2014 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

  9. Veiligheid en doelmatigheid van telefonische triage op de Nederlandse huisartsenpost.

    NARCIS (Netherlands)

    Huibers, L.; Smits, M.; Wensing, M.; Giesen, P.

    2016-01-01

    Background: In general practitioner cooperatives (GP cooperatives) triage nurses perform telephone triage to determine the urgency and required type of care for patients. At the start, there were concerns about the safety of triage, but since then triage has further professionalized. Aim: Giving an

  10. Mental health triage in emergency medicine.

    Science.gov (United States)

    Smart, D; Pollard, C; Walpole, B

    1999-02-01

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

  11. What is orthopaedic triage? A systematic review

    Science.gov (United States)

    Morris, Joanne H; James, Rebecca E; Davey, Rachel; Waddington, Gordon

    2015-01-01

    Rationale, aims and objectives Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as ‘triage’ services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on ‘best practice’ to assist health care facilities. Method A comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken. Results 1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes. Conclusions This systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics. PMID:25410703

  12. [Triage in acute medical admission units.

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Folkestad, Lars; Hallas, Peter

    2010-01-01

    INTRODUCTION: Many emergency departments use validated triage tools. It is currently undocumented if such a practice is common in Danish medical admission units (MAU). The current study was conducted in order to clarify this. MATERIAL AND METHODS: Questionnaire survey with data collected from....... At 87% of the MAUs, a doctor was contacted by the admitting physician, while the contact was the responsibility of a nurse in 13% of MAUs. None of the contacted MAUs used a validated triage tool and 95% answered that they triaged on the basis of individual clinical assessment of patients. However, 22......% answered that selected groups of patients were routinely assessed by a senior physician. CONCLUSION: None of the Danish MAUs uses a validated triage tool to prioritize acutely admitted medical patients. Udgivelsesdato: 2010-May-31...

  13. Optimal Sector Sampling for Drive Triage

    Science.gov (United States)

    2013-06-01

    known files, which we call target data, that could help identify a drive holding evidence such as child pornography or malware. Triage is needed to sift...we call target data, that could help identify a drive holding evidence such as child pornography or malware. Triage is needed to sift through drives...situations where the user is looking for known data.1 One example is a law enforcement officer searching for evidence of child pornography from a large num

  14. 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...

  15. 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.

  16. Physician in Triage Versus Rotational Patient Assignment.

    Science.gov (United States)

    Traub, Stephen J; Bartley, Adam C; Smith, Vernon D; Didehban, Roshanak; Lipinski, Christopher A; Saghafian, Soroush

    2016-05-01

    Physician in triage and rotational patient assignment are different front-end processes that are designed to improve patient flow, but there are little or no data comparing them. To compare physician in triage with rotational patient assignment with respect to multiple emergency department (ED) operational metrics. Design-Retrospective cohort review. Patients-Patients seen on 23 days on which we utilized a physician in triage with those patients seen on 23 matched days when we utilized rotational patient assignment. There were 1,869 visits during physician in triage and 1,906 visits during rotational patient assignment. In a simple comparison, rotational patient assignment was associated with a lower median length of stay (LOS) than physician in triage (219 min vs. 233 min; difference of 14 min; 95% confidence interval [CI] 5-27 min). In a multivariate linear regression incorporating multiple confounders, there was a nonsignificant reduction in the geometric mean LOS in rotational patient assignment vs. physician in triage (204 min vs. 217 min; reduction of 6.25%; 95% CI -3.6% to 15.2%). There were no significant differences between groups for left before being seen, left subsequent to being seen, early (within 72 h) returns, early returns with admission, or complaint ratio. In a single-site study, there were no statistically significant differences in important ED operational metrics between a physician in triage model and a rotational patient assignment model after adjusting for confounders. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Primary Trauma Triage Performed by Bystanders: An Observation Study.

    Science.gov (United States)

    Nordberg, Martin; Castrén, Maaret; Lindström, Veronica

    2016-08-01

    The aim of this study was to evaluate whether bystanders with no training in triage can correctly prioritize three injured patients by using a triage instrument. An observational study was conducted. Participants performed a primary triage on three paper-based patient cases and answered 11 questions during a public event in the center of Stockholm, Sweden. A total of 69 persons participated in the study. The success rate among all the participants for correct triage of the three patient cases was 52 percent. The female participants and younger participants (triage to a greater extent. The over-triage was 12.5 percent and under-triage was 6.3 percent. Participants with no prior knowledge of triage instruments may be capable of triaging injured patients with the help of an easy triage instrument. The over- and under-triage percentages were low, and this may indicate that the developed triage instrument is relatively easy to use. It may also indicate that bystanders can identify a severely injured patient. Nordberg M , Castrén M , Lindström V . Primary trauma triage performed by bystanders: an observation study. Prehosp Disaster Med. 2016;31(4):353-357.

  18. Push-pull quinoidal porphyrins.

    Science.gov (United States)

    Smith, Martin J; Blake, Iain M; Clegg, William; Anderson, Harry L

    2018-05-01

    A family of push-pull quinoidal porphyrin monomers has been prepared from a meso-formyl porphyrin by bromination, thioacetal formation, palladium-catalyzed coupling with malononitrile and oxidation with DDQ. Attempts at extending this synthesis to a push-pull quinoidal/cumulenic porphyrin dimer were not successful. The crystal structures of the quinoidal porphyrins indicate that there is no significant contribution from singlet biradical or zwitterionic resonance forms. The crystal structure of an ethyne-linked porphyrin dimer shows that the torsion angle between the porphyrin units is only about 3°, in keeping with crystallographic results on related compounds, but contrasting with the torsion angle of about 35° predicted by computational studies. The free-base quinoidal porphyrin monomers form tightly π-stacked layer structures, despite their curved geometries and bulky aryl substituents.

  19. Pull remanufacturing: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Levine, L.O.

    1992-09-01

    This paper describes how pull production methods have been applied to a manual transmission remanufacturing line at Tooele Army Depot in Utah. The paper emphasizes techniques for linking the control of disassembly and cleaning operations to the repair and assembly portions of the production system (PP&C). The primary objective is to show that production planning and control can be simplified when pull mechanisms are combined with shop floor improvements. One approach to applying MRP II to remanufacturing is to use a separate production schedule for the disassembly and assembly portions of the operation. This approach is primarily needed when managing the delivery and inventory of cores is critical to the successful operation of a remanufacturing organization. Because Army depots frequently have an adequate inventory of cores on hand (somewhere on-site), this requirement is usually less significant. Therefore, it is possible to eliminate the use of a master production schedule for disassembly and rely on pull linkages from the repair and assembly operations to control the activity of the disassembly and cleaning operations. In remanufacturing environments having multiple products and adequate buffers of core inventory, effective coordination of disassembly and cleaning functions with assembly production requirements becomes a key production control issue.

  20. Pull remanufacturing: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Levine, L.O.

    1992-09-01

    This paper describes how pull production methods have been applied to a manual transmission remanufacturing line at Tooele Army Depot in Utah. The paper emphasizes techniques for linking the control of disassembly and cleaning operations to the repair and assembly portions of the production system (PP C). The primary objective is to show that production planning and control can be simplified when pull mechanisms are combined with shop floor improvements. One approach to applying MRP II to remanufacturing is to use a separate production schedule for the disassembly and assembly portions of the operation. This approach is primarily needed when managing the delivery and inventory of cores is critical to the successful operation of a remanufacturing organization. Because Army depots frequently have an adequate inventory of cores on hand (somewhere on-site), this requirement is usually less significant. Therefore, it is possible to eliminate the use of a master production schedule for disassembly and rely on pull linkages from the repair and assembly operations to control the activity of the disassembly and cleaning operations. In remanufacturing environments having multiple products and adequate buffers of core inventory, effective coordination of disassembly and cleaning functions with assembly production requirements becomes a key production control issue.

  1. [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.

  2. Toxicokinetic Triage for Environmental Chemicals.

    Science.gov (United States)

    Wambaugh, John F; Wetmore, Barbara A; Pearce, Robert; Strope, Cory; Goldsmith, Rocky; Sluka, James P; Sedykh, Alexander; Tropsha, Alex; Bosgra, Sieto; Shah, Imran; Judson, Richard; Thomas, Russell S; Setzer, R Woodrow

    2015-09-01

    Toxicokinetic (TK) models link administered doses to plasma, blood, and tissue concentrations. High-throughput TK (HTTK) performs in vitro to in vivo extrapolation to predict TK from rapid in vitro measurements and chemical structure-based properties. A significant toxicological application of HTTK has been "reverse dosimetry," in which bioactive concentrations from in vitro screening studies are converted into in vivo doses (mg/kg BW/day). These doses are predicted to produce steady-state plasma concentrations that are equivalent to in vitro bioactive concentrations. In this study, we evaluate the impact of the approximations and assumptions necessary for reverse dosimetry and develop methods to determine whether HTTK tools are appropriate or may lead to false conclusions for a particular chemical. Based on literature in vivo data for 87 chemicals, we identified specific properties (eg, in vitro HTTK data, physico-chemical descriptors, and predicted transporter affinities) that correlate with poor HTTK predictive ability. For 271 chemicals we developed a generic HT physiologically based TK (HTPBTK) model that predicts non-steady-state chemical concentration time-courses for a variety of exposure scenarios. We used this HTPBTK model to find that assumptions previously used for reverse dosimetry are usually appropriate, except most notably for highly bioaccumulative compounds. For the thousands of man-made chemicals in the environment that currently have no TK data, we propose a 4-element framework for chemical TK triage that can group chemicals into 7 different categories associated with varying levels of confidence in HTTK predictions. For 349 chemicals with literature HTTK data, we differentiated those chemicals for which HTTK approaches are likely to be sufficient, from those that may require additional data. Published by Oxford University Press on behalf of Society of Toxicology 2015. This work is written by US Government employees and is in the public

  3. Triage capabilities of medical trainees in Ghana using the South ...

    African Journals Online (AJOL)

    Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care. Adam Gyedu, Kwabena Agbedinu, Mohammed Dalwai, Maxwell Osei-Ampofo, Emmanuel Kweku Nakua, Rockefeller Oteng, Barclay Stewart ...

  4. Conservatives Anticipate and Experience Stronger Emotional Reactions to Negative Outcomes.

    Science.gov (United States)

    Joel, Samantha; Burton, Caitlin M; Plaks, Jason E

    2014-02-01

    The present work examined whether conservatives and liberals differ in their anticipation of their own emotional reactions to negative events. In two studies, participants imagined experiencing positive or negative outcomes in domains that do not directly concern politics. In Study 1, 190 American participants recruited online (64 male, Mage  = 32 years) anticipated their emotional responses to romantic relationship outcomes. In Study 2, 97 Canadian undergraduate students (26 male, Mage  = 21 years) reported on their anticipated and experienced emotional responses to academic outcomes. In both studies, more conservative participants predicted they would feel stronger negative emotions following negative outcomes than did more liberal participants. Furthermore, a longitudinal follow-up of Study 2 participants revealed that more conservative participants actually felt worse than more liberal participants after receiving a lower-than-desired exam grade. These effects remained even when controlling for the Big Five traits, prevention focus, and attachment style (Study 1), and optimism (Study 2). We discuss how the relationship between political orientation and anticipated affect likely contributes to differences between conservatives and liberals in styles of decision and policy choices. © 2013 Wiley Periodicals, Inc.

  5. Evaluating Age in the Field Triage of Injured Persons

    Science.gov (United States)

    Nakamura, Yoko; Daya, Mohamud; Bulger, Eileen M.; Schreiber, Martin; Mackersie, Robert; Hsia, Renee Y.; Mann, N. Clay; Holmes, James F.; Staudenmayer, Kristan; Sturges, Zachary; Liao, Michael; Haukoos, Jason; Kuppermann, Nathan; Barton, Erik D.; Newgard, Craig D.

    2012-01-01

    Study Objective In this study, we evaluated (1) trauma under-triage by age group; (2) the association between age and serious injury after accounting for other field triage criteria and confounders; and (3) the potential impact of a mandatory age triage criterion for field triage. Methods This was a retrospective cohort study of injured children and adults transported by 48 EMS agencies to 105 hospitals in 6 regions of the Western U.S. from 2006 through 2008. We used probabilistic linkage to match EMS records to hospital records, including: trauma registries, state discharge databases and emergency department databases. The primary outcome measure was serious injury, as measured by an Injury Severity Score (ISS) ≥ 16. We assessed under-triage (ISS ≥ 16 and triage-negative or transport to a non-trauma center) by age decile and used multivariable logistic regression models to estimate the association (linear and non-linear) between age and ISS ≥ 16, adjusted for important confounders. We also evaluated the potential impact of age on triage efficiency and trauma center volume. Results 260,027 injured patients were evaluated and transported by EMS over the 3-year study period. Under-triage increased for patients over 60 years of age, reaching approximately 60% for those older than 90 years. There was a strong non-linear association between age and ISS ≥ 16. For patients not meeting other triage criteria, the probability of serious injury was most notable after 60 years. A mandatory age triage criterion would have decreased under-triage at the expense of over-triage, with one ISS ≥ 16 patient identified for every 60–65 additional patients transported to major trauma centers. Conclusion Trauma under-triage increases in patients older than 60 years. While the probability of serious injury increases among triage-negative patients with increasing age, the use of a mandatory age triage criterion appears inefficient for improving field triage. PMID:22633339

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

    African Journals Online (AJOL)

    Background: Limited health service resources must be used in a manner which does “the most for the most”. This is partly achieved through the use of a triage system. Whereas efforts have been made to introduce paediatric triage in Uganda such as Emergency Triage Assessment and Treatment Plus (ETAT+), it is not clear ...

  7. Comparison of an informally structured triage system, the emergency severity index, and the manchester triage system to distinguish patient priority in the emergency department

    NARCIS (Netherlands)

    Storm-Versloot, Marja N.; Ubbink, Dirk T.; Kappelhof, Johan; Luitse, Jan S. K.

    2011-01-01

    The objective was to compare the validity of an existing informally structured triage system with the Emergency Severity Index (ESI) and the Manchester Triage System (MTS). A total of 900 patients were prospectively triaged by six trained triage nurses using the three systems. Triage ratings of 421

  8. TRIAGE — A SOUTH AFRICAN PERSPECTIVE

    African Journals Online (AJOL)

    Enrique

    system, but particularly in one facing these challenges. HISTORICAL BACKGROUND. The word triage means to sort or choose. The French surgeon, Baron Jean Larrey, prioritised medical care on Napoleon's battlefields. He sorted patients according to medical priority rather than rank (a revolutionary concept at the time).

  9. Station Program Note Pull Automation

    Science.gov (United States)

    Delgado, Ivan

    2016-01-01

    Upon commencement of my internship, I was in charge of maintaining the CoFR (Certificate of Flight Readiness) Tool. The tool acquires data from existing Excel workbooks on NASA's and Boeing's databases to create a new spreadsheet listing out all the potential safety concerns for upcoming flights and software transitions. Since the application was written in Visual Basic, I had to learn a new programming language and prepare to handle any malfunctions within the program. Shortly afterwards, I was given the assignment to automate the Station Program Note (SPN) Pull process. I developed an application, in Python, that generated a GUI (Graphical User Interface) that will be used by the International Space Station Safety & Mission Assurance team here at Johnson Space Center. The application will allow its users to download online files with the click of a button, import SPN's based on three different pulls, instantly manipulate and filter spreadsheets, and compare the three sources to determine which active SPN's (Station Program Notes) must be reviewed for any upcoming flights, missions, and/or software transitions. Initially, to perform the NASA SPN pull (one of three), I had created the program to allow the user to login to a secure webpage that stores data, input specific parameters, and retrieve the desired SPN's based on their inputs. However, to avoid any conflicts with sustainment, I altered it so that the user may login and download the NASA file independently. After the user has downloaded the file with the click of a button, I defined the program to check for any outdated or pre-existing files, for successful downloads, to acquire the spreadsheet, convert it from a text file to a comma separated file and finally into an Excel spreadsheet to be filtered and later scrutinized for specific SPN numbers. Once this file has been automatically manipulated to provide only the SPN numbers that are desired, they are stored in a global variable, shown on the GUI, and

  10. Self-Induced Backaction Optical Pulling Force

    Science.gov (United States)

    Zhu, Tongtong; Cao, Yongyin; Wang, Lin; Nie, Zhongquan; Cao, Tun; Sun, Fangkui; Jiang, Zehui; Nieto-Vesperinas, Manuel; Liu, Yongmin; Qiu, Cheng-Wei; Ding, Weiqiang

    2018-03-01

    We achieve long-range and continuous optical pulling in a periodic photonic crystal background, which supports a unique Bloch mode with the self-collimation effect. Most interestingly, the pulling force reported here is mainly contributed by the intensity gradient force originating from the self-induced backaction of the object to the self-collimation mode. This force is sharply distinguished from the widely held conception of optical tractor beams based on the scattering force. Also, this pulling force is insensitive to the angle of incidence and can pull multiple objects simultaneously.

  11. Triage level assignment and nurse characteristics and experience.

    Science.gov (United States)

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

    2018-06-01

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

  12. 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

  13. Environmental triage decisions during a drought

    OpenAIRE

    Gorddard, Russell J.; Connor, Jeffery D.; Ranjan, Ram

    2009-01-01

    The Murray Darling Basin Current is currently in drought. There are low water levels in most dams, and increased uncertainty about future rainfall. As a result management of the ecosystems in the basin that depend on river flows involves some hard decisions about what assets to save and what assets to let go. This paper models this triage problem using a stochastic and dynamic programming approach. This model is used to identify how optimal management is affected by hysteretic and irreversibl...

  14. The Copenhagen Triage Algorithm: a randomized controlled trial.

    Science.gov (United States)

    Hasselbalch, Rasmus Bo; Plesner, Louis Lind; Pries-Heje, Mia; Ravn, Lisbet; Lind, Morten; Greibe, Rasmus; Jensen, Birgitte Nybo; Rasmussen, Lars S; Iversen, Kasper

    2016-10-10

    Crowding in the emergency department (ED) is a well-known problem resulting in an increased risk of adverse outcomes. Effective triage might counteract this problem by identifying the sickest patients and ensuring early treatment. In the last two decades, systematic triage has become the standard in ED's worldwide. However, triage models are also time consuming, supported by limited evidence and could potentially be of more harm than benefit. The aim of this study is to develop a quicker triage model using data from a large cohort of unselected ED patients and evaluate if this new model is non-inferior to an existing triage model in a prospective randomized trial. 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 (n = 50.000) admitted to the ED in two large acute hospitals. Centers are randomly assigned to perform either CTA or DEPT triage first and then use the other triage model in the last time period. The CTA stratifies patients into 5 acuity levels in two steps. First, a scoring chart based on vital values is used to classify patients in an immediate category. Second, a clinical assessment by the ED nurse can alter the result suggested by the score up to two categories up or one down. The primary end-point is 30-day mortality and secondary end-points are length of stay, time to treatment, admission to intensive care unit, and readmission within 30 days. If proven non-inferior to standard DEPT triage, CTA will be a faster and simpler triage model that is still able to detect the critically ill. Simplifying triage will lessen the burden for the ED staff and possibly allow faster treatment. Clinicaltrials.gov: NCT02698319 , registered 24. of February 2016, retrospectively registered.

  15. The pull in olympic weightlifting.

    Science.gov (United States)

    Enoka, R M

    1979-01-01

    Data from five experienced weightlifters on the vertical forces applied to the barbell and system (barbell and lifter) during the pull were in excellent agreement with earlier displacement-time descriptions of the double knee bend as consisting of two stages of extension interrupted by a period of realignment (second knee bend). The vertical component of the ground reaction force (Rz) consisted of three phases: Weighting I, Unweighting, and Weighting II. The relative magnitude of the Rz impulse with respect to the system weight impulse (as an indicant of the proportion of the Rz impulse contributing to system acceleration) ranged from 118--141% for Weighting I, 74--89% for Unweighting, and 122--135% for Weighting II. In agreement with published theoretical calculations the most experienced and successful lifter produced the larger phase of positive acceleration first. The rebending of the knees was associated with the Unweighting phase. Although this latter interval corresponded to a phase of barbell deceleration, it appeared that the concomitant enhancement of the back, hip, and knee extensor activity outweighed any adverse effects.

  16. Pediatric Triage in a Severe Pandemic: Maximizing Survival by Establishing Triage Thresholds.

    Science.gov (United States)

    Gall, Christine; Wetzel, Randall; Kolker, Alexander; Kanter, Robert K; Toltzis, Philip

    2016-09-01

    To develop and validate an algorithm to guide selection of patients for pediatric critical care admission during a severe pandemic when Crisis Standards of Care are implemented. Retrospective observational study using secondary data. Children admitted to VPS-participating PICUs between 2009-2012. A total of 111,174 randomly selected nonelective cases from the Virtual PICU Systems database were used to estimate each patient's probability of death and duration of ventilation employing previously derived predictive equations. Using real and projected statistics for the State of Ohio as an example, triage thresholds were established for casualty volumes ranging from 5,000 to 10,000 for a modeled pandemic with peak duration of 6 weeks and 280 pediatric intensive care beds. The goal was to simultaneously maximize casualty survival and bed occupancy. Discrete Event Simulation was used to determine triage thresholds for probability of death and duration of ventilation as a function of casualty volume and the total number of available beds. Simulation was employed to compare survival between the proposed triage algorithm and a first come first served distribution of scarce resources. Population survival was greater using the triage thresholds compared with a first come first served strategy. In this model, for five, six, seven, eight, and 10 thousand casualties, the triage algorithm increased the number of lives saved by 284, 386, 547, 746, and 1,089, respectively, compared with first come first served (all p triage thresholds based on probability of death and duration of mechanical ventilation determined from actual critically ill children's data demonstrated superior population survival during a simulated overwhelming pandemic.

  17. The Role of Patients' Stories in Emergency Medicine Triage.

    Science.gov (United States)

    Roscoe, Lori A; Eisenberg, Eric M; Forde, Colin

    2016-09-01

    Emergency medicine is a communicative activity, and characteristics such as incomplete information, time pressure, and the potentially serious consequences of errors complicate effective communication and decision making. The present study examined the triage process as an interpretive activity driven in part by the patient's story. Of four identified communication processes in the emergency department (ED), the "handoff" of patients between shifts has been identified as especially problematic since missing contextual details from patients' stories increased the probability of errors. The problematic nature of patient handoffs led to our interest in triage, the initial site of interpretation and decision making. Triage distinguishes patients with emergent medical conditions requiring immediate care from those who can more safely wait for medical attention. We report results from 110 hours of observing the triage process and semistructured interviews with 16 triage nurses in a Level I Trauma Center in an urban teaching hospital in the southeastern United States. Field notes and interview transcripts were analyzed and coded to explore decision rules and information sources used in triage decision making. Triage nurses generally discounted patients' stories in favor of information from visual cues and vital signs. Patients' stories tended to influence the triage process only in certain cases when the story contained information that was not readily apparent, such as a recent organ transplant. Triage nurses' reliance on "gut feeling," however, might be a kind of narrative sense-making that combines observable and measurable clinical facts with the narrative competence to utilize intuition and past experience.

  18. [Spanish nurses' survey on triage in hospital emergency departments].

    Science.gov (United States)

    Sánchez-Bermejo, Raúl

    2015-01-01

    To describe the opinions of Spanish nurses on hospital emergency department (ED) triage and to compare their level of satisfaction with different triage systems. Descriptive survey-based study of the opinions of nurses working in Spanish EDs. The online questionnaire was self-administered by the respondents. Items covered demographic data, degrees of experience and training, level of satisfaction, and aspects related to triage in general and to the type of triage used in the respondent's hospital. Valid responses were received from 833 of the 857 nurses contacted (97.2% response rate); the nurses worked at 161 hospitals. Eighty hospitals (49.7%) used the Andorran Triage System adapted as the Spanish Triage System (ATM-STS) and 49 (30.4%) used the Manchester Triage System (MTS). The mean (SD) age of respondents was 38.5 (7.8) years; 652 (78.3%) of the respondents were women. Nurses were responsible for triage in 140 (87%) of the hospitals. Four hundred nurses (48.0%) believed triage is a full-team responsibility and 367 (44.0%) believed it was a nursing responsibility. Six hundred three (77.2%) had received specific training in triage. Seven hundred nine (85.1%) believed that triage always or almost always ensures better care for patients with the most serious emergencies, 681 (81.7%) believed that the triage nurse's opinion is taken into consideration, and 663 (79.6%) believed that patients are seen by a physician according to the assigned triage level. Nurses feel supported and generally respected by other nurses. Two hundred thirty (26.7%) would change the triage system they use, but only 100 (43.5%) could name a system they would switch to. Triage is performed by nurses in most of the hospitals, although nearly half of the respondents believe this responsibility should be shared with doctors. Nurses have a good opinion of triage and are generally satisfied with it, but there is variation according to the system implemented in their hospital.

  19. [Competence of triage nurses in hospital emergency departments].

    Science.gov (United States)

    Martínez-Segura, Estrella; Lleixà-Fortuño, Mar; Salvadó-Usach, Teresa; Solà-Miravete, Elena; Adell-Lleixà, Mireia; Chanovas-Borrás, Manel R; March-Pallarés, Gemma; Mora-López, Gerard

    2017-06-01

    To identify associations between sociodemographic characteristics variables and competence levels of triage nurses in hospital emergency departments. Descriptive, cross-sectional, multicenter study of triage nurses in hospital emergency departments in the southwestern area of Catalonia (Ebre River territory). We used an instrument for evaluating competencies (the COM_VA questionnaire) and recording sociodemographic variables (age, sex, total work experience, emergency department experience, training in critical patient care and triage) and perceived confidence when performing triage. We then analyzed the association between these variables and competency scores. Competency scores on the COM_VA questionnaire were significantly higher in nurses with training in critical patient care (P=.001) and triage (P=0.002) and in those with longer emergency department experience (P<.0001). Perceived confidence when performing triage increased with competency score (P<.0001) and training in critical patient care (P<.0001) and triage (P=.045). The competence of triage nurses and their perception of confidence when performing triage increases with emergency department experience and training.

  20. Major incident triage: Derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT).

    Science.gov (United States)

    Vassallo, James; Beavis, John; Smith, Jason E; Wallis, Lee A

    2017-05-01

    Triage is a key principle in the effective management at a major incident. There are at least three different triage systems in use worldwide and previous attempts to validate them, have revealed limited sensitivity. Within a civilian adult population, there has been no work to develop an improved system. A retrospective database review of the UK Joint Theatre Trauma Registry was performed for all adult patients (>18years) presenting to a deployed Military Treatment Facility between 2006 and 2013. Patients were defined as Priority One if they had received one or more life-saving interventions from a previously defined list. Using first recorded hospital physiological data (HR/RR/GCS), binary logistic regression models were used to derive optimum physiological ranges to predict need for life-saving intervention. This allowed for the derivation of the Modified Physiological Triage Tool-MPTT (GCS≥14, HR≥100, 12triage tools was then performed using sensitivities and specificities with 95% confidence intervals. Differences in performance were assessed for statistical significance using a McNemar test with Bonferroni correction. Of 6095 patients, 3654 (60.0%) had complete data and were included in the study, with 1738 (47.6%) identified as priority one. Existing triage tools had a maximum sensitivity of 50.9% (Modified Military Sieve) and specificity of 98.4% (Careflight). The MPTT (sensitivity 69.9%, 95% CI 0.677-0.720, specificity 65.3%, 95% CI 0.632-0.675) showed an absolute increase in sensitivity over existing tools ranging from 19.0% (Modified Military Sieve) to 45.1% (Triage Sieve). There was a statistically significant difference between the performance (ptriage systems, whilst maintaining an appropriate rate of over-triage and minimising under-triage within the context of predicting the need for a life-saving intervention in a military setting. Further work is required to both prospectively validate this system and to identify its performance within a

  1. [Ability to predict hospitalization and resource requirements: comparison of the 3M Triage Assistance system and the combined Spanish Triage System and Andorran Triage Model].

    Science.gov (United States)

    Sánchez Bermejo, Raúl; Ramos Miranda, Nuria; Sánchez Paniagua, Ana Belén; Barrios Vicente, Elena; Fernández Centeno, Esther; Díaz Chaves, Miguel Ángel; Rodríguez Blanco, Claudio José; López Sánchez-Elez, Mónica; Timón López, Raquel; Jiménez Luján, Esther; Fernández Bordallo, Ricardo; Marín Martín, Jonathan; Alonso Sánchez, Pedro; Moreno Fernández-Vegue, Yolanda; Herrera García, Lucía; Álvarez Gregori, J A; Juárez González, Ricardo

    2016-02-01

    To determine the validity of 2 triage systems: the 3M Triage Assistance System (3M-TAS) and the combined Spanish Triage System and Andorran Triage Model (SET-MAT) for predicting hospitalization and use of emergency resources; and to estimate the level of agreement between them. Prospective observational study of consecutive cohorts classified with the studied triage systems in the emergency department (ED) of a secondary-level hospital between March 24 and April 30, 2014. Patients were classified blindly and simultaneously between 9 AM and 10 PM by a clinical nurse using the SET-MAT program and a researcher nurse using the 3M-TAS software. We collected patients' demographic details and assigned triage level, laboratory and imaging tests ordered, specialist consultations requested in the ED, length of stay until discharge from the department, and destination on discharge. Outcome variables were hospitalization and use of at least 1 resource in the ED. A total of 3379 emergencies were included. The conventionally weighted κ statistic for agreement between the 2 triage systems was 0.26, but the triage-weighted κ was 0.17. The 3M-TAS software was better able to predict hospitalization than the SET-MAT (P<.001); however, the 2 systems, predictions of resource usage were similar (P=.111). Agreement between the 3M-TAS and SET-MAT triage systems was poor, although they predicted similar use of resources in the ED. The 3M-TAS was better able to predict hospital admission than the SET-MAT.

  2. Push-Pull Locomotion for Vehicle Extrication

    Science.gov (United States)

    Creager, Colin M.; Johnson, Kyle A.; Plant, Mark; Moreland, Scott J.; Skonieczny, Krzysztof

    2014-01-01

    For applications in which unmanned vehicles must traverse unfamiliar terrain, there often exists the risk of vehicle entrapment. Typically, this risk can be reduced by using feedback from on-board sensors that assess the terrain. This work addressed the situations where a vehicle has already become immobilized or the desired route cannot be traversed using conventional rolling. Specifically, the focus was on using push-pull locomotion in high sinkage granular material. Push-pull locomotion is an alternative mode of travel that generates thrust through articulated motion, using vehicle components as anchors to push or pull against. It has been revealed through previous research that push-pull locomotion has the capacity for generating higher net traction forces than rolling, and a unique optical flow technique indicated that this is the result of a more efficient soil shearing method. It has now been found that pushpull locomotion results in less sinkage, lower travel reduction, and better power efficiency in high sinkage material as compared to rolling. Even when starting from an "entrapped" condition, push-pull locomotion was able to extricate the test vehicle. It is the authors' recommendation that push-pull locomotion be considered as a reliable back-up mode of travel for applications where terrain entrapment is a possibility.

  3. '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.

  4. [Triage in acute medical admission units.

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Folkestad, Lars; Hallas, Peter

    2010-01-01

    the intern on call at the medical departments of all Danish hospitals listed on sundhed.dk. RESULTS: We received 87 answers from 60 individual MAUs covered by a total of 83 interns on call. The MAUs had a median of eight beds and 14 admissions a day. An intern was on call 24 hours a day at 95% of the MAUs......% answered that selected groups of patients were routinely assessed by a senior physician. CONCLUSION: None of the Danish MAUs uses a validated triage tool to prioritize acutely admitted medical patients. Udgivelsesdato: 2010-May-31...

  5. 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

  6. 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 ...

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

    African Journals Online (AJOL)

    Background: More than 100 unbooked patients present daily to the Mitchell's Plain Community Health Centre (MPCHC), and are triaged by a doctor, with the assistance of a staff nurse. The quality of the triage assessments has been found to be variable, with patients often being deferred without their vital signs being ...

  8. 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…

  9. Walk-In Triage Systems in University Counseling Centers

    Science.gov (United States)

    Shaffer, Katharine S.; Love, Michael M.; Chapman, Kelsey M.; Horn, Angela J.; Haak, Patricia P.; Shen, Claire Y. W.

    2017-01-01

    To meet the complex mental health needs of students, some university counseling centers (UCCs) have implemented walk-in triage intake systems, which have not yet been empirically investigated. This study compared client and clinician differences (N = 5564) between a traditional scheduled intake system (Year 1) and a walk-in triage system (Year 2)…

  10. Reliability and validity of triage systems in paediatric emergency care

    NARCIS (Netherlands)

    M. van Veen (Mirjam); H.A. Moll (Henriëtte)

    2009-01-01

    textabstractBackground. Triage in paediatric emergency care is an important tool to prioritize seriously ill children. Triage can also be used to identify patients who do not need urgent care and who can safely wait. The aim of this review was to provide an overview of the literature on reliability

  11. 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....

  12. Interrater Reliability Testing of the Maternal Fetal Triage Index.

    Science.gov (United States)

    Ruhl, Catherine; Scheich, Benjamin; Onokpise, Brea; Bingham, Debra

    2015-01-01

    To conduct interrater reliability testing of the Maternal Fetal Triage Index (MFTI), a standardized tool for obstetric triage. Observational study of a convenience sample of nurses' triage assessments of hospital-based obstetric patients. A birth unit of a suburban hospital located in a large metropolitan region with approximately 5,200 births annually. Ten registered nurses provided triage assessments of 211 pregnant women. Using blinded paired triage assessments, we assessed the reproducibility of the triage priority levels assigned using the MFTI. Priority levels assigned by the MFTI research nurse and the study nurses were in agreement for 154 of the 211 (72.9%) triage assessments. The strength of agreement was classified as good based upon the weighted kappa score of 0.65. There was no statistically significant difference in the accuracy of assigning priority levels between the day and night shifts The interrater reliability of the MFTI met the minimum strength of agreement threshold goal of 0.60 when used by nurses in a large birth unit to assign priority for evaluation. Based on this finding, the MFTI can be recommended for use in obstetric triage settings. Additional testing should be done to measure how this standardized tool improves care processes and outcomes. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  13. Paediatric triage in South Africa | Cheema | South African Journal of ...

    African Journals Online (AJOL)

    Reducing child mortality is a high priority in sub-Saharan Africa, and swift, appropriate triage can make an important contribution to this goal. 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, in many parts of South Africa no formal system for ...

  14. Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care.

    Science.gov (United States)

    Gyedu, Adam; Agbedinu, Kwabena; Dalwai, Mohammed; Osei-Ampofo, Maxwell; Nakua, Emmanuel Kweku; Oteng, Rockefeller; Stewart, Barclay

    2016-01-01

    The incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained in SATS, as well as to compare triage capabilities between senior medical students and senior house officers to examine the effectiveness of our curriculum for house officer training with regards to triage. Sixty each of senior medical students and senior house officers who had not undergone specific triage or SATS training were asked to triage 25 previously validated emergency vignettes using the SATS. Estimates of reliability and validity were calculated. Additionally, over- and under-triage, as well as triage performance between the medical students and house officers was assessed against a reference standard. Fifty-nine senior medical students (98% response rate) and 43 senior house officers (72% response rate) completed the survey (84% response rate overall). A total of 2,550 triage assignments were included in the analysis (59 medical student and 43 house officer triage assignments for 25 vignettes each; 1,475 and 1,075 triage assignments, respectively). Inter-rater reliability was moderate (quadratically weighted κ 0.59 and 0.60 for medical students and house officers, respectively). Triage using SATS performed by these groups had low sensitivity (medical students: 54%, 95% CI 49-59; house officers: 55%, 95% CI 48-60) and moderate specificity (medical students: 84%, 95% CI 82 - 89; house officers: 84%, 95% CI 82 - 97). Both groups under-triaged most 'emergency' level vignette patients (i.e. SATS Red; 80 and 82% for medical students and house officers, respectively). There was no difference between the groups for any metric. Although the SATS has proven utility in a number of different settings in LMICs, its success relies on

  15. Nurses' evaluation of a new formalized triage system in the emergency department - a qualitative study

    DEFF Research Database (Denmark)

    Johansen, Mette Brehm; Forberg, Jakob Lundager

    2011-01-01

    Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED.......Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED....

  16. 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.

  17. Triage at the Emergency Department: association between triage levels and patient outcome

    Directory of Open Access Journals (Sweden)

    Juliana Barros Becker

    2015-10-01

    Full Text Available AbstractOBJECTIVEIdentify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP.METHODSRetrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05.RESULTSMen with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001.CONCLUSIONThe high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.

  18. Accuracy in ED Triage for Symptoms of Acute Myocardial Infarction.

    Science.gov (United States)

    Sanders, Susan F; DeVon, Holli A

    2016-07-01

    More than 6 million people present to emergency departments across the United States annually with symptoms of acute myocardial infarction (AMI). Of the 1 million patients with AMI, 350,000 die during the acute phase. Accurate ED triage can reduce mortality and morbidity, yet accuracy rates are low. In this study we explored the relationship between patient and nurse characteristics and accuracy of triage in patients with symptoms of AMI. This retrospective, descriptive study used patient data from electronic medical records. The sample of 286 patients was primarily white, with a mean age of 61.44 years (standard deviation [SD], ±13.02), and no history of heart disease. The sample of triage nurses was primarily white and female, with a mean age of 45.46 years (SD, ±11.72) and 18 years of nursing experience. Nineteen percent of the nurses reported having earned a bachelor's degree. Emergency nurse triage accuracy was 54%. Patient race and presence of chest pain were significant predictors of accuracy. Emergency nurse age was a significant predictor of accuracy in triage, but years of experience in nursing was not a significant predictor. Of the 9 variables investigated, only patient race, symptom presentation, and emergency nurse age were significant predictors of triage accuracy. Inconsistency in triage decisions may be due to other conditions not yet explored, such as critical thinking skills and executive functions. This study adds to the body of evidence regarding ED triage of patients with symptoms of AMI. However, further exploration into decisions at triage is warranted to improve accuracy, expedite care, and improve outcomes. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  19. Alert Triage v 0.1 beta

    Energy Technology Data Exchange (ETDEWEB)

    2016-01-06

    In the cyber security operations of a typical organization, data from multiple sources are monitored, and when certain conditions in the data are met, an alert is generated in an alert management system. Analysts inspect these alerts to decide if any deserve promotion to an event requiring further scrutiny. This triage process is manual, time-consuming, and detracts from the in-depth investigation of events. We have created a software system that uses supervised machine learning to automatically prioritize these alerts. In particular we utilize active learning to make efficient use of the pool of unlabeled alerts, thereby improving the performance of our ranking models over passive learning. We have demonstrated the effectiveness of our system on a large, real-world dataset of cyber security alerts.

  20. 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.

  1. Effects of Gloves and Pulling Task on Achievable Downward Pull Forces on a Rung.

    Science.gov (United States)

    Beschorner, Kurt E; Slota, Gregory P; Pliner, Erika M; Spaho, Egli; Seo, Na Jin

    2018-03-01

    Objective We examined the impacts of pulling task (breakaway and pull-down tasks at different postures), glove use, and their interaction on achievable downward pull forces from a ladder rung. Background Posture, glove use, and the type of pulling task are known to affect the achievable forces. However, a gap in the literature exists regarding how these factors affect achievable downward pulling forces, which are relevant to recovery from a perturbation during ladder climbing. Methods Forty subjects completed four downward pulling tasks (breakaway force; pull force at maximum height, shoulder height, and a middle height), using three glove conditions with varying coefficient of friction (COF) levels (cotton glove, low COF; bare hand, moderate COF; and latex-coated glove, high COF) with their dominant and nondominant hand. The outcome variable was the maximum force normalized to body weight. Results The highest forces were observed for the highest hand postures (breakaway and maximum height). Increased COF led to higher forces and had a larger effect on breakaway force than the other tasks. The dominant hand was associated with higher forces than the nondominant hand. Male subjects generated greater forces than female subjects, particularly for higher hand positions. Conclusion This study suggests that a higher hand position on the ladder, while avoiding low-friction gloves, may be effective for improving recovery from ladder perturbations. Application This study may guide preferred climbing strategies (particularly those that lead to a higher hand position) for improving recovery from a perturbation during ladder climbing.

  2. How Triage Nurses Use Discretion: a Literature Review

    Directory of Open Access Journals (Sweden)

    Lars Emil Fagernes Johannessen

    2016-02-01

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

  3. Self-rated worry in acute care telephone triage

    DEFF Research Database (Denmark)

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

    2018-01-01

    BACKGROUND: Telephone triage is used to assess acute illness or injury. Clinical decision making is often assisted by triage tools that lack callers' perspectives. This study analysed callers' perception of urgency, defined as degree of worry in acute care telephone calls. AIM: To explore...... 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...

  4. Shifting Gears: Triage and Traffic in Urban India.

    Science.gov (United States)

    Solomon, Harris

    2017-09-01

    While studies of triage in clinical medical literature tend to focus on the knowledge required to carry out sorting, this article details the spatial features of triage. It is based on participation observation of traffic-related injuries in a Mumbai hospital casualty ward. It pays close attention to movement, specifically to adjustments, which include moving bodies, changes in treatment priority, and interruptions in care. The article draws on several ethnographic cases of injury and its aftermath that gather and separate patients, kin, and bystanders, all while a triage medical authority is charged with sorting them out. I argue that attention must be paid to differences in movement, which can be overlooked if medical decision-making is taken to be a static verdict. The explanatory significance of this distinction between adjustment and adjudication is a more nuanced understanding of triage as an iterative, spatial process. © 2017 by the American Anthropological Association.

  5. UK pulls out of plans for ILC

    CERN Multimedia

    Durrani, Matin

    2007-01-01

    "A funding crisis at one of the UK's leading research councils has forced the country to pull out of plans for the International Linear Collider (ILC). The science and Technology Facilities Council (STFC) says in a report published today that it does not see "a practicable path towards the realization of this facility as currently conceived on a reasonable timescale". (1 page)

  6. Web-Based Triage in a College Health Setting

    Science.gov (United States)

    Sole, Mary Lou; Stuart, Patricia L.; Deichen, Michael

    2006-01-01

    The authors describe the initiation and use of a Web-based triage system in a college health setting. During the first 4 months of implementation, the system recorded 1,290 encounters. More women accessed the system (70%); the average age was 21.8 years. The Web-based triage system advised the majority of students to seek care within 24 hours;…

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

    Science.gov (United States)

    Gray, R; Fawcett, T

    2014-05-01

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

  8. Visitation og triage af akut indlagte medicinske patienter

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Folkestad, Lars; Hallas, Peter

    2010-01-01

    Many emergency departments use validated triage tools. It is currently undocumented if such a practice is common in Danish medical admission units (MAU). The current study was conducted in order to clarify this.......Many emergency departments use validated triage tools. It is currently undocumented if such a practice is common in Danish medical admission units (MAU). The current study was conducted in order to clarify this....

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    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...... colonoscopy. In addition, triage may reduce the frequency of unnecessary colonoscopies by 25%....

  10. 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.

  11. Weightlifting pulling derivatives: rationale for implementation and application.

    Science.gov (United States)

    Suchomel, Timothy J; Comfort, Paul; Stone, Michael H

    2015-06-01

    This review article examines previous weightlifting literature and provides a rationale for the use of weightlifting pulling derivatives that eliminate the catch phase for athletes who are not competitive weightlifters. Practitioners should emphasize the completion of the triple extension movement during the second pull phase that is characteristic of weightlifting movements as this is likely to have the greatest transference to athletic performance that is dependent on hip, knee, and ankle extension. The clean pull, snatch pull, hang high pull, jump shrug, and mid-thigh pull are weightlifting pulling derivatives that can be used in the teaching progression of the full weightlifting movements and are thus less complex with regard to exercise technique. Previous literature suggests that the clean pull, snatch pull, hang high pull, jump shrug, and mid-thigh pull may provide a training stimulus that is as good as, if not better than, weightlifting movements that include the catch phase. Weightlifting pulling derivatives can be implemented throughout the training year, but an emphasis and de-emphasis should be used in order to meet the goals of particular training phases. When implementing weightlifting pulling derivatives, athletes must make a maximum effort, understand that pulling derivatives can be used for both technique work and building strength-power characteristics, and be coached with proper exercise technique. Future research should consider examining the effect of various loads on kinetic and kinematic characteristics of weightlifting pulling derivatives, training with full weightlifting movements as compared to training with weightlifting pulling derivatives, and how kinetic and kinematic variables vary between derivatives of the snatch.

  12. Import-push or Export-pull?

    DEFF Research Database (Denmark)

    Jäkel, Ina Charlotte

    2014-01-01

    Does the selection effect of trade work solely through competition from imports, or does the export market further contribute to firm selection? This paper provides a re-interpretation of the different mechanisms in terms of selection on profitability - rather than productivity - and derives novel...... predictions regarding the export market and the role of product differentiation. Empirical results for a sample of Danish manufacturing industries confirm the import- "push" hypothesis as well as the export- "pull" hypothesis, but also reveal differences across industries. The selection effect of trade...... is mainly driven by the "import-push" if product differentiation is high, whereas it is driven by the "export-pull" if goods are homogeneous....

  13. Import-push or Export-pull?

    DEFF Research Database (Denmark)

    Jäkel, Ina Charlotte

    Does the selection effect of trade work solely through competition from imports, or does the export market further contribute to firm selection? This paper provides a re-interpretation of the different mechanisms in terms of selection on profitability - rather than productivity - and derives novel...... predictions regarding the export market and the role of product differentiation. Empirical results for a sample of Danish manufacturing industries confirm the import-"push" hypothesis as well as the export-"pull" hypothesis, but also reveal differences across industries. The selection effect of trade...... is mainly driven by the "import-push" if product differentiation is high, whereas it is driven by the "export-pull" if goods are homogeneous....

  14. Delayed pull-in transitions in overdamped MEMS devices

    Science.gov (United States)

    Gomez, Michael; Moulton, Derek E.; Vella, Dominic

    2018-01-01

    We consider the dynamics of overdamped MEMS devices undergoing the pull-in instability. Numerous previous experiments and numerical simulations have shown a significant increase in the pull-in time under DC voltages close to the pull-in voltage. Here the transient dynamics slow down as the device passes through a meta-stable or bottleneck phase, but this slowing down is not well understood quantitatively. Using a lumped parallel-plate model, we perform a detailed analysis of the pull-in dynamics in this regime. We show that the bottleneck phenomenon is a type of critical slowing down arising from the pull-in transition. This allows us to show that the pull-in time obeys an inverse square-root scaling law as the transition is approached; moreover we determine an analytical expression for this pull-in time. We then compare our prediction to a wide range of pull-in time data reported in the literature, showing that the observed slowing down is well captured by our scaling law, which appears to be generic for overdamped pull-in under DC loads. This realization provides a useful design rule with which to tune dynamic response in applications, including state-of-the-art accelerometers and pressure sensors that use pull-in time as a sensing mechanism. We also propose a method to estimate the pull-in voltage based only on data of the pull-in times.

  15. Customized Pull Systems for Single-Product Flow Lines

    NARCIS (Netherlands)

    Gaury, E.G.A.; Kleijnen, J.P.C.; Pierreval, H.

    1998-01-01

    Traditionally pull production systems are managed through classic control systems such as Kanban, Conwip, or Base stock, but this paper proposes ‘customized’ pull control. Customization means that a given production line is managed through a pull control system that in principle connects each stage

  16. Friction Pull Plug Welding in Aluminum Alloys

    Science.gov (United States)

    Brooke, Shane A.; Bradford, Vann

    2012-01-01

    NASA's Marshall Space Flight Center (MSFC) has recently invested much time and effort into the process development of Friction Pull Plug Welding (FPPW). FPPW, is a welding process similar to Friction Push Plug Welding in that, there is a small rotating part (plug) being spun and simultaneously pulled (forged) into a larger part. These two processes differ, in that push plug welding requires an internal reaction support, while pull plug welding reacts to the load externally. FPPW was originally conceived as a post proof repair technique for the Space Shuttle fs External Tank. FPPW was easily selected as the primary weld process used to close out the termination hole on the Constellation Program's ARES I Upper Stage circumferential Self-Reacting Friction Stir Welds (SR-FSW). The versatility of FPPW allows it to also be used as a repair technique for both SR-FSW and Conventional Friction Stir Welds. To date, all MSFC led development has been concentrated on aluminum alloys (2195, 2219, and 2014). Much work has been done to fully understand and characterize the process's limitations. A heavy emphasis has been spent on plug design, to match the various weldland thicknesses and alloy combinations. This presentation will summarize these development efforts including weld parameter development, process control, parameter sensitivity studies, plug repair techniques, material properties including tensile, fracture and failure analysis.

  17. Review of triage reform: the case for national consensus on a single triage scale for clients with a mental illness in Australian emergency departments.

    Science.gov (United States)

    Broadbent, Marc; Creaton, Anne; Moxham, Lorna; Dwyer, Trudy

    2010-03-01

    The aim of this paper is to examine the use of mental health triage scales in Australian emergency departments (EDs) and to explore the use of the Australasian Triage Scale (ATS) with existing mental health triage scales. Since the introduction of mainstreaming and deinstitutionalisation in Australian mental health care, the number of clients presenting to Australian EDs has been increasing. It has become apparent that the lack of mental health descriptors in existing triage scales diminishes the ability of ED triage staff to accurately assess clients with a mental illness. In response to this, specialised mental health triage scales have been developed and introduced into practice. Concurrently, mental health descriptors have been incorporated into the ATS used across Australian EDs. A review of English language literature was conducted. The data bases Proquest, Synergy and CINAHL were searched using the key words 'emergency department', 'triage', 'mental health' and again using the term 'emergency mental health triage'. There is a paucity of literature surrounding the use of mental health triage scales in Australian EDs; 18 articles were found to be directly relevant to the subject matter. Currently clients with a mental illness presenting to the ED may be triaged against one of four mental health triage scales. Research has shown that the mental health descriptors in the ATS are not as reliable as a specialised mental health triage scale. This has implications for clinical practice on two levels. First, it affects the initial triage assessment in the ED and the ability for mental health clinicians to respond in a timely manner and this will have an impact on clinical outcomes. Second, the use of the mental health triage criteria in the ATS may misrepresent ED workloads and affect data pertaining to ED performance.

  18. A pilot study examining the speed and accuracy of triage for simulated disaster patients in an emergency department setting: Comparison of a computerized version of Canadian Triage Acuity Scale (CTAS) and Simple Triage and Rapid Treatment (START) methods.

    Science.gov (United States)

    Curran-Sills, Gwynn; Franc, Jeffrey M

    2017-09-01

    To compare emergency department triage nurses' time to triage and accuracy of a simulated mass casualty incident (MCI) population using a computerized version of CTAS or START systems. This pilot study was a prospective trial using a convenience sample. A total of 20 ED triage nurses, 10 in each arm of the study, were recruited. The paper-based questionnaire contained nine simulated MCI vignettes. An expert panel arrived at consensuses on the wording of the vignettes and created a standard triage score from which to compare the study participants. Linear regression and chi-squared test were used to examine the time to triage and accuracy of triage, respectively. The mean triage time for computerized CTAS (cCTAS) and START were 138 seconds/patient and 33 seconds/patient, respectively. The effect size due to triage method was 108 seconds/patient (95% CI 83-134 seconds/patient). The cumulative triage accuracy for the cCTAS and START tools were 70/90 (77.8%) and 65/90 (72.2%), respectively. The percent difference between cumulative triage was 6% (95% CI -19-8%). Triage nurses completed START triage 105 seconds/patient faster when compared to cCTAS triage and a similar level of accuracy between the two methods was achieved. However, when the typing time is taken into consideration cCTAS took 45 seconds/patient longer. The use of either CTAS or START in the ED during a MCI may be reasonable but choosing one method over another is not justified from this investigation.

  19. Criterion validity of a computer-assisted instrument of self-triage (ca-ISET) compared to the validity of regular triage in an ophthalmic emergency department.

    Science.gov (United States)

    Eijk, Eva S V; Wefers Bettink-Remeijer, Marijke; Timman, Reinier; Heres, Marion H B; Busschbach, Jan J V

    2016-01-01

    The computer-assisted version of a self-triage tool (ca-ISET) for an ophthalmic emergency department (ED) was developed to increase the validity of the triage procedure when trained ED staff is absent. We tested whether sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) of the ca-ISET deviated from regular triage. Patients ≥18 years visiting the ED of the Rotterdam Eye Hospital in the Netherlands were invited to participate in this prospective study. This ED focuses on eye-related problems. Patient recruitment was carried out during working hours. The ca-ISET is a touch operated software application and the algorithm of the triage is based in the Manchester triage system. For all participants three triage scores were determined by (1) the participant using the ca-ISET; (2) triage by a regular, trained triage assistant and (3) triage by one physician who was specially trained in ophthalmic triage. The diagnosis of the physician was chosen as the reference standard to define criterion validity. The order of triage administration was alternated per patient. Only cases with triage scores from the two triage systems and the reference standard were included. The outcome variables, four triage colours, were transformed into a binary score: high urgent and low urgent. The difference between the ca-ISET and regular triage in terms of sensitivity, specificity, NPV and PPV was tested by Z-scores. Of 247 eligible patients, data was elicited from 189 patients (average age 54 years, range 18-89). The sensitivity of the ca-ISET (0.89, CI: 0.75-0.96) did not differ from the sensitivity of the regular triage (0.69, CI: 0.53-0.82, Z=1.74, p=0.08). The ca-ISET was less specific (0.78, CI: 0.71-0.84) than the regular triage (0.92, CI=0.86-0.95, Z=3.04, p=0.00). We found no significant difference between the ca-ISET and regular triage for PPV (Z=0.19, p=0.85) and NPV (Z=0.03, p=0.98). The sensitivity, PPV and NPV of the ca-ISET does not

  20. Triage practices in stroke units: Physicians' perceptions and ethical issues.

    Science.gov (United States)

    Yger, M; Crozier, S; Dubourdieu, S; Vivien, B; Dolveck, F; Samson, Y

    2016-02-01

    We aimed to explore acute stroke admission decisions and to discuss ethical issues in triage practices in stroke units (SUs) in France. In this study, 337 questionnaires were sent to physicians involved in acute admission to SUs in Île-de-France (neurologists and physicians from emergency medical services). The questionnaires comprised questions about physicians' perceptions of the reasonable allocation of SU beds and admission criteria for patients in SU in clinical vignettes illustrating complex situations. In total, 162 questionnaires were fully completed. There were some discrepancies in perceptions and reporting practices between emergency physicians and neurologists concerning patient admission criteria. Triage choices were more frequently declared by emergency physicians than by neurologists and were related to the difficulty of obtaining a positive response for the admission of certain complex patients (particularly those with comorbidities). Despite recommendations stating that all patients with stroke should be admitted to SUs, this study has shown that triage practices exist in stroke admission decisions. The triage depends on the role and perceptions of each physician in acute stroke management. These decisions suggest reflections on the applicability of distributive justice theories and on ethical issues in triage practices in medicine. Copyright © 2015. Published by Elsevier Masson SAS.

  1. Solar cell contact pull strength as a function of pull-test temperature

    Science.gov (United States)

    Yasui, R. K.; Berman, P. A.

    1972-01-01

    Four types of solar cell contacts were given pull-strength tests at temperatures between -173 and +165 C. Contacts tested were: (1) solder-coated titanium-silver contacts on n-p cells, (2) palladium-containing titanium-silver contacts on n-p cells, (3) titanium-silver contacts on 0.2-mm-thick n-p cells, and (4) solder-coated electroless-nickel-plated contacts on p-n cells. Maximum pull strength was demonstrated at temperatures significantly below the air mass zero cell equilibrium temperature of +60 C. At the lowest temperatures, the chief failure mechanism was silicon fracture along crystallographic planes; at the highest temperatures, it was loss of solder strength. In the intermediate temperatures, many failure mechanisms operated. Pull-strength tests give a good indication of the suitability of solar cell contact systems for space use. Procedures used to maximize the validity of the results are described.

  2. 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...... triage model, Danish Emergency Process Triage (DEPT). DEPT is inspired by the Swedish ADAPT system, but modified for a Danish context. This paper summarizes the cumulated experience with the new system....

  3. 'Down-triage' for children with abnormal vital signs: evaluation of a new triage practice at a paediatric emergency department in Japan.

    Science.gov (United States)

    Takahashi, Takuto; Inoue, Nobuaki; Shimizu, Naoki; Terakawa, Toshiro; Goldman, Ran D

    2016-08-01

    Assessment of abnormal vital signs in triage is a challenge in the paediatric emergency department (PED), since vital signs may reflect anxiety, fever or pain rather than the clinical deterioration of the child. We aimed to evaluate the efficacy of subjective 'down-triage' (change of the initially determined acuity levels) of Japanese Triage and Acuity Scale (JTAS). This is a retrospective cohort study of patients in PED up to 15 years of age at a tertiary paediatric medical centre in Japan during a 1-year period. At the end of every JTAS triage process, PED nurses were allowed to 'down-triage' acuity levels of well-appearing patients with abnormal HR or RR, which were presumably attributable to fever, crying or being upset. We compared predictive performance of the triage system before and after 'down-triage' using admission rate as the primary outcome. Among 37 961 PED visits during the study period, we analysed 37 219 records. A total of 17 089 patients (45.9%) were 'down-triaged' after their initial triage allocation upon arrival. Admission rates after 'down-triage' (83%, 33%, 7%, 1% and 3% for levels 1-5, respectively), compared with those of unmodified initial level (16%, 11%, 6%, 2% and 6% for levels 1-5, respectively), had a better apparent relevance with the anticipated admission rates of Canadian Triage and Acuity Scale. Modification of JTAS through 'down-triage' by experienced staff improves prediction of disposition in a PED. Further research is needed to determine an objective protocol for 'down-triage' to ensure safe practice in a PED. 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/

  4. 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

  5. Racial Differences in Pediatric Emergency Department Triage Scores.

    Science.gov (United States)

    Zook, Heather G; Kharbanda, Anupam B; Flood, Andrew; Harmon, Brian; Puumala, Susan E; Payne, Nathaniel R

    2016-05-01

    Racial disparities are frequently reported in emergency department (ED) care. To examine racial differences in triage scores of pediatric ED patients. We hypothesized that racial differences existed but could be explained after adjusting for sociodemographic and clinical factors. We examined all visits to two urban, pediatric EDs between August 2009 and March 2010. Demographic and clinical data were electronically extracted from the medical record. We used logistic regression to analyze racial differences in triage scores, controlling for possible covariates. There were 54,505 ED visits during the study period, with 7216 (13.2%) resulting in hospital admission. White patients accounted for 36.4% of visits, African Americans 28.5%, Hispanics 18.0%, Asians 4.1%, and American Indians 1.8%. After adjusting for potential confounders, African American (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI] 1.69-2.12), Hispanic (aOR 1.77, 95% CI 1.55-2.02), and American Indian (aOR 2.57, 95% CI 1.80-3.66) patients received lower-acuity triage scores than Whites. In three out of four subgroup analyses based on presenting complaints (breathing difficulty, abdominal pain, fever), African Americans and Hispanics had higher odds of receiving low-acuity triage scores. No racial differences were detected for patients with presenting complaints of laceration/head injury/arm injury. However, among patients admitted to the hospital, African Americans (aOR 1.47, 95% CI 1.13-1.90) and Hispanics (aOR 1.71, CI 1.22-2.39) received lower-acuity triage scores than Whites. After adjusting for available sociodemographic and clinical covariates, African American, Hispanic, and American Indian patients received lower-acuity triage scores than Whites. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Push-pull vs captodative aromaticity.

    Science.gov (United States)

    Shainyan, Bagrat A; Fettke, Anja; Kleinpeter, Erich

    2008-10-30

    Vinylogs of fulvalenes with cyclopropenyl and cyclopentadienyl moieties attached either to different carbon atoms ( c-C 3H 2CHCHC 5H 4- c, 7) or to the same carbon atom [XC( c-C 3H 2)( c-C 5H 4), 10] [X = CH 2; C(CN) 2; C(NH 2) 2; C(OCH 2) 2; O; c-C 3H 2; c-C 5H 4; SiH 2; CCl 2] of the double bond inserted between the two rings are examined theoretically at the B3LYP/6-311G(d,p) level. Both types of compounds are shown to possess aromaticity, which was called "push-pull" and "captodative" aromaticity, respectively. For the captodative mesoionic structures XC( c-C 3H 2)( c-C 5H 4), the presence of both the two aromatic moieties and the CC double bond is the necessary and sufficient condition for their existence as energetic minima on the potential energy surface. Aromatic stabilization energy (ASE) was assessed by the use of homodesmotic reactions and heats of hydrogenation. Spatial magnetic criteria (through space NMR shieldings, TSNMRS) of the two types of vinylogous fulvalenes 7 and 10 have been calculated by the GIAO perturbation method employing the nucleus independent chemical shift (NICS) concept of Paul von Rague Schleyer, and visualized as iso-chemical-shielding surfaces (ICSS) of various sizes and directions. TSNMRS values can be successfully employed to visualize and quantify the partial push-pull and captodative aromaticity of both the three- and five-membered ring moieties. In addition, the push -pull effect in compounds 7 and 10 could be quantified by the occupation quotient pi* CC/pi CC of the double bond inserted between the two rings.

  7. The value of the trauma mechanism in the triage of severely injured elderly

    NARCIS (Netherlands)

    Nijboer, J.M.M.; van der Sluis, C.K.; Dijkstra, P.U.; ten Duis, H.J.

    Background: The triage of trauma patients is currently based on the trauma mechanism. However, it is known that elderly patients can sustain severe injuries due to insignificant trauma mechanisms. As such, triage methods might be questionable. Objective: To evaluate whether current trauma triage

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

    African Journals Online (AJOL)

    S Soogun

    based on the gender of the patient, the triage history, the time of triage, patients' vital signs, the side-room tests performed, application of the discriminator lists, the opinion of the senior healthcare worker, the colour coding of the patient, the time taken to see the doctor and the patient outcome. The findings in the triage sheet ...

  9. Telephone triage in general practices: A written case scenario study in the Netherlands

    NARCIS (Netherlands)

    Smits, M.; Hanssen, S.; Huibers, L.; Giesen, P.H.

    2016-01-01

    OBJECTIVE: General practices increasingly use telephone triage to manage patient flows. During triage, the urgency of the call and required type of care are determined. This study examined the organization and adequacy of telephone triage in general practices in the Netherlands. DESIGN:

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

    NARCIS (Netherlands)

    R. Backhaus (Ramona); N.J.A. van Exel (Job); A.A. de Bont (Antoinette)

    2013-01-01

    markdownabstract__Abstract__ __Background:__ 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

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

    African Journals Online (AJOL)

    Objective: Triage is an essential first step in the efficient and effective running of any emergency department. A good triage tool saves lives and reduces mortality. The Triage Early Warning Score (TEWS) is a useful tool used to identify patients in emergency departments who are at risk of deterioration and who may require ...

  12. 'Advanced triage' geeft snellere patiëntdoorstroming SEH, zonder verlies aan kwaliteit van zorg

    NARCIS (Netherlands)

    Rosmulder, Remco W.; Krabbendam, J. J. Koos; Kerkhoff, A. H. M. Toon; Schinkel, Erik R.; Beenen, Ludo F. M.; Luitse, Jan S. K.

    2010-01-01

    OBJECTIVE: To investigate whether 'advanced triage' improved patient flow among self-referred patients in the emergency department of a level 1 trauma centre and, most importantly, whether the quality of medical care was maintained. In advanced triage, the triage nurse initiates additional

  13. Swedish emergency department triage and interventions for improved patient flows: a national update.

    Science.gov (United States)

    Farrokhnia, Nasim; Göransson, Katarina E

    2011-12-08

    In Scandinavia, emergency department triage and patient flow processes, are under development. In Sweden, the triage development has resulted in two new triage scales, the Adaptive Process Triage and the Medical Emergency Triage and Treatment System. Both these scales have logistic components, aiming to improve patient flows. The aim of this study was to report the development and current status of emergency department triage and patient flow processes in Sweden. In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74) Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows. Nearly all (97%) EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%). Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59%) of the EDs have implemented or plan to implement nurse requested X-ray. There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.

  14. 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....

  15. Improved abnormal Pap smear triage using cervical cancer biomarkers.

    Science.gov (United States)

    Killeen, Jeffrey L; Dye, Timothy; Grace, Chelestes; Hiraoka, Mark

    2014-01-01

    The current system of Pap smear screening and management of abnormal cytology has resulted in a marked reduction in invasive cervical cancer. Many women, however, are not found to have significant precursor lesions. This is due to the poor specificity of high-risk human papillomavirus (HPV) triage. More specific cervical cancer biomarkers may be more effective triage tools than hr-HPV. We evaluated whether a dual stain for p16 and Ki-67 might improve the triage of abnormal Pap smears. p16/Ki-67 immunostaining was performed on additional slides prepared from 515 women with abnormal Pap smears (301 atypical squamous cells of undetermined significance [ASCUS], 169 low-grade squamous intraepithelial lesion [LSIL], 29 atypical squamous cells-cannot exclude high-grade lesion [ASC-H], 16 high-grade squamous intraepithelial lesion [HSIL]). High-risk HPV typing was performed on all cases. Immunostaining and hr-HPV were compared in relation to their diagnostic accuracy for the detection of biopsy-proven cervical intraepithelial neoplasia (CIN) 2/3. A cost analysis comparing hr-HPV versus immunostaining as the initial triage tool used for abnormal Pap smears was also performed. High-risk HPV was positive in 127 (42.2%) ASCUS, 129 (76.3%) LSIL, 20 (69.0%) ASC-H, and 15 (93.8%) HSIL. p16/Ki-67 was positive in 54 (17.9%) ASCUS, 73 (43.2%) LSIL, 19 (65.5%) ASC-H, and 15 (93.8%) HSIL. For detection of CIN 2/3, sensitivity/specificity of hr-HPV and p16/Ki-67 was 89.29%/14.94% and 96.43%/60.92%, respectively. Overall, diagnostic accuracy was statistically significantly higher for p16/Ki-67 compared with hr-HPV. Compared to HPV, immunostain triage could have generated approximately $46,000 savings in the study population. The triage of abnormal Pap smears by p16/Ki-67 immunostaining shows comparable sensitivity, improved specificity, and significantly improved diagnostic performance when compared to hr-HPV. Immunostaining is of value in triaging LSIL and ASC-H Pap smears in addition

  16. Pull-production in repetitive remanufacturing

    Energy Technology Data Exchange (ETDEWEB)

    McCaskey, D.W. Jr.

    1992-09-01

    In the past, production activity control practices in most repetitive remanufacturing facilities resembled those used in intermittent production operations. These operations were characterized by large amounts of work-in-process (WIP), frequent work stoppages due to part shortages, excessive overtime, low product velocity, informal scheduling between dependent operations, low employee and management moral, and a lot of wasted time, material, labor, and space. Improvement in production activity control (PAC) methods for repetitive remanufactures has been hampered by uncertainty in: supply of incoming assets, configuration of assets, process times to refurbish assets, and yields in reclamation processes. collectively these uncertainties make shop floor operations seem uncontrollable. However, one United States Army depot has taken on the challenge. Through management supported, cross-functional teams, the Tooele Army Depot has designed and implemented pull-production systems for two of its major products, with several others to follow. This article presents a generalized version of Tooele`s pull-production system and highlights design characteristics which are specific to remanufacturing applications.

  17. Pull-production in repetitive remanufacturing

    Energy Technology Data Exchange (ETDEWEB)

    McCaskey, D.W. Jr.

    1992-09-01

    In the past, production activity control practices in most repetitive remanufacturing facilities resembled those used in intermittent production operations. These operations were characterized by large amounts of work-in-process (WIP), frequent work stoppages due to part shortages, excessive overtime, low product velocity, informal scheduling between dependent operations, low employee and management moral, and a lot of wasted time, material, labor, and space. Improvement in production activity control (PAC) methods for repetitive remanufactures has been hampered by uncertainty in: supply of incoming assets, configuration of assets, process times to refurbish assets, and yields in reclamation processes. collectively these uncertainties make shop floor operations seem uncontrollable. However, one United States Army depot has taken on the challenge. Through management supported, cross-functional teams, the Tooele Army Depot has designed and implemented pull-production systems for two of its major products, with several others to follow. This article presents a generalized version of Tooele's pull-production system and highlights design characteristics which are specific to remanufacturing applications.

  18. 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...

  19. The prospective validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to major incident triage.

    Science.gov (United States)

    Vassallo, James; Horne, S; Smith, J E; Wallis, L A

    2017-12-01

    Triage is a key principle in the effective management of major incidents. There is limited evidence to support existing triage tools, with a number of studies demonstrating poor performance at predicting the need for a life-saving intervention. The Modified Physiological Triage Tool (MPTT) is a novel triage tool derived using logistic regression, and in retrospective data sets has shown optimum performance at predicting the need for life-saving intervention. Physiological data and interventions were prospectively collected for consecutive adult patients with trauma (>18 years) presenting to the emergency department at Camp Bastion, Afghanistan, between March and September 2011. Patients were considered priority 1 (P1) if they received one or more interventions from a previously defined list. Patients were triaged using existing triage tools and the MPTT. Performance was measured using sensitivity and specificity, and a McNemar test with Bonferroni calculation was applied for tools with similar performance. The study population comprised 357 patients, of whom 214 (59.9%) were classed as P1. The MPTT (sensitivity: 83.6%, 95% CI 78.0% to 88.3%; specificity: 51.0%, 95% CI 42.6% to 59.5%) outperformed all existing triage tools at predicting the need for life-saving intervention, with a 19.6% absolute reduction in undertriage compared with the existing Military Sieve. The improvement in undertriage comes at the expense of overtriage; rates of overtriage were 11.6% higher with the MPTT than the Military Sieve. Using a McNemar test, a statistically significant (ptriage tools at predicting the need for life-saving intervention, with the lowest rates of undertriage while maintaining acceptable levels of overtriage. Having now been validated on both military and civilian cohorts, we recommend that the major incident community consider adopting the MPTT for the purposes of primary triage. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

    2014-01-01

    Background 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©. Methods 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. Results 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 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 to determine if it results in improved care. PMID:24645674

  2. Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models

    Science.gov (United States)

    2012-01-01

    Background The management of emergency departments (EDs) principally involves maintaining effective patient flow and care. Different triage models are used today to achieve these two goals. The aim of this study was to compare the performance of different triage models used in three Swedish EDs. Using efficiency and quality indicators, we compared the following triage models: physician-led team triage, nurse first/emergency physician second, and nurse first/junior physician second. Methods All data of patients arriving at the three EDs between 08:00- and 21:00 throughout 2008 were collected and merged into a database. The following efficiency indicators were measured: length of stay (LOS) including time to physician, time from physician to discharge, and 4-hour turnover rate. The following quality indicators were measured: rate of patients left before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days. Results Data from 147,579 patients were analysed. The median length of stay was 158 minutes for physician-led team triage, compared with 243 and 197 minutes for nurse/emergency physician and nurse/junior physician triage, respectively (p triage, 5.3% for nurse/emergency physician, and 9.6% for nurse/junior physician triage (p triage, 1.0%, compared with 2.1%, and 2.5% for nurse/emergency physician, and nurse/junior physician, respectively (p triage and 1.0% for the two other triage models (p triage seemed advantageous, both expressed as efficiency and quality indicators, compared with the two other models. PMID:22905993

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

    Science.gov (United States)

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

    2015-04-10

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

  4. Non-slipping domains of a pulled spool

    International Nuclear Information System (INIS)

    Wagner, Clemens; Vaterlaus, Andreas

    2014-01-01

    We have investigated the pulled spool by considering pulling angles up to 360 ∘ . Our focus was on downward pulling forces with pulling angles in the range of 180 ∘ to 360 ∘ . In this range we have found a domain of pulling angles where the spool never starts to slip independent of the strength of the pulling force. The size of the domain depends on the static friction coefficient and on the moment of inertia of the spool. The non-slipping domain is mainly formed around the critical angle where the static friction force becomes zero. For low static friction the non-slipping domain decays into two different domains. We have determined the limiting angles of the non-slipping domains and explored the transitions from a single domain to two separated domains in parameter space. (paper)

  5. 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 ...

  6. Using Triage Figuratively to Describe Effective Teaching in Physical Education

    Science.gov (United States)

    Henkel, Steven A.

    2016-01-01

    This article presents critical outcomes for physical education in a "triage" framework by comparing the process of determining the severity of injuries at the scene of an accident to the process of prioritizing decisions in the classroom. The intent is to reduce all possible outcomes of effective teaching to six nonnegotiable outcomes…

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    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....

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

    Science.gov (United States)

    Cady, Rhonda G.; Finkelstein, Stanley M.

    2015-01-01

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

  9. Perspectives of oil pulling therapy in dental practice

    Directory of Open Access Journals (Sweden)

    T Lakshmi

    2013-01-01

    Full Text Available Oil pulling has its origin in Ayurvedic medicine, is a natural remedy to improve oral health. Its antibacterial properties help to eradicate the bacteria and other debris from adhering to the oral cavity. It reduces the accumulation of plaque, prevents halitosis, cavities, gingivitis. It is used to heal the bleeding gums and mouth ulcers. Oil pulling with sesame oil improves overall health. Other than oral health, oil pulling also helps in reducing asthma, allergies, chronic fatigue, diabetes, migraine headaches and chronic skin problems. It works by detoxifying or cleansing the body. The aim of this article is to highlight the benefits of oil pulling in management of oral health.

  10. 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.

  11. Verbal feedback in therapeutic communities: pull-ups and reciprocated pull-ups as predictors of graduation.

    Science.gov (United States)

    Warren, Keith; Hiance, Danielle; Doogan, Nathan; De Leon, George; Phillips, Gary

    2013-04-01

    The most important proximal outcomes for residents of therapeutic communities (TCs) are retention and successful completion of the program. At this point there has been no quantitative analysis of the relationship between the exchange of corrective reminders, or pull-ups, between peers in TCs and graduation. This study draws on a database of pull-ups exchanged between 5464 residents of three midwestern TCs. Residents who send more pull-ups to peers and who reciprocate pull-ups with a larger percentage of peers are more likely to graduate. Residents who receive more pull-ups from peers and staff and a larger percentage of whose peers reciprocate pull-ups that they send are less likely to graduate. Implications of these findings for program theory and program improvement are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. 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...

  13. Assessment of hospital-based adult triage at emergency receiving areas in hospitals in Northern Uganda.

    Science.gov (United States)

    Opiro, Keneth; Wallis, Lee; Ogwang, Martin

    2017-06-01

    Limited health service resources must be used in a manner which does "the most for the most". This is partly achieved through the use of a triage system. Whereas efforts have been made to introduce paediatric triage in Uganda such as Emergency Triage Assessment and Treatment Plus (ETAT+), it is not clear if hospitals have local protocols for adult triage being used in each setting. To determine the presence of existing hospital triage systems, the cadre of staff undertaking triage and barriers to development/improvement of formal triage systems. This was a descriptive cross-sectional study. Acholi sub-region was randomly selected for the study among the three sub-regions in Northern Uganda. The study was conducted in 6 of the 7 hospitals in the region. It was a written self-administered questionnaire. Thirty-three participants from 6 hospitals consented and participated in the study. Only one hospital (16.7%) of the 6 hospitals surveyed had a formal hospital-based adult triage protocol in place. Only 2 (33.3%) hospitals had an allocated emergency department, the rest receive emergency patients/perform triage from OPD and wards. Lack of training, variation of triage protocols from hospital to another, shortage of staff on duty, absence of national guidelines on triage and poor administrative support were the major barriers to improvement/development of formal triage in all these hospitals. Formal adult hospital-based triage is widely lacking in Northern Uganda and staff do perform subjective "eyeball" judgments to make triage decisions.

  14. Telephone triage in general practices: A written case scenario study in the Netherlands.

    Science.gov (United States)

    Smits, Marleen; Hanssen, Suzan; Huibers, Linda; Giesen, Paul

    2016-01-01

    General practices increasingly use telephone triage to manage patient flows. During triage, the urgency of the call and required type of care are determined. This study examined the organization and adequacy of telephone triage in general practices in the Netherlands. Cross-sectional observational study using a web-based survey among practice assistants including questions on background characteristics and triage organization. Furthermore, practice assistants were asked to assess the required type of care of written case scenarios with varying health problems and levels of urgency. To determine the adequacy of the assessments, a comparison with a reference standard was made. In addition, the association between background characteristics and triage organization and the adequacy of triage was examined. Daytime general practices. Practice assistants. Over- and under-estimation, sensitivity, specificity. The response rate was 41.1% (n = 973). The required care was assessed adequately in 63.6% of cases, was over-estimated in 19.3%, and under-estimated in 17.1%. The sensitivity of identifying patients with a highly urgent problem was 76.7% and the specificity was 94.0%. The adequacy of the assessments of the required care was higher for more experienced assistants and assistants with fixed daily work meetings with the GP. Triage training, use of a triage tool, and authorization of advice were not associated with adequacy of triage. Triage by practice assistants in general practices is efficient (high specificity), but potentially unsafe in highly urgent cases (suboptimal sensitivity). It is important to train practice assistants in identifying highly urgent cases. General practices increasingly use telephone triage to manage patient flows, but little is known about the organization and adequacy of triage in daytime practices. Telephone triage by general practice assistants is efficient, but potentially unsafe in highly urgent cases. The adequacy of triage is higher

  15. Impact of triage guidelines on prehospital triage: comparison of guidelines with a statistical model.

    Science.gov (United States)

    Parikh, Priti P; Parikh, Pratik; Guthrie, Bradley; Mamer, Logan; Whitmill, Melissa; Erskine, Timothy; Woods, Randy; Saxe, Jonathan

    2017-12-01

    The American College of Surgeons developed the National Field Triage Decision Scheme (NFTDS) that has been adapted by many trauma centers in the nation, but quantitative evidence of its efficacy is unclear. We compare the NFTDS and state of Ohio guidelines to the "observed" rates and with rates derived using a statistical model. We used 4757 trauma records from 2008-2012 available from the state and calculated undertriage (UT) and overtriage (OT) rates. We then simulated the NFTDS and the state guidelines for those years and estimated the corresponding UT and OT rates. We finally compared these rates with those derived from a multivariate logistic regression model. For the state data, both NFTDS and state guidelines produced lower UT rate (∼9%) compared with the observed rate (∼17%), whereas the OT rates were higher (>85%) than the observed rates (∼54%). The statistical model identified novel factors that were not directly available in the NFTDS; change in responsiveness (odds ratio [OR] = 1.924) and complaint in body (OR = 3.140), back (OR = 1.890), chest (OR = 3.191), head (OR = 3.878), and abdomen (OR = 2.966). Although the statistical model performed similar to observed rates, it performed considerably better than NFTDS (UT = 1.93% versus 9.03%; OT = 66.42% versus 87.52%) and state guidelines (UT = 2.18% versus 8.72%; OT = 64.09% versus 86.52%). The current NFTDS and state's triage guidelines do not appear to achieve the ACS recommendation of <5% UT and <35% OT rates in the state of Ohio. Inclusion of region-specific factors may help enhance the current NFTDS guidelines and aid in the first impression or judgment of the Emergency Medical Services personnel to improve trauma care and reduce cost. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Push-Pull Laser-Atomic Oscillator

    International Nuclear Information System (INIS)

    Jau, Y.-Y.; Happer, W.

    2007-01-01

    A vapor of alkali-metal atoms in the external cavity of a semiconductor laser, pumped with a time-independent injection current, can cause the laser to self-modulate at the 'field-independent 0-0 frequency' of the atoms. Push-pull optical pumping by the modulated light drives most of the atoms into a coherent superposition of the two atomic sublevels with an azimuthal quantum number m=0. The atoms modulate the optical loss of the cavity at the sharply defined 0-0 hyperfine frequency. As in a maser, the system is not driven by an external source of microwaves, but a very stable microwave signal can be recovered from the modulated light or from the modulated voltage drop across the laser diode. Potential applications for this new phenomenon include atomic clocks, the production of long-lived coherent atomic states, and the generation of coherent optical combs

  17. 2 Major incident triage and the implementation of a new triage tool, the MPTT-24.

    Science.gov (United States)

    Vassallo, James; Smith, Jason

    2017-12-01

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

  18. DSM-5 field survey: hair-pulling disorder (trichotillomania).

    Science.gov (United States)

    Lochner, Christine; Grant, Jon E; Odlaug, Brian L; Woods, Douglas W; Keuthen, Nancy J; Stein, Dan J

    2012-12-01

    The aim of this multisite field survey was to examine the DSM-IV-TR criteria, proposed DSM-5 diagnostic criteria, as well as a number of possible additional diagnostic criteria, in patients with hair-pulling disorder (HPD, or trichotillomania). Four sites were involved. Participants older than 10 years of age, male or female, with hair-pulling symptoms in the last 4 weeks were included. Participants were assessed with two modules based on the Structured Clinical Interview for DSM (SCID-I/P), which addressed the DSM-IV-TR criteria set as well as proposed DSM-5 diagnostic criteria for HPD, respectively. Additional questions were established to test other possible diagnostic criteria. Eighty-four (79 female, 5 male, 83 adult) participants with current hair-pulling symptoms were included. All of these participants had recurrent hair-pulling and most (n = 82 [98%]) reported repeated attempts to decrease or stop hair-pulling, and 70 (n = 70 [83%]) met the clinical significance criterion. Diagnostic criteria focused on "urge," "tension," "need," "drive," or "impulse" to pull, or pleasure, gratification or relief during or after pulling, were endorsed by many, but not all. Individuals who did endorse such criteria had significantly more severe hair-pulling symptoms. These data support the proposed diagnostic criteria for HPD in adults. Although most adult patients have urges to pull or experience a sense of relief on pulling, as in the case of skin-picking disorder, such phenomena are not universal and so should not be included in the diagnostic criteria. An additional criterion focused on repeated attempts to decrease or stop hair-pulling seems warranted. © 2012 Wiley Periodicals, Inc.

  19. Pushing and pulling in relation to musculoskeletal complaints

    NARCIS (Netherlands)

    Hoozemans, M. J M; Van Der Beek, Allard J.; Frings-Dresen, M. H. W.

    2000-01-01

    The first cross-sectional analyses are presented of a longitudinal study regarding the relationship between pushing and pulling and musculoskeletal disorders. Workers exposed to pushing and pulling and workers who had administrative tasks received a questionnaire. A significant association between

  20. Affective and Sensory Correlates of Hair Pulling in Pediatric Trichotillomania

    Science.gov (United States)

    Meunier, Suzanne A.; Tolin, David F.; Franklin, Martin

    2009-01-01

    Hair pulling in pediatric populations has not received adequate empirical study. Investigations of the affective and sensory states contributing to the etiology and maintenance of hair pulling may help to elucidate the classification of trichotillomania (TTM) as an impulse control disorder or obsessive-compulsive spectrum disorder. The current…

  1. Pull-Through Capacity in Plywood and OSB

    DEFF Research Database (Denmark)

    Munch-Andersen, Jørgen; Sørensen, John Dalsgaard

    The characteristic pull-through capacity of heads of nails and screws is needed to determine the rope effect for laterally loaded fasteners used to fix sheathing to timberframes. There is no values given in EN 1995 (Eurocode 5) but data for the pull through capacity of nail and screw heads has been...

  2. Frobenius Pull Backs of Vector Bundles in Higher Dimensions

    Indian Academy of Sciences (India)

    We prove that for a smooth projective variety of arbitrary dimension and for a vector bundle over , the Harder–Narasimhan filtration of a Frobenius pull back of is a refinement of the Frobenius pull back of the Harder–Narasimhan filtration of , provided there is a lower bound on the characteristic (in terms of rank of ...

  3. Laparoscopically assisted anorectal pull-through for rectovestibular ...

    African Journals Online (AJOL)

    Laparoscopically assisted anorectal pull-through for rectovestibular fistula. Taha Alkhatrawi, Radi Elsherbini, Waheed Alturkistani. Abstract. Purpose Laparoscopically assisted anorectal pull-through (LAARP) has been described as an alternative to posterior sagittal anorectoplasty for the surgical treatment of rectourethral ...

  4. Frobenius pull backs of vector bundles in higher dimensions

    Indian Academy of Sciences (India)

    ... of a Frobenius pull back of is a refinement of the Frobenius pull back of the Harder–Narasimhan filtration of , provided there is a lower bound on the characteristic (in terms of rank of and the slope of the destabilizing sheaf of the cotangent bundle of ). We also recall some examples, due to Raynaud and Monsky, ...

  5. Analytical Model for Hook Anchor Pull-Out

    DEFF Research Database (Denmark)

    Brincker, Rune; Ulfkjær, Jens Peder; Adamsen, Peter

    1995-01-01

    A simple analytical model for the pull-out of a hook anchor is presented. The model is based on a simplified version of the fictitious crack model. It is assumed that the fracture process is the pull-off of a cone shaped concrete part, simplifying the problem by assuming pure rigid body motions...

  6. Analytical Model for Hook Anchor Pull-out

    DEFF Research Database (Denmark)

    Brincker, Rune; Ulfkjær, J. P.; Adamsen, P.

    A simple analytical model for the pull-out of a hook anchor is presented. The model is based on a simplified version of the fictitious crack model. It is assumed that the fracture process is the pull-off of a cone shaped concrete part, simplifying the problem by assuming pure rigid body motions...

  7. Workload balancing capability of pull systems in MTO production

    NARCIS (Netherlands)

    Germs, R.; Riezebos, J.

    2010-01-01

    Pull systems focusing on throughput time control and applicable in situations with high variety and customisation are scarce. This paper compares three unit-based pull systems that can cope with such situations: POLCA, CONWIP and m-CONWIP. These systems control the shop floor throughput time of

  8. 30 CFR 75.828 - Trailing cable pulling.

    Science.gov (United States)

    2010-07-01

    ... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Underground High-Voltage Distribution High-Voltage... any equipment other than the continuous mining machine. The cable manufacturer's recommended pulling procedures must be followed when pulling the trailing cable with equipment other than the continuous mining...

  9. Young entrepreneurs pushed by necessity and pulled by opportunity

    DEFF Research Database (Denmark)

    Cheraghi, Maryam

    2017-01-01

    . The push by necessity and pull by opportunity are exerted by institutions in society such as its economy and culture. The purpose here is to account for how young entrepreneurs' experiences of opportunity-pull and necessity-push are influenced by society's economic wealth and culture, as traditional versus...

  10. On the Push-Pull Mobile Learning of Electric Welding

    Science.gov (United States)

    Chung, Chih-Chao; Dzan, Wei-Yuan; Cheng, Yuh-Ming; Lou, Shi-Jer

    2017-01-01

    This study aims to explore the learning effects and attitudes of students in the course electric welding practice in a university of science and technology to which the push-pull technology-based mobile learning system is applied. In this study, the push-pull technology is adopted to establish a mobile learning system and develop the Push-pull…

  11. Pre-hospital triage performance after standardized trauma courses.

    Science.gov (United States)

    Lampi, Maria; Junker, Johan; Berggren, Peter; Jonson, Carl-Oscar; Vikström, Tore

    2017-05-19

    The pre-hospital triage process aims at identifying and prioritizing patients in the need of prompt intervention and/or evacuation. The objective of the present study was to evaluate triage decision skills in a Mass Casualty Incident drill. The study compares two groups of participants in Advanced Trauma Life Support and Pre-Hospital Trauma Life Support courses. A questionnaire was used to deal with three components of triage of victims in a Mass Casualty Incident: decision-making; prioritization of 15 hypothetical casualties involved in a bus crash; and prioritization for evacuation. Swedish Advanced Trauma Life Support and Pre-Hospital Trauma Life Support course participants filled in the same triage skills questionnaire just before and after their respective course. One hundred fifty-three advanced Trauma Life Support course participants were compared to 175 Pre-Hospital Trauma Life Support course participants. The response rates were 90% and 95%, respectively. A significant improvement was found between pre-test and post-test for the Pre-Hospital Trauma Life Support group in regards to decision-making. This difference was only noticeable among the participants who had previously participated in Mass Casualty Incident drills or had experience of a real event (pre-test mean ± standard deviation 2.4 ± 0.68, post-test mean ± standard deviation 2.60 ± 0.59, P = 0.04). No improvement was found between pre-test and post-test for either group regarding prioritization of the bus crash casualties or the correct identification of the most injured patients for immediate evacuation. Neither Advanced Trauma Life Support nor Pre-Hospital Trauma Life Support participants showed general improvement in their tested triage skills. However, participation in Mass Casualty Incident drills or experience of real events prior to the test performed here, were shown to be advantageous for Pre-Hospital Trauma Life Support participants. These courses should be

  12. The appropriateness of, and compliance with, telephone triage decisions: a systematic review and narrative synthesis.

    Science.gov (United States)

    Blank, Lindsay; Coster, Joanne; O'Cathain, Alicia; Knowles, Emma; Tosh, Jonathan; Turner, Janette; Nicholl, Jon

    2012-12-01

    This paper is a report of the synthesis of evidence on the appropriateness of, and compliance with, telephone triage decisions. Telephone triage plays an important role in managing demand for health care. Important questions are whether triage decisions are appropriate and patients comply with them. CINAHL, Cochrane Clinical Trials Database, Medline, Embase, Web of Science, and Psyc Info were searched between 1980-June 2010. Rapid Evidence Synthesis. The principles of rapid evidence assessment were followed. We identified 54 relevant papers: 26 papers reported appropriateness of triage decision, 26 papers reported compliance with triage decision, and 2 papers reported both. Nurses triaged calls in most of the studies (n=49). Triage decisions rated as appropriate varied between 44-98% and compliance ranged from 56-98%. Variation could not be explained by type of service or method of assessing appropriateness. However, inconsistent definitions of appropriateness may explain some variation. Triage decisions to contact primary care may have lower compliance than decisions to contact emergency services or self care. Telephone triage services can offer appropriate decisions and decisions that callers comply with. However, the association between the appropriateness of a decision and subsequent compliance requires further investigation and further consideration needs to be given to the minority of calls which are inappropriately managed. We suggest that a definition of appropriateness incorporating both accuracy and adequacy of triage decision should be encouraged. © 2012 Blackwell Publishing Ltd.

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

    Science.gov (United States)

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

    2016-05-01

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

  14. [Triage duration times: a prospective descriptive study in a level 1° emergency department].

    Science.gov (United States)

    Bambi, Stefano; Ruggeri, Marco

    2017-01-01

    Triage is the most important tool for clinical risk management in emergency departments (ED). The timing measurement of its phases is fundamental to establish indicators and standards for the optimization of the system. To evaluate the duration time of the phases of triage; to evaluate some variables exerting influence on nurses' performance. prospective descriptive study performed in the ED of Careggi Teaching Hospital in Florence. 14 nurses enrolled by stratified randomization proportion (1/3 of the whole staff ), according to classes of length of service. Triage processes on 150 adult patients were recorded. The mean age of nurses was 39.7 years (SD ± 5.2, range 29-50); the average length of service was 10.3 years (SD ± 4.4, range 3-18); average of triage experience was 8.6 years (SD ± 4.3, range 2-13). The median time from patient's arrival to the end of the triage process was 04': 04" (range 00':47"- 18':08"); the median duration of triage was 01':11" (range 00':07" -11':27"). The length of service and triage experience did not influence the medians of recorded intervals of time, but there were some limitations due to the low sample size. Interruptions were observed 111 (74%) of triage cases. the recorded triage time intervals were similar to those reported in international literature. Actions are needed to reduce the impact of interruptions on triage process' times.

  15. Comparing the Accuracy of Three Pediatric Disaster Triage Strategies: A Simulation-Based Investigation.

    Science.gov (United States)

    Cicero, Mark X; Overly, Frank; Brown, Linda; Yarzebski, Jorge; Walsh, Barbara; Shabanova, Veronika; Auerbach, Marc; Riera, Antonio; Adelgais, Kathleen; Meckler, Garth; Cone, David C; Baum, Carl R

    2016-04-01

    It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes. We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients' expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased). There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (Ptriage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM.

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

    Directory of Open Access Journals (Sweden)

    M. Dalwai*

    2013-12-01

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

  17. Casing pull tests for directionally drilled environmental wells

    Energy Technology Data Exchange (ETDEWEB)

    Staller, G.E.; Wemple, R.P. [Sandia National Labs., Albuquerque, NM (United States); Layne, R.R. [Charles Machine Works, Inc., Perry, OK (United States)

    1994-11-01

    A series of tests to evaluate several types of environmental well casings have been conducted by Sandia National Laboratories (SNL) and it`s industrial partner, The Charles Machine Works, Inc. (CMW). A test bed was constructed at the CMW test range to model a typical shallow, horizontal, directionally drilled wellbore. Four different types of casings were pulled through this test bed. The loads required to pull the casings through the test bed and the condition of the casing material were documented during the pulling operations. An additional test was conducted to make a comparison of test bed vs actual wellbore casing pull loads. A directionally drilled well was emplaced by CMW to closely match the test bed. An instrumented casing was installed in the well and the pull loads recorded. The completed tests are reviewed and the results reported.

  18. Tracer gas evaluations of push-pull ventilation system performance.

    Science.gov (United States)

    Ojima, Jun

    2009-01-01

    A push-pull ventilation system is effective for hazardous material exhaustion. Although a push-pull ventilation system has advantages over a local exhaust hood, some laborious adjustments are required. The pertinence of the adjustments is uncertain because it is difficult to evaluate the performance of a push-pull ventilation system quantitatively. In this study, a measurement of the capture efficiency of a push-pull ventilation system was carried out by means of a tracer gas method. The capture efficiency decreased to 39.3-78.5% when blockage material, a dummy worker and a cross draft, were set in the ventilation zone, but the efficiency was 95.1-97.9% when the cross draft was stopped. The results suggest that the uniform flow of a push-pull ventilation system will detour a blockage and the performance of the system will not be reduced unless a cross draft disturbs the uniform flow.

  19. Casing pull tests for directionally drilled environmental wells

    International Nuclear Information System (INIS)

    Staller, G.E.; Wemple, R.P.; Layne, R.R.

    1994-11-01

    A series of tests to evaluate several types of environmental well casings have been conducted by Sandia National Laboratories (SNL) and it's industrial partner, The Charles Machine Works, Inc. (CMW). A test bed was constructed at the CMW test range to model a typical shallow, horizontal, directionally drilled wellbore. Four different types of casings were pulled through this test bed. The loads required to pull the casings through the test bed and the condition of the casing material were documented during the pulling operations. An additional test was conducted to make a comparison of test bed vs actual wellbore casing pull loads. A directionally drilled well was emplaced by CMW to closely match the test bed. An instrumented casing was installed in the well and the pull loads recorded. The completed tests are reviewed and the results reported

  20. The Eldicus prospective, observational study of triage decision making in European intensive care units: Part I-European Intensive Care Admission Triage Scores (EICATS)

    DEFF Research Database (Denmark)

    Sprung, Charles L; Baras, Mario; Iapichino, Gaetano

    2012-01-01

    decision rule based on 28-day mortality rates of admitted and refused 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 a request for intensive......:: The initial refusal score and final triage score provide objective data for rejecting patients that will die even if admitted to the intensive care unit and survive if refused intensive care unit admission.......OBJECTIVE:: Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage...

  1. One-two-triage: validation and reliability of a novel triage system for low-resource settings.

    Science.gov (United States)

    Khan, Ayesha; Mahadevan, S V; Dreyfuss, Andrea; Quinn, James; Woods, Joan; Somontha, Koy; Strehlow, Matthew

    2016-10-01

    To validate and assess reliability of a novel triage system, one-two-triage (OTT), that can be applied by inexperienced providers in low-resource settings. This study was a two-phase prospective, comparative study conducted at three hospitals. Phase I assessed criterion validity of OTT on all patients arriving at an American university hospital by comparing agreement among three methods of triage: OTT, Emergency Severity Index (ESI) and physician-defined acuity (the gold standard). Agreement was reported in normalised and raw-weighted Cohen κ using two different scales for weighting, Expert-weighted and triage-weighted κ. Phase II tested reliability, reported in Fleiss κ, of OTT using standardised cases among three groups of providers at an urban and rural Cambodian hospital and the American university hospital. Normalised for prevalence of patients in each category, OTT and ESI performed similarly well for expert-weighted κ (OTT κ=0.58, 95% CI 0.52 to 0.65; ESI κ=0.47, 95% CI 0.40 to 0.53) and triage-weighted κ (κ=0.54, 95% CI 0.48 to 0.61; ESI κ=0.57, 95% CI 0.51 to 0.64). Without normalising, agreement with gold standard was less for both systems but performance of OTT and ESI remained similar, expert-weighted (OTT κ=0.57, 95% CI 0.52 to 0.62; ESI κ=0.6, 95% CI 0.58 to 0.66) and triage-weighted (OTT κ=0.31, 95% CI 0.25 to 0.38; ESI κ=0.41, 95% CI 0.35 to 0.4). In the reliability phase, all triagers showed fair inter-rater agreement, Fleiss κ (κ=0.308). OTT can be reliably applied and performs as well as ESI compared with gold standard, but requires fewer resources and less experience. 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/

  2. 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.

  3. Pivot Nursing: An Alternative to Traditional ED Triage.

    Science.gov (United States)

    Christensen, Maria; Rosenberg, Mark; Mahon, Eileen; Pineda, Sharon; Rojas, Eva; Soque, Victoria; Johansen, Mary L

    2016-09-01

    A 7.2% increase in patient volume from 130,700 to 140,800 in 2012 prompted St Joseph's Regional Medical Center Emergency Department to review existing triage processes to decrease turnaround time. "Pivot triage" is a new, efficient intake process that entails use of 4 rather than 8 determinants to identify acuity levels. The purpose of this performance improvement project was to create alternatives to traditional triage to decrease ED length of stay and door-to-physician time. After education, the pivot process was implemented using 4 determinants established by a multidisciplinary team. The pivot process was slowly implemented for 6 hours over a 1-week period to work out processing issues. Arrival time, door-to-physician time, and departure time from the emergency department were elements used to calculate the patient's turnaround time. Length of ED stay was collected monthly beginning in the fourth quarter of 2011. Comparisons were made after Pivot implementation in the fourth quarter of 2012. Despite the increasing volume, the mean door-to-physician time decreased from 71 to 40 minutes, a 43.7% reduction. The overall turnaround time decreased from 220 to 181 minutes, representing approximately a 17.7% reduction. The percentage of patients who left without being seen decreased from 2.5% to 1.0%. The pivot process improved patient flow in the emergency department, reducing time spent by the patient in the department. The pivot process is a viable alternative to traditional triage. Nurses are able to accurately pivot patients with a reduced amount of information. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  4. The use of triage in Danish Emergency Departments

    DEFF Research Database (Denmark)

    Østergaard Lindberg, Søren; la Cour, Jeppe Lerche; Folkestad, Lars

    2011-01-01

    The emergency departments (EDs) handle approximately 1,000,000 contacts annually. Danish health care is undergoing reorganization that involves the creation of fewer and larger EDs to handle these contacts. There is therefore a need to prioritize the use of resources to optimize treatment. We thu...... wanted to investigate if Danish EDs are using triage systems and, if so, which systems they are using....

  5. Mass Casualty Incident Primary Triage Methods in China

    Science.gov (United States)

    Chen, Jin-Hong; Yang, Jun; Yang, Yu; Zheng, Jing-Chen

    2015-01-01

    Objective: To evaluate the technical characteristics and application of mass casualty incident (MCI) primary triage (PT) methods applied in China. Data Sources: Chinese literature was searched by Chinese Academic Journal Network Publishing Database (founded in June 2014). The English literature was searched by PubMed (MEDLINE) (1950 to June 2014). We also searched Official Websites of Chinese Central Government's (http://www.gov.cn/), National Health and Family Planning Commission of China (http://www.nhfpc.gov.cn/), and China Earthquake Information (http://www.csi.ac.cn/). Study Selection: We included studies associated with mass casualty events related to China, the PT applied in China, guidelines and standards, and application and development of the carding PT method in China. Results: From 3976 potentially relevant articles, 22 met the inclusion criteria, 20 Chinese, and 2 English. These articles included 13 case reports, 3 retrospective analyses of MCI, two methods introductions, three national or sectoral criteria, and one simulated field testing and validation. There were a total of 19 kinds of MCI PT methods that have been reported in China from 1950 to 2014. In addition, there were 15 kinds of PT methods reported in the literature from the instance of the application. Conclusions: The national and sectoral current triage criteria are developed mainly for earthquake relief. Classification is not clear. Vague criteria (especially between moderate and severe injuries) operability are not practical. There are no triage methods and research for children and special populations. There is no data and evidence supported triage method. We should revise our existing classification and criteria so it is clearer and easier to be grasped in order to build a real, practical, and efficient PT method. PMID:26415807

  6. 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.

  7. Improved quality and efficiency after the introduction of physician-led team triage in an emergency department.

    Science.gov (United States)

    Burström, Lena; Engström, Marie-Louise; Castrén, Maaret; Wiklund, Tony; Enlund, Mats

    2016-01-01

    Overcrowding in the emergency department (ED) may negatively affect patient outcomes, so different triage models have been introduced to improve performance. Physician-led team triage obtains better results than other triage models. We compared efficiency and quality measures before and after reorganization of the triage model in the ED at our county hospital. We retrospectively compared two study periods with different triage models: nurse triage in 2008 (baseline) and physician-led team triage in 2012 (follow-up). Physician-led team triage was in use during day-time and early evenings on weekdays. Data were collected from electronic medical charts and the National Mortality Register. We included 20,073 attendances in 2008 and 23,765 in 2012. The time from registration to physician presentation decreased from 80 to 33 min (P triage improved the efficiency and quality in EDs.

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

    DEFF Research Database (Denmark)

    Brehm Johansen, Mette; Forberg, Jakob Lundager

    2011-01-01

    Introduction: Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED. Material and methods: Semi-structured qualitative interviews were conducted with 15 emergency nurses....... The interviews were preceded by observations of the work of the ED nurses in which focus was on the triage process. Results: Formalized triage was experienced to improve the overview of patients and resources at the ED, and the nurses described that they felt more assured when prioritizing between patients...... aspects of nursing. Difficulties were occasionally experienced when categorizing patients with diffuse symptoms according to the standardized triage symptoms and signs’ algorithms. Conclusion: Introducing a formalized triage system in the ED was experienced to give a better overview and more overall...

  9. 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

  10. Triage quality control is missing tools-a new observation technique for ED quality improvement.

    Science.gov (United States)

    Malmström, Tomi; Harjola, Veli-Pekka; Torkki, Paulus; Kumpulainen, Salla; Malmström, Raija

    2017-04-01

    Correct assessment of patient urgency is critical to ensuring patient safety in emergency departments (EDs). Although significant time and effort have been devoted to developing triage systems, less attention has been paid to the development of quality control. The aim of this study is to introduce and test observation technique, which enables identifying of patient groups at risk of erroneous assessment in triage. The introduced technique is aimed to be less laborious to use than existing triage quality control methods. The study developed an observation technique for identifying patients with possible erroneous assessments in triage. Data sample for the observation technique is carried out with survey form filled in by nurse. Hospital ED with ~74 000 patient visits annually. Consecutive adult patients in an ED for baseline study period of 14 days (1774 patients) in 2010 and control study period of 4 days (541 patients) in 2012. Triage observation technique for continuous improvement of triage performance. Primary measures of triage improvement were triage accuracy and nurses' ability to predict patient admissions. With the observation technique the ED staff was able to identify patient groups at risk for erroneous triage. Under-triage related mostly to patients with chest pain, shortness of breath, collapse, stomach pain and infections. Instead injures and muscular skeletal symptoms were seldom undertriaged even though they are common. EDs can control triage quality with simple observation technique. The usability of observation technique and triage quality improvement process were good. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  11. Biomechanical study of the final push-pull in archery.

    Science.gov (United States)

    Leroyer, P; Van Hoecke, J; Helal, J N

    1993-02-01

    The purpose of this study was to analyse archery performance among eight archers of different abilities by means of displacement pull-hand measurements during the final push-pull phase of the shoot. The archers showed an irregular displacement negatively related to their technical level. Displacement signal analysis showed high power levels in both the 0-5 Hz and 8-12 Hz ranges. The latter peak corresponds to electromyographic tremor observed during a prolonged push-pull effort. The results are discussed in relation to some potentially helpful training procedures such as biofeedback and strength conditioning.

  12. 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.

  13. [Triage protocols for mass casualty incidents : An overview 30 years after START].

    Science.gov (United States)

    Streckbein, S; Kohlmann, T; Luxen, J; Birkholz, T; Prückner, S

    2016-08-01

    Since the publication of the first mass casualty triage protocol approximately 30 years ago, numerous adaptions and alternatives have been introduced and are currently in use throughout the world. This variety may represent a challenge for the cooperation between emergency medical providers and the interoperability of emergency medical services often required during mass casualty incidents. To enhance cooperation and interoperability a standardization of triage protocols is required. This survey was carried out in order to identify and characterize published triage protocols on national and international levels. Furthermore, evidence for validation of the identified triage algorithms was discussed and recommendations for standardization of triage protocols are given. In a systematic literature search 59 relevant articles were identified and evaluated with respect to the given objectives. A total of 12 triage concepts were identified and characterized which are categorized according to the basic principle. The endpoints of the studies, the chosen observation units and the mode of data collection were discussed with respect to their impact on validation. Furthermore, the impact of the degree and dynamics of system capacity overload, which are pathognomonic for mass casualty incidents, were discussed. There is not sufficient evidence to declare one of the triage protocols superior in all aspects to the others and no triage protocol has been implemented on a comprehensive level in Germany. In order to initialize a national or regional convergence process towards an interoperability of emergency medical services, the model uniform core criteria for mass casualty triage approach has been identified as being appropriate.

  14. Development and interrater reliability of the UK Mental Health Triage Scale.

    Science.gov (United States)

    Sands, Natisha; Elsom, Stephen; Colgate, Robert; Haylor, Helen; Prematunga, Roshani

    2016-08-01

    Mental health triage scales are clinical tools used at point of entry to specialist mental health service to provide a systematic way of categorizing the urgency of clinical presentations, and determining an appropriate service response and an optimal timeframe for intervention. The aim of the present study was to test the interrater reliability of a mental health triage scale developed for use in UK mental health triage and crisis services. An interrater reliability study was undertaken. Triage clinicians from England and Wales (n = 66) used the UK Mental Health Triage Scale (UK MHTS) to rate the urgency of 21 validated mental health triage scenarios derived from real occasions of triage. Interrater reliability was calculated using Kendall's coefficient of concordance (w) and intraclass correlation coefficient (ICC) statistics. The average ICC was 0.997 (95% confidence interval (CI): 0.996-0.999 (F (20, 1300) = 394.762, P triage scales employed within effective mental health triage systems offer possibilities for not only improved patient outcomes and experiences, but also for efficient use of finite specialist mental health services. © 2016 The Authors International Journal of Mental Health Nursing published by Wiley Publishing Asia Pty Ltd on behalf of Australian College of Mental Health Nurses Inc.

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

    Science.gov (United States)

    Adeniji, Adeloye Amoo

    2016-01-01

    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. PMID:27380788

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

    Directory of Open Access Journals (Sweden)

    Gary D Cantrell

    2012-12-01

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

  17. Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models

    Directory of Open Access Journals (Sweden)

    Burström Lena

    2012-08-01

    Full Text Available Abstract Background The management of emergency departments (EDs principally involves maintaining effective patient flow and care. Different triage models are used today to achieve these two goals. The aim of this study was to compare the performance of different triage models used in three Swedish EDs. Using efficiency and quality indicators, we compared the following triage models: physician-led team triage, nurse first/emergency physician second, and nurse first/junior physician second. Methods All data of patients arriving at the three EDs between 08:00- and 21:00 throughout 2008 were collected and merged into a database. The following efficiency indicators were measured: length of stay (LOS including time to physician, time from physician to discharge, and 4-hour turnover rate. The following quality indicators were measured: rate of patients left before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days. Results Data from 147,579 patients were analysed. The median length of stay was 158 minutes for physician-led team triage, compared with 243 and 197 minutes for nurse/emergency physician and nurse/junior physician triage, respectively (p  Conclusions Physician-led team triage seemed advantageous, both expressed as efficiency and quality indicators, compared with the two other models.

  18. 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).

  19. Mechanism of oil-pulling therapy -In vitro study

    Directory of Open Access Journals (Sweden)

    Sharath Asokan

    2011-01-01

    Conclusion: The myth that the effect of oil-pulling therapy on oral health was just a placebo effect has been broken and there are clear indications of possible saponification and emulsification process, which enhances its mechanical cleaning action.

  20. Push and pull strategies: applications for health care marketing.

    Science.gov (United States)

    Kingsley, B R

    1987-08-01

    As health care markets mature and expand, strategies available in other industries become useful. This article examines how traditional push-pull strategies apply to health care. Marketers using a push strategy recognize that the sale of their services or goods is dependent upon the endorsement of a middleman and promote their product through the middleman. Those using a pull strategy market directly to the consumer. In this article, the author outlines the advantages and disadvantages of using each strategy.

  1. Simulation training with structured debriefing improves residents' pediatric disaster triage performance.

    Science.gov (United States)

    Cicero, Mark X; Auerbach, Marc A; Zigmont, Jason; Riera, Antonio; Ching, Kevin; Baum, Carl R

    2012-06-01

    Pediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners' acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance. A 10-victim school-shooting scenario was created. Victims were portrayed by adult volunteers, and by high- and low-fidelity simulation manikins that responded physiologically to airway maneuvers. Learners were pediatrics residents. Expected triage levels were not revealed. After a didactic session, learners completed the first simulation. Learners assigned triage levels to all victims, and recorded responses on a standardized form. A group structured debriefing followed the first simulation. The debriefing allowed learners to review the victims and discuss triage rationale. A new 10-victim trauma disaster scenario was presented one week later, and a third scenario was presented five months later. During the second and third scenarios, learners again assigned triage levels to multiple victims. Wilcoxon sign rank tests were used to compare pre- and post-test scores and performance on pre- and post-debriefing simulations. A total of 53 learners completed the educational intervention. Initial mean triage performance was 6.9/10 patients accurately triaged (range = 5-10, SD = 1.3); one week after the structured debriefing, the mean triage performance improved to 8.0/10 patients (range = 5-10, SD = 1.37, P < .0001

  2. The Respiratory Rate: A Neglected Triage Tool for Pre-hospital Identification of Trauma Patients.

    Science.gov (United States)

    Yonge, John D; Bohan, Phillip Kemp; Watson, Justin J; Connelly, Christopher R; Eastes, Lynn; Schreiber, Martin A

    2017-12-06

    Under-triaged trauma patients have worse clinical outcomes. We evaluated the capability of four pre-hospital variables to identify this population at the lowest level trauma activation (level 3). A retrospective review of adult trauma activations from 2004 to 2014 was completed. Pre-hospital vital signs and Glasgow Coma Scale were converted to categorical variables. Patients were under-triaged based on meeting current level 1 or 2 criteria, or requiring a pre-defined critical intervention. Logistic regression was used to determine the association between the pre-hospital variables and under-triaged patients. Odds ratios and 95% confidence intervals were calculated for a comprehensive model, grouping all causes of under-triage as a single unit, and 16 individual models, one for each under-triage criterion. A new level 2 criterion was generated and internally validated. In total, 12,332 activations occurred during the study period. Four hundred and sixty-six (5.9%) patients were under-triaged. Compared to patients with a normal respiratory rate (RR), tachypneic patients were more likely to be under-triaged for any reason, OR 1.7 [1.3-2.1], p < 0.001. In the individual event analysis, tachypneic patients were more likely to have flail chest, OR 22 [2.9-168.3], p = 0.003; require a chest tube, OR 3 [1.8-4.9], p < 0.001; or require emergent intubation, OR 1.6 [1.1-2.8], p = 0.04, compared to patients with a normal RR. The data-driven triage modification was tachypnea with suspected thoracic injury which reduced the under-triage rate by 1.2%. Tachypnea with suspected thoracic injury is the strongest level 2 triage modification to reduce level 3 under-triage.

  3. Pediatric Disaster Triage: Multiple Simulation Curriculum Improves Prehospital Care Providers' Assessment Skills.

    Science.gov (United States)

    Cicero, Mark Xavier; Whitfill, Travis; Overly, Frank; Baird, Janette; Walsh, Barbara; Yarzebski, Jorge; Riera, Antonio; Adelgais, Kathleen; Meckler, Garth D; Baum, Carl; Cone, David Christopher; Auerbach, Marc

    2017-01-01

    Paramedics and emergency medical technicians (EMTs) triage pediatric disaster victims infrequently. The objective of this study was to measure the effect of a multiple-patient, multiple-simulation curriculum on accuracy of pediatric disaster triage (PDT). Paramedics, paramedic students, and EMTs from three sites were enrolled. Triage accuracy was measured three times (Time 0, Time 1 [two weeks later], and Time 2 [6 months later]) during a disaster simulation, in which high and low fidelity manikins and actors portrayed 10 victims. Accuracy was determined by participant triage decision concordance with predetermined expected triage level (RED [Immediate], YELLOW [Delayed], GREEN [Ambulatory], BLACK [Deceased]) for each victim. Between Time 0 and Time 1, participants completed an interactive online module, and after each simulation there was an individual debriefing. Associations between participant level of training, years of experience, and enrollment site were determined, as were instances of the most dangerous mistriage, when RED and YELLOW victims were triaged BLACK. The study enrolled 331 participants, and the analysis included 261 (78.9%) participants who completed the study, 123 from the Connecticut site, 83 from Rhode Island, and 55 from Massachusetts. Triage accuracy improved significantly from Time 0 to Time 1, after the educational interventions (first simulation with debriefing, and an interactive online module), with a median 10% overall improvement (p triage accuracy showed greatest improvement in overall accuracy for YELLOW triage patients (Time 0 50% accurate, Time1 100%), followed by RED patients (Time 0 80%, Time 1 100%). There was no significant difference in accuracy between Time 1 and Time 2 (p = 0.073). This study shows that the multiple-victim, multiple-simulation curriculum yields a durable 10% improvement in simulated triage accuracy. Future iterations of the curriculum can target greater improvements in EMT triage accuracy.

  4. Comparison between static maximal force and handbrake pulling force.

    Science.gov (United States)

    Chateauroux, E; Wang, X

    2012-01-01

    The measurement of maximum pulling force is important not only for specifying force limit of industrial workers but also for designing controls requiring high force. This paper presents a comparison between maximal static handbrake pulling force (FST) and force exerted during normal handbrake pulling task (FDY). These forces were measured for different handle locations and subject characteristics. Participants were asked to pull a handbrake on an adjustable car mock-up as they would do when parking their own car, then to exert a force as high as possible on the pulled handbrake. Hand pulling forces were measured using a six-axes force sensor. 5 fixed handbrake positions were tested as well as a neutral handbrake position defined by the subject. FST and FDY were significantly correlated. Both were found to be dependent on handbrake position, age and gender. As expected, women and older subjects exerted lower forces. FST was significantly higher than FDY. The ratio FmR (FDY divided by FST) was also analyzed. Women showed higher FmR than men meaning that the task required a higher amount of muscle capability for women. FmR was also influenced by handbrake location. These data will be useful for handbrake design.

  5. 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

  6. ABCDE-Triage-kiireellisyysluokittelu päivystyspoliklinikalla

    OpenAIRE

    Tikka, Juuso; Sund, Antti

    2016-01-01

    Opinnäytetyön aiheena on ABCDE-Triage-kiireellisyysluokittelu päivystyspoliklinikalla. Työn taustalla on potilaiden hoidontarpeen arvioinnin merkitys hoitoon pääsyssä päivystyspoliklinikalla. Opinnäytetyö toteutettiin yhteistyössä kantahämäläisen päivystyspoliklinikan kanssa. Opinnäytetyön tavoitteena oli tutkia ABCDE-Triagen toimivuutta päivystyspoliklinikalla. Tarkoituksena oli saada selville, millä tavoin ABCDE-Triagen käyttöönotto on vaikuttanut potilaiden hoidontarpeen arviointiin, m...

  7. Teaching mass casualty triage skills using immersive three-dimensional virtual reality.

    Science.gov (United States)

    Vincent, Dale S; Sherstyuk, Andrei; Burgess, Lawrence; Connolly, Kathleen K

    2008-11-01

    Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three-dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self-efficacy. Twenty-four medical students were taught principles of mass casualty triage using three short podcasts, followed by an immersive VR exercise in which learners donned a head-mounted display (HMD) and three motion tracking sensors, one for their head and one for each hand. They used a gesture-based command system to interact with multiple VR casualties. For triage score, one point was awarded for each correctly identified main problem, required intervention, and triage category. For intervention score, one point was awarded for each correct VR intervention. Scores were analyzed using one-way analysis of variance (ANOVA) for each student. Before and after surveys were used to measure self-efficacy and reaction to the training. Four students were excluded from analysis due to participation in a recent triage research program. Results from 20 students were analyzed. Triage scores and intervention scores improved significantly during Scenario B (p learning to be an effective first responder. Novice learners demonstrated improved triage and intervention scores, speed, and self-efficacy during an iterative, fully immersed VR triage experience.

  8. 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.

  9. From Doctor to Nurse Triage in the Danish Out-of-Hours Primary Care Service

    DEFF Research Database (Denmark)

    Moth, Grete; Huibers, Linda; Vedsted, Peter

    2013-01-01

    applied experiences from The Netherlands on nurse performance in the OOH triage concerning the number of calls per hour. Using the 2011 number of calls in one region, we examined three hypothetical scenarios with nurse triage and calculated the differences in fee costs. Results. A new organisation with 97...

  10. Cross-Sectional Study of Women with Trichotillomania: A Preliminary Examination of Pulling Styles, Severity, Phenomenology, and Functional Impact

    Science.gov (United States)

    Flessner, Christopher A.; Woods, Douglas W.; Franklin, Martin E.; Keuthen, Nancy J.; Piacentini, John

    2009-01-01

    The current study utilized a cross-sectional design to examine pulling severity, phenomenology, functional impact, and "focused" and "automatic" pulling styles in women with TTM across a wide age spectrum. "Automatic" pulling refers to pulling occurring primarily out of one's awareness, while "focused" pulling refers to pulling with a compulsive…

  11. Paramedic Application of a Triage Sieve: A Paper-Based Exercise.

    Science.gov (United States)

    Cuttance, Glen; Dansie, Kathryn; Rayner, Tim

    2017-02-01

    Introduction Triage is the systematic prioritization of casualties when there is an imbalance between the needs of these casualties and resource availability. The triage sieve is a recognized process for prioritizing casualties for treatment during mass-casualty incidents (MCIs). While the application of a triage sieve generally is well-accepted, the measurement of its accuracy has been somewhat limited. Obtaining reliable measures for triage sieve accuracy rates is viewed as a necessity for future development in this area. The goal of this study was to investigate how theoretical knowledge acquisition and the practical application of an aide-memoir impacted triage sieve accuracy rates. Two hundred and ninety-two paramedics were allocated randomly to one of four separate sub-groups, a non-intervention control group, and three intervention groups, which involved them receiving either an educational review session and/or an aide-memoir. Participants were asked to triage sieve 20 casualties using a previously trialed questionnaire. The study showed the non-intervention control group had a correct accuracy rate of 47%, a similar proportion of casualties found to be under-triaged (37%), but a significantly lower number of casualties were over-triaged (16%). The provision of either an educational review or aide-memoir significantly increased the correct triage sieve accuracy rate to 77% and 90%, respectively. Participants who received both the educational review and aide-memoir had an overall accuracy rate of 89%. Over-triaged rates were found not to differ significantly across any of the study groups. This study supports the use of an aide-memoir for maximizing MCI triage accuracy rates. A "just-in-time" educational refresher provided comparable benefits, however its practical application to the MCI setting has significant operational limitations. In addition, this study provides some guidance on triage sieve accuracy rate measures that can be applied to define

  12. Inter-rater agreement of the triage system RETTS-HEV

    DEFF Research Database (Denmark)

    Larsen, Louise Pape; Kirkegaard, Hans; Nissen, Louise

    2014-01-01

    Objective The purpose of this study was to evaluate the inter-rater agreement among nurses using the triage system RETTS-HEV (rapid emergency triage and treatment system – hospital unit west) in a Danish emergency department (ED). Background The use of triage systems in Denmark has been implemented...... recently together with structural changes in hospital organization. Testing and evaluation is therefore needed. The RETTS-HEV is a five-scale triage system being used in the ED of Herning, Denmark, since May 2010. The ED is semilarge, with 29 000 annual visits. Materials and methods Consecutive patients...... presenting to the ED were assessed by both a duty and a study nurse using RETTS-HEV. Nurses did not receive training before the study. In all, 146 patients were enroled and a blinded, paired and simultaneous triage was conducted independently to evaluate inter-rater agreement using Fleiss j. Results A total...

  13. Construct Related Validity for the Baumgartner Modified Pull-Up Test

    Science.gov (United States)

    Baumgartner, Ted A.; Gaunt, Sharon j.

    2005-01-01

    Traditionally the pull-up was used as a measure of arm and shoulder girdle strength and endurance. This measure did not discriminate among ability levels because many zero scores occur. Baumgartner (1978) developed a modified pull-up test that was easier than the traditional pull-up test. The Baumgartner Modified Pull-Up (BMPU) has been used as an…

  14. 25 CFR 542.8 - What are the minimum internal control standards for pull tabs?

    Science.gov (United States)

    2010-04-01

    .... (1) Pull tab inventory (including unused tickets) shall be controlled to assure the integrity of the... of the pull tab sales. (3) The issue of pull tabs to the cashier or sales location shall be... of each month, a person or persons independent of pull tab sales and inventory control shall verify...

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

    Directory of Open Access Journals (Sweden)

    Adeloye A. Adeniji

    2016-03-01

    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

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

    Science.gov (United States)

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

    2015-01-01

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

  17. Traumatic Spinal Cord Injury Emergency Service Triage Patterns and the Associated Emergency Department Outcomes.

    Science.gov (United States)

    Selvarajah, Shalini; Haider, Adil H; Schneider, Eric B; Sadowsky, Cristina L; Becker, Daniel; Hammond, Edward R

    2015-12-15

    Paralysis is an indication for trauma patients to be preferentially triaged by emergency services to designated level I or II trauma centers (TC). We sought to describe triage practices for patients with acute traumatic spinal cord injury (TSCI) and its associated emergency department (ED) outcomes. Adults ages ≥ 18 years with a diagnosis of acute TSCI (International Classification of Diseases-9: 806 and 952) in the 2006-2011 United States Nationwide Emergency Department Sample were included in these analyses. Outcomes assessed include triage to non-trauma centers (NTC), which is referred to as "under-triage," and ED mortality. Of 117,444 adults with TSCI, 33.4% were under-triaged to NTC. Under-triage was more prevalent with increasing age. Among patients under-triaged to NTC, 37.4% had new injury severity score (NISS) >15, representing severe injuries or polytrauma. Among patients with NISS >15, the odds of ED mortality in NTC were four-fold greater compared to level I trauma centers (TC-I) (adjusted odds ratio [AOR] = 4.06; 95% confidence interval = 1.87-8.79; p triage of adults with acute TSCI occurred in at least one-third of the cases. Patients triaged to NTC rather than TC-I experienced higher likelihood of death in the ED even after controlling for personal and injury characteristics. Further research is necessary to elucidate detailed clinical and logistical factors that may be associated with under-triage of acute TSCI, to facilitate interventions aimed at improving patient experience and outcomes.

  18. Factors associated with triage assignment of emergency department patients ultimately diagnosed with acute myocardial infarction.

    Science.gov (United States)

    Ryan, Kimberley; Greenslade, Jaimi; Dalton, Emily; Chu, Kevin; Brown, Anthony F T; Cullen, Louise

    2016-02-01

    The objective of this study was to explore factors associated with the triage category assigned by the triage nurse for patients ultimately diagnosed with acute myocardial infarction. This was a retrospective analysis of 12 months of data, on adult emergency department patients ultimately diagnosed with acute myocardial infarction. Data were obtained from hospital databases and included patient demographics, patient clinical characteristics and nurses' experience. Of the 153 patients, 20% (95% CI: 14-27%) were given a lower urgency triage category than recommended by international guidelines. Compared to patients who were triaged Australasian Triage Category 1 or 2, patients with an Australasian Triage Category 3-5 were older (mean age 76 versus 68 years), more likely to be female (63% versus 32%), more likely to present without chest pain (93% versus 35%) and less likely to have a cardiac history (3.3% versus 17.9%). A slightly higher proportion of patients Australasian Triage Category 3-5 were triaged by an experienced nurse (50%) compared to patients categorised Australasian Triage Category 1-2 (35.2%) but this finding did not reach statistical significance. One in five presentations was given a lower urgency triage category than recommended by international guidelines, potentially leading to delays in medical treatment. The absence of chest pain was the defining characteristic in this group of patients, along with other factors identified by previous research such as being of female sex and elderly. Copyright © 2015 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  19. 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.

  20. Five-level emergency triage systems: variation in assessment of validity.

    Science.gov (United States)

    Kuriyama, Akira; Urushidani, Seigo; Nakayama, Takeo

    2017-11-01

    Triage systems are scales developed to rate the degree of urgency among patients who arrive at EDs. A number of different scales are in use; however, the way in which they have been validated is inconsistent. Also, it is difficult to define a surrogate that accurately predicts urgency. This systematic review described reference standards and measures used in previous validation studies of five-level triage systems. We searched PubMed, EMBASE and CINAHL to identify studies that had assessed the validity of five-level triage systems and described the reference standards and measures applied in these studies. Studies were divided into those using criterion validity (reference standards developed by expert panels or triage systems already in use) and those using construct validity (prognosis, costs and resource use). A total of 57 studies examined criterion and construct validity of 14 five-level triage systems. Criterion validity was examined by evaluating (1) agreement between the assigned degree of urgency with objective standard criteria (12 studies), (2) overtriage and undertriage (9 studies) and (3) sensitivity and specificity of triage systems (7 studies). Construct validity was examined by looking at (4) the associations between the assigned degree of urgency and measures gauged in EDs (48 studies) and (5) the associations between the assigned degree of urgency and measures gauged after hospitalisation (13 studies). Particularly, among 46 validation studies of the most commonly used triages (Canadian Triage and Acuity Scale, Emergency Severity Index and Manchester Triage System), 13 and 39 studies examined criterion and construct validity, respectively. Previous studies applied various reference standards and measures to validate five-level triage systems. They either created their own reference standard or used a combination of severity/resource measures. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All

  1. Using robotic telecommunications to triage pediatric disaster victims.

    Science.gov (United States)

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

    2012-01-01

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

  2. CoIN: a network analysis for document triage.

    Science.gov (United States)

    Hsu, Yi-Yu; Kao, Hung-Yu

    2013-01-01

    In recent years, there was a rapid increase in the number of medical articles. The number of articles in PubMed has increased exponentially. Thus, the workload for biocurators has also increased exponentially. Under these circumstances, a system that can automatically determine in advance which article has a higher priority for curation can effectively reduce the workload of biocurators. Determining how to effectively find the articles required by biocurators has become an important task. In the triage task of BioCreative 2012, we proposed the Co-occurrence Interaction Nexus (CoIN) for learning and exploring relations in articles. We constructed a co-occurrence analysis system, which is applicable to PubMed articles and suitable for gene, chemical and disease queries. CoIN uses co-occurrence features and their network centralities to assess the influence of curatable articles from the Comparative Toxicogenomics Database. The experimental results show that our network-based approach combined with co-occurrence features can effectively classify curatable and non-curatable articles. CoIN also allows biocurators to survey the ranking lists for specific queries without reviewing meaningless information. At BioCreative 2012, CoIN achieved a 0.778 mean average precision in the triage task, thus finishing in second place out of all participants. Database URL: http://ikmbio.csie.ncku.edu.tw/coin/home.php.

  3. Remote triage support algorithm based on fuzzy logic.

    Science.gov (United States)

    Achkoski, Jugoslav; Koceski, S; Bogatinov, D; Temelkovski, B; Stevanovski, G; Kocev, I

    2017-06-01

    This paper presents a remote triage support algorithm as a part of a complex military telemedicine system which provides continuous monitoring of soldiers' vital sign data gathered on-site using unobtrusive set of sensors. The proposed fuzzy logic-based algorithm takes physiological data and classifies the casualties according to their health risk level, calculated following the Modified Early Warning Score (MEWS) methodology. To verify the algorithm, eight different evaluation scenarios using random vital sign data have been created. In each scenario, the hypothetical condition of the victims was assessed in parallel both by the system as well as by 50 doctors with significant experience in the field. The results showed that there is high (0.928) average correlation of the classification results. This suggests that the proposed algorithm can be used for automated remote triage in real life-saving situations even before the medical team arrives at the spot, and shorten the response times. Moreover, an additional study has been conducted in order to increase the computational efficiency of the algorithm, without compromising the quality of the classification results. 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/.

  4. IMPAIRED EXECUTIVE FUNCTIONING IN PEDIATRIC TRICHOTILLOMANIA (HAIR PULLING DISORDER).

    Science.gov (United States)

    Flessner, Christopher A; Brennan, Elle; Murphy, Yolanda E; Francazio, Sarah

    2016-03-01

    No neurocognitive examinations of pediatric trichotillomania (hair pulling disorder; HPD) have taken place. As a result, science's understanding of the underlying pathophysiology associated with HPD in youths is greatly lacking. The present study seeks to begin to address this gap in the literature via examination of executive functioning in a stimulant-free sample of children with HPD. Sixteen and 23 children between 9 and 17 years of age meeting DSM-5 diagnostic criteria for HPD or classified as a healthy control, respectively, were recruited (N = 39) to complete structured interviews, self-reports, and a subset of tests from the Cambridge Automatic Neurocognitive Test Assessment Battery (CANTAB) assessing cognitive flexibility/reversal learning (intradimensional/extradimensional; IED), working memory (spatial span; SSP), and planning and organization (Stocking of Cambridge; SOC). Hierarchical regression analyses indicated that, after controlling for appropriate covariates, diagnostic status predicted impaired performance on both the IED (reversal learning only) and SOC (planning and organization) but failed to predict cognitive flexibility or working memory capacity. Correlational analyses revealed that pulling severity was strongly related to working memory capacity, while disparate relationships between pulling styles (automatic, focused pulling) were evident with respect to working memory and planning and organization. Children with HPD performed more poorly on tasks of executive functioning as compared to controls. Correlational analyses suggest potentially distinct pathophysiology underlying automatic and focused pulling warranting further research. Limitations and future areas of inquiry are discussed. © 2015 Wiley Periodicals, Inc.

  5. Pulling cylindrical particles using a soft-nonparaxial tractor beam

    DEFF Research Database (Denmark)

    Novitsky, Andrey; Ding, Weiqiang; Wang, Maoyan

    2017-01-01

    In order to pull objects towards the light source a single tractor beam inevitably needs to be strongly nonparaxial. This stringent requirement makes such a tractor beam somewhat hypothetical. Here we reveal that the cylindrical shape of dielectric particles can effectively mitigate...... the nonparaxiality requirements, reducing the incidence angle of the partial plane waves of the light beam down to 45 degrees and even to 30 degrees for respectively dipole and dipole-quadrupole objects. The optical pulling force attributed to the interaction of magnetic dipole and magnetic quadrupole moments...... of dielectric cylinders occurs due to the TE rather than TM polarization. Therefore, the polarization state of the incident beam can be utilized as an external control for switching between the pushing and pulling forces. The results have application values towards optical micromanipulation, transportation...

  6. 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

  7. Pulling a polymer with anisotropic stiffness near a sticky wall

    International Nuclear Information System (INIS)

    Tabbara, R; Owczarek, A L

    2012-01-01

    We solve exactly a two-dimensional partially directed walk model of a semi-flexible polymer that has one end tethered to a sticky wall, while a pulling force away from the adsorbing surface acts on the free end of the walk. This model generalizes a number of previously considered adsorption models by incorporating individual horizontal and vertical stiffness effects, in competition with a variable pulling angle. A solution to the corresponding generating function is found by means of the kernel method. While the phases and related phase transitions are similar in nature to those found previously the analysis of the model in terms of its physical variables highlights various novel structures in the shapes of the phase diagrams and related behaviour of the polymer. We review the results of previously considered sub-cases, augmenting these findings to include analysis with respect to the model’s physical variables—namely, temperature, pulling force, pulling angle away from the surface, stiffness strength and the ratio of vertical to horizontal stiffness potentials, with our subsequent analysis for the general model focusing on the effect that stiffness has on this pulling angle range. In analysing the model with stiffness we also pay special attention to the case where only vertical stiffness is included. The physical analysis of this case reveals behaviour more closely resembling that of an upward pulling force acting on a polymer than it does of a model where horizontal stiffness acts. The stiffness–temperature phase diagram exhibits re-entrance for low temperatures, previously only seen for three-dimensional or co-polymer models. For the most general model we delineate the shift in the physical behaviour as we change the ratio of vertical to horizontal stiffness between the horizontal-only and the vertical-only stiffness regimes. We find that a number of distinct physical characteristics will only be observed for a model where the vertical stiffness dominates

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

    Science.gov (United States)

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

    2018-02-01

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

  9. 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.

  10. Mode conversion enables optical pulling force in photonic crystal waveguides

    DEFF Research Database (Denmark)

    Zhu, Tongtong; Novitsky, Andrey; Cao, Yongyin

    2017-01-01

    to the conservation of linear momentum. We present the quantitative agreement between the results derived from the mode conversion analysis and those from rigorous simulation using the finite-difference in the time-domain numerical method. Importantly, the optical pulling scheme presented here is robust and broadband...... with a larger forward momentum and the 1st order mode with a smaller forward momentum. When the 1st order mode is launched, the scattering by the object inside the waveguide results in the conversion from the 1st order mode to the 0th order mode, thus creating the optical pulling force according...

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

    Science.gov (United States)

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

    2016-02-11

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

  12. Evaluation of symptom checkers for self diagnosis and triage: audit study

    Science.gov (United States)

    Semigran, Hannah L; Linder, Jeffrey A; Gidengil, Courtney

    2015-01-01

    Objective To determine the diagnostic and triage accuracy of online symptom checkers (tools that use computer algorithms to help patients with self diagnosis or self triage). Design Audit study. Setting Publicly available, free symptom checkers. Participants 23 symptom checkers that were in English and provided advice across a range of conditions. 45 standardized patient vignettes were compiled and equally divided into three categories of triage urgency: emergent care required (for example, pulmonary embolism), non-emergent care reasonable (for example, otitis media), and self care reasonable (for example, viral upper respiratory tract infection). Main outcome measures For symptom checkers that provided a diagnosis, our main outcomes were whether the symptom checker listed the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations). For symptom checkers that provided a triage recommendation, our main outcomes were whether the symptom checker correctly recommended emergent care, non-emergent care, or self care (n=532 standardized patient evaluations). Results The 23 symptom checkers provided the correct diagnosis first in 34% (95% confidence interval 31% to 37%) of standardized patient evaluations, listed the correct diagnosis within the top 20 diagnoses given in 58% (55% to 62%) of standardized patient evaluations, and provided the appropriate triage advice in 57% (52% to 61%) of standardized patient evaluations. Triage performance varied by urgency of condition, with appropriate triage advice provided in 80% (95% confidence interval 75% to 86%) of emergent cases, 55% (47% to 63%) of non-emergent cases, and 33% (26% to 40%) of self care cases (Ptriage advice across the 23 individual symptom checkers ranged from 33% (95% confidence interval 19% to 48%) to 78% (64% to 91%) of standardized patient evaluations. Conclusions Symptom checkers had deficits in both triage and diagnosis. Triage advice from symptom checkers

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

    Directory of Open Access Journals (Sweden)

    Sasser, Scott

    2011-07-01

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

  14. Implementing street triage: a qualitative study of collaboration between police and mental health services.

    Science.gov (United States)

    Horspool, Kimberley; Drabble, Sarah J; O'Cathain, Alicia

    2016-09-07

    Street Triage is a collaborative service between mental health workers and police which aims to improve the emergency response to individuals experiencing crisis, but peer reviewed evidence of the effectiveness of these services is limited. We examined the design and potential impact of two services, along with factors that hindered and facilitated the implementation of the services. We conducted 14 semi-structured interviews with mental health and police stakeholders with experience of a Street Triage service in two locations of the UK. Framework analysis identified themes related to key aspects of the Street Triage service, perceived benefits of Street Triage, and ways in which the service could be developed in the future. Stakeholders endorsed the Street Triage services which utilised different operating models. These models had several components including a joint response vehicle or a mental health worker in a police control room. Operating models were developed with consideration of the local geographical and population density. The ability to make referrals to the existing mental health service was perceived as key to the success of the service yet there was evidence to suggest Street Triage had the potential to increase pressure on already stretched mental health and police services. Identifying staff with skills and experience for Street Triage work was important, and their joint response resulted in shared decision making which was less risk averse for the police and regarded as in the interest of patient care by mental health professionals. Collaboration during Street Triage improved the understanding of roles and responsibilities in the 'other' agency and led to the development of local information sharing agreements. Views about the future direction of the service focused on expansion of Street Triage to address other shared priorities such as frequent users of police and mental health services, and a reduction in the police involvement in crisis

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

    Directory of Open Access Journals (Sweden)

    María Teresa ICART ISERN

    2016-09-01

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

  16. 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.

  17. Oil pulling: A traditional method on the edge of evidence

    Directory of Open Access Journals (Sweden)

    H Mythri

    2017-01-01

    Full Text Available Introduction: Oil pulling is an ancient, traditional folk remedy that has been practiced for centuries in India and southern Asia as a holistic Ayurvedic technique. The practice of oil pulling involves placing a tablespoon of an edible oil (e.g. sesame, olive, sunflower, coconut inside the mouth, and swishing or “pulling” the oil through the teeth and oral cavity for anywhere from 1–5 minutes to up to 20 minutes or longer. Materials and Methods: Articles related to oil pulling were collected by using oil pulling as Keyword in Google and Medline. Out of the 21 related articles published till 2016, 6 articles with the proper study designs were used for analysis. Results: The studies were unreliable for many reasons, including the misinterpretation of results due to small sample size and improper study design. Conclusion: Though the promoters claim it as one of the best method to be as adjuvant to mechanical control methods, scientific evidences are lacking.

  18. Vertical string-pulling in green jays (Cyanocorax yncas).

    Science.gov (United States)

    Manrique, Héctor Marín; Molina, Adriano-Bruno Chaves; Posada, Sandra; Colell, Montserrat

    2017-07-01

    The cognition of green jays (Cyanocorax yncas), a non Corvus corvid species, was investigated by using the string-pulling paradigm. Five adult green jays performed a vertical string-pulling task in which they had to retrieve a worm attached to the end of a vertical hanging string while sitting on their perch. In the first experiment, three of the subjects managed to retrieve the worm by pulling on the string with their beaks and stepping on the resulting loop, and thereafter repeating this sequence until the worm was accessible. When subjects were given a choice between two strings in subsequent experiments 2-4, they chose at random between the string connected to the worm and the one connected to a slice of a wooden dowel. In experiment 5, subjects that had failed the previous discrimination series were able, nevertheless, to solve a more stringent vertical string array in which they had to pull up the whole length of the string without any visual access to the worm at the end. We discuss green jays' performance in comparison with other corvid species in which cognition has been more extensively investigated. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Push an pull forces in the building and construction industry

    NARCIS (Netherlands)

    Frings-Dresen, M. H. W.; Windhorst, Judith; Hoozemans, M. J M; Van Der Beek, Allard J.; Van der Molen, Henk F.

    2000-01-01

    Push and pull activities are increasing in the building and construction industry. These activities can be assumed as one of the risk factors for the development of low back and upper extremity complaints. For a risk evaluation, besides the frequency and the duration of the activities, information

  20. Stability and servo-control of the crystal pulling process

    International Nuclear Information System (INIS)

    Johansen, T.H.

    1990-11-01

    The paper analyzes why the crystal pulling process needs servo-control, and how it can be implemented. Special emphasis is put on the fundamental question of inherent stability, and how to interpret the signal from a balance when the weighing method is used for cystal diameter detection. 15 refs., 13 figs

  1. 'Push' and 'pull' factors influencing the learning of destination ...

    African Journals Online (AJOL)

    This article argues that social, cultural, economic and personal factors affect immigrants' choices to learn a new language in a 'push' and 'pull' manner. Conditions in the origin country and the immigrants' personal lives are referred to as 'push' factors. Conditions in the host community and the attitudes of established ...

  2. Pull factors in the political economy of international commercial sex ...

    African Journals Online (AJOL)

    Pull factors in the political economy of international commercial sex work in Nigeria. Ifeanyi P Onyeonoru. Abstract. No Abstract. African Sociological Review 2004, 8(2): 115-135. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  3. Forces Required to Pull the Superficial Fascia in Facelifts.

    Science.gov (United States)

    Byun, Jin Suk; Hwang, Kun; Lee, Sang Yun; Song, Jae Min; Kim, Hun

    2018-02-01

    The aims of this study were to characterize the histology of the sideburn and cheek area and to measure the force required to pull the superficial fascia (SF) of Asians in facelift procedures. The hemiface of a formalin-fixed Korean male adult cadaver (77 years old) was used to study the histology of the sideburn and cheek area. In 42 patients during facelift procedures, the force needed to pull the overlying skin at the midpoint between the sideburn and nasolabial fold 2 mm was measured using a tensiometer. In the cheek, the superficial fatty layer of the superficial fascia (SFS) was found to maintain its thickness throughout the region between the dermis and the membranous layer of the superficial fascia (MSF). The MSF was continuous with the superficial temporal fascia (STF). In the sideburn, the MSF and parotid fascia closely adhered to each other. The force required to move the overlying skin 2 mm when pulling the MSF (10.27 ± 3.64 N) was more than twice as great (217%) as the force required when pulling the SFS (4.73 ± 2.15 N; P tension than MSF to move the overlying skin. In the cheek area, less tension is needed to move the overlying skin than in the sideburn area.

  4. Pressure Tests on SG Pulled Tubes at TSP Level

    Science.gov (United States)

    Boccanfuso, Marc; Mathon, Cédric

    In 2009, 12 tubes were pulled at the tube support plate level of a Steam Generator at one of France's oldest nuclear power plants. In order to identify the involved mechanisms and to characterise the defects, metallurgical examinations were carried out on these tubes.

  5. THE PULL FACTORS OF INTRA-URBAN RESIDENTIAL MOBILITY ...

    African Journals Online (AJOL)

    Abstract. The principal objective of this study is to identify the major dimensions of the pull factors of residential mobility in Calabar, Nigeria. The data used in the study were generated from a comprehensive questionnaire survey involving. 869 households in the study area. The Principal Component Analysis (PCA).

  6. Magnetic characterization of superparamagnetic nanoparticles pulled through model membranes.

    Science.gov (United States)

    Barnes, Allison L; Wassel, Ronald A; Mondalek, Fadee; Chen, Kejian; Dormer, Kenneth J; Kopke, Richard D

    2007-01-04

    To quantitatively compare in-vitro and in vivo membrane transport studies of targeted delivery, one needs characterization of the magnetically-induced mobility of superparamagnetic iron oxide nanoparticles (SPION). Flux densities, gradients, and nanoparticle properties were measured in order to quantify the magnetic force on the SPION in both an artificial cochlear round window membrane (RWM) model and the guinea pig RWM. Three-dimensional maps were created for flux density and magnetic gradient produced by a 24-well casing of 4.1 kilo-Gauss neodymium-iron-boron (NdFeB) disc magnets. The casing was used to pull SPION through a three-layer cell culture RWM model. Similar maps were created for a 4 inch (10.16 cm) cube 48 MGOe NdFeB magnet used to pull polymeric-nanoparticles through the RWM of anesthetized guinea pigs. Other parameters needed to compute magnetic force were nanoparticle and polymer properties, including average radius, density, magnetic susceptibility, and volume fraction of magnetite. A minimum force of 5.04 x 10(-16) N was determined to adequately pull nanoparticles through the in-vitro model. For the guinea pig RWM, the magnetic force on the polymeric nanoparticles was 9.69 x 10-20 N. Electron microscopy confirmed the movement of the particles through both RWM models. As prospective carriers of therapeutic substances, polymers containing superparamagnetic iron oxide nanoparticles were succesfully pulled through the live RWM. The force required to achieve in vivo transport was significantly lower than that required to pull nanoparticles through the in-vitro RWM model. Indeed very little force was required to accomplish measurable delivery of polymeric-SPION composite nanoparticles across the RWM, suggesting that therapeutic delivery to the inner ear by SPION is feasible.

  7. Lithospheric-scale centrifuge models of pull-apart basins

    Science.gov (United States)

    Corti, Giacomo; Dooley, Tim P.

    2015-11-01

    We present here the results of the first lithospheric-scale centrifuge models of pull-apart basins. The experiments simulate relative displacement of two lithospheric blocks along two offset master faults, with the presence of a weak zone in the offset area localising deformation during strike-slip displacement. Reproducing the entire lithosphere-asthenosphere system provides boundary conditions that are more realistic than the horizontal detachment in traditional 1 g experiments and thus provide a better approximation of the dynamic evolution of natural pull-apart basins. Model results show that local extension in the pull-apart basins is accommodated through development of oblique-slip faulting at the basin margins and cross-basin faults obliquely cutting the rift depression. As observed in previous modelling studies, our centrifuge experiments suggest that the angle of offset between the master fault segments is one of the most important parameters controlling the architecture of pull-apart basins: the basins are lozenge shaped in the case of underlapping master faults, lazy-Z shaped in case of neutral offset and rhomboidal shaped for overlapping master faults. Model cross sections show significant along-strike variations in basin morphology, with transition from narrow V- and U-shaped grabens to a more symmetric, boxlike geometry passing from the basin terminations to the basin centre; a flip in the dominance of the sidewall faults from one end of the basin to the other is observed in all models. These geometries are also typical of 1 g models and characterise several pull-apart basins worldwide. Our models show that the complex faulting in the upper brittle layer corresponds at depth to strong thinning of the ductile layer in the weak zone; a rise of the base of the lithosphere occurs beneath the basin, and maximum lithospheric thinning roughly corresponds to the areas of maximum surface subsidence (i.e., the basin depocentre).

  8. Force feedback effects on single molecule hopping and pulling experiments

    Science.gov (United States)

    Rico-Pasto, M.; Pastor, I.; Ritort, F.

    2018-03-01

    Single-molecule experiments with optical tweezers have become an important tool to study the properties and mechanisms of biological systems, such as cells and nucleic acids. In particular, force unzipping experiments have been used to extract the thermodynamics and kinetics of folding and unfolding reactions. In hopping experiments, a molecule executes transitions between the unfolded and folded states at a preset value of the force [constant force mode (CFM) under force feedback] or trap position [passive mode (PM) without feedback] and the force-dependent kinetic rates extracted from the lifetime of each state (CFM) and the rupture force distributions (PM) using the Bell-Evans model. However, hopping experiments in the CFM are known to overestimate molecular distances and folding free energies for fast transitions compared to the response time of the feedback. In contrast, kinetic rate measurements from pulling experiments have been mostly done in the PM while the CFM is seldom implemented in pulling protocols. Here, we carry out hopping and pulling experiments in a short DNA hairpin in the PM and CFM at three different temperatures (6 °C, 25 °C, and 45 °C) exhibiting largely varying kinetic rates. As expected, we find that equilibrium hopping experiments in the CFM and PM perform well at 6 °C (where kinetics are slow), whereas the CFM overestimates molecular parameters at 45 °C (where kinetics are fast). In contrast, nonequilibrium pulling experiments perform well in both modes at all temperatures. This demonstrates that the same kind of feedback algorithm in the CFM leads to more reliable determination of the folding reaction parameters in irreversible pulling experiments.

  9. Modelling the behaviour of the push-pull gel dosimeter

    International Nuclear Information System (INIS)

    Bosi, S.G.; Davies, J.B.; Gorjiara, T.; Baldock, C.

    2010-01-01

    Full text: Recent development of a gel dosimeter based on the radiobleaching pigment, genipin, allows development of a new 3D optically scanned gel dosimeter-the p ush-pull g el. This gel would contain two spectrally complementary pigments, one which darkens with dose and another (e.g. genipin) which bleaches. The two pigments deal separately with the high and low dose ends of the dosimeter's dynamic range. The bleaching pigment would be optimised for high sensitivity and the darkening pigment for low. Employing dual pigments, optimised independently, relaxes the need for compromise between sensitivity at low dose and accuracy at high dose. Such a gel, after exposure, would be read using two successive optical CT scans, at two different wavelengths. The reduction in sensitivity of the darkening pigment (allowed by the use of push-pull) would reduce the occurrence of regions of high optical attenuation which can generate optical CT artefacts. Simulated optical CT reconstructions of the optical density map (Fig. La) scanned at the darkening pigment wavelength of a hypothetical push-pull gel, confirms the reduction in susceptibility to artefacts. Fig. I b shows a profile through the map with no stray light added. The centre of the profile in Fig. I d shows a cupping artefact produced by 10 ppm of stray light. The similarity of Fig. Ic and b show that a 30% sensitivity reduction allowed by push-pull, renders the artefact negligible. This paper presents the results of' these simulations of a push-pull gel scanned using optical CT and also some results of experiments with genipin gel. (author)

  10. Factors influencing the implementation of the guideline Triage in emergency departments: a qualitative study

    NARCIS (Netherlands)

    Janssen, M.A.P.; van Achterberg, T.; Adriaansen, M.J.M.; Kampshoff, C.S.; Schalk, D.M.J.; Mintjes-de Groot, A.J.

    2012-01-01

    Aims and objectives. The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline.

  11. Factors influencing the implementation of the guideline triage in emergency departments: a qualitative study.

    NARCIS (Netherlands)

    Janssen, M.A.M.; Achterberg, T. van; Adriaansen, M.J.M.; Kampshoff, C.S.; Schalk, D.M.; Mintjes-de Groot, A.J.

    2012-01-01

    AIMS AND OBJECTIVES: The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline.

  12. Comparison of the Emergency Severity Index (ESI and the Taiwan Triage System in Predicting Resource Utilization

    Directory of Open Access Journals (Sweden)

    Chih-Hsien Chi

    2006-01-01

    Conclusion: ESI produces more accurate discriminating patient acuity, ED LOS and hospitalization rate than TTS. Adopting a standardized 5-level triage tool might improve resource utilization planning of ED practice.

  13. 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

  14. [Practice assistant sometimes misses urgent request for help: telephone triage in general practice].

    Science.gov (United States)

    Smits, M; Hanssen, S; Huibers, L; Giesen, P

    2016-01-01

    To assess the organisation and appropriateness of telephone triage in general practices in the Netherlands. Cross-sectional observational study. Via e-mail we invited all members of the Dutch Association of practice assistants to complete an online survey. The questionnaire included questions about practice assistants' background characteristics and the practices' triage organisation. Furthermore, they were asked to assess the indicated type of care for a number of fictive case scenarios involving a variety of health problems and levels of urgency. To determine the appropriateness of the respondents' assessments, each was compared to a reference standard agreed by experts. In addition, the association between practice assistants' background characteristics and organizational setup of the triage organisation with the appropriateness of triage was examined. The response rate was 41.1% (N=973). The required care was assessed appropriately in 63.6% of the cases, over-estimated in 19.3% and under-estimated in 17.1% of cases. The sensitivity of identifying patients with a highly urgent problem was 76.7%, whereas the specificity was 94.0%. The appropriateness of the assessments of the required care was higher for more experienced assistants and assistants with regular daily work meetings with the GP. Triage training, use of a triage tool and authorization of advice provision were not associated with appropriateness of triage. Triage by practice assistants in general practices is efficient, but potentially unsafe in highly urgent cases. It is therefore important to train practice assistants in the identification of highly urgent cases.

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

    Science.gov (United States)

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

    2015-11-01

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

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

    Science.gov (United States)

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

    2016-01-01

    Objectives 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. Design 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. Setting A predefined area of Sussex, South East England, UK. Participants All people who were detained under section 136 within the predefined area or had contact with the street triage team. Interventions The street triage model used here was based on a psychiatric nurse attending incidents with a police constable. Primary and secondary outcome measures 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. Results Detentions under section 136 in the street triage period were significantly lower than in the usual response period (118 vs 194 incidents, respectively; χ2 (1df) 18.542, ptriage period compared to £1077 in the usual response period. Conclusions 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. PMID:26868943

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

    Science.gov (United States)

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

    2014-10-01

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

  18. The Role Descriptions of Triage Nurse in Emergency Department: A Delphi Study

    Directory of Open Access Journals (Sweden)

    Mohsen Ebrahimi

    2016-01-01

    Full Text Available Background. Triage nurses play a pivotal role in the emergency department. However some researchers have attempted to expand triage nurse’s role; remarkable discrepancies exist among scholarly communities. The aim was to develop a role description of triage nurse relying on the experts. Methods. A modified Delphi study consisting of 3 rounds was performed from March to October 2014. In the first round, an extensive review of the literature was conducted. Expert selection was conducted through a purposeful sample of 38 emergency medicine experts. Results. Response rates for the second and third rounds were 37% and 58%. Average age of panelists was (38.42±5.94 years. Thirty-nine out of 54 items reached to the final round. Prioritizing had the higher agreement rate and least agreement on triage related interventions. Conclusion. Triage nursing as a relatively new role for nurses needs significant development to be practiced. Comprehensive educational programs and developmental research are required to support diagnostic and therapeutic interventions in triage practice by nurses.

  19. Impact of an Emergency Triage Assessment and Treatment (ETAT)-based triage process in the paediatric emergency department of a Guatemalan public hospital.

    Science.gov (United States)

    Crouse, Heather L; Torres, Francisco; Vaides, Henry; Walsh, Michael T; Ishigami, Elise M; Cruz, Andrea T; Torrey, Susan B; Soto, Miguel A

    2016-08-01

    Triage process implementation has been shown to be effective at improving patient outcomes. This study sought to develop, implement and assess the impact of an Emergency Triage Assessment and Treatment (ETAT)-based emergency triage process in the paediatric emergency department (PED) of a public hospital in Guatemala. The study was a quality improvement comparison with a before/after design. Uptake was measured by percentage of patients with an assigned triage category. Outcomes were hospital admission rate, inpatient length of stay (LOS), and mortality as determined by two distinct medical record reviews for 1 year pre- and post-intervention: a random sample (RS) of all PED patients and records for all critically-ill (CI) children [serious diagnoses or admission to the paediatric intensive care unit (PICU)]. Demographics, diagnoses and disposition were recorded. The RS totalled 1027 (51.4% male); median ages pre- and post-intervention were 2.0 and 2.4 years, respectively. There were 196 patients in the CI sample, of whom 56.6% were male and one-third were neonates; median ages of the CI group pre- and post-intervention were 3.1 and 5.6 months, respectively. One year after implementation, 97.5% of medical records had been assigned triage categories. Triage categories (RS/CI) were: emergency (2.9%/54.6%), priority (47.6%/44.4%) and non-urgent (49.4%/1.0%). The CI group was more frequently diagnosed with shock (25%/1%), seizures (9%/0.5%) and malnutrition (6%/0.5%). Admission rates for the RS (8% vs 4%, P=0.01) declined after implementation. For the CI sample, admission rate to the PICU (47% vs 24%, P=0.002) decreased and LOS (7.3 vs 5.7 days, P=0.09) and mortality rates (12% vs 6%, P=0.15) showed trends toward decreasing post-implementation. Paediatric-specific triage algorithms can be implemented and sustained in resource-limited settings. Significant decreases in admission rates (both overall and for the PICU) and trends towards decreased LOS and mortality rates

  20. Different Results of Proximal Coronary Endarterectomy via Conventional Pull-Out Method

    OpenAIRE

    Başar Sareyyüpoğlu; Özgür Yıldırım; Kaan Kırali

    2012-01-01

    In these cases we overview two different results of coronary endarterectomy via conventional pull-out method. Performing proximal aggressive coronary endarterectomy by pull-out method can cause undesirable complication in the proximal coronary artery segment.

  1. The Phenomenology of Hair Pulling Urges in Trichotillomania: A Comparative Approach

    OpenAIRE

    Madjar, Shai; Sripada, Chandra S.

    2016-01-01

    Trichotillomania is a disorder characterized by recurrent urges to pull out one's hair, but the experiential characteristics of hair pulling urges are poorly understood. This study used a comparative approach to understand the subjective phenomenology of hair pulling: participants with trichotillomania symptoms were asked about their hair pulling urges as well as their urges to eat unhealthy foods. Participants who reported experiencing problematic unhealthy food urges were identified and ask...

  2. The phenomenology of hair pulling urges in trichotillomania: a comparative approach

    OpenAIRE

    Shai eMadjar; Shai eMadjar; Chandra S. Sripada; Chandra S. Sripada

    2016-01-01

    Trichotillomania is a disorder characterized by recurrent urges to pull out one’s hair, but the experiential characteristics of hair pulling urges are poorly understood. This study used a comparative approach to understand the subjective phenomenology of hair pulling: participants with trichotillomania symptoms were asked about their hair pulling urges as well as their urges to eat unhealthy foods. Participants who reported experiencing problematic unhealthy food urges were identified and ask...

  3. 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.

  4. Pharmacotherapy of trichotillomania (hair pulling disorder): an updated systematic review.

    Science.gov (United States)

    Rothbart, Rachel; Stein, Dan J

    2014-12-01

    Individuals affected by trichotillomania (TTM) (hair-pulling disorder) consciously or non-consciously pull out their own body hair. The disorder has recently been incorporated into a chapter entitled, 'Obsessive-Compulsive and Related Disorders' in the diagnostic and statistical manual of mental disorders, fifth edition. The review describes the literature currently available on the pharmacotherapy for TTM, including both randomized controlled trials and open-label trials of pharmacotherapy for TTM in adults or children. Early work focused on the serotonin reuptake inhibitors; however, the majority of the trials have been negative. There is a small body of evidence focused on pharmacotherapy for TTM. In future, larger trials are required to expand on the preliminary evidence available for N-acetylcysteine, olanzapine and dronabinol in recent trials.

  5. Pull-in and wrinkling instabilities of electroactive dielectric actuators

    Energy Technology Data Exchange (ETDEWEB)

    De Tommasi, D; Puglisi, G; Zurlo, G [Dipartimento di Ingegneria Civile e Ambientale, Politecnico di Bari, 70125 Bari (Italy); Saccomandi, G [Dipartimento di Ingegneria Industriale, Universita degli Studi di Perugia, 06125 Perugia (Italy)

    2010-08-18

    We propose a model to analyse the insurgence of pull-in and wrinkling failures in electroactive thin films. We take into consideration both cases of voltage and charge control, the role of pre-stretch and the size of activated regions, which are all crucial factors in technological applications of electroactive polymers (EAPs). Based on simple geometrical and material assumptions we deduce an explicit analytical description of these phenomena, allowing a clear physical interpretation of different failure mechanisms such as the occurrence of pull-in and wrinkling. Despite our simple assumptions, the comparison with experiments shows a good qualitative and, interestingly, quantitative agreement. In particular our model shows, in accordance with experiments, the existence of different optimal pre-stretch values, depending on the choice of the actuating parameter of the EAP.

  6. Frobenius pull backs of vector bundles in higher dimensions

    Indian Academy of Sciences (India)

    In case E is not semistable, then one has the notion of Harder–Narasimhan filtration of E. In this paper, we discuss the behaviour of Harder–Narasimhan filtrations of torsion free sheaves on X, under Frobenius pull-backs. We recall a well-known result (Corollary 2p in [7]) of Shepherd–Barron and Sun. (Theorem 3.1 in [8]):.

  7. Laparoscopic Swenson pull-through procedure for congenital megacolon.

    Science.gov (United States)

    George, C; Hammes, M; Schwarz, D

    1995-11-01

    Constipation that is unresponsive to conventional remedies is the primary symptom of congenital megacolon (ie, Hirschsprung's disease). The cause of congenital megacolon is lack of ganglion cells in the bowel. The laparoscopic Swenson pull-through procedure involves removing the aganglionic segment of the colon, bringing the normally decompressed bowel through the pelvic floor, and anastomosing the bowel to the anorectal verge. Advantages of the laparoscopic approach include shorter lengths of hospital stay and fewer complications resulting from disruption of skin integrity.

  8. 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...

  9. White matter integrity in hair-pulling disorder (trichotillomania).

    Science.gov (United States)

    Roos, Annerine; Fouche, Jean-Paul; Stein, Dan J; Lochner, Christine

    2013-03-30

    Hair-pulling disorder (trichotillomania, HPD) is a disabling condition that is characterized by repetitive hair-pulling resulting in hair loss. Although there is evidence of structural grey matter abnormalities in HPD, there is a paucity of data on white matter integrity. The aim of this study was to explore white matter integrity using diffusion tensor imaging (DTI) in subjects with HPD and healthy controls. Sixteen adult female subjects with HPD and 13 healthy female controls underwent DTI. Hair-pulling symptom severity, anxiety and depressive symptoms were also assessed. Tract-based spatial statistics were used to analyze data on fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). There were no differences in DTI measures between HPD subjects and healthy controls. However, there were significant associations of increased MD in white matter tracts of the fronto-striatal-thalamic pathway with longer HPD duration and increased HPD severity. Our findings suggest that white matter integrity in fronto-striatal-thalamic pathways in HPD is related to symptom duration and severity. The molecular basis of measures of white matter integrity in HPD deserves further exploration. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. Directional preference in dogs: Laterality and "pull of the north".

    Science.gov (United States)

    Adámková, Jana; Svoboda, Jan; Benediktová, Kateřina; Martini, Sabine; Nováková, Petra; Tůma, David; Kučerová, Michaela; Divišová, Michaela; Begall, Sabine; Hart, Vlastimil; Burda, Hynek

    2017-01-01

    Laterality is a well described phenomenon in domestic dogs. It was shown that dogs, under calm Earth's magnetic field conditions, when marking their home ranges, tend to head about north- or southwards and display thus magnetic alignment. The question arises whether magnetic alignment might be affected or even compromised by laterality and vice versa. We tested the preference of dogs to choose between two dishes with snacks that were placed left and right, in different compass directions (north and east, east and south, south and west or west and north) in front of them. Some dogs were right-lateral, some left-lateral but most of them were ambilateral. There was a preference for the dish placed north compared to the one placed east of the dog ("pull of the north"). This effect was highly significant in small and medium-sized breeds but not in larger breeds, highly significant in females, in older dogs, in lateralized dogs but less significant or not significant in males, younger dogs, or ambilateral dogs. Laterality and "pull of the north" are phenomena which should be considered in diverse tasks and behavioral tests with which dogs or other animals might be confronted. The interaction and possible conflict between lateralization and "pull of the north" might be also considered as a reason for shifted magnetic alignment observed in different animal species in different contexts.

  11. Destructive examination and analyses of pulled steam generator tubes

    International Nuclear Information System (INIS)

    Kim, Dong Jin; Kim, H. P.; Kim, J. S.; Lim, Y. S.; Hwang, S. S.; Kim, S. W.; Jeong, M. K.; Hong, J. H.; Kim, W. W.

    2011-07-01

    Steam generator model F in Kori 3, Younggwang 2 and Younggwang 1 as 950MWe PWR was provided by Westinghouse. Steam generator tube made of Alloy 600TT material (outer diameter 0.688'(17.475 mm), thickness 0.04'(1.016mm) in Blairsville was provided by Huntington alloys. Steam generator in Ulchin 4 as 1000MWe KHNP PWR was manufactured by Doosan heavy industry and steam generator tubes were manufactured by B and W (Bobcock and Wilcox). Alloy 600 MA was used as steam generator tubing material of outer diameter 19.05mm and thickness 1.07mm. Five tubes of Alloy 600TT which showed crack signal from non-destructive examination were pulled from Kori 3, Younggwang 2 and Younggwang 1. Two tubes which showed crack signal from non-destructive examination were pulled from Ulchin 4. For the pulled tubes, KAERI performed destructive examination. Through the destructive examination, the existence of cracks were confirmed and the cause of crack was investigated. Remedy was also suggested to mitigate the present circumstances. Stress corrosion cracking (SCC) was observed for Alloy 600TT tubes. It was recommended that the sludge content should be lowered, deleterious elements and MRI should be maintained continuously. For Ulchin 4, SCC was confirmed for Alloy 600MA tubes. It is necessary to lower and remove the sludge in the near term. In the longer term, replacement of steam generator was suggested

  12. Future application of Czochralski crystal pulling for silicon

    Science.gov (United States)

    Matlcok, J. H.

    1985-08-01

    Czochralski (Cz) crystal pulling has been the predominant method used for preparing silicon single crystal for the past twenty years. The fundamental technology used has changed little. However, great strides have been made in learning how to make the crystals bigger and of better quality at ever increasing productivity rates. Currently charge sizes of 50 kg of polycrystal silicon are being used for production and crystals up to ten inches in diameter have been grown without major difficulty. The largest material actually being processed in silicon wafer form is 150 mm (6 inches) in diameter. Growing of crystals in a magnetic field has proved to be particularly useful for microscopic impurity control. Major developments in past years on equipment for Cz crystal pulling have included the automatic growth control of the diameter as well as the starting core of the crystal, the use of magnetic fields and around the crystal puller to supress convection, various recharging schemes for dopant control and the use of continuous liquid feed in the crystal puller. The latter, while far from being a reliable production process, is ideal in concept for major improvement in Cz crystal pulling. The Czochralski process will maintain its dominance of silicon crystal production for many years.

  13. The string-pulling paradigm in comparative psychology.

    Science.gov (United States)

    Jacobs, Ivo F; Osvath, Mathias

    2015-05-01

    String pulling is one of the most widely used paradigms in comparative psychology. First documented 2 millennia ago, it has been a well-established scientific paradigm for a century. More than 160 bird and mammal species have been tested in over 200 studies with countless methodological variations. The paradigm can be used to address a wide variety of issues on animal cognition; for example, what animals understand about contact and connection as well as whether they rely on perceptual feedback, grasp the functionality of strings, generalize across conditions, apply their knowledge flexibly, and possess insight. Mammals are typically tested on a horizontal configuration, birds on a vertical one, making the studies difficult to compare; in particular, pulling a string vertically requires better coordination and attention. A species' performance on the paradigm is often influenced by its ecology, especially concerning whether limbs are used for foraging. Many other factors can be of importance and should be considered. The string-pulling paradigm is easy to administer, vary, and apply to investigate a wide array of cognitive abilities. Although it can be and has been used to compare species, divergent methods and unclear reporting have limited its comparative utility. With increasing research standards, the paradigm is expected to become an even more fundamental tool in comparative psychology. (c) 2015 APA, all rights reserved).

  14. Tissue Triage and Freezing for Models of Skeletal Muscle Disease

    Science.gov (United States)

    Meng, Hui; Janssen, Paul M.L.; Grange, Robert W.; Yang, Lin; Beggs, Alan H.; Swanson, Lindsay C.; Cossette, Stacy A.; Frase, Alison; Childers, Martin K.; Granzier, Henk; Gussoni, Emanuela; Lawlor, Michael W.

    2014-01-01

    Skeletal muscle is a unique tissue because of its structure and function, which requires specific protocols for tissue collection to obtain optimal results from functional, cellular, molecular, and pathological evaluations. Due to the subtlety of some pathological abnormalities seen in congenital muscle disorders and the potential for fixation to interfere with the recognition of these features, pathological evaluation of frozen muscle is preferable to fixed muscle when evaluating skeletal muscle for congenital muscle disease. Additionally, the potential to produce severe freezing artifacts in muscle requires specific precautions when freezing skeletal muscle for histological examination that are not commonly used when freezing other tissues. This manuscript describes a protocol for rapid freezing of skeletal muscle using isopentane (2-methylbutane) cooled with liquid nitrogen to preserve optimal skeletal muscle morphology. This procedure is also effective for freezing tissue intended for genetic or protein expression studies. Furthermore, we have integrated our freezing protocol into a broader procedure that also describes preferred methods for the short term triage of tissue for (1) single fiber functional studies and (2) myoblast cell culture, with a focus on the minimum effort necessary to collect tissue and transport it to specialized research or reference labs to complete these studies. Overall, this manuscript provides an outline of how fresh tissue can be effectively distributed for a variety of phenotypic studies and thereby provides standard operating procedures (SOPs) for pathological studies related to congenital muscle disease. PMID:25078247

  15. 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.

  16. A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures.

    Science.gov (United States)

    Culley, Joan M; Svendsen, Erik

    2014-01-01

    Mass casualty incidents (MCIs) include natural (eg, earthquake) or human (eg, terrorism or technical) events. They produce an imbalance between medical needs and resources necessitating the use of triage strategies. Triage of casualties must be performed accurately and efficiently if providers are to do the greatest good for the greatest number. There is limited research on the validation of triage system efficacy in determining the priority of care for victims of MCI, particularly those involving chemicals. To review the literature on the validation of current triage systems to assign on-site treatment status codes to victims of mass casualties, particularly those involving chemicals, using actual patient outcomes. The focus of this article is a systematic review of the literature to describe the influences of MCIs, particularly those involving chemicals, on current triage systems related to the on-site assignment of treatment status codes to a victim and the validation of the assigned code using actual patient outcomes. There is extensive literature published on triage systems used for MCI but only four articles used actual outcome data to validate mass casualty triage outcomes including three for chemical events. Currently, the amount and type of data collected are not consistent or standardized and definitions are not universal. Current literature does not provide needed evidence on the validity of triage systems for MCI in particular those involving chemicals. Well designed studies are needed to validate the reliability, sensitivity, and specificity of triage systems used for MCI including those involving chemicals.

  17. Evaluation of the implementation of the South African Triage System at an academic hospital in central Haiti.

    Science.gov (United States)

    Rouhani, Shada A; Aaronson, Emily; Jacques, Angella; Brice, Sandy; Marsh, Regan H

    2017-07-01

    Effective triage is an important part of high quality emergency care, yet is frequently lacking in resource-limited settings. The South African Triage Scale (SATS) is designed for these settings and consists of a numeric score (triage early warning score, TEWS) and a list of clinical signs (known as discriminators). Our objective was to evaluate the implementation of SATS at a new teaching hospital in Haiti. A random sample of emergency department charts from October 2013 were retrospectively reviewed for the completeness and accuracy of the triage form, correct calculation of the triage score, and final patient disposition. Over and under triage were calculated. Comparisons were evaluated with chi-squared analysis. Of 390 charts were reviewed, 385 contained a triage form and were included in subsequent analysis. The final triage color was recorded for 68.4% of patients, clinical discriminators for 48.6%, and numeric score for 96.1%. The numeric score was calculated correctly 78.3% of the time; in 13.2% of patients a calculation error was made that would have changed triage priority. In 23% of cases, chart review identified clinical discriminators should have been circled but were not recorded. Overtriage and undertriage were 75.6% and 7.4% respectively. This study demonstrates that with limited structured training, SATS was widely adopted, but the clinical discriminators were used less commonly than the numeric score. This should be considered in future implementations of SATS. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Triage of war-injured troops in the Iran-Iraq War

    Directory of Open Access Journals (Sweden)

    Masoud Saghafi-Nia

    2008-02-01

    Full Text Available

    • BACKGROUND: This study compared the triage of Iran-Iraq war-injured troops within the first two years of the war with that after the first two years.
    • METHODS: This was a retrospective study, which compared the triage of the admissions for abdominal injuries during the first two years of the Iran-Iraq War with that in the next 6 years. Out of nearly 50,000 cases, 1,176 ones were randomly selected and their triage information was recorded and analyzed. 
    • RESULTS: About 12.5% of patients were operated on within less than 8 hours during the first two years. From 1982 towards the end of the conflict (1988, the patients were treated within progressively shorter periods of sustaining injury; 68.8% were operated on within less than 4 hours of injury. The mean delay between injury and treatment in the first two years of war was 12 hours while it was 5 hours between 1982 and 1988. The difference was significant (P<0.05 but the mortality rate was not significantly different.
    • CONCLUSIONS: Patient triage was conducted differently at various stages of conflict. Better patient triage after 1982, may have been due to improved care and more specialized triage of injured troops.
    • Key words: Iran-Iraq war, abdominal injuries, triage.

  19. 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.

  20. Agreement between triage category and patient's perception of priority in emergency departments.

    Science.gov (United States)

    Toloo, Ghasem-Sam; Aitken, Peter; Crilly, Julia; FitzGerald, Gerry

    2016-10-18

    Patients attending hospital emergency departments (ED) commonly cite the urgency and severity of their condition as the main reason for choosing the ED. However, the patients' perception of urgency and severity may be different to the nurses' perception of their urgency and severity, which is underpinned by their professional experience, knowledge, training and skills. This discordance may be a cause of patient dissatisfaction. The purpose of this study is to understand the extent of agreement/disagreement between the patient's perceived priority and actual triage category and associated factors. A cross-sectional survey of 417 patients attending eight public hospital EDs in Queensland, Australia between March and May 2011 was conducted. The survey included patient's perceived priority and other health-related, socio-demographic and perceptual factors. Patients' triage category data were retrieved from their ED records and linked back to their survey data. Descriptive and multinomial logistic regression analyses were used. Over 48 % of the respondents expected to be given higher priority than the actual triage category they were assigned; 31 % had their perceived priority matched with the triage category; and 20 % of the respondents expected a lower priority than the triage category they received (Kappa 0.07, p triage category or anticipated a lower priority. In the multivariate analysis, only perceived urgency remained significantly associated with expected higher priority (OR = 1.27, 95 % CI: 1.14-1.43). Our findings clearly confirmed the discrepancy between patient perception of urgency and staff assessment of urgency. This can have important implications particularly for the patients who underrate the urgency of their condition. Improved and open communication and the incorporation of the 'patient voice' into the triage process require understanding the patient's perspectives and their involvement in the decision making process. Noted differences

  1. Hirschsprung's disease: problems with transition-zone pull-through.

    Science.gov (United States)

    Ghose, S I; Squire, B R; Stringer, M D; Batcup, G; Crabbe, D C

    2000-12-01

    It is generally accepted that if surgery for Hirschsprung's disease is to be successful, ganglionic bowel must be anastomosed to the lower rectum or anal canal. Above the aganglionic distal bowel lies a transition zone (TZ) where more subtle abnormalities of innervation are apparent. The significance of this transition zone in respect to the functional outcome of surgery has received little attention. The aim of this study was to identify the incidence of transition zone pull-through (TZPT) in a cohort of children who underwent surgery for Hirschsprung's disease, to identify the reasons why TZPTs occurred, and to identify the functional consequences. The authors report the long-term outcome of these children with emphasis on bowel function and the results of subsequent surgery. A Retrospective study was conducted of children treated at a single institution from 1979 through 1994. TZPT patients were subject to detailed review of surgical records and histopathologic material. Thirteen children were identified with a TZPT. In 12 cases, histopathologic errors contributed to the TZPT: in 5 cases this was caused by single point biopsies missing an asymmetrical TZ, whereas in 7 cases the histopathologic features of the TZ were not recognized. In 1 case the TZPT was caused by surgical error. As a consequence of the TZPT 7 children underwent repeat pull-through. One child is fully continent, one has daytime fecal continence, and 2 others are incontinent. Two children have permanent stomas. One child is clean with antegrade colonic washouts. Repeat pull-throughs were not attempted in 6 children. Two children have achieved full continence, 2 have permanent stomas, 1 is clean with antegrade colonic washouts, and 1 child receives regular suppositories. Transition zone pull-throughs occurred because of a combination of surgical and histopathologic errors. The transition zone may follow an asymmetric course around the circumference of the bowel and may be missed if single

  2. Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

    Directory of Open Access Journals (Sweden)

    Jonsson Håkan

    2011-06-01

    Full Text Available Abstract Emergency department (ED triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity. Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability was limited for one triage scale and insufficient or

  3. Effect of Reverse Triage on Creation of Surge Capacity in a Pediatric Hospital.

    Science.gov (United States)

    Kelen, Gabor D; Troncoso, Ruben; Trebach, Joshua; Levin, Scott; Cole, Gai; Delaney, Caitlin M; Jenkins, J Lee; Fackler, James; Sauer, Lauren

    2017-04-03

    The capacity of pediatric hospitals to provide treatment to large numbers of patients during a large-scale disaster remains a concern. Hospitals are expected to function independently for as long as 96 hours. Reverse triage (early discharge), a strategy that creates surge bed capacity while conserving resources, has been modeled for adults but not pediatric patients. To estimate the potential of reverse triage for surge capacity in an academic pediatric hospital. In this retrospective cohort study, a blocked, randomized sampling scheme was used including inpatients from 7 units during 196 mock disaster days distributed across the 1-year period from December 21, 2012, through December 20, 2013. Patients not requiring any critical interventions for 4 successive days were considered to be suitable for low-risk immediate reverse triage. Data were analyzed from November 1, 2014, through November 21, 2016. Proportionate contribution of reverse triage to the creation of surge capacity measured as a percentage of beds newly available in each unit and in aggregate. Of 3996 inpatients, 501 were sampled (268 boys [53.5%] and 233 girls [46.5%]; mean [SD] age, 7.8 [6.6] years), with 10.8% eligible for immediate low-risk reverse triage and 13.2% for discharge by 96 hours. The psychiatry unit had the most patients eligible for immediate reverse triage (72.7%; 95% CI, 59.6%-85.9%), accounting for more than half of the reverse triage effect. The oncology (1.3%; 95% CI, 0.0%-3.9%) and pediatric intensive care (0%) units had the least effect. Gross surge capacity using all strategies (routine patient discharges, full use of staffed and unstaffed licensed beds, and cancellation of elective and transfer admissions) was estimated at 57.7% (95% CI, 38.2%-80.2%) within 24 hours and 84.1% (95% CI, 63.9%-100%) by day 4. Net surge capacity, estimated by adjusting for routine emergency department admissions, was about 50% (range, 49.1%-52.6%) throughout the 96-hour period. By accepting higher

  4. Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

    Science.gov (United States)

    2011-01-01

    Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other

  5. Triage for Patients with Spinal Complaints: A Systematic Review of the Literature.

    Science.gov (United States)

    McEvoy, Claire; Wiles, Louise; Bernhardsson, Susanne; Grimmer, Karen

    2017-01-01

    The aim of this study is to provide a systematic overview of the past decade of literature on processes of triage for patients with spinal pain, outcomes measured and markers of effectiveness. A systematic search of the literature with narrative synthesis of findings was conducted. Studies in English language of any design concerning spinal triage programmes for adults with acute or chronic spinal complaints were considered for inclusion. Electronic database searches were conducted in OVID, Medline, Embase, CINAHL, Health Source Nursing, Scopus and Web of Science. Additional references were sourced through pearling reference lists, and expert input. Findings were synthesized descriptively. Of 216 potentially relevant records, 21 papers (20 studies) were included. There was little commonality in triage activities/programmes and outcomes, although physiotherapists were common members of triage programmes. Positive outcomes were reported most commonly for wait times, with several studies also reporting high levels of patient and physician satisfaction. Outcomes such as surgical conversion rates and selection accuracy were less clear. Spinal triage programmes have the potential to improve efficiency of care for outpatients with spinal complaints. The evidence gaps in health outcomes, service models and cost effectiveness should be addressed by more robust prospective research designs. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    L N Goldstein

    2017-03-01

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

  8. 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

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

    International Nuclear Information System (INIS)

    Bazan, Jose G.; Chang, Polly; Balog, Robert; D'Andrea, Annalisa; Shaler, Thomas; Lin, Hua; Lee, Shirley; Harrison, Travis; Shura, Lei; Schoen, Lucy; Knox, Susan J.; Cooper, David E.

    2014-01-01

    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

  10. External validation and modification of a pediatric trauma triage tool.

    Science.gov (United States)

    Nasr, Ahmed; Mikrogianakis, Angelo; McDowall, Dorothy; Wales, Paul

    2007-03-01

    Simon et al. developed a simple secondary triage tool (mPTS) based on physiologic parameters and physical findings to identify pediatric trauma patients who had a low likelihood of serious injury. Such patients could be treated in the emergency room without full trauma team activation. Our objective was to evaluate the mPTS on the trauma population at our institution, a Level I pediatric trauma center. This was a retrospective cohort study of all trauma team activations at The Hospital for Sick Children (Sick Kids) (1999-2002), excluding penetrating trauma and burns. Patients were stratified into high-risk (Injury Severity Score [ISS] >or=12) and low-risk (ISS mPTS evaluates airway integrity, open wounds, neurologic status, hemodynamics, and skeletal integrity and applies a score of 1 point to each criterion. There were 628 trauma patients (382 boys, mean age of 8 +/- 3.8 years). The mPTS had a sensitivity of 92% and a positive predictive value (PPV) of 47% when applied to our population. The mPTS missed 21 patients with significant injuries, many were intra-abdominal. We modified the mPTS to include contusions to head and/or torso and a history of loss of consciousness and a 7-point score was developed. After modification the sensitivity was 99%, specificity 21%, and PPV of 46% with a 20% reduction in unnecessary trauma team activations. The original mPTS by Simon et al. was not sensitive enough when applied to our population. The Sick Kids modification to the score improved the sensitivity to 99%. The PPV of 46% indicates a safe level of overtriage is maintained. The Sick Kids mPTS remains easy to apply and would have reduced trauma team activation by 20%.

  11. Benefit of "Push-pull" Locomotion for Planetary Rover Mobility

    Science.gov (United States)

    Creager, Colin M.; Moreland, Scott Jared; Skonieczny, K.; Johnson, K.; Asnani, V.; Gilligan, R.

    2011-01-01

    As NASAs exploration missions on planetary terrains become more aggressive, a focus on alternative modes of locomotion for rovers is necessary. In addition to climbing steep slopes, the terrain in these extreme environments is often unknown and can be extremely hard to traverse, increasing the likelihood of a vehicle or robot becoming damaged or immobilized. The conventional driving mode in which all wheels are either driven or free-rolling is very efficient on flat hard ground, but does not always provide enough traction to propel the vehicle through soft or steep terrain. This paper presents an alternative mode of travel and investigates the fundamental differences between these locomotion modes. The methods of push-pull locomotion discussed can be used with articulated wheeled vehicles and are identified as walking or inchinginch-worming. In both cases, the braked non-rolling wheels provide increased thrust. An in-depth study of how soil reacts under a rolling wheel vs. a braked wheel was performed by visually observing the motion of particles beneath the surface. This novel technique consists of driving or dragging a wheel in a soil bin against a transparent wall while high resolution, high-rate photographs are taken. Optical flow software was then used to determine shearing patterns in the soil. Different failure modes were observed for the rolling and braked wheel cases. A quantitative comparison of inching vs. conventional driving was also performed on a full-scale vehicle through a series of drawbar pull tests in the Lunar terrain strength simulant, GRC-1. The effect of tire stiffness was also compared; typically compliant tires provide better traction when driving in soft soil, however its been observed that rigid wheels may provide better thrust when non-rolling. Initial tests indicate up to a possible 40 increase in pull force capability at high slip when inching vs. rolling.

  12. N -annulated perylene-based push-pull-type sensitizers

    KAUST Repository

    Qi, Qingbiao

    2015-02-06

    Alkoxy-wrapped N-annulated perylene (NP) was synthesized and used as a rigid and coplanar π-linker for three push-pull type metal-free sensitizers QB1-QB3. Their optical and electrochemical properties were tuned by varying the structure of acceptor. These new dyes were applied in Co(II)/(III) based dye-sensitized solar cells, and power conversion efficiency up to 6.95% was achieved, indicating that NP could be used as a new building block for the design of high-performance sensitizers in the future.

  13. Nonlinear Finite Element Analysis of Pull-Out Test

    DEFF Research Database (Denmark)

    Saabye Ottesen, N

    1981-01-01

    A specific pull-out test used to determine in-situ concrete compressive strength is analyzed. This test consists of a steel disc that is extracted from the structure. The finite element analysis considers cracking as well as strain hardening and softening in the pre- and post-failure region......, respectively. The aim is to attain a clear insight into structural behavior. Special attention is given to the failure mode. Severe cracking occurs and the stress distribution is very inhomogeneous. However, large compressive forces run from the disc in a rather narrow band towards the support...

  14. Early abdomino-perineal pull-through vaginoplasty

    Directory of Open Access Journals (Sweden)

    Ilhan Ciftci

    2013-01-01

    Full Text Available Vaginal agenesis is known as one of the Mόllerian anomalies. Mόllerian anomalies occur during gonadal development and differentiation, and may lead to complex outcomes. McKusick-Kaufman syndrome (MKS is an autosomal recessive multiple malformation syndrome characterized by Mόllerian anomalies with hydrometrocolpos (HMC and postaxial polydactyly (PAP. We report a case of a female newborn that developed hydronephrosis and respiratory distress due to compression of the cystic mass and underwent surgery on postpartum day 3. Pull-through vaginoplasty was performed with an abdomino-perineal approach. We report the unique treatment approach in this case.

  15. Implementation and evaluation of a pre-assessment telephone triage system in an outpatient photopheresis service.

    Science.gov (United States)

    Rushton, Cherie; Robertson, Leeah; Taylor, Tracie; Taylor, Peter; Alfred, Arun

    2017-04-13

    The prompt assessment of patients as fit for photopheresis is imperative to ensure delivery of a safe and efficient service. Before January 2015 the photopheresis unit was reliant on patients contacting the department directly to cancel their appointment if they were unwell or were suffering from any pre-defined exclusion criteria. Methods to reduce the number of cancellations and patients arriving unwell were therefore examined. The authors combined aspects of patient pre-assessment with telephone triage to develop a system that could provide better care and improve the use of resources within the department. The pre-assessment telephone triage system successfully reduced cancellations and increased patient awareness of conditions that would prevent delivery of photopheresis treatment. Subsequently the quality improvement initiative established that the pre-assessment telephone triage system saved the photopheresis unit over £33 000 over a 12-month period.

  16. Can ambulance telephone triage using NHS Pathways accurately identify paediatric cardiac arrest?

    Science.gov (United States)

    Deakin, Charles D; England, Simon; Diffey, Debbie; Maconochie, Ian

    2017-07-01

    Most out-of-hospital paediatric cardiac arrests (CA) are not identified until a call is made to the emergency medical services. Accurate identification increases overall survival by enabling immediate ambulance dispatch and delivery of bystander CPR. European ambulance services use a variety of didactic telephone scripts to interrogate the caller and rapidly identify paediatric CA. The performance of these scripts has not been reported. This study aims to evaluate the diagnostic accuracy of the NHS Pathways as a telephone triage tool to identify patients less than 16 years age in cardiac arrest. All emergency calls to South Central Ambulance Service (SCAS) over a 12-month period screened by 'NHS Pathways' v9.04 were identified. All actual or presumed paediatric CAs (telephone triage system for identifying CA. Further work is required to refine telephone triage pathways for paediatric cardiac arrest. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. 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......%) coronary artery diameter stenosis with a sensitivity, specificity, and positive and negative predictive value of 99%, 81%, 96% and 95%, respectively. CCTA was used to triage patients into guideline defined treatment groups of "no or medical treatment", "referral to percutaneous coronary intervention......" or to "coronary artery bypass graft surgery" and was compared to the index ICA. CCTA correctly triaged patients in 86% of cases. During a median follow-up of 50 months, the presence of an occluded artery by CCTA was associated with adverse outcome. CONCLUSION: CCTA has high diagnostic and prognostic value...

  18. 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

    percutaneous coronary intervention (PPCI)). There are limited data on achievable system delays in an optimal STEMI system of care using prehospital diagnosis to triage patients with STEMI directly to percutaneous coronary intervention (PCI) centres. We examined the proportion of tentative prehospital STEMI...... 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

  19. 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...

  20. 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.

  1. Call-duration and triage decisions in out of hours cooperatives with and without the use of an expert system

    NARCIS (Netherlands)

    Ong, Rob S. G.; Post, Johan; van Rooij, Harry; de Haan, Jan

    2008-01-01

    Background: Cooperatives delivering out of hours care in the Netherlands are hesitant about the use of expert systems during triage. Apart from the extra costs, cooperatives are not sure that quality of triage is sufficiently enhanced by these systems and believe that call duration will be prolonged

  2. Successful five-item triage for the broad spectrum of mental disorders in pregnancy - A validation study

    NARCIS (Netherlands)

    C. Quispel (Chantal); T.A.J. Schneider (Tom); W.J.G. Hoogendijk (Witte); G.J. Bonsel (Gouke); M.P. Lambregtse-van den Berg (Mijke)

    2015-01-01

    textabstractBackground: Mental disorders are prevalent during pregnancy, affecting 10% of women worldwide. To improve triage of a broad spectrum of mental disorders, we investigated the decision impact validity of: 1) a short set of currently used psychiatric triage items, 2) this set with the

  3. DNA methylation analysis in self-sampled brush material as a triage test in hrHPV-positive women

    NARCIS (Netherlands)

    Boers, A.; Bosgraaf, R. P.; van Leeuwen, R. W.; Schuuring, E.; Heideman, D. A. M.; Massuger, L. F. A. G.; Verhoef, V. M. J.; Bulten, J.; Melchers, W. J. G.; van der Zee, A. G. J.; Bekkers, R. L. M.; Wisman, G. B. A.

    2014-01-01

    Background: Primary high-risk human papillomavirus (hrHPV) testing in cervical cancer screening shows relatively low specificity, which makes triage testing necessary. In this study, DNA methylation analysis was compared with cytology for triage testing in hrHPV-positive women. Moreover, feasibility

  4. Automated electrocardiogram interpretation programs versus cardiologists' triage decision making based on teletransmitted data in patients with suspected acute coronary syndrome

    DEFF Research Database (Denmark)

    Clark, Elaine N; Ripa, Maria Sejersten; Clemmensen, Peter

    2010-01-01

    and to assess the effectiveness of cardiologists' triage decisions for these patients based on initial electrocardiogram. Twelve-lead electrocardiograms were recorded in ambulances using a LIFEPAK 12 monitor/defibrillator (Physio-Control, Inc., Redmond, Washington) and transmitted digitally to an attending.......02) and the cardiologists (p = 0.004). Triage decisions were effective, with good agreement between cardiologists' decisions and discharge diagnoses....

  5. Comparison of clinical-based and ECG-based triage of acute chest pain in the Emergency Department.

    Science.gov (United States)

    Dechamps, Melanie; Castanares-Zapatero, Diego; Berghe, Patrick Vanden; Meert, Philippe; Manara, Alessandro

    2017-12-01

    In the Emergency Department, chest pain triage systems are based on either clinical features or ECG recording. In this prospective, single-center, observational study, we aimed to compare the diagnostic performance of these triage systems in distinguishing acute coronary syndromes (ACS) from diseases of mild severity. Patients were sorted into the triage systems based on collected data at admission and on a systematic 12-lead ECG performed at triage. The final diagnosis was determined after a 30-day follow-up. For ACS, we determined a high-acuity triage score (Level 1 or 2) as being adequate, and for mild severity diseases a low-acuity triage score (Level 3, 4 or 5) as being adequate. The diagnostic performance of all studied systems was moderate (AUC from 0.644 to 0.694), with no statistically significant difference found between them. However, characteristics of the systems differed because the clinical-based systems had a higher sensitivity (87-91%) but lower specificity (32-39%) compared with the ECG-based system (sensitivity 62% and specificity 64%). A higher sensitivity limits the risk of a patient with acute coronary syndrome staying unsafely in the waiting room, while a higher specificity prevents overcrowding. ECG at triage also ensures that no STEMIs or high-risk NSTEMIs are missed. Based on these findings, each Emergency Depatment could more accurately select the triage system that fits their local particularities.

  6. 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

  7. Predicting Ebola infection: A malaria-sensitive triage score for Ebola virus disease.

    Directory of Open Access Journals (Sweden)

    Mary-Anne Hartley

    2017-02-01

    Full Text Available The non-specific symptoms of Ebola Virus Disease (EVD pose a major problem to triage and isolation efforts at Ebola Treatment Centres (ETCs. Under the current triage protocol, half the patients allocated to high-risk "probable" wards were EVD(-: a misclassification speculated to predispose nosocomial EVD infection. A better understanding of the statistical relevance of individual triage symptoms is essential in resource-poor settings where rapid, laboratory-confirmed diagnostics are often unavailable.This retrospective cohort study analyses the clinical characteristics of 566 patients admitted to the GOAL-Mathaska ETC in Sierra Leone. The diagnostic potential of each characteristic was assessed by multivariate analysis and incorporated into a statistically weighted predictive score, designed to detect EVD as well as discriminate malaria. Of the 566 patients, 28% were EVD(+ and 35% were malaria(+. Malaria was 2-fold more common in EVD(- patients (p<0.05, and thus an important differential diagnosis. Univariate analyses comparing EVD(+ vs. EVD(- and EVD(+/malaria(- vs. EVD(-/malaria(+ cohorts revealed 7 characteristics with the highest odds for EVD infection, namely: reported sick-contact, conjunctivitis, diarrhoea, referral-time of 4-9 days, pyrexia, dysphagia and haemorrhage. Oppositely, myalgia was more predictive of EVD(- or EVD(-/malaria(+. Including these 8 characteristics in a triage score, we obtained an 89% ability to discriminate EVD(+ from either EVD(- or EVD(-/malaria(+.This study proposes a highly predictive and easy-to-use triage tool, which stratifies the risk of EVD infection with 89% discriminative power for both EVD(- and EVD(-/malaria(+ differential diagnoses. Improved triage could preserve resources by identifying those in need of more specific differential diagnostics as well as bolster infection prevention/control measures by better compartmentalizing the risk of nosocomial infection.

  8. Predicting Ebola infection: A malaria-sensitive triage score for Ebola virus disease.

    Science.gov (United States)

    Hartley, Mary-Anne; Young, Alyssa; Tran, Anh-Minh; Okoni-Williams, Harry Henry; Suma, Mohamed; Mancuso, Brooke; Al-Dikhari, Ahmed; Faouzi, Mohamed

    2017-02-01

    The non-specific symptoms of Ebola Virus Disease (EVD) pose a major problem to triage and isolation efforts at Ebola Treatment Centres (ETCs). Under the current triage protocol, half the patients allocated to high-risk "probable" wards were EVD(-): a misclassification speculated to predispose nosocomial EVD infection. A better understanding of the statistical relevance of individual triage symptoms is essential in resource-poor settings where rapid, laboratory-confirmed diagnostics are often unavailable. This retrospective cohort study analyses the clinical characteristics of 566 patients admitted to the GOAL-Mathaska ETC in Sierra Leone. The diagnostic potential of each characteristic was assessed by multivariate analysis and incorporated into a statistically weighted predictive score, designed to detect EVD as well as discriminate malaria. Of the 566 patients, 28% were EVD(+) and 35% were malaria(+). Malaria was 2-fold more common in EVD(-) patients (p<0.05), and thus an important differential diagnosis. Univariate analyses comparing EVD(+) vs. EVD(-) and EVD(+)/malaria(-) vs. EVD(-)/malaria(+) cohorts revealed 7 characteristics with the highest odds for EVD infection, namely: reported sick-contact, conjunctivitis, diarrhoea, referral-time of 4-9 days, pyrexia, dysphagia and haemorrhage. Oppositely, myalgia was more predictive of EVD(-) or EVD(-)/malaria(+). Including these 8 characteristics in a triage score, we obtained an 89% ability to discriminate EVD(+) from either EVD(-) or EVD(-)/malaria(+). This study proposes a highly predictive and easy-to-use triage tool, which stratifies the risk of EVD infection with 89% discriminative power for both EVD(-) and EVD(-)/malaria(+) differential diagnoses. Improved triage could preserve resources by identifying those in need of more specific differential diagnostics as well as bolster infection prevention/control measures by better compartmentalizing the risk of nosocomial infection.

  9. 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.

  10. 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.

  11. 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

  12. Capnography as a rapid assessment and triage tool for chemical terrorism.

    Science.gov (United States)

    Krauss, Baruch

    2005-08-01

    The assessment and triage of victims of chemical terrorism in the emergency department and the prehospital setting has become an important priority. This article proposes the use of capnography as a prehospital assessment and triage tool for monitoring victims of chemical terrorism and for critically ill patients. Capnography provides the ABCs in less than 15 seconds and identifies the common complications of chemical terrorism. Further, the reliability of capnography is not affected by motion artifact or low perfusion and it is accurate and reliable in actively seizing patients. Emergency departments and emergency medical services systems should consider adding capnography to their chemical terrorism education and training.

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

    Science.gov (United States)

    Kaposy, Chris

    2010-01-01

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

  14. 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...

  15. HOM identification by bead pulling in the Brookhaven ERL cavity

    CERN Document Server

    Hahn, H; Jain, Puneet; Johnson, Elliott C; Xu, Wencan

    2014-01-01

    Exploratory measurements of the Brookhaven Energy Recovery Linac (ERL) cavity at superconducting temperature produced a long list of high order modes (HOMs). The niobium 5-cell cavity is terminated at each end with HOM ferrite dampers that successfully reduce the Q-factors to levels required to avoid beam break up (BBU) instabilities. However, a number of un-damped resonances with Q≥106 were found at 4 K and their mode identification forms the focus of this paper. The approach taken here consists of bead pulling on a copper (Cu) replica of the ERL cavity with dampers involving various network analyzer measurements. Several different S21 transmission measurements are used, including those taken from the fundamental input coupler to the pick-up probe across the cavity, others between beam-position monitor probes in the beam tubes, and also between probes placed into the cells. The bead pull technique suitable for HOM identification with a metallic needle or dielectric bead is detailed. This paper presents the...

  16. Simulation of push-pull inverter using wide bandgap devices

    Science.gov (United States)

    Al-badri, Mustafa; Matin, Mohammed A.

    2016-09-01

    This paper discusses the use of wide bandgap devices (SiC-MOSFET) in the design of a push-pull inverter which provides inexpensive low power dc-ac inverters. The parameters used were 1200V SiC MOSFET(C2M0040120D) made by power company ROHM. This modeling was created using parameters that were provided from a device datasheet. The spice model is provided by this company to study the effect of adding this component on push-pull inverter ordinary circuit and compared results between SiC MOSFET and silicon MOSFET (IRFP260M). The results focused on Vout and Vmos stability as well as on output power and MOSFET power loss because it is a very crucial aspect on DC-AC inverter design. These results are done using the National Instrument simulation program (Multisim 14). It was found that power loss is better in the 12 and 15 vdc inverter. The Vout in the SIC MOSFET circuit shows more stability in the high current low resistance load in comparison to the Silicon MOSFET circuit and this will improve the overall performance of the circuit.

  17. Selectively Encrypted Pull-Up Based Watermarking of Biometric data

    Science.gov (United States)

    Shinde, S. A.; Patel, Kushal S.

    2012-10-01

    Biometric authentication systems are becoming increasingly popular due to their potential usage in information security. However, digital biometric data (e.g. thumb impression) are themselves vulnerable to security attacks. There are various methods are available to secure biometric data. In biometric watermarking the data are embedded in an image container and are only retrieved if the secrete key is available. This container image is encrypted to have more security against the attack. As wireless devices are equipped with battery as their power supply, they have limited computational capabilities; therefore to reduce energy consumption we use the method of selective encryption of container image. The bit pull-up-based biometric watermarking scheme is based on amplitude modulation and bit priority which reduces the retrieval error rate to great extent. By using selective Encryption mechanism we expect more efficiency in time at the time of encryption as well as decryption. Significant reduction in error rate is expected to be achieved by the bit pull-up method.

  18. Lessons learned from tubes pulled from French steam generators

    International Nuclear Information System (INIS)

    Berge, Ph.; Boursier, J.M.; Dallery, D.; De Keroulas, F.; Rouillon, Y.

    1998-01-01

    Since 1981, the Chinon Hot Laboratory has completed more than 380 metallurgical examinations of pulled French steam generator tubes. Electricite de France decided to perform such investigations from the very outset of the French nuclear program, in order to contribute to nuclear power plant safety. The main reasons for withdrawing tubes are to evaluate the degradation, to validate non destructive examination (NDE) techniques, to gain a better understanding of cracking phenomena, and to ensure that the criteria on which plugging operations are based remain conservative. Considerable experience has been accumulated in the field of primary water stress corrosion cracking (PWSCC), OD (secondary) side corrosion, leak and burst tests, and various tube plugging techniques. This paper focuses on the PWSCC phenomenon and on the secondary side corrosion process, and in particular, attempts to correlate French data from pulled tubes with the results of fundamental R and D studies. Finally, within the framework of the Nuclear Power Plant Safety and Maintenance Policy, all these results are discussed in terms of optimization of the field inspection of tube bundles and plugging criteria. (author)

  19. Assessing Field Triage Decisions and the International Classification Injury Severity Score (ICISS) at Predicting Outcomes of Trauma Patients.

    Science.gov (United States)

    Allen, Casey J; Baldor, Daniel J; Schulman, Carl I; Pizano, Louis R; Livingstone, Alan S; Namias, Nicholas

    2017-06-01

    Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS <0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED). We assess outcomes of those with an ICISS <0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed. ICISS was calculated from the product of the survival risk ratios for a patient's three worst injuries. Outcomes were compared between patients with ICISS <0.85 either triaged to the ED or its separate, neighboring, free-standing TC at a large urban hospital. A total of 32,191 (83%) patients were triaged to the ED by EMS and 6,827 (17%) were triaged to the TC. Of these, 2544 had an ICISS <0.85, with 2145 (84%) being triaged to the TC and 399 (16%) to the ED. In these patients, those taken to the TC more often required admission, and those taken to the ED had better outcomes. When the confounders influencing triage to an ED or a TC are eliminated, those triaged by EMS to the ED rather than the TC had better overall outcomes. EMS providers better identified patients at risk for mortality than did the retrospective application of ICISS. ICISS <0.85 does not identify the absolute need for TC as EMS providers were able to appropriately triage a large portion of this population to the ED.

  20. Triage in an adult emergency service: patient satisfaction.

    Science.gov (United States)

    Silva, Pollyane Liliane; Paiva, Luciana; Faria, Veridiana Bernardes; Ohl, Rosali Isabel Barduchi; Chavaglia, Suzel Regina Ribeiro

    2016-01-01

    Assess the degree of patient satisfaction with triage in the adult emergency service of a public hospital. 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. 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. There was a high level of patient satisfaction, evidenced by the strong association of user satisfaction with the items investigated. Avaliar o grau de satisfação dos usuários no setor de Acolhimento com Classificação de Risco do Pronto-Socorro Adulto de um hospital público. Pesquisa exploratória, descritiva e transversal com abordagem quantitativa. Foram entrevistados 300 usuários e os dados foram analisados por meio de estatística descritiva a partir de variáveis sociodemográficas e as relacionadas à satisfação do usuário. Houve predominância do sexo feminino, nível de escolaridade fundamental e idade média de 41 anos. A maioria dos entrevistados respondeu estar satisfeito em relação aos itens: agilidade no atendimento; acolhimento; confiança; ambiência (conforto, limpeza, sinalização), humanização (educação, respeito e interesse); agilidade no encaminhamento/agendamento de consulta e expectativa sobre o serviço. Verificou-se elevado grau de satisfação dos usuários, evidenciada pela forte associação da satisfação do usuário com os itens investigados.

  1. Technology and trend management at the interface of technology push and market pull

    DEFF Research Database (Denmark)

    Maier, Maximilian; Hofmann, Maximilian; Brem, Alexander

    2016-01-01

    Technology push and market pull innovation strategies are playing an important role for the effective management of ideas, technologies, and trends. The coexistence of these two approaches led to many debates and the focus switched several times from putting more effort into technology push aspects...... to fostering market pull approaches in the last decades. Still, there is no in-depth exploration of the interface of technology push and market pull and only few conceptual models are dealing with the connection between technology push and market pull in particular. Therefore, this study puts an exploratory...... focus on the innovation management processes of a global outdoor manufacturer with a special emphasis on the interface between technology push and market pull. From the case findings and our literature we conceptualise a non-linear innovation model that systematically integrates market pull...

  2. Optical pulling force and conveyor belt effect in resonator-waveguide system.

    Science.gov (United States)

    Intaraprasonk, Varat; Fan, Shanhui

    2013-09-01

    We present the theoretical condition and actual numerical design that achieves an optical pulling force in resonator-waveguide systems, where the direction of the force on the resonator is in the opposite direction to the input light in the waveguide. We also show that this pulling force can occur in conjunction with the lateral optical equilibrium effect, such that the resonator is maintained at the fixed distance from the waveguide while experiencing the pulling force.

  3. Impact of Androstenone on Leash Pulling and Jumping Up in Dogs

    OpenAIRE

    Glenna Pirner; John McGlone

    2016-01-01

    Simple Summary Behavior problems such as leash pulling and jumping up are common reasons given for relinquishing dogs to animal shelters. Interomones are chemical signals produced by one species that elicit an effect on a different species; this study examines the effects of androstenone (produced by boars) on dog leash pulling and jumping up behavior. Androstenone in spray form reduces leash pulling behavior compared to a control spray. This interomone may provide instant relief for behavior...

  4. Comparison of crack propagation analyses in a pull-out test

    Science.gov (United States)

    Gontarz, Jakub; Podgórski, Jerzy; Siegmund, Michał

    2018-01-01

    This paper describes the computer analysis of the pull-out test for determining the force needed to pull out a rock fragment and the shape of this fractured fragment. The material analyzed is sandstone. Two tasks were analyzed depending on the length of the pulling anchor. The analysis also included a comparison of the various crack propagation methods in computer programs using the Finite Element Method. It is planned to perform laboratory tests to verify the accuracy of selected computer methods.

  5. Scapula kinematics of pull-up techniques: Avoiding impingement risk with training changes

    OpenAIRE

    Prinold, Joe A.I.; Bull, Anthony M.J.

    2016-01-01

    Objectives Overhead athletic activities and scapula dyskinesia are linked with shoulder pathology; pull-ups are a common training method for some overhead sports. Different pull-up techniques exist: anecdotally some are easier to perform, and others linked to greater incidences of pathology. This study aims to quantify scapular kinematics and external forces for three pull-up techniques, thus discussing potential injury implications. Design An observational study was performed with eleven par...

  6. Manipulative interventions for reducing pulled elbow in young children.

    Science.gov (United States)

    Krul, Marjolein; van der Wouden, Johannes C; Kruithof, Emma J; van Suijlekom-Smit, Lisette Wa; Koes, Bart W

    2017-07-28

    Pulled elbow (nursemaid's elbow) is a common injury in young children. It often results from a sudden pull on the arm, usually by an adult or taller person, which pulls the radius through the annular ligament, resulting in subluxation (partial dislocation) of the radial head. It can also be caused by a fall or twist. The child experiences sudden acute pain and loss of function in the affected arm. Pulled elbow is usually treated by manual reduction of the subluxed radial head. Various manoeuvres can be applied; most commonly, supination of the forearm, often combined with flexion, and (hyper-)pronation. It is unclear which is most successful. This is an update of a Cochrane review first published in 2009 and last updated in 2011. To compare the effects (benefits and harms) of the different methods used to manipulate pulled elbow in young children. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, LILACS, PEDro, clinical trial registers and reference lists of articles. Date of last search: September 2016. Randomised or quasi-randomised controlled clinical trials evaluating manipulative interventions for pulled elbow were included. Our primary outcome was failure at the first attempt, necessitating further treatment. Two review authors independently evaluated trials for inclusion, assessed risk of bias, and extracted data. We pooled data using a fixed-effect model. Overall, nine trials with 906 children (all younger than seven years old and 58% of whom were female) were included, of which five trials were newly identified in this update. Eight trials were performed in emergency departments or ambulatory care centres, and one was performed in a tertiary paediatric orthopaedic unit. Four trials were conducted in the USA, three in Turkey, one in Iran, and one in Spain. Five trials were at high risk of selection bias because allocation was not concealed and all

  7. Method to measure the force to pull and to break pin bones of fish.

    Science.gov (United States)

    Balaban, Murat O; Jie, Hubert; Yin Yee, Yin; Alçiçek, Zayde

    2015-02-01

    A texture measurement device was modified to measure the force required to pull pin bones from King salmon (Oncorhynchus tshawytscha), snapper (Pagrus auratus), and kahawai (Arripis trutta). Pulled bones were also subjected to tension to measure the breaking force. For all fish, the pulling force depended on the size of the fish, and on the length of the pin bone (P bones. For example, fresh small salmon (about 1500 g whole) required 600 g on average to pull pin bones, and large fish (about 3700 g whole) required 850 g. Longer bones required greater pulling force. The breaking force followed the same trend. In general, the breaking force was greater than the pulling force. This allows the removal of the bones without breaking them. There was no statistically significant (P > 0.05) difference between the forces (both pulling and breaking) from fresh and frozen/thawed samples, although in general frozen/thawed samples required less force to pull. With the quantification of pulling and breaking forces for pin bones, it is possible to design and build better, "more intelligent" pin bone removal equipment. © 2015 Institute of Food Technologists®

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

    Science.gov (United States)

    Cecon, Roberta Stofeles; Franceschini, Sylvia do Carmo Castro; Peluzio, Maria do Carmo Gouveia; Hermsdorff, Helen Hermana Miranda; Priore, Silvia Eloiza

    2017-01-01

    To verify the influence of overweight and alteration in the perception of the corporal image during the triage of eating disorders. 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. 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. 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.

  9. 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....

  10. 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.

  11. Accuracy of triage for children with chronic illness and infectious symptoms

    NARCIS (Netherlands)

    N. Seiger (Nienke); M.V. Veen (Mirjam Van); E.W. Steyerberg (Ewout); J. van der Lei (Johan); H.A. Moll (Henriëtte)

    2013-01-01

    textabstractOBJECTIVE: This prospective observational study aimed to assess the validity of the Manchester Triage System (MTS) for children with chronic illnesses who presented to the emergency department (ED) with infectious symptoms. METHODS: Children (<16 years old) presenting to the ED of a

  12. 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

  13. 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.

  14. 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 ...

  15. 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.

  16. Measuring Evidential Weight in Digital Forensic Investigations: a Role for Bayesian Networks in Digital Forensic Triage

    OpenAIRE

    Overill, Richard Edward; Chow, Kam-Pui

    2017-01-01

    A method for obtaining a quantitative measure of the relative weight of each individual item of evidence in a digital forensic investigation by means of a Bayesian network is described. The resulting evidential weights can then be used to determine a near-optimal cost-effective triage scheme for the investigation in question.

  17. 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.

  18. Impact of revised triage to improve throughput in an ED with limited traditional fast track population.

    Science.gov (United States)

    Gardner, Ryan M; Friedman, Nathan A; Carlson, Michael; Bradham, Tamala S; Barrett, Tyler W

    2018-01-01

    Emergency department (ED) crowding is associated with patient safety concerns, increased patients left without being seen (LWBS), low patient satisfaction, and lost ED revenue. The objective was to measure the impact of a revised triage process on ED throughput. This study took place at an urban, university-affiliated, adult ED with an annual census of 70,000 and admission rate of 34%. The revised triage approach included: identifying eligible patients at triage based on complaint, comorbidities, and illness acuity; and reallocating a nurse practitioner (NP) into our triage area. We trialed the intervention from 1100-2300 on weekdays from January 13-26, 2016. Adult patients who were not likely to require intensive evaluations were eligible. Primary outcomes were throughput measures including: time to provider, ED length of stay (LOS), and LWBS. Pre- and post-intervention metrics were compared using the Mann-Whitney U test, given the non-normal distribution of the metrics. The NP evaluated 120 patients of which 101 (84%) were discharged, 3 (2.5%) admitted, and 16 (13%) required more intense evaluation. Time to provider decreased from a median (IQR) of 42 (16, 114) to 27 (12.4, 81.5) minutes (ptriage intervention was associated with improvements in several ED throughput metrics and a reduction in LWBS. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Meeting the Demand for College Student Concerns in College Counseling Centers: Evaluating a Clinical Triage System

    Science.gov (United States)

    Hardy, Jennifer A.; Weatherford, Ryan D.; Locke, Benjamin D.; DePalma, Natalie Hernandez; D'Iuso, Nadia T.

    2011-01-01

    University counseling centers, experiencing an imbalance between student demand and available resources, respond in various ways. The current mixed-method study evaluated one university counseling center transitioning from a wait-list system to a triage method of managing demand. Significant reductions in wait time and increase in attendance were…

  20. The effectiveness of the South African Triage Score (SATS) in a rural ...

    African Journals Online (AJOL)

    Background. The Modified Early Warning Score (MEWS) is used to monitor medical inpatients in hospitals in the developed world. The South African Triage Score (SATS) was developed from the MEWS, and its use throughout South Africa has been proposed. Objectives. We aimed to assess the effectiveness of the SATS in ...

  1. Improving Emergency Department Triage Classification with Computerized Clinical Decision Support at a Pediatric Hospital

    Science.gov (United States)

    Kunisch, Joseph Martin

    2012-01-01

    Background: The Emergency Severity Index (ESI) is an emergency department (ED) triage classification system based on estimated patient-specific resource utilization. Rules for a computerized clinical decision support (CDS) system based on a patient's chief complaint were developed and tested using a stochastic model for predicting ESI scores.…

  2. Nurse-administered early warning score system can be used for emergency department triage

    DEFF Research Database (Denmark)

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

    2011-01-01

    Studies have shown that early warning score systems can identify in-patients at high risk of catastrophic deterioration and this may possibly be used for an emergency department (ED) triage. Bispebjerg Hospital has introduced a multidisciplinary team (MT) in the ED activated by the Bispebjerg Early...

  3. [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.

  4. Treating Trichotillomania (Hair-Pulling Disorder) in a Child.

    Science.gov (United States)

    Snorrason, Ivar; Walther, Michael R; Elkin, T David; Woods, Douglas W

    2016-11-01

    Although cognitive behavioral treatments (CBTs) have been recommended as first-line interventions for trichotillomania (hair-pulling disorder [HPD]), research on CBT for young children with HPD is limited. We illustrate the use of family-based CBT for HPD in an 8-year-old boy. The client had a 5-year history of chronic HPD and several large bald spots on the crown of his head. Treatment primarily comprised habit reversal training (HRT) and function-based interventions. The child showed significant improvement in HPD severity and impairment after 8 weekly sessions, although complete abstinence was not achieved. The findings underscore the importance of parental involvement in the treatment and show that children as young as 8 years of age can successfully use strategies taught in HRT. © 2016 Wiley Periodicals, Inc.

  5. Prostitution push and pull: male and female perspectives.

    Science.gov (United States)

    Vanwesenbeeck, Ine

    2013-01-01

    Smith, Grov, Seal, and McCall's (2012) analysis, focusing on how young men become, and stay, involved in male escorting, is a welcome contribution to the still relatively thin male sex worker literature. For this study group, notably supportive working surroundings, effective coping strategies, and a growing sense of "self-efficacy" eventually turn sex work into an increasingly comfortable experience and viable moneymaking option. In this commentary, I add some reflections from a broader perspective to these insights. I also consider some evidence on the numbers of men and women in sex work and make some observations on male versus female positions related to push and pull factors, stigma, and the experience of sex work.

  6. Laser pushing or pulling of absorbing airborne particles

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Chuji, E-mail: cw175@msstate.edu; Gong, Zhiyong [Mississippi State University, Starkville, Mississippi 39759 (United States); Pan, Yong-Le; Videen, Gorden [U.S. Army Research Laboratory, 2800 Powder Mill Road, Adelphi, Maryland 20783 (United States)

    2016-07-04

    A single absorbing particle formed by carbon nanotubes in the size range of 10–50 μm is trapped in air by a laser trapping beam and concurrently illuminated by another laser manipulating beam. When the trapping beam is terminated, the movement of the particle controlled by the manipulating beam is investigated. We report our observations of light-controlled pushing and pulling motions. We show that the movement direction has little relationship with the particle size and manipulating beam's parameters but is dominated by the particle's orientation and morphology. With this observation, the controllable optical manipulation is now able to be generalized to arbitrary particles, including irregularly shaped absorbing particles that are shown in this work.

  7. Pulling G Human Responses to High and Low Gravity

    CERN Document Server

    Seedhouse, Erik

    2013-01-01

    Formula 1 racing drivers, figher pilots, astronauts - G forces are an integral part of their lives - How do racing drivers sustain high G loads and not pass out? - What accelerative forces are unleashed when a fighter pilot ejects from a high-performance jet? - What is it like being launched into space and what are the effects on astronauts living in zero G on board the International Space Station? - How do aircraft simulate zero G? Pulling G gives a unique insight into how G forces affect people working inthe high and low G environments. It examines the risks of high and low acceleration and explains the physiology of surviving in these environments. The history of G-related research is described, together with present-day and future development of methods to cope with the effects of increased and reduced G.

  8. Can Team Triage Improve Patient Flow in the Emergency Department? A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Ming, Thomas; Lai, Aaron; Lau, Pui-Man

    2016-01-01

    This systematic review was performed as a feasibility study for revamping the triage service of an emergency department (ED) in a district hospital. In view of the overcrowding problem that plagues EDs worldwide, we reviewed evidence from randomized controlled trials (RCTs) to determine whether ED team triage improves patient flow in comparison with single-nurse triage. We measured improvement in patient flow in terms of the reduction in length of stay (LOS) or wait time (WT) for all ED patients. Adopting the Cochrane methodology, we searched and evaluated data sources for RCTs comparing patients assessed by an ED triage team, with patients receiving single-nurse triage at the same site. The data extracted were independently reviewed by 2 authors for inclusion and quality assessment. As for risk of bias across studies, there was an overall assessment of every outcome across the included studies according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria for RCTs. In total, 2,164 studies were identified and 2,106 were excluded on the basis of title/abstract, leaving 58 articles for full assessment. Four trials (all cluster RCTs) involving 14,772 patients (165 clusters) met the inclusion criteria. On the basis of our analysis, there was no statistically significant or clinically relevant reduction of LOS and WT for all patients in these studies. One study reported death as an outcome: Relative risk was 0.34 (95% CI [0.01, 8.24]), which suggested that team triage might reduce mortality. Overall, although we have found no conclusive evidence from RCTs to support the use of team triage for improving patient flow in the ED, the results need not deter nursing managers intending to introduce team triage for improving the morale of the triage nurse. However, they may need to consider economic and organizational factors, such as resource reallocation and staff receptiveness, in implementing the new practice.

  9. Evaluation of a novel algorithm for primary mass casualty triage by paramedics in a physician manned EMS system: a dummy based trial

    Science.gov (United States)

    2014-01-01

    Background The Amberg-Schwandorf Algorithm for Primary Triage (ASAV) is a novel primary triage concept specifically for physician manned emergency medical services (EMS) systems. In this study, we determined the diagnostic reliability and the time requirements of ASAV triage. Methods Seven hundred eighty triage runs performed by 76 trained EMS providers of varying professional qualification were included into the study. Patients were simulated using human dummies with written vital signs sheets. Triage results were compared to a standard solution, which was developed in a modified Delphi procedure. Test performance parameters (e.g. sensitivity, specificity, likelihood ratios (LR), under-triage, and over-triage) were calculated. Time measurements comprised the complete triage and tagging process and included the time span for walking to the subsequent patient. Results were compared to those published for mSTaRT. Additionally, a subgroup analysis was performed for employment status (career/volunteer), team qualification, and previous triage training. Results For red patients, ASAV sensitivity was 87%, specificity 91%, positive LR 9.7, negative LR 0.139, over-triage 6%, and under-triage 10%. There were no significant differences related to mSTaRT. Per patient, ASAV triage required a mean of 35.4 sec (75th percentile 46 sec, 90th percentile 58 sec). Volunteers needed slightly more time to perform triage than EMS professionals. Previous mSTaRT training of the provider reduced under-triage significantly. There were significant differences in time requirements for triage depending on the expected triage category. Conclusions The ASAV is a specific concept for primary triage in physician governed EMS systems. It may detect red patients reliably. The test performance criteria are comparable to that of mSTaRT, whereas ASAV triage might be accomplished slightly faster. From the data, there was no evidence for a clinically significant reliability difference between typical

  10. Evaluation of a novel algorithm for primary mass casualty triage by paramedics in a physician manned EMS system: a dummy based trial.

    Science.gov (United States)

    Wolf, Philipp; Bigalke, Marc; Graf, Bernhard M; Birkholz, Torsten; Dittmar, Michael S

    2014-08-28

    The Amberg-Schwandorf Algorithm for Primary Triage (ASAV) is a novel primary triage concept specifically for physician manned emergency medical services (EMS) systems. In this study, we determined the diagnostic reliability and the time requirements of ASAV triage. Seven hundred eighty triage runs performed by 76 trained EMS providers of varying professional qualification were included into the study. Patients were simulated using human dummies with written vital signs sheets. Triage results were compared to a standard solution, which was developed in a modified Delphi procedure. Test performance parameters (e.g. sensitivity, specificity, likelihood ratios (LR), under-triage, and over-triage) were calculated. Time measurements comprised the complete triage and tagging process and included the time span for walking to the subsequent patient. Results were compared to those published for mSTaRT. Additionally, a subgroup analysis was performed for employment status (career/volunteer), team qualification, and previous triage training. For red patients, ASAV sensitivity was 87%, specificity 91%, positive LR 9.7, negative LR 0.139, over-triage 6%, and under-triage 10%. There were no significant differences related to mSTaRT. Per patient, ASAV triage required a mean of 35.4 sec (75th percentile 46 sec, 90th percentile 58 sec). Volunteers needed slightly more time to perform triage than EMS professionals. Previous mSTaRT training of the provider reduced under-triage significantly. There were significant differences in time requirements for triage depending on the expected triage category. The ASAV is a specific concept for primary triage in physician governed EMS systems. It may detect red patients reliably. The test performance criteria are comparable to that of mSTaRT, whereas ASAV triage might be accomplished slightly faster. From the data, there was no evidence for a clinically significant reliability difference between typical staffing of mobile intensive care units

  11. Evaluation of the performance of French physician-staffed emergency medical service in the triage of major trauma patients.

    Science.gov (United States)

    Hamada, Sophie Rym; Gauss, Tobias; Duchateau, François-Xavier; Truchot, Jennifer; Harrois, Anatole; Raux, Mathieu; Duranteau, Jacques; Mantz, Jean; Paugam-Burtz, Catherine

    2014-06-01

    Proper prehospital triage of trauma patients is a cornerstone for the process of care of trauma patients. In France, emergency physicians perform this process according to a national triage algorithm called Vittel Triage Criteria (VTC), introduced in 2002 to help the triage decision-making process. The aim of this two-center study was to evaluate the performance of the triage process based on the VTC to identify major trauma patients in the Paris area. This was a retrospective analysis of two cohorts. The first cohort consisted of all patients admitted between January 2011 and September 2012 in two trauma referral centers in the region of Paris (Ile de France) and allowed estimation of overtriage. Undertriage was assessed in a second cohort made up of all prehospital trauma interventions from one emergency medicine sector during the same period. Adequate triage was defined by a direct admission of patients with an Injury Severity Score (ISS) greater than 15 into one of the regional trauma centers, and undertriage was defined as an initial nonadmission to a trauma center. Overtriage was defined by an admission of patients with an ISS of 15 or lower to a trauma center. The performance of the VTC was evaluated according to a strict to-the-letter application of the VTC and termed as theoretical triage. Logistic regression was performed to identify VTC criteria able to predict major trauma. Among 998 admitted patients of the first cohort, 173 patients (17%) were excluded because they were not directly admitted in the first 24 hours. In the first cohort (n = 825), adequate triage was 58% and overtriage was 42%. In the second cohort (n = 190), adequate triage was 40%, overtriage was 60%, and undertriage was less than 1%. Theoretical triage generated a nonsignificantly lower overtriage and a higher undertriage compared with observed triage. The most powerful predictors of major trauma were paralysis (odds ratio [OR,] 0.09; 95% confidence interval [CI], 0.03-0.22), flail

  12. Bajan Birds Pull Strings: Two Wild Antillean Species Enter the Select Club of String-Pullers.

    Science.gov (United States)

    Audet, Jean-Nicolas; Ducatez, Simon; Lefebvre, Louis

    2016-01-01

    String-pulling is one of the most popular tests in animal cognition because of its apparent complexity, and of its potential to be applied to very different taxa. In birds, the basic procedure involves a food reward, suspended from a perch by a string, which can be reached by a series of coordinated pulling actions with the beak and holding actions of the pulled lengths of string with the foot. The taxonomic distribution of species that pass the test includes several corvids, parrots and parids, but in other families, data are much spottier and the number of individuals per species that succeed is often low. To date, the association between string-pulling ability and other cognitive traits was never tested. It is generally assumed that string-pulling is a complex form of problem-solving, suggesting that performance on string-pulling and other problem-solving tasks should be correlated. Here, we show that individuals of two innovative species from Barbados, the bullfinch Loxigilla barbadensis and the Carib grackle Quiscalus lugubris fortirostris, pass the string-pulling test. Eighteen of the 42 bullfinches tested succeeded, allowing us to correlate performance on this test to that on several other behavioral measurements. Surprisingly, string-pulling in bullfinches was unrelated to shyness, neophobia, problem-solving, discrimination and reversal learning performance. Only two of 31 grackles tested succeeded, precluding correlational analyses with other measures but still, the two successful birds largely differed in their other behavioral traits.

  13. The Phenomenology of Hair Pulling Urges in Trichotillomania: A Comparative Approach

    Science.gov (United States)

    Madjar, Shai; Sripada, Chandra S.

    2016-01-01

    Trichotillomania is a disorder characterized by recurrent urges to pull out one's hair, but the experiential characteristics of hair pulling urges are poorly understood. This study used a comparative approach to understand the subjective phenomenology of hair pulling: participants with trichotillomania symptoms were asked about their hair pulling urges as well as their urges to eat unhealthy foods. Participants who reported experiencing problematic unhealthy food urges were identified and asked to compare the phenomenological characteristics of their hair pulling and unhealthy food urges across a variety of dimensions. Results revealed significant differences for only some urge properties measured, and differences that existed were small to moderate in magnitude. Qualitative comparisons of the two urges revealed situational characteristics of hair pulling that could explain these small to moderate differences between the two urges. We conclude that hair pulling urges may be more comparable to ordinary urges such as unhealthy food urges than one might expect, but that hair pulling urges may nevertheless be rated as slightly more severe due to situational characteristics of these urges. This conception may improve clinician and lay understanding of the condition, assist with destigmatization efforts, and facilitate the development of treatment strategies. PMID:26925017

  14. Drawbar Pull and Its Effect on the Weight Distribution of a Tractor

    Directory of Open Access Journals (Sweden)

    Adam Polcar

    2017-01-01

    Full Text Available This article aims to experimentally determine how the tractor’s weight distribution changes during loading by drawbar pull, and how the tractor’s weight affects its drawbar pull properties. Drive wheel ballasting has a significant effect on the drawbar pull and wheel slip of the tractor - travelling gear losses. To achieve these objectives, we conducted experimental measurements on the tractor Case IH Magnum 370 CVX. The results show that higher drawbar pull is achieved in tractors with a higher weight. The measured increase of drawbar pull was 15,8 kN between maximal and minimal weight (∆ 2320 kg. All variants show an equal percentage increase in the weight on the rear axle of the tractor (+ 6 %. Increasing the tractor’s weight affected the drawbar pull as well as the wheel slip. As the tractor’s weight increases, there is a smaller increase in wheel slip as the drawbar pull increases. The results confirmed that tractor ballasting is important in order to achieve optimum drawbar pull properties, but it is necessary to keep in mind that the higher the weight of the machine or equipment, the larger the effect on the soil.

  15. The phenomenology of hair pulling urges in trichotillomania: a comparative approach

    Directory of Open Access Journals (Sweden)

    Shai eMadjar

    2016-02-01

    Full Text Available Trichotillomania is a disorder characterized by recurrent urges to pull out one’s hair, but the experiential characteristics of hair pulling urges are poorly understood. This study used a comparative approach to understand the subjective phenomenology of hair pulling: participants with trichotillomania symptoms were asked about their hair pulling urges as well as their urges to eat unhealthy foods. Participants who reported experiencing problematic unhealthy food urges were identified and asked to compare the phenomenological characteristics of their hair pulling and unhealthy food urges across a variety of dimensions. Results revealed significant differences for only some urge properties measured, and differences that existed were small to moderate in magnitude. Qualitative comparisons of the two urges revealed situational characteristics of hair pulling that could explain these small to moderate differences between the two urges. We conclude that hair pulling urges may be more comparable to ordinary urges such as unhealthy food urges than one might expect, but that hair pulling urges may nevertheless be rated as slightly more severe due to situational characteristics of these urges. This conception may improve clinician and lay understanding of the condition, assist with destigmatization efforts, and facilitate the development of treatment strategies.

  16. Impact of push-pull technology on the nutritional status of farmers ...

    African Journals Online (AJOL)

    This study examined the impact of push-pull technology (PPT) on the nutritional status of children aged 1-12 years. Non-push-pull (NPPT) farmers were used as a control group to establish a comparative model for this study. It determined household production, consumption, and surpluses, comparing the PPT adopters to ...

  17. Stochastic Finite Element Method for analyzing static and dynamic pull-in of microsystems

    NARCIS (Netherlands)

    Hannot, S.D.A.; Verhoosel, C.V.; Rixen, D.J.

    2010-01-01

    Electro–mechanical sensors and actuators are a specific type of microsystems. The electrostatic pull-in value is one of the defining characteristics for these devices. Because the material and geometrical properties of micro fabricated systems are often very uncertain, this pull-in value can be

  18. The Phenomenology of Hair Pulling Urges in Trichotillomania: A Comparative Approach.

    Science.gov (United States)

    Madjar, Shai; Sripada, Chandra S

    2016-01-01

    Trichotillomania is a disorder characterized by recurrent urges to pull out one's hair, but the experiential characteristics of hair pulling urges are poorly understood. This study used a comparative approach to understand the subjective phenomenology of hair pulling: participants with trichotillomania symptoms were asked about their hair pulling urges as well as their urges to eat unhealthy foods. Participants who reported experiencing problematic unhealthy food urges were identified and asked to compare the phenomenological characteristics of their hair pulling and unhealthy food urges across a variety of dimensions. Results revealed significant differences for only some urge properties measured, and differences that existed were small to moderate in magnitude. Qualitative comparisons of the two urges revealed situational characteristics of hair pulling that could explain these small to moderate differences between the two urges. We conclude that hair pulling urges may be more comparable to ordinary urges such as unhealthy food urges than one might expect, but that hair pulling urges may nevertheless be rated as slightly more severe due to situational characteristics of these urges. This conception may improve clinician and lay understanding of the condition, assist with destigmatization efforts, and facilitate the development of treatment strategies.

  19. Force direction in pushing and pulling and Musculo-Skeletal load

    NARCIS (Netherlands)

    Looze, M.P. de; Kuijer, P.P.F.M.

    1999-01-01

    In pushing and pulling wheeled objects, the effect of the exerted force on local musculo-skeletal loads depends on the direction of force exertion. Several questions about the direction of force exertion in pushing and pulling, the effects of handle height and force level on force direction, and the

  20. Push-Pull Ventilation in a Painting Shop for Large Steel Constructions

    DEFF Research Database (Denmark)

    Svidt, Kjeld; Heiselberg, Per

    This paper describes the analysis of a push-pull ventilation system for a painting shop that is used for painting steel chimneys and windmill towers.......This paper describes the analysis of a push-pull ventilation system for a painting shop that is used for painting steel chimneys and windmill towers....

  1. Optimization of Contact Force and Pull-in Voltage for Series based MEMS Switch

    Directory of Open Access Journals (Sweden)

    Abhijeet KSHIRSAGAR

    2010-04-01

    Full Text Available Cantilever based metal-to-metal contact type MEMS series switch has many applications namely in RF MEMS, Power MEMS etc. A typical MEMS switch consists of a cantilever as actuating element to make the contact between the two metal terminals of the switch. The cantilever is pulled down by applying a pull-in voltage to the control electrode that is located below the middle portion of the cantilever while only the tip portion of the cantilever makes contact between the two terminals. Detailed analysis of bending of the cantilever for different pull-in voltages reveals some interesting facts. At low pull-in voltage the cantilever tip barely touches the two terminals, thus resulting in very less contact area. To increase contact area a very high pull-in voltage is applied, but it lifts the tip from the free end due to concave curving of the cantilever in the middle region of the cantilever where the electrode is located. Again it results in less contact area. Furthermore, the high pull-in voltage produces large stress at the base of the cantilever close to the anchor. Therefore, an optimum, pull-in voltage must exist at which the concave curving is eliminated and contact area is maximum. In this paper authors report the finding of optimum contact force and pull-in voltage.

  2. A different approach for the ergonomic evaluation of pushing and pulling in practice.

    NARCIS (Netherlands)

    Kuijer, P.P.F.M.; Hoozemans, M.J.M.; Frings-Dresen, M.H.W.

    2007-01-01

    Recent epidemiological studies show that pushing and pulling increase the risks of shoulder complaints and not necessarily of low back complaints. Moreover, the magnitude of the exerted hand forces during pushing and pulling is poorly related to the magnitude of the mechanical loading of the low

  3. Quantifying the net slab pull force as a driving mechanism for plate tectonics

    NARCIS (Netherlands)

    Schellart, W. P.

    2004-01-01

    It has remained unclear how much of the negative buoyancy force of the slab (FB) is used to pull the trailing plate at the surface into the mantle. Here I present three-dimensional laboratory experiments to quantify the net slab pull force (FNSP) with respect to FB during subduction. Results show

  4. Impact of the ABCDE triage on the number of patient visits to the emergency department.

    Science.gov (United States)

    Kantonen, Jarmo; Kaartinen, Johanna; Mattila, Juho; Menezes, Ricardo; Malmila, Mia; Castren, Maaret; Kauppila, Timo

    2010-06-03

    Many Finnish emergency departments (ED) serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care specialists are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to tertiary 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 those patients who need it the most. A face-to-face triage system based on the letters A (patient 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 was applied in the main ED in the City of Vantaa, Finland (Peijas Hospital) as an attempt to provide immediate treatment for the most acute patients. The first step was an initial patient assessment by a health care professional (triage nurse). If the patient was not considered to be in need of immediate care (i.e. A-D) he was allocated to group E and examined after the more urgent patients were treated. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the combined ED. To study the effect of the intervention on patient flow, numbers monthly visits to doctors were recorded before and after intervention in Peijas ED and, simultaneously, in control EDs (Myyrmäki in Vantaa, Jorvi and Puolarmetsä in Espoo). To study does the implementation of the triage system redirect patients to other health services, numbers of monthly visits to doctors were also scored in the private health care and public office hour services of Vantaa primary

  5. Impact of the ABCDE triage on the number of patient visits to the emergency department

    Directory of Open Access Journals (Sweden)

    Menezes Ricardo

    2010-06-01

    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 specialists are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to tertiary 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 those patients who need it the most. Methods A face-to-face triage system based on the letters A (patient 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 was applied in the main ED in the City of Vantaa, Finland (Peijas Hospital as an attempt to provide immediate treatment for the most acute patients. The first step was an initial patient assessment by a health care professional (triage nurse. If the patient was not considered to be in need of immediate care (i.e. A-D he was allocated to group E and examined after the more urgent patients were treated. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the combined ED. To study the effect of the intervention on patient flow, numbers monthly visits to doctors were recorded before and after intervention in Peijas ED and, simultaneously, in control EDs (Myyrmäki in Vantaa, Jorvi and Puolarmetsä in Espoo. To study does the implementation of the triage system redirect patients to other health services, numbers of monthly visits to doctors were also scored in the private health care and public

  6. Optimizing psychological interventions for trichotillomania (hair-pulling disorder): an update on current empirical status

    Science.gov (United States)

    Snorrason, Ivar; Berlin, Gregory S; Lee, Han-Joo

    2015-01-01

    Trichotillomania (hair-pulling disorder) is a psychiatric condition characterized by a persistent habit of pulling out one’s hair. In treatment-seeking populations, hair-pulling disorder can be severe, chronic, and difficult to treat. In the early 1970s, behavioral interventions (eg, habit reversal training) were developed and proved effective in treating chronic hair-pulling for many individuals. In order to further increase treatment efficacy and improve long-term outcome, several authors have developed augmented treatment protocols that combine traditional behavioral strategies with other cognitive-behavioral interventions, including cognitive therapy, dialectical behavioral therapy, and acceptance and commitment therapy. In the present review, we give an overview of the clinical and diagnostic features of hair-pulling disorder, describe different cognitive-behavioral interventions, and evaluate research on their efficacy. PMID:25897268

  7. Electromyographical Comparison of a Traditional, Suspension Device, and Towel Pull-Up

    Directory of Open Access Journals (Sweden)

    Snarr Ronald L.

    2017-08-01

    Full Text Available Strengthening muscles of the back may have various implications for improving functions of daily living, aiding in the transfer of power in throwing, and assist in injury prevention of the shoulder complex. While several versions of the pull-up exist, there is currently no literature comparing their differences. The purpose of this investigation was to compare the electromyographical activity of the latissimus dorsi, posterior deltoid, middle trapezius, and biceps brachii while performing three variations of the pull-up. Resistance-trained men and women (n =15, age = 24.87 ± 6.52 years participated in this study by performing traditional pull-ups, suspension device pull-ups, and towel pull-ups in a randomized fashion. Each pull-up was performed for three repetitions with a 1.5 bi-acromial grip-width for each participant. Normalized (%MVC electromyographical values were recorded for each muscle group during each pull-up variation. No significant differences existed within the latissimus dorsi, biceps brachii or posterior deltoid between any of the exercises. For the middle trapezius, towel pull-ups provided significantly lower muscle activity than the traditional pull-up, while no differences between suspension pull-ups and the other variations occurred. In conclusion, only one muscular difference existed between the exercise variations and all versions examined provided electromyographical values, determined by current literature, to invoke a sufficient stimulus to promote increases in muscle strength and hypertrophy. Although further research is needed, practitioners can be confident when programming any of the movement variations examined when attempting to elicit adaptations of muscular strength and hypertrophy.

  8. An assessment of nurse-led triage at Connaught Hospital, Sierra Leone in the immediate post-Ebola period

    Directory of Open Access Journals (Sweden)

    Richard Lowsby

    2017-06-01

    Discussion: The triage process is functioning effectively in the emergency centre after the Ebola epidemic and provides a reliable assessment of undifferentiated patients presenting to the hospital to ensure that they are seen in a timely manner based on acuity.

  9. Mass-casualty triage training for international healthcare workers in the Asia-Pacific region using manikin-based simulations.

    Science.gov (United States)

    Vincent, Dale S; Berg, Benjamin W; Ikegami, Keiichi

    2009-01-01

    More than half of the world's disasters occur in the Asia-Pacific region. A simulation-based exercise to teach healthcare workers prehospital triage, tagging, and treatment methods was used to link disaster management theory to practice with a student-centered, hands-on educational activity. Various strategies for teaching disaster health education have been advocated, and best-practice disaster education models continue to be sought. A manikin-based, primary triage and treatment course was adapted for international healthcare providers in the Asia-Pacific region using symbolic representations of triage categories and physical findings. The pedagogical construct that was used was an interactive, formative assessment in which faculty members mediated learner information gathering and interpretation during four simulation scenarios. After establishing a multi-casualty disaster context, a wireless, audience response system anonymously collected learner responses to four clinical situations: (1) leg wound (hemorrhagic shock/immediate); (2) chest wound (tension pneumothorax/immediate); (3) head wound (traumatic brain injury/expectant); and (4) limb trauma (leg fracture/delayed). There were 182 healthcare providers from eight Asia-Pacific countries (including the US) that participated in four simulation seminars. The simulation sessions were successfully tailored to groups of learners that varied in size and professional composition. Expectant and delayed triage categories posed the greatest challenge to learners. In one of two groups that were queried, learner self-confidence in applying principles of triage and treatment improved significantly. At the conclusion of the simulation sessions, learners strongly agreed that manikin-based simulation improved their understanding of triage, and should be used to teach principles of primary triage and treatment. Simulation training represents an opportunity to engage learners regardless of language and cultural barriers

  10. A Multi-Site Assessment of the ACSCOT Field Triage Decision Scheme for Identifying Seriously Injured Children and Adults

    Science.gov (United States)

    Newgard, Craig D; Zive, Dana; Holmes, James F; Bulger, Eileen M; Staudenmayer, Kristan; Liao, Michael; Rea, Thomas; Hsia, Renee Y; Wang, N Ewen; Fleischman, Ross; Jui, Jonathan; Mann, N Clay; Haukoos, Jason S; Sporer, Karl A; Gubler, K Dean; Hedges, Jerris R

    2011-01-01

    Background ACSCOT has developed and updated field trauma triage protocols for decades, yet the ability to identify major trauma patients remains unclear. We estimate the diagnostic value of the Field Triage Decision Scheme for identifying major trauma patients (Injury Severity Score [ISS] ≥ 16) in a large and diverse multi-site cohort. Study Design This was a retrospective cohort study of injured children and adults transported by 94 EMS agencies to 122 hospitals in 7 regions of the Western U.S. from 2006 through 2008. Patients who met any of the field trauma triage criteria (per EMS personnel) were considered triage positive. Hospital outcome measures were probabilistically linked to EMS records through trauma registries, state discharge data and emergency department data. The primary outcome defining a “major trauma patient” was ISS ≥ 16. Results 122,345 injured patients were evaluated and transported by EMS over the 3-year period, of who 34.5% met at least one triage criterion and 5.8% had ISS ≥ 16. The overall sensitivity and specificity of the criteria for identifying major trauma patients were 85.8% (95% CI 85.0 – 86.6%) and 68.7% (95% CI 68.4 – 68.9%). Triage sensitivity and specificity differed by age: 84.1% and 66.4% (0 – 17 years); 89.5% and 64.3% (18 – 54 years); and 79.9% and 75.4% (≥ 55 years). Evaluating the diagnostic value of triage by hospital destination (transport to Level I/II trauma centers) did not substantially improve these findings. Conclusions The sensitivity of the Field Triage Decision Scheme for identifying major trauma patients is lower and specificity higher than previously described, particularly among elders. PMID:22107917

  11. 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.

  12. A family study of trichotillomania and chronic hair pulling.

    Science.gov (United States)

    Keuthen, Nancy J; Altenburger, Erin M; Pauls, David

    2014-03-01

    Little is known about the etiology of hair pulling (HP) and its relationship to other obsessive compulsive (OC) spectrum disorders. In a large-sample family study, we examined the familial aggregation of HP and co-transmission of obsessive compulsive disorder (OCD) and skin picking (SP). Our sample consisted of 110 proband cases with HP and 48 controls without HP, plus 128 first-degree case relatives and 50 first-degree control relatives. Case versus control relatives had higher recurrence risk estimates for both HP and OCD but not SP. The finding that HP is familial is consistent with the only existing twin study. Additional analyses suggest that there may be a familial subtype of HP with comorbid OCD. Those adult proband cases with HP + OCD had more anxiety and depression than cases without OCD. Probands with HP + OCD also had earlier onset of OCD. Identification of an HP subtype with comorbid OCD may have significant theoretical and treatment implications. The data did not provide evidence for an etiologic relationship between HP and SP. Replication of these findings in future studies with larger cohorts of case and control relatives is warranted. © 2014 Wiley Periodicals, Inc.

  13. Tunable Push-Pull Interactions in 5-Nitrosopyrimidines.

    Science.gov (United States)

    Procházková, Eliška; Čechová, Lucie; Tarábek, Ján; Janeba, Zlatko; Dračínský, Martin

    2016-05-06

    The effect of push-pull interactions in a series of variously substituted 5-nitrosopyrimidines on the strength of intramolecular hydrogen bonds, the height of rotational barriers around formally single bonds, UV-vis spectra and electrochemical behavior is explored. Intramolecular charge transfer (ICT) leads to a shift of electron density from electron-donating substituents, which is readily observable by NMR spectroscopy. The 5-nitroso group is able to form strong intramolecular hydrogen bonds with neighboring amino substituents. As a result, two rotamers with reversed orientation of the 5-nitroso group are observed for compounds with two different hydrogen-bond donors in neighboring positions. The barriers of interconversion between the two rotamers are strongly influenced by ICT, whereas the ratio of such rotamers depends primarily on the character of the hydrogen-bond donors. The ICT also significantly affects the position of UV-vis absorption maxima, which can be tuned in a broad range of 100 nm by the selection of appropriate substituents. Finally, ICT influences oxidation potential of the 5-nitrosopyrimidines and the stability of the resulting nitroso radical cations, the structures of which are determined by EPR spectroscopy.

  14. Measurement of Vehicle Air Conditioning Pull-Down Period

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, John F [ORNL; Huff, Shean P [ORNL; Moore, Larry G [ORNL; West, Brian H [ORNL

    2016-08-01

    Air conditioner usage was characterized for high heat-load summer conditions during short driving trips using a 2009 Ford Explorer and a 2009 Toyota Corolla. Vehicles were parked in the sun with windows closed to allow the cabin to become hot. Experiments were conducted by entering the instrumented vehicles in this heated condition and driving on-road with the windows up and the air conditioning set to maximum cooling, maximum fan speed and the air flow setting to recirculate cabin air rather than pull in outside humid air. The main purpose was to determine the length of time the air conditioner system would remain at or very near maximum cooling power under these severe-duty conditions. Because of the variable and somewhat uncontrolled nature of the experiments, they serve only to show that for short vehicle trips, air conditioning can remain near or at full cooling capacity for 10-minutes or significantly longer and the cabin may be uncomfortably warm during much of this time.

  15. Primary Triage in a Mass-casualty Event Possesses a Risk of Increasing Informational Confusion: A Simulation Study Using Shannon's Entropy.

    Science.gov (United States)

    Ajimi, Yasuhiko; Sasaki, Masaru; Uchida, Yasuyuki; Kaneko, Ichiro; Nakahara, Shinya; Sakamoto, Tetsuya

    2016-10-01

    Introduction Primary triage in a mass-casualty event setting using low-visibility tags may lead to informational confusion and difficulty in judging triage attribution of patients. In this simulation study, informational confusion during primary triage was investigated using a method described in a prior study that applied Shannon's Information Theory to triage. Hypothesis Primary triage using a low-visibility tag leads to a risk of informational confusion in prioritizing care, owing to the intermingling of pre- and post-triage patients. It is possible that Shannon's entropy evaluates the degree of informational confusion quantitatively and improves primary triage. The Simple Triage and Rapid Treatment (START) triage method was employed. In Setting 1, entropy of a triage area with 32 patients was calculated for the following situations: Case 1 - all 32 patients in the triage area at commencement of triage; Case 2 - 16 randomly imported patients to join 16 post-triage patients; Case 3 - eight patients imported randomly and another eight grouped separately; Case 4 - 16 patients grouped separately; Case 5 - random placement of all 32 post-triage patients; Case 6 - isolation of eight patients of minor priority level; Case 7 - division of all patients into two groups of 16; and Case 8 - separation of all patients into four categories of eight each. In Setting 2, entropies in the triage area with 32 patients were calculated continuously with each increase of four post-triage patients in Systems A and B (System A - triage conducted in random manner; and System B - triage arranged into four categories). In Setting 1, entropies in Cases 1-8 were 2.00, 3.00, 2.69, 2.00, 2.00, 1.19, 1.00, and 0.00 bits/symbol, respectively. Entropy increased with random triage. In Setting 2, entropies of System A maintained values the same as, or higher than, those before initiation of triage: 2.00 bits/symbol throughout the triage. The graphic waveform showed a concave shape and took 3

  16. Multi-Scale Pull-Out Resistance of Steel Reinforcing Bar Embedded in Hybrid Fiber Reinforced Concrete (HYFRC)

    Science.gov (United States)

    Lin, A.; Ostertag, C. P.

    2017-09-01

    This paper investigates the pull-out resistance of a steel reinforcing bar embedded in a strain hardening hybrid fiber reinforced concrete that utilizes both polyvinyl alcohol (PVA) microfibers and hooked-end steel macrofibers. Both unconfined and specimens confined with transverse steel spiral reinforcements were investigated. Pull-out tests on rebars embedded in unconfined concrete revealed brittle splitting failure whereas rebars embedded in unconfined HyFRC exhibited ductile frictional pull-out behavior. The high early rebar pull-out resistance in HyFRC is linked to an improved pull-out resistance of the steel macrofibers due to the micro/macrofiber synergy. Steel macrofiber pull-out tests revealed that the PVA microfibers are very effective in enhancing the pull-out resistance of the steel macrofibers which then lead to an overall performance enhancement of the rebar pull-out resistance.

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

    Science.gov (United States)

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

    2018-01-01

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

  18. Analyzing the Usability of the 5-Level Canadian Triage and Acuity Scale By Paramedics in the Prehospital Environment.

    Science.gov (United States)

    Smith, D Todd; Snyder, Audrey; Hollen, Patricia J; Anderson, Joel G; Caterino, Jeffrey M

    2015-11-01

    ED crowding negatively affects throughput, quality of care, and outcomes. Paramedics do not have an evidence-based, feasible triage instrument to guide classification of patients. No studies have compared the Canadian Triage and Acuity Scale (CTAS) used by prehospital paramedics against the Emergency Severity Index (ESI) used by nurses in the emergency department. This study sought to determine if a relationship exists between paramedics' triage scores and emergency nurses' scores in the emergency department using 2 common 5-level triage instruments, as well as to determine whether either instrument correlates with patient admission. CTAS scores determined by paramedics on arrival at the emergency department were compared with the initial ESI scores determined by emergency nurses. Both scores were compared with the patient's disposition status. Data analyses included descriptive statistics, χ(2) statistics, and hierarchical regression analysis. The analysis included 2,222 patients. There was a poor relationship between the CTAS and the ESI at the facility (P = .599, κ = -0.003). The final regression model explained 32.9% of the admission variance (P triage rates. Additional studies are indicated to better understand prehospital paramedic triage and its impact on throughput. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  19. 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.

  20. [Evidence of the validity of the Emergency Severity Index for triage in a general hospital emergency department].

    Science.gov (United States)

    Hernández Ruipérez, Tomás; Leal Costa, César; Adánez Martínez, María de Gracia; García Pérez, Bartolomé; Nova López, Daniel; Díaz Agea, José Luis

    2015-10-01

    To determine whether the Emergency Severity Index (ESI) is valid for triage according to evidence based on classifying real patients in a general referral hospital's emergency department. Observational, cross-sectional descriptive study carried out in the emergency department of Hospital Clínico Universitario Virgen de la Arrixaca in Murcia. Thirty-two nurses used the ESI algorithm to triage 410 patients as they arrived seeking care. The results were compared to a gold standard (a triage expert's opinion, which was later confirmed by an expert committee after discussion, if necessary, of cases for which opinions were not unanimous). We calculated sensitivity, specificity, under- and over-triage rates, as well as descriptive statistics about resource assignment, exitus, patients who left without being seen, destination on discharge, and times. ESI was highly correlated with resources (ρ = -0.717, P < .01) and moderately correlated with destination on discharge (ρ = -0.437, P < .01). Regarding time spent in the department, we found that patients assigned ESI levels 1 and 2 had significantly longer stays, and those assigned ESI levels 4 and 5 had significantly shorter stays (p < 0,001). Interobserver agreement was good or very good, indicating that this triage tool is reliable. This pilot of the ESI triage algorithm in the emergency department of a referral hospital found evidence supporting the system's validity.

  1. [Design and validation of a clinical simulation method for teaching nurses to use the Emergency Severity Index for triage].

    Science.gov (United States)

    Hernández Ruipérez, Tomás; Adánez Martínez, María de Gracia; Díaz Agea, José Luís; García Pérez, Bartolomé; Leal Costa, César

    2015-06-01

    To design and validate a clinical simulation method for training nurses to use the Emergency Severity Index (ESI) for triage. Descriptive, cross-sectional study carried out in the emergency department of Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, Spain. The educational intervention had 3 phases focused on theory, skills, and application. The participants, who were nurses with at least a year's experience in the emergency department, numbered 55, 43, and 32 in each phase, respectively. They undertook training in ESI for triage (phase 1), participated in simulations with patient-actors (phase 2), and applied their acquired skills (phase 3). We used Cohen's K and the intraclass correlation coefficient (ICC) to compare the nurses' triage assignments to gold-standard triage assignments. We had data for 1100, 799, and 410 observations of performance in each phase, respectively. Agreement statistics between the nurses' performance and the gold standard were 0.68, 0.67, and 0.68 (Cohen's K) and 0.870, 0.836, and 0.811 (ICC) in each phase, respectively. These results reflect good agreement. This study supports the relevance of clinical simulations for training nurses to implement structured triage, and in particular to use the ESI. We can state that this study opens the door to further research into whether the reliability of triage can be improved by using this approach, specifically whether it can facilitate better interobserver agreement.

  2. 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)

  3. Smart MCI Tracking and Tracing System Based on Colored Active RFID TriageTags

    Directory of Open Access Journals (Sweden)

    Ching Hsiang Chang

    2011-02-01

    Full Text Available With regards of quick response, its importance can’t be ingored during the mass‐casualty incident (MCI event. This paper focuses on the application of a mass‐casualty incidents system in tracking and tracing with the use of the colored active Radio Frequency Identification (RFID triage tag to make information of each vicim visual at the base of operations as soon as possible. Its main funtion mentioned in this paper is to traige the victims with the means of active colored tag. Meanwhile, the injuried information will be saved as data in PDA reader. In the process of the victim’s arrival in the hospital emergency department and the treatment data sheet will be sent back by the hospital information system, so that this system will get the RFID triage tag ID. This system of tracing and tracking is called as a smart MCIs management system.

  4. Pull-In Analysis of the Flat Circular CMUT Cell Featuring Sealed Cavity

    Directory of Open Access Journals (Sweden)

    Wen Zhang

    2015-01-01

    Full Text Available Capacitive micromachined ultrasonic transducers (CMUTs are one of the appealing MEMS devices. Most studies treat CMUTs as rigid plates vibrating in open air, ignoring the mechanical boundary conditions for simplification and resulting in cumulative errors in coupled fields. This paper presents a new analytical model for the pull-in characteristics of the flat circular CMUT cell featuring sealed cavity. Utilizing the plate theory coupled with Boyle’s law, the paper establishes a strong relation between the pressures inside the sealed cavity and the pull-in characteristics for the first time. Not only did we point out that the existence of the pressure inside the sealed cavity cannot be omitted, but we also quantified the direct effect of the pressure ratios on the pull-in phenomenon. The pull-in voltages increase while the pull-in ratios decrease with the pressure ratios of the pressure inside the sealed cavity to the ambient pressure. The proposed calculation process delivers a good approximation of the pull-in voltages and displacements, which are consistent with COMSOL simulation results. Particularly, the percentage error of our calculation process is 6.986% for the worst case. Therefore, our proposed analytical model accurately and efficiently predicts the pull-in characteristics and this paper offers new perspectives and reference value in designing and modeling the CMUTs.

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

    Directory of Open Access Journals (Sweden)

    Boakye O

    2016-05-01

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

  6. Dicentric assay: Inter-laboratory comparison in Indian laboratories for routine and triage applications

    International Nuclear Information System (INIS)

    Bakkiam, D.; Bhavani, M.; Anantha Kumar, A. Arul; Sonwani, Swetha; Venkatachalam, P.; Sivasubramanian, K.; Venkatraman, B.

    2015-01-01

    An Inter-Laboratory Comparison (ILC) study on Dicentric Chromosome Assay (DCA) was carried out between two Indian biodosimetry labs. Human peripheral blood samples exposed to 10 different doses of X-rays up to 5 Gy were shared between the labs to generate calibration data. Validation of calibration curves was done by dose estimation of coded samples exposed to X- or gamma radiation. Reliability of the DCA data for triage application was evaluated by scoring 20, 50 and 100 metaphases in the dose range of 0.5–3.0 Gy. No significant difference was observed between labs regarding the established calibration data as well as the DCA triage dose assessments. Scoring of 20 metaphases (MP) was adequate to detect radiation exposure of >2 Gy whereas 50 MP were sufficient to determine exposures of 0.5 Gy. Both labs performed the DCA in a reliable manner and made the first step in setting up a biodosimetry network in India. - Highlights: • This is the first Inter-Laboratory Comparison (ILC) study from India on Dicentric Chromosomal Assay (DCA) for both routine and triage biodosimetry applications. • No significant difference in the in vitro dose response curve parameters (slope, intercept and curvature) between labs. • Validation of calibration curves was done by blind trial method using samples exposed to different doses of X-rays and gamma rays. • Triage analysis was done by scoring 20, 50 and 100 metaphases for dose determination. • Scoring 20 metaphases is adequate to detect radiation exposure of 2 Gy and 50 metaphases is sufficient to determine radiation exposures of as low as 0.5 Gy. • The feasibility of formation of biodosimetry network in India which is essential especially when the country is aiming at capacity building in nuclear energy is demonstrated

  7. Five-Canon Feedback: Triaging Errors in Writing With Classical Rhetoric.

    Science.gov (United States)

    Madson, Michael

    2018-02-01

    Nurse educators may be asked to provide feedback on writing, encountering the challenge of determining which errors to address, when, and how. This Teaching Tips article, drawing on the author's experience in writing instruction, summarizes a novel framework for error triage: the five canons of classical rhetoric as described by the Roman rhetorician Quintilian. J Contin Nurs Educ. 2018;49(2):57-59. Copyright 2018, SLACK Incorporated.

  8. 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.

  9. Exploring the characteristics of high-performing hospitals that influence trauma triage and transfer.

    Science.gov (United States)

    Gagliardi, Anna R; Nathens, Avery B

    2015-02-01

    Many trauma patients might be first cared for at nondesignated centers before transfer to a trauma center. Limited research has investigated determinants of timely triage and transfer to identify those amenable to quality improvement. This study explored factors influencing timely triage and transfer in a regional trauma system. Centers (n = 15) with both long and short transfer times (emergency department length of stay before transfer) in Ontario were identified using a regional trauma registry. Physicians and nurses in these centers were interviewed with a view to determining factors that either impeded or enabled rapid decisions regarding the need for transfer to a trauma center. A grounded theory approach and constant comparative technique were used to collect and analyze data. Nineteen physicians and eight nurses participated. Clinician level (experience, training, personality, fear of judgment, nursing role), institutional level (guidelines, continuing education, trauma infrastructure, human resources) and system-level (bed availability, referral center, air transport, communication with trauma centers) factors influenced timely decision making. Participants offered several recommendations to improve care. These included guidelines for transfer, a "no refusal" policy at trauma centers, improved air transport and referral center services, as well as further regionalization. Additional features of hospitals with shorter transfer times included coaching of new staff, team meetings, leadership engagement, sharing of performance data, and minimum work hours for physicians. Numerous interacting factors that may influence trauma triage and transfer were identified. These findings can be used by policy makers, health care managers, and clinicians in emergency departments or trauma centers to evaluate and improve trauma triage and transfer, or plan new services. The findings can also be used by researchers to examine the relevance of these factors in other settings

  10. 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.

  11. Nuclear terrorism: triage and medical management of radiation and combined-injury casualties.

    Science.gov (United States)

    Flynn, Daniel F; Goans, Ronald E

    2006-06-01

    This article addresses the medical effects of nuclear explosions and other forms of radiation exposure, assessment of radiation dose, triage of victims, definitive treatment of radiation and combined-injury casualties, and planning for emergency services after a terrorist attack involving a nuclear device. It reviews historical events of mass radiation-induced casualties and fatalities at Hiroshima, Chernobyl, and Goiania, and discusses various scenarios for nuclear terrorism.

  12. Can Triage Nurses Accurately Predict Patient Dispositions in the Emergency Department?

    Science.gov (United States)

    Alexander, Danette; Abbott, Lincoln; Zhou, Qiuping; Staff, Ilene

    2016-11-01

    Contemporary emergency departments experience crowded conditions with poor patient outcomes. If triage nurses could accurately predict admission, one theoretical intervention to reduce crowding is to place patients in the admission cue on arrival to the emergency department. The purpose of this study was to determine if triage nurses could accurately predict patient dispositions. This prospective study was conducted in a tertiary academic hospital's emergency department using a data collection tool embedded in the ED electronic information system. Study variables included the predicted and actual disposition, as well as level of care, gender, age, and Emergency Severity Index level. Data were collected for 28 consecutive days from September 17 through October 9, 2013. Sensitivity and specificity, positive and negative predictive values, and accuracy of prediction, as well as the associations between patient characteristics and nurse prediction, were calculated. A total of 5,135 cases were included in the analysis. The triage nurses predicted admissions with a sensitivity of 71.5% and discharges with a specificity of 88.0%. Accuracy was significantly higher for younger patients and for patients at very low or very high severity levels. Although the ability to predict admissions at triage by nurses was not adequate to support a change in the bed procurement process, a specificity of 88.0% could have implications for rapid ED discharges or other low-acuity processes designed within the emergency department. Further studies in additional settings and on alternative interventions are needed. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  13. 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.

  14. 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.

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

    OpenAIRE

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

    2017-01-01

    PURPOSE: The 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 METHODS: The 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 ti...

  16. The FAST-ED App: A Smartphone Platform for the Field Triage of Patients With Stroke.

    Science.gov (United States)

    Nogueira, Raul G; Silva, Gisele S; Lima, Fabricio O; Yeh, Yu-Chih; Fleming, Carol; Branco, Daniel; Yancey, Arthur H; Ratcliff, Jonathan J; Wages, Robert Keith; Doss, Earnest; Bouslama, Mehdi; Grossberg, Jonathan A; Haussen, Diogo C; Sakano, Teppei; Frankel, Michael R

    2017-05-01

    The Emergency Medical Services field triage to stroke centers has gained considerable complexity with the recent demonstration of clinical benefit of endovascular treatment for acute ischemic stroke. We sought to describe a new smartphone freeware application designed to assist Emergency Medical Services professionals with the field assessment and destination triage of patients with acute ischemic stroke. Review of the application's platform and its development as well as the different variables, assessments, algorithms, and assumptions involved. The FAST-ED (Field Assessment Stroke Triage for Emergency Destination) application is based on a built-in automated decision-making algorithm that relies on (1) a brief series of questions assessing patient's age, anticoagulant usage, time last known normal, motor weakness, gaze deviation, aphasia, and hemineglect; (2) a database of all regional stroke centers according to their capability to provide endovascular treatment; and (3) Global Positioning System technology with real-time traffic information to compute the patient's eligibility for intravenous tissue-type plasminogen activator or endovascular treatment as well as the distances/transportation times to the different neighboring stroke centers in order to assist Emergency Medical Services professionals with the decision about the most suitable destination for any given patient with acute ischemic stroke. The FAST-ED smartphone application has great potential to improve the triage of patients with acute ischemic stroke, as it seems capable to optimize resources, reduce hospital arrivals times, and maximize the use of both intravenous tissue-type plasminogen activator and endovascular treatment ultimately leading to better clinical outcomes. Future field studies are needed to properly evaluate the impact of this tool in stroke outcomes and resource utilization. © 2017 American Heart Association, Inc.

  17. Scapula kinematics of pull-up techniques: Avoiding impingement risk with training changes.

    Science.gov (United States)

    Prinold, Joe A I; Bull, Anthony M J

    2016-08-01

    Overhead athletic activities and scapula dyskinesia are linked with shoulder pathology; pull-ups are a common training method for some overhead sports. Different pull-up techniques exist: anecdotally some are easier to perform, and others linked to greater incidences of pathology. This study aims to quantify scapular kinematics and external forces for three pull-up techniques, thus discussing potential injury implications. An observational study was performed with eleven participants (age=26.8±2.4 years) who regularly perform pull-ups. The upward motions of three pull-up techniques were analysed: palms facing anterior, palms facing posterior and wide-grip. A skin-fixed scapula tracking technique with attached retro-reflective markers was used. High intra-participant repeatability was observed: mean coefficients of multiple correlations of 0.87-1.00 in humerothoracic rotations and 0.77-0.90 for scapulothoracic rotations. Standard deviations of hand force was low: <5% body weight. Significantly different patterns of humerothoracic, scapulothoracic and glenohumeral kinematics were observed between the pull-up techniques. The reverse technique has extreme glenohumeral internal-external rotation and large deviation from the scapula plane. The wide technique has a reduced range of pro/retraction in the same HT plane of elevation and 90° of arm abduction with 45° external rotation was observed. All these factors suggest increased sub-acromial impingement risk. The scapula tracking technique showed high repeatability. High arm elevation during pull-ups reduces sub-acromial space and increases pressure, increasing the risk of impingement injury. Wide and reverse pull-ups demonstrate kinematics patterns linked with increased impingement risk. Weight-assisted front pull-ups require further investigation and could be recommended for weaker participants. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  18. 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.

  19. Patients' experience of being triaged directly to a psychologist in primary care: a qualitative study.

    Science.gov (United States)

    Dahlöf, Linda; Simonsson, Anna; Thorn, Jörgen; Larsson, Maria Eh

    2014-10-01

    In a primary health-care centre (PHCC) situated in a segregated area with low socio-economic status, 'primary care triage' has increased efficiency and accessibility. In the primary-care triage, the nurse sorts the patient to the appropriate PHCC profession according to described symptoms. Aim The aim of this study was to examine the patients' experience of being triaged directly to a psychologist for assessment. Interviews were conducted with 20 patients and then analysed using qualitative content analysis. The results show that patients contacting the PHCC for mental health issues often are active agents with their own intent to see a psychologist, not a doctor, as a first-hand choice when contacting the PHCC. Seeking help for mental health issues is described as a sensitive issue that demands building up strength before contacting. The quick access to the preferred health-care professional is appreciated. The nurse was perceived as a caring facilitator rather than a decision maker. It is the patient's wish rather than the symptoms that directs the sorting. The patients' expectations when meeting the psychologist were wide and diverse. The structured assessment sometimes collided and sometimes united with these expectations, yielding different outcome satisfaction. The results could be seen in line with the present goal to increase patients' choice in the health-care system. The improved accessibility to the psychologist seems to meet community expectations. The results also indicate a need for providing more prior information about the assessment and potential outcomes.

  20. 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.

  1. Exploring the third delay: an audit evaluating obstetric triage at Mulago National Referral Hospital.

    Science.gov (United States)

    Forshaw, Jennifer; Raybould, Stephanie; Lewis, Emilie; Muyingo, Mark; Weeks, Andrew; Reed, Kate; Manikam, Logan; Byamugisha, Josaphat

    2016-10-10

    Mulago National Referral Hospital has the largest maternity unit in sub-Saharan Africa. It is situated in Uganda, where the maternal mortality ratio is 310 per 100,000 live births. In 2010 a 'Traffic Light System' was set up to rapidly triage the vast number of patients who present to the hospital every day. The aim of this study was to evaluate the effectiveness of the obstetric department's triage system at Mulago Hospital with regard to time spent in admissions and to identify urgent cases and factors adversely affecting the system. A prospective audit of the obstetric admissions department was carried out at the Mulago Hospital. Data were obtained from tagged patient journeys using two data collection tools and compiled using Microsoft Excel. StatsDirect was used to compose graphs to illustrate the results. Informal triage was occurring 46 % of the time at the first checkpoint in a woman's journey, but the 'Traffic Light System' was not being used and many of the patient's vital signs were not being recorded. It is hypothesised that the 'Traffic Light System' is not being used due to its focus on examination finding and diagnosis, implying that it is not suitable for an early stage in the patient's journey. Replacing it with a simple algorithm to categorise women into the urgency with which they need to be seen could rectify this.

  2. 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

    DEFF Research Database (Denmark)

    Barfod, Charlotte; Laurtizen, Marlene Mp; Danker, Jakob K

    2012-01-01

    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 Hillerod 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...

  3. Drawbar Pull (DP) Procedures for Off-Road Vehicle Testing

    Science.gov (United States)

    Creager, Colin; Asnani, Vivake; Oravec, Heather; Woodward, Adam

    2017-01-01

    As NASA strives to explore the surface of the Moon and Mars, there is a continued need for improved tire and vehicle development. When tires or vehicles are being designed for off-road conditions where significant thrust generation is required, such as climbing out of craters on the Moon, it is important to use a standard test method for evaluating their tractive performance. The drawbar pull (DP) test is a way of measuring the net thrust generated by tires or a vehicle with respect to performance metrics such as travel reduction, sinkage, or power efficiency. DP testing may be done using a single tire on a traction rig, or with a set of tires on a vehicle; this report focuses on vehicle DP tests. Though vehicle DP tests have been used for decades, there are no standard procedures that apply to exploration vehicles. This report summarizes previous methods employed, shows the sensitivity of certain test parameters, and provides a body of knowledge for developing standard testing procedures. The focus of this work is on lunar applications, but these test methods can be applied to terrestrial and planetary conditions as well. Section 1.0 of this report discusses the utility of DP testing for off-road vehicle evaluation and the metrics used. Section 2.0 focuses on test-terrain preparation, using the example case of lunar terrain. There is a review of lunar terrain analogs implemented in the past and a discussion on the lunar terrain conditions created at the NASA Glenn Research Center, including methods of evaluating the terrain strength variation and consistency from test to test. Section 3.0 provides details of the vehicle test procedures. These consist of a review of past methods, a comprehensive study on the sensitivity of test parameters, and a summary of the procedures used for DP testing at Glenn.

  4. The Utility of Point-of-Care Testing at Emergency Department Triage by Nurses in Simulated Scenarios.

    Science.gov (United States)

    Pines, Jesse M; Zocchi, Mark S; Buchanan, Mary Elizabeth; Shah, Manish N; Travers, Debbie

    We developed and tested simulated patient scenarios to assess how normal or abnormal point-of-care (POC) test results at triage change prioritization decisions. This was a cross-sectional study where our team developed simulated scenarios and presented them to triage nurses from 3 academic medical centers. Twenty-four scenarios were constructed on the basis of 12 clinical indications from a protocol previously developed by our team. In each scenario, nurses were presented with 2 patients with the same Emergency Severity Index Version 4 (ESI v.4; Agency for Healthcare Research and Quality, Rockville, MD) triage level (Level 2 or Level 3). One of the patients met the inclusion criteria for POC testing under the protocol (cases), whereas the other patient did not (controls). Nurses were asked which of the 2 patients to prioritize first in 3 separate rounds: first without any POC test results, once with abnormal POC test results for case patients, and once with normal POC test results for case patients. Prioritization decisions that changed on the basis of abnormal POC results were defined as "up-triage" and prioritization decisions that changed on the basis of normal results were defined as "down-triage." A total of 39 nurses completed 468 scenarios. In scenarios without any POC test results, 42.3% of case patients were prioritized first. When POC test results were abnormal, 71.6% of cases were prioritized first. When POC test results were normal, 32.7% of case patients were prioritized first. An abnormal POC test resulted in up-triage in 32.5% of the scenarios. When POC test results were normal, there was down-triage in 18.6% of the scenarios. Up- and down-triage rates varied considerably by scenario and clinical indication. Point-of-care testing at emergency department triage results in reasonably high rates of up- and down-triage in simulated scenarios; however, POC tests for specific indications appear to be more useful than others.

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

    Science.gov (United States)

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

    2016-11-11

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

  6. Triage strategies in cervical cancer detection in Mexico: methods of the FRIDA Study.

    Science.gov (United States)

    Torres-Ibarra, Leticia; Lazcano-Ponce, Eduardo; Franco, Eduardo L; Cuzick, Jack; Hernández-Ávila, Mauricio; Lorincz, Attila; Rivera, Berenice; Ramírez, Paula; Mendiola-Pastrana, Indira; Rudolph, Samantha E; León-Maldonado, Leith; Hernández, Rubí; Barrios, Elizabeth; Gravitt, Patti; Moscicki, Anna Barbara; Schmeler, Kathleen M; Flores, Yvonne N; Méndez-Hernández, Pablo; Salmerón, Jorge

    2016-04-01

    This paper describes the study design and baseline characteristics of the study population, including the first 30 829 women who enrolled in the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage (FRIDA Study). This is a large population based study that is evaluating the performance and cost-effectiveness of different triage strategies for high-risk HPV (hrHPV) positive women in Mexico. The target population is more than 100 000 women aged 30 to 64 years who attend the Cervical Cancer Screening Program in 100 health centers in the state of Tlaxcala, Mexico. Since August 2013, all women in the region have been invited to enroll in the study. The study participants are evaluated to determine hrHPV infection using the Cobas 4800 HPV test. The HPV-16/18 genotyping and cytology triage strategies are performed as reflex tests in all hrHPV-positive participants. Women with a positive HPV-16/18 test and/or abnormal cytology (atypical squamous cells of undetermined significance or worse, ASCUS+) are referred for colposcopy evaluation, where a minimum of four biopsies and an endocervical sample are systematically collected. Histologic confirmation is performed by a standardized panel of pathologists. Among the 30 829 women who have been screened, the overall prevalence of hrHPV is 11.0%. The overall prevalence of HPV16 and HPV18 are 1.5% and 0.7%, respectively. Cytological abnormalities (ASCUS+) were detected in 11.8% of the hrHPV-positive women. A total of 27.0% (920/3,401) of the hrHPV-positive women were referred to colposcopy because of a positive HPV16/18 test and/or abnormal reflex cytology, (31.6% had only ASCUS+, 53.6% were HPV16/18 positive with a normal cytology result, and 9.5% were positive to both triage tests). The results of this study will help policy makers and health service providers establish the best practices for triage in cervical cancer screening in Mexico and other countries.

  7. Task shifting of triage to peer expert informal care providers at a tertiary referral HIV clinic in Malawi: a cross-sectional operational evaluation.

    Science.gov (United States)

    Landes, Megan; Thompson, Courtney; Mwinjiwa, Edson; Thaulo, Edith; Gondwe, Chrissie; Akello, Harriet; Chan, Adrienne K

    2017-05-09

    HIV treatment models in Africa are labour intensive and require a high number of skilled staff. In this context, task-shifting is considered a feasible alternative for ART service delivery. In 2006, a lay health cadre of expert patients (EPs) at a tertiary referral HIV clinic in Zomba, Malawi was capacitated. There are few evaluations of EP program efficacy in this setting. Triage is the process of prioritizing patients in terms of the severity of their condition and ensures that no harmful delays occur to treatment and care. This study evaluates the safety of task-shifting triage, in an ambulatory low resource setting, to EPs. As a quality improvement exercise in April 2010, formal triage training was conducted by adapting the World Health Organization Emergency Triage Assessment and Treatment Triage Module Guidelines. A cross sectional observation study was conducted 2 years after the intervention. Triage assessments performed by EPs were repeated by a clinical officer (gold standard) to assess sensitivities, specificities, positive and negative predictive values for EP triage scores. Proportions were calculated for categories of disposition by stratifying by EP and clinician triage scores. A total of 467 patients were triaged by 7 EPs and re-triaged by clinical officers. With combined triage scores for emergency and priority patients we report a sensitivity of 85% and specificity of 74% for the EP scoring, with a low positive predictive value (41%) and a high negative predictive value (96%). We calculate a serious miss rate of EP scoring (i.e. missed priority or emergency patients) as 2.2%. Admission rates to hospital were highest among those patients triaged as emergency cases either by the EP's (21%) or the clinicians (83%). Fewer patients triaged as priority by either EPs (5%) or clinicians (15%) were admitted to hospital, however these patients had the highest prevalence of same day lab testing and/or specialty referral. Our study provides reassurance that

  8. 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

  9. Design and Implementation of a Telephone Triage/Advice Service: An Instrument of Demand Management at USA Medical Department Activity-Heidelberg

    National Research Council Canada - National Science Library

    Hamilton, Priscilla

    1997-01-01

    .... Demand management systems may involve health care "gatekeepers," prevention and wellness programs, self-care instruction, and frequently employ telephone triage and advice capabilities Telephonic...

  10. Comorbidity and quality of life in adults with hair pulling disorder (Trichotillomania)

    NARCIS (Netherlands)

    Houghton, D.C.; Maas, J.; Twohig, M.P.; S., Saunders; Compton, S.; Neil-Barnett, A.

    2016-01-01

    Hair pulling disorder (HPD; trichotillomania) is thought to be associated with significant psychiatric comorbidity and functional impairment. However, few methodologically rigorous studies of HPD have been conducted, rendering such conclusions tenuous. The following study examined comorbidity and

  11. On-bead chemical synthesis and display of phosphopeptides for affinity pull-down proteomics

    DEFF Research Database (Denmark)

    Malene, Brandt; Madsen, Jens C.; Bunkenborg, Jakob

    2006-01-01

    (aldehyde) at the C terminus for potential activity-based proteomics. The synthetic support-bound Bad phosphopeptides were able to pull down 14-3-3zeta. Furthermore, Bad phosphopeptides bound endogenous 14-3-3 proteins, and all seven members of the 14-3-3 family were identified by mass spectrometry......We describe a new method for phosphopeptide proteomics based on the solid-phase synthesis of phosphopeptides on beads suitable for affinity pull-down experiments. Peptide sequences containing the Bad Ser112 and Ser136 phosphorylation motifs were used as bait in affinity pull-down experiments....... In control experiments, none of the unphosphorylated Bad peptides bound transfected 14-3-3zeta or endogenous 14-3-3. We conclude that the combined synthesis and display of phosphopeptides on-bead is a fast and efficient method for affinity pull-down proteomics....

  12. Comorbidity and quality of life in adults with hair pulling disorder

    NARCIS (Netherlands)

    Houghton, D.C.; Maas, J.; Twohig, M.P.; Saunders, S.M.; Compton, S.N.; Neal-Barnett, A.M.; Franklin, M.E.; Woods, D.W.

    2016-01-01

    Hair pulling disorder (HPD; trichotillomania) is thought to be associated with significant psychiatric comorbidity and functional impairment. However, few methodologically rigorous studies of HPD have been conducted, rendering such conclusions tenuous. The following study examined comorbidity and

  13. Micro/nano-mechanical test system employing tensile test holder with push-to-pull transformer

    Science.gov (United States)

    Oh, Yunje; Cyrankowski, Edward; Shan, Zhiwei; Asif, Syed Amanula Syed

    2013-05-07

    A micromachined or microelectromechanical system (MEMS) based push-to-pull mechanical transformer for tensile testing of micro-to-nanometer scale material samples including a first structure and a second structure. The second structure is coupled to the first structure by at least one flexible element that enables the second structure to be moveable relative to the first structure, wherein the second structure is disposed relative to the first structure so as to form a pulling gap between the first and second structures such that when an external pushing force is applied to and pushes the second structure in a tensile extension direction a width of the pulling gap increases so as to apply a tensile force to a test sample mounted across the pulling gap between a first sample mounting area on the first structure and a second sample mounting area on the second structure.

  14. Comparative analysis of thrust production for distinct arm-pull styles in competitive swimming.

    Science.gov (United States)

    Loebbecke, Alfred von; Mittal, Rajat

    2012-07-01

    A computational fluid dynamics (CFD) based analysis of the propulsive forces generated by two distinct styles of arm-pulls in front-crawl as well as backstroke is presented in this Technical Brief. Realistic models of the arm pulling through water are created by combining underwater video footage and laser-scans of an arm with computer animation. The contributions of drag and lift forces on the arm to thrust are computed from CFD, and it is found that lift forces provide a dominant contribution to thrust for all the arm-pull styles examined. However, contrary to accepted notions in swimming, pronounced sculling (lateral motion) not only does not increase the contribution of lift forces on the hand to overall thrust, it decreases the contribution of drag forces to thrust. Consequently, pronounced sculling seems to reduce the effectiveness of the arm-pull.

  15. Load Absorption Force-Time Characteristics Following the Second Pull of Weightlifting Derivatives.

    Science.gov (United States)

    Suchomel, Timothy J; Lake, Jason P; Comfort, Paul

    2017-06-01

    The purpose of this study was to compare the load absorption force-time characteristics of weightlifting catching and pulling derivatives. Twelve resistance-trained men performed repetitions of the hang power clean (HPC), jump shrug (JS), and hang high pull (HHP) on a force platform with 30, 45, 65, and 80% of their 1-repetition maximum HPC. Load absorption phase duration, mean force, and work were calculated from the force-time data. The HHP produced a significantly longer load absorption phase duration compared with the HPC (p weightlifting pulling derivatives examined in the current study (JS and HHP) produced greater load absorption demands after the second pull compared with the weightlifting catching derivative (HPC). The JS and HHP may be used as effective training stimuli for load absorption during impact tasks such as jumping.

  16. Growth of platinum fibers using the micro-pulling-down method

    Science.gov (United States)

    Nihei, Takayuki; Yokota, Yuui; Arakawa, Mototaka; Ohashi, Yuji; Kurosawa, Shunsuke; Kamada, Kei; Chani, Valery; Yoshikawa, Akira

    2017-06-01

    Platinum (Pt) crystalline fibers were grown from the melt by the micro-pulling-down (μ-PD) method using the ZrO2 ceramics crucible. The diameter of the grown Pt fiber was controlled by the ϕ1 mm outlet made at the bottom of the crucible and the Pt fiber of 0.95±0.03 mm in diameter and over 5 m in length was obtained at 10 mm/min pulling-down rate. In addition, the Pt fiber was grown at 1-110 mm/min pulling rates while the liquid-solid interface reached the bottom of the crucible and the crystal growth became unstable at 120 mm/min pulling rate. Few grain boundaries were observed in the scanning electron microscopy image of the Pt fibers and there were some spots with high intensity in the pole figures.

  17. 29 CFR 1915.114 - Chain falls and pull-lifts.

    Science.gov (United States)

    2010-07-01

    ... (CONTINUED) OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR SHIPYARD EMPLOYMENT Gear and Equipment for Rigging and Materials Handling § 1915.114 Chain falls and pull-lifts. The provisions of this section shall...

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

    Science.gov (United States)

    de Carvalho, José Crespo; Ramos, Madalena; Paixão, Carina

    2013-01-01

    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 first steps to implement a remote triage system by telephone, and has begun to reduce the previously necessary movement of impaired patients.

  19. Study on pollution control in residential kitchen based on the push-pull ventilation system

    DEFF Research Database (Denmark)

    Zhou, Bin; Chen, Feng; Dong, Zhibo

    2016-01-01

    Highlights •The push-pull ventilation system is proposed to improve IAQ inside kitchen, where air is supplied through slot air curtain and then exhausted through range hood. •CO2 reduction efficiency with application of air curtain in experiment and simulation in breathing zone was 23.7% and 23.......1%, respectively. •By orthogonal method, the influence of factors on pollution control of the push-pull ventilation system was presented....

  20. Ultrasonic Evaluation of the Pull-Off Adhesion between Added Repair Layer and a Concrete Substrate

    Science.gov (United States)

    Czarnecki, Slawomir

    2017-10-01

    This paper concerns the evaluation of the pull-off adhesion between a concrete added repair layer with variable thickness and a concrete substrate, based on parameters assessed using ultrasonic pulse velocity (UPV) method. In construction practice, the experimental determination of pull-off adhesion f b, between added repair layer and a concrete substrate is necessary to assess the quality of repair. This is usually carried out with the use of pull-off method which results in local damage of the added concrete layer in all the testing areas. Bearing this in mind, it is important to describe the method without these disadvantages. The prediction of the pull-off adhesion of the two-layer concrete elements with variable thickness of each layer might be provided by means of UPV method with two-sided access to the investigated element. For this purpose, two-layered cylindrical specimens were obtained by drilling the borehole from a large size specially prepared concrete element. Those two-layer elements were made out of concrete substrate layer and Polymer Cement Concrete (PCC) mortar as an added repair layer. The values of pull-off adhesion f b of the elements were determined before obtaining the samples by using the semi-destructive pull-off method. The ultrasonic wave velocity was determined in samples with variable thickness of each layer and was then compared to theoretical ultrasonic wave velocity predicted for those specimens. The regression curve for the dependence of velocity and pull-off adhesion, determined by the pulloff method, was made. It has been proved that together with an increase of ratio of investigated ultrasonic wave velocity divided by theoretical ultrasonic wave velocity, the pull-off adhesion value f b between added repair layer with variable thickness and a substrate layer also increases.

  1. A Formalization for Specifying and Implementing Correct Pull-Stream Modules

    OpenAIRE

    Lavoie, Erick; Hendren, Laurie

    2018-01-01

    Pull-stream is a JavaScript demand-driven functional design pattern based on callback functions that enables the creation and easy composition of independent modules that are used to create streaming applications. It is used in popular open source projects and the community around it has created over a hundred compatible modules. While the description of the pull-stream design pattern may seem simple, it does exhibit complicated termination cases. Despite the popularity and large uptake of th...

  2. Hair pulling disorder (trichotillomania): genes, neurobiology, and a model for understanding impulsivity and compulsivity.

    Science.gov (United States)

    Flessner, Christopher A; Knopik, Valerie S; McGeary, John

    2012-10-30

    Hair pulling disorder (trichotillomania) affects at least 3.7 million people in the United States and results in marked functional impairment. This article reviews empirical research investigating the genetics and neurobiology of hair pulling disorder (HPD). We also discuss recent advances in the characterization of this phenotype which have led to evidence supporting the existence of at least two disparate pulling styles-automatic and focused pulling. These pulling styles exhibit facets of behavioral processes, impulsivity and compulsivity, characteristic of several classes of disorders (e.g., obsessive-compulsive spectrum disorders, impulse control disorders). Available genetic, neurobiological, and clinical data support the importance of impulsivity for conceptualizing HPD. Impulsivity alone is insufficient to fully understand this complex phenotype. Characterizations of both automatic and focused pulling as well as preliminary findings from affective neuroscience across species highlight the importance of compulsivity for understanding HPD. Opposing and complementary aspects to impulsivity-compulsivity provide a more comprehensive conceptualization of HPD and supports HPD's potential importance for advancing scientific inquiry in relation to the pathogenesis and treatment of related phenotypes. This review concludes with a description of areas-phenotype, neurobiology, and genes-in need of further study. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. Optimizing psychological interventions for trichotillomania (hair-pulling disorder: an update on current empirical status

    Directory of Open Access Journals (Sweden)

    Snorrason I

    2015-04-01

    Full Text Available Ivar Snorrason, Gregory S Berlin, Han-Joo Lee Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA Abstract: Trichotillomania (hair-pulling disorder is a psychiatric condition characterized by a persistent habit of pulling out one's hair. In treatment-seeking populations, hair-pulling disorder can be severe, chronic, and difficult to treat. In the early 1970s, behavioral interventions (eg, habit reversal training were developed and proved effective in treating chronic hair-pulling for many individuals. In order to further increase treatment efficacy and improve long-term outcome, several authors have developed augmented treatment protocols that combine traditional behavioral strategies with other cognitive-behavioral interventions, including cognitive therapy, dialectical behavioral therapy, and acceptance and commitment therapy. In the present review, we give an overview of the clinical and diagnostic features of hair-pulling disorder, describe different cognitive-behavioral interventions, and evaluate research on their efficacy. Keywords: trichotillomania, hair-pulling, cognitive-behavioral therapy, diagnosis, review

  4. Revision laryngeal framework surgery performed by directly pulling the lateral cricoarytenoid muscle.

    Science.gov (United States)

    Kanazawa, T; Komazawa, D; Watanabe, Y; Ichimura, K

    2014-10-01

    Revision laryngeal framework surgery is usually performed for medialisation laryngoplasty failure, rather than for failure after arytenoid adduction. We describe a new method for revision arytenoid adduction surgery, performed by directly pulling the lateral cricoarytenoid muscle ('lateral cricoarytenoid muscle pull surgery'). We describe a case of revision laryngeal framework surgery, present a literature review and describe the advantages of lateral cricoarytenoid muscle pull surgery over the original method of arytenoid adduction using a posterior approach. Medialisation laryngoplasty combined with arytenoid adduction was performed following unilateral vocal fold paralysis from mediastinal surgery, resulting in severe glottic insufficiency. The patient's voice improved after the initial surgery, but had deteriorated 18 months later. Revision surgery was performed using lateral cricoarytenoid muscle pull surgery, and her voice recovered normally in terms of perceptual impression. The post-operative course was uneventful for 10 months following revision surgery. To our knowledge, this is the first case of revision arytenoid adduction performed using a lateral cricoarytenoid muscle pull approach. Lateral cricoarytenoid muscle pull surgery should therefore be considered as a new fenestration approach for arytenoid adduction.

  5. Effect of Body Position on Force Production During the Isometric Midthigh Pull.

    Science.gov (United States)

    Beckham, George K; Sato, Kimitake; Santana, Hugo A P; Mizuguchi, Satoshi; Haff, G Gregory; Stone, Michael H

    2018-01-01

    Beckham, GK, Sato, K, Santana, HAP, Mizuguchi, S, Haff, GG, and Stone, MH. Effect of body position on force production during the isometric midthigh pull. J Strength Cond Res 32(1): 48-56, 2018-Various body positions have been used in the scientific literature when performing the isometric midthigh pull resulting in divergent results. We evaluated force production in the isometric midthigh pull in bent (125° knee and 125° hip angles) and upright (125° knee, 145° hip angle) positions in subjects with (>6 months) and without (weightlifting derivatives. A mixed-design ANOVA was used to evaluate the effect of pull position and weightlifting experience on peak force, force at 50, 90, 200, and 250 ms. There were statistically significant main effects for weightlifting experience and pull position for all variables tested, and statistically significant interaction effects for peak force, allometrically scaled peak force, force at 200 ms, and force at 250 ms. Calculated effect sizes were small to large for all variables in subjects with weightlifting experience, and were small to moderate between positions for all variables in subjects without weightlifting experience. A central finding of the study is that the upright body position (125° knee and 145° hip) should be used given that forces generated are highest in that position. Actual joint angles during maximum effort pulling should be measured to ensure body position is close to the position intended.

  6. Impact of Androstenone on Leash Pulling and Jumping Up in Dogs.

    Science.gov (United States)

    Pirner, Glenna; McGlone, John

    2016-05-09

    Dogs are relinquished to shelters due to behavioral problems, such as leash pulling and jumping up. Interomones are chemical cues produced by one species that elicit a response in a different species. We reported earlier that androstenone, a swine sex pheromone, acts as an interomone to reduce barking in dogs. Here we report two models using 10 dogs/study: a dog jumping and a dog walking model. For the leash-pulling model, each time the dog pulled on the leash the walker either did nothing (NOT), or sprayed the dog with water (H₂O), androstenone + water (ANH), androstenone 0.1 µg/mL (AND1), or androstenone 1.0 µg/mL (AND2). The number of pulls during each walk was counted. For the jumping up model, each time the dog jumped the researcher did nothing (NOT), or sprayed the dog with H₂O, ANH, AND1, or AND2. The number of jumps and the time between jumps were recorded. In Study 1, ANH, AND1, and AND2 each reduced leash pulling more than NOT and H₂O (pleash pulling. The burst of air intended as a disruptive stimulus in the correction sprays may be too harsh for more sensitive dogs, and as such use of these sprays is cautioned in these animals. For other dogs, this interomone can be used to stop some behavior immediately or as a part of a training program to reduce undesirable behavior.

  7. Changes of muscular load with aging in the motion of pulling up disposable diapers.

    Science.gov (United States)

    Yoto, Tsuyoshi Yi; Sakuragawa, Satoshi; Suzuki, Taka-aki; Tamura, Hisae; Yamaki, Rumi; Fujioka, Yoshihisa; Katsuura, Tetsuo

    2010-01-01

    To elucidate how aging affects the muscular load required for pulling up pants-style disposable diapers, and why some elderly people cannot pull up the rear of their disposable diapers well, we evaluated the electromyogram (EMG) of 8 young subjects (21.5+/-1.5 years) and 7 elderly subjects (71.6+/-6.1 years). EMG was measured for four muscles--biceps brachii, deltoid, brachioradialis, and flexor carpi ulnaris. We evaluated the muscular load during a series of motions for pulling a disposable diaper up at the front and the rear of the body using an EMG-Video Synchronous Split Method. The analysis revealed that the front and the rear integral EMG of elderly subjects were both significantly larger than those of young subjects for all four muscles. For the deltoid and flexor carpi ulnaris muscles, the maximum amplitude of EMG when pulling up the rear of the disposable diapers was significantly larger in the elderly subjects than the young ones. These results suggest that the muscular load involved in pulling up the rear of disposable diapers may increase due to changes in body habitus caused by aging. Since muscular strength decreases with age, it seems likely that the elderly individuals will eventually be unable to pull up the rear of their diapers.

  8. An investigation into the cognition behind spontaneous string pulling in New Caledonian crows.

    Directory of Open Access Journals (Sweden)

    Alex H Taylor

    Full Text Available The ability of some bird species to pull up meat hung on a string is a famous example of spontaneous animal problem solving. The "insight" hypothesis claims that this complex behaviour is based on cognitive abilities such as mental scenario building and imagination. An operant conditioning account, in contrast, would claim that this spontaneity is due to each action in string pulling being reinforced by the meat moving closer and remaining closer to the bird on the perch. We presented experienced and naïve New Caledonian crows with a novel, visually restricted string-pulling problem that reduced the quality of visual feedback during string pulling. Experienced crows solved this problem with reduced efficiency and increased errors compared to their performance in standard string pulling. Naïve crows either failed or solved the problem by trial and error learning. However, when visual feedback was available via a mirror mounted next to the apparatus, two naïve crows were able to perform at the same level as the experienced group. Our results raise the possibility that spontaneous string pulling in New Caledonian crows may not be based on insight but on operant conditioning mediated by a perceptual-motor feedback cycle.

  9. 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.

  10. Optimal Triage Test Characteristics to Improve the Cost-Effectiveness of the Xpert MTB/RIF Assay for TB Diagnosis: A Decision Analysis

    Science.gov (United States)

    van’t Hoog, Anna H.; Cobelens, Frank; Vassall, Anna; van Kampen, Sanne; Dorman, Susan E.; Alland, David; Ellner, Jerrold

    2013-01-01

    Background High costs are a limitation to scaling up the Xpert MTB/RIF assay (Xpert) for the diagnosis of tuberculosis in resource-constrained settings. A triaging strategy in which a sensitive but not necessarily highly specific rapid test is used to select patients for Xpert may result in a more affordable diagnostic algorithm. To inform the selection and development of particular diagnostics as a triage test we explored combinations of sensitivity, specificity and cost at which a hypothetical triage test will improve affordability of the Xpert assay. Methods In a decision analytical model parameterized for Uganda, India and South Africa, we compared a diagnostic algorithm in which a cohort of patients with presumptive TB received Xpert to a triage algorithm whereby only those with a positive triage test were tested by Xpert. Findings A triage test with sensitivity equal to Xpert, 75% specificity, and costs of US$5 per patient tested reduced total diagnostic costs by 42% in the Uganda setting, and by 34% and 39% respectively in the India and South Africa settings. When exploring triage algorithms with lower sensitivity, the use of an example triage test with 95% sensitivity relative to Xpert, 75% specificity and test costs $5 resulted in similar cost reduction, and was cost-effective by the WHO willingness-to-pay threshold compared to Xpert for all in Uganda, but not in India and South Africa. The gain in affordability of the examined triage algorithms increased with decreasing prevalence of tuberculosis among the cohort. Conclusions A triage test strategy could potentially improve the affordability of Xpert for TB diagnosis, particularly in low-income countries and with enhanced case-finding. Tests and markers with lower accuracy than desired of a diagnostic test may fall within the ranges of sensitivity, specificity and cost required for triage tests and be developed as such. PMID:24367555

  11. An investigation of the validity of the Work Assessment Triage Tool clinical decision support tool for selecting optimal rehabilitation interventions for workers with musculoskeletal injuries.

    Science.gov (United States)

    Qin, Ziling; Armijo-Olivo, Susan; Woodhouse, Linda J; Gross, Douglas P

    2016-03-01

    To evaluate the concurrent validity of a clinical decision support tool (Work Assessment Triage Tool (WATT)) developed to select rehabilitation treatments for injured workers with musculoskeletal conditions. Methodological study with cross-sectional and prospective components. Data were obtained from the Workers' Compensation Board of Alberta rehabilitation facility in Edmonton, Canada. A total of 432 workers' compensation claimants evaluated between November 2011 and June 2012. Percentage agreement between the Work Assessment Triage Tool and clinician recommendations was used to determine concurrent validity. In claimants returning to work, frequencies of matching were calculated and compared between clinician and Work Assessment Triage Tool recommendations and the actual programs undertaken by claimants. The frequency of each intervention recommended by clinicians, Work Assessment Triage Tool, and case managers were also calculated and compared. Percentage agreement between clinician and Work Assessment Triage Tool recommendations was poor (19%) to moderate (46%) and Kappa = 0.37 (95% CI -0.02, 0.76). The Work Assessment Triage Tool did not improve upon clinician recommendations as only 14 out of 31 claimants returning to work had programs that contradicted clinician recommendations, but were consistent with Work Assessment Triage Tool recommendations. Clinicians and case managers were inclined to recommend functional restoration, physical therapy, or no rehabilitation while the Work Assessment Triage Tool recommended additional evidence-based interventions, such as workplace-based interventions. Our findings do not provide evidence of concurrent validity for the Work Assessment Triage Tool compared with clinician recommendations. Based on these results, we cannot recommend further implementation of the Work Assessment Triage Tool. However, the Work Assessment Triage Tool appeared more likely than clinicians to recommend interventions supported by evidence

  12. 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.

  13. A systematic review of triage-related interventions to improve patient flow in emergency departments

    Directory of Open Access Journals (Sweden)

    Asplund Kjell

    2011-07-01

    Full Text Available Abstract Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department, and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency

  14. A systematic review of triage-related interventions to improve patient flow in emergency departments.

    Science.gov (United States)

    Oredsson, Sven; Jonsson, Håkan; Rognes, Jon; Lind, Lars; Göransson, Katarina E; Ehrenberg, Anna; Asplund, Kjell; Castrén, Maaret; Farrohknia, Nasim

    2011-07-19

    Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in

  15. 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.

  16. 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.

  17. 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.

  18. Affective correlates of trichotillomania across the pulling cycle: Findings from an Italian sample of self-identified hair pullers.

    Science.gov (United States)

    Bottesi, Gioia; Cerea, Silvia; Ouimet, Allison J; Sica, Claudio; Ghisi, Marta

    2016-12-30

    Etiological models of trichotillomania (TTM) conceptualize hair pulling as a dysfunctional emotion regulation strategy; accordingly, some research has found that affective states change differentially across the hair pulling cycle. We explored emotional changes in a sample of Italian individuals reporting TTM. Eighty-nine participants reporting TTM completed a 12-item section of the Italian Hair Pulling Questionnaire online and rated the extent to which they had experienced 12 affective states before, during, and after hair pulling. Overall, participants reported increased levels of shame, sadness, and frustration from pre- to post-pulling, and decreased levels of calmness after hair pulling episodes. Moreover, participants reported increased pleasure and relief across the pulling cycle, and variations in the direction of change for anger and anxiety depending on the hair pulling phase. Lastly, reported boredom decreased across the hair pulling cycle. These findings highlight the importance of considering emotional changes experienced across the pulling cycle in Italian hair pullers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Nurse-administered early warning score system can be used for emergency department triage

    DEFF Research Database (Denmark)

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

    2011-01-01

    Studies have shown that early warning score systems can identify in-patients at high risk of catastrophic deterioration and this may possibly be used for an emergency department (ED) triage. Bispebjerg Hospital has introduced a multidisciplinary team (MT) in the ED activated by the Bispebjerg Early...... Warning Score (BEWS). The BEWS is calculated on the basis of respiratory frequency, pulse, systolic blood pressure, temperature and level of consciousness. The aim of this study is to evaluate the ability of the BEWS to identify critically ill patients in the ED and to examine the feasibility of using...

  20. An exertional heat illness triage tool for a jungle training environment.

    Science.gov (United States)

    Smith, Mike; Withnall, R; Boulter, M

    2017-09-06

    This article introduces a practical triage tool designed to assist commanders, jungle training instructors (JTIs) and medical personnel to identify Defence Personnel (DP) with suspected exertional heat illness (EHI). The challenges of managing suspected EHI in a jungle training environment and the potential advantages to stratifying the urgency of evacuation are discussed. This tool has been designed to be an adjunct to the existing MOD mandated heat illness recognition and first aid training. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. 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.

  2. Health assessment of raptors in triage in Belo Horizonte, MG, Brazil

    OpenAIRE

    Andery, D de A; Ferreira Junior, FC; Araújo, AV de; Vilela, DA da R; Marques, MVR; Marin, SY; Horta, RS; Ortiz, MC; Resende, JS de; Martins, NR da S

    2013-01-01

    Falconiformes (n=82), Strigiformes (n=84) and Cathartiformes (n=14) at a triage center (CETAS-Belo Horizonte, IBAMA, Brazil) were examined between 2008 and 2010 . No bird was reactive at hemagglutination-inhibition (HI) for antibodies against Mycoplasma gallisepticum (Mg). Two Caracara plancus (2/68) had HI titers (16-32) against Newcastle disease virus. No Chlamydophila psittaci DNA was detected in the liver (PCR; n=95). Blood smears (Giemsa; n=89) and spleen fragments (PCR; n=82) were 13.5%...

  3. 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

  4. Educational Triage and Ability-Grouping in Primary Mathematics: A Case-Study of the Impacts on Low-Attaining Pupils

    Science.gov (United States)

    Marks, Rachel

    2014-01-01

    This case-study, drawing on an unanticipated theme arising from a wider study of ability-grouping in primary mathematics, documents some of the consequences of educational triage in the final year of one primary school. The paper discusses how a process of educational triage, as a response to accountability pressures, is justified by teachers on…

  5. Nursing Perceptions of the Emergency Severity Index as a Triage Tool in the United Arab Emirates: A Qualitative Analysis.

    Science.gov (United States)

    Mistry, Binoy; Balhara, Kamna S; Hinson, Jeremiah S; Anton, Xavier; Othman, Iman Yassin; E'nouz, Maysoon Abdel Latif; Avila, Norman Agustin; Henry, Sophia; Levin, Scott; De Ramirez, Sarah Stewart

    2017-11-19

    With emergency department crowding becoming an increasing problem across the globe, nursing triage to prioritize patients receiving care is ever more important. ESI is the most common triage system used in the United States and is increasingly used worldwide. This qualitative study that explores emergency nursing perceptions of the ESI identifies strengths, weaknesses, and barriers to implementation of the ESI internationally. We conducted a cross-sectional qualitative analysis using semistructured interviews of 27 emergency triage nurses. Content analysis was performed by 2 independent coders, using NVivo software to identify and analyze important themes. Interview coding revealed 7 core themes related to use of the ESI (frequencies indicated in parentheses): ease of use (90), speed and efficiency (135), patient safety (12), accuracy and reliability (30), challenging patient characteristics (123), subjectivity and variability (173), and effect of triage system on team dynamics (100). Intercoder agreement was excellent (Cohen's unweighted kappa = 0.84). Subjectivity and variability in ESI score assignment consistently emerged in all interviews and included variability in number and use of resources, definition of "high risk," nursing experience, and subjectivity in pain assessment. Although emergency nurses perceive the ESI as easy to use, there are concerns about the subjectivity and variability inherent in the ESI that can lead to a functional lack of triage and a burden of undifferentiated ESI level 3 patients. These limitations in separating critically ill patients and in stratifying patients based on anticipated required resources points to the need for improvement in the ESI algorithm or a more objective triage system that can predict patient outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Stephane T. Tshitenge

    2016-07-01

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

  7. 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

    2016-03-01

    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.

  8. Effect of vitrification on number of inner cell mass in mouse blastocysts in conventional straw, closed pulled straw, open pulled straw and cryoloop carriers

    International Nuclear Information System (INIS)

    Ghasem, S.; Negar, K.

    2013-01-01

    Objective: To compare the effect of using open and closed carriers on count of inner cell mass in vitrified mouse blastocyst after warming. Methods: The experimental study was conducted at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, from April to September 2010. Forty female NMRI (Naval Medical Research Institute, USA) mice were injected with pregnant mares serum gonadotropin and human chorionic gonadotropin in order to induce super ovulation. Following the latter injection, two or three females were caged with the same-breed male mice. The presence of vaginal plug was examined the following morning. To collect blastocyst embryos, the pregnant females were sacrificed by cervical dislocation at 88-90 hours after the injection and dissected. Blastocysts were collected in phosphate-buffered saline and allocated to four groups: vitrification in conventional straw, closed pulled straw, open pulled straw and cryoloop. The vitrification solution was ethylene glycol, Ficol and sucrose (EFS) 20% and 40%. After storage for 1 month in liquid nitrogen, the blastocysts were thawed in 0.5 M sucrose then cultured in M16 medium. After 6 hours of culture, the number of expanded blastocysts was recorded and stained by double-dye technique. After staining, the number of total cell and inner cell mass was calculated. Results: The re-expansion rate of blastocysts in the cryoloop group (n=90; 78.26%) was significantly higher (p<0.05) than open pulled straw (n=83; 69.16%), closed pulled straw (n=68; 54.83%) and conventional straws (n=63; 51.21%) groups. Significant differences (p<0.05) in the number of inner cell mass in blastocysts vitrified in open pulled straws, closed straws and cryoloop with blastocysts cryopreserved in conventional straws. Conclusion: The re-expansion rate and total cell number of mouse blastocysts vitrified using open system had a better result compared with the closed system. The value of cryoloop and open pulled straws as carriers in

  9. Conception and evaluation of a new triage algorithm based on the processing of vital and physiological parameters

    OpenAIRE

    Ibáñez Gil, Ana Blanca

    2014-01-01

    Se define un accidente con múltiples víctimas como aquel en el que los servicios de emergencia se ven desbordados por el número de víctimas. Se trata de situaciones de emergencia en las que una rápida respuesta de los paramédicos permite salvar muchas vidas. Una vez que un accidente de este tipo ha sido declarado, el protocolo de actuación es, en primer lugar, llevar a cabo triage de las víctimas, seguido por su posterior tratamiento y traslado a los centros de atención médica. El triage e...

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

    Directory of Open Access Journals (Sweden)

    Crespo de Carvalho J

    2013-12-01

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

  11. Evolution of the potential energy landscape with static pulling force for two model proteins.

    Science.gov (United States)

    Wales, David J; Head-Gordon, Teresa

    2012-07-26

    The energy landscape is analyzed for off-lattice bead models of protein L and protein G as a function of a static pulling force. Two different pairs of attachment points (pulling directions) are compared in each case, namely, residues 1/56 and 10/32. For the terminal residue pulling direction 1/56, the distinct global minimum structures are all extended, aside from the compact geometry that correlates with zero force. The helical turns finally disappear at the highest pulling forces considered. For the 10/32 pulling direction, the changes are more complicated, with a variety of competing arrangements for beads outside the region where the force is directly applied. These alternatives produce frustrated energy landscapes, with low-lying minima separated by high barriers. The calculated folding pathways in the absence of force are in good agreement with previous work. The N-terminal hairpin folds first for protein L and the C-terminal hairpin for protein G, which exhibits an intermediate. However, for a relatively low static force, where the global minimum retains its structure, the folding mechanisms change, sometimes dramatically, depending on the protein and the attachment points. The scaling relations predicted by catastrophe theory are found to hold in the limit of short path lengths.

  12. Testing problem solving in turkey vultures (Cathartes aura) using the string-pulling test.

    Science.gov (United States)

    Ellison, Anne Margaret; Watson, Jane; Demers, Eric

    2015-01-01

    To examine problem solving in turkey vultures (Cathartes aura), six captive vultures were presented with a string-pulling task, which involved drawing a string up to access food. This test has been used to assess cognition in many bird species. A small piece of meat suspended by a string was attached to a perch. Two birds solved the problem without apparent trial-and-error learning; a third bird solved the problem after observing a successful bird, suggesting that this individual learned from the other vulture. The remaining birds failed to complete the task. The successful birds significantly reduced the time needed to solve the task from early trials compared to late trials, suggesting that they had learned to solve the problem and improved their technique. The successful vultures solved the problem in a novel way: they pulled the string through their beak with their tongue, and may have gathered the string in their crop until the food was in reach. In contrast, ravens, parrots and finches use a stepwise process; they pull the string up, tuck it under foot, and reach down to pull up another length. As scavengers, turkey vultures use their beak for tearing and ripping at carcasses, but possess large, flat, webbed feet that are ill-suited to pulling or grasping. The ability to solve this problem and the novel approach used by the turkey vultures in this study may be a result of the unique evolutionary pressures imposed on this scavenging species.

  13. Pulling an intruder from a granular material: a novel depinning experiment

    Science.gov (United States)

    Zhang, Yue; Behringer, Robert

    2017-06-01

    Two-dimensional impact experiments by Clark et al. [2] identified the source of inertial drag to be caused by `collisions' with a latent force network, leading to large fluctuations of the force experienced by the impactor. These collisions provided the major drag on an impacting intruder until the intruder was nearly at rest. As a complement, we consider controlled pull-out experiments where a buried intruder is pulled out of a material, starting from rest. This provides a means to better understand the non-inertial part of the drag force, and to explore the mechanisms associated with the force fluctuations. To some extent, the pull out process is a time reversed version of the impact process. In order to visualize this pulling process, we use 2D photoelastic disks from which circular intruders of different radii are pulled out. We present results about the dynamics of the intruder and the structures of the force chains inside the granular system as captured by slow and high speed imaging.

  14. Push-pull tests for estimating effective porosity: expanded analytical solution and in situ application

    Science.gov (United States)

    Paradis, Charles J.; McKay, Larry D.; Perfect, Edmund; Istok, Jonathan D.; Hazen, Terry C.

    2018-03-01

    The analytical solution describing the one-dimensional displacement of the center of mass of a tracer during an injection, drift, and extraction test (push-pull test) was expanded to account for displacement during the injection phase. The solution was expanded to improve the in situ estimation of effective porosity. The truncated equation assumed displacement during the injection phase was negligible, which may theoretically lead to an underestimation of the true value of effective porosity. To experimentally compare the expanded and truncated equations, single-well push-pull tests were conducted across six test wells located in a shallow, unconfined aquifer comprised of unconsolidated and heterogeneous silty and clayey fill materials. The push-pull tests were conducted by injection of bromide tracer, followed by a non-pumping period, and subsequent extraction of groundwater. The values of effective porosity from the expanded equation (0.6-5.0%) were substantially greater than from the truncated equation (0.1-1.3%). The expanded and truncated equations were compared to data from previous push-pull studies in the literature and demonstrated that displacement during the injection phase may or may not be negligible, depending on the aquifer properties and the push-pull test parameters. The results presented here also demonstrated the spatial variability of effective porosity within a relatively small study site can be substantial, and the error-propagated uncertainty of effective porosity can be mitigated to a reasonable level (effective porosity of fine-grained fill material.

  15. Types of avoidance in hair-pulling disorder (trichotillomania): An exploratory and confirmatory analysis.

    Science.gov (United States)

    Slikboer, Reneta; Castle, David J; Nedeljkovic, Maja; Rossell, Susan L

    2018-03-01

    Hair-pulling disorder (HPD) or Trichotillomania is a complex disorder with frequent relapses. Avoidance has been highlighted as an important behavioural feature in HPD. To improve our understanding of avoidance, two studies were conducted to identify the types of avoidance that may be experienced by those who pull hair. Internet questionnaires were used to collect data. Data from study one was split into two subsets. An exploratory factor analysis was conducted to identify the different types of avoidance experienced by those reporting symptoms of hair pulling (subset one, n = 278), followed by a confirmatory factor analysis (subset two, n = 295). In study two a MANOVA was conducted (n = 300) to examine whether levels of avoidance differed between controls and those with hair pulling symptoms. Participants with hair pulling symptoms had greater levels of avoidance on each of the five types: 'Avoidance of non-social goals', 'Self-concealment', 'Behavioural social avoidance', 'Avoidance of relationship problem solving' and 'Avoidance of thinking about the future'. These data expand on the current literature, which has predominantly focused on experiential avoidance. Future research will need to validate these findings in a clinical group. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Pulling an intruder from a granular material: a novel depinning experiment

    Directory of Open Access Journals (Sweden)

    Zhang Yue

    2017-01-01

    Full Text Available Two-dimensional impact experiments by Clark et al. [2] identified the source of inertial drag to be caused by ‘collisions’ with a latent force network, leading to large fluctuations of the force experienced by the impactor. These collisions provided the major drag on an impacting intruder until the intruder was nearly at rest. As a complement, we consider controlled pull-out experiments where a buried intruder is pulled out of a material, starting from rest. This provides a means to better understand the non-inertial part of the drag force, and to explore the mechanisms associated with the force fluctuations. To some extent, the pull out process is a time reversed version of the impact process. In order to visualize this pulling process, we use 2D photoelastic disks from which circular intruders of different radii are pulled out. We present results about the dynamics of the intruder and the structures of the force chains inside the granular system as captured by slow and high speed imaging.

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

    Science.gov (United States)

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

    2016-01-01

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

  18. Telephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trial.

    Science.gov (United States)

    Holt, Tim A; Fletcher, Emily; Warren, Fiona; Richards, Suzanne; Salisbury, Chris; Calitri, Raff; Green, Colin; Taylor, Rod; Richards, David A; Varley, Anna; Campbell, John

    2016-03-01

    Telephone triage is an increasingly common means of handling requests for same-day appointments in general practice. To determine whether telephone triage (GP-led or nurse-led) reduces clinician-patient contact time on the day of the request (the index day), compared with usual care. A total of 42 practices in England recruited to the ESTEEM trial. Duration of initial contact (following the appointment request) was measured for all ESTEEM trial patients consenting to case notes review, and that of a sample of subsequent face-to-face consultations, to produce composite estimates of overall clinician time during the index day. Data were available from 16,711 initial clinician-patient contacts, plus 1290 GP, and 176 nurse face-to-face consultations. The mean (standard deviation) duration of initial contacts in each arm was: GP triage 4.0 (2.8) minutes; nurse triage 6.6 (3.8) minutes; and usual care 9.5 (5.0) minutes. Estimated overall contact duration (including subsequent contacts on the same day) was 10.3 minutes for GP triage, 14.8 minutes for nurse triage, and 9.6 minutes for usual care. In nurse triage, more than half the duration of clinician contact (7.7 minutes) was with a GP. This was less than the 9.0 minutes of GP time used in GP triage. Telephone triage is not associated with a reduction in overall clinician contact time during the index day. Nurse-led triage is associated with a reduction in GP contact time but with an overall increase in clinician contact time. Individual practices may wish to interpret the findings in the context of the available skill mix of clinicians. © British Journal of General Practice 2016.

  19. Classifying free-text triage chief complaints into syndromic categories with natural language processing.

    Science.gov (United States)

    Chapman, Wendy W; Christensen, Lee M; Wagner, Michael M; Haug, Peter J; Ivanov, Oleg; Dowling, John N; Olszewski, Robert T

    2005-01-01

    Develop and evaluate a natural language processing application for classifying chief complaints into syndromic categories for syndromic surveillance. Much of the input data for artificial intelligence applications in the medical field are free-text patient medical records, including dictated medical reports and triage chief complaints. To be useful for automated systems, the free-text must be translated into encoded form. We implemented a biosurveillance detection system from Pennsylvania to monitor the 2002 Winter Olympic Games. Because input data was in free-text format, we used a natural language processing text classifier to automatically classify free-text triage chief complaints into syndromic categories used by the biosurveillance system. The classifier was trained on 4700 chief complaints from Pennsylvania. We evaluated the ability of the classifier to classify free-text chief complaints into syndromic categories with a test set of 800 chief complaints from Utah. The classifier produced the following areas under the ROC curve: Constitutional = 0.95; Gastrointestinal = 0.97; Hemorrhagic = 0.99; Neurological = 0.96; Rash = 1.0; Respiratory = 0.99; Other = 0.96. Using information stored in the system's semantic model, we extracted from the Respiratory classifications lower respiratory complaints and lower respiratory complaints with fever with a precision of 0.97 and 0.96, respectively. Results suggest that a trainable natural language processing text classifier can accurately extract data from free-text chief complaints for biosurveillance.

  20. 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.

  1. Patient compliance with telephone triage recommendations: a meta-analytic review.

    Science.gov (United States)

    Purc-Stephenson, Rebecca J; Thrasher, Christine

    2012-05-01

    To systematically investigate the extent to which patients comply with triage advice from telenurses and to identify factors that potentially influence compliance. Findings from 13 studies identified through interdisciplinary research databases (1990-2010) were meta-analyzed. Separate pooled analyses compared patients' compliance rates for emergency services and office care (13 outcomes), emergency services and self care (13 outcomes), and self care and office care (12 outcomes). Overall patient compliance was 62%, but varied by intensity of care recommended with low compliance rates for advice to see a general practitioner. Reasons for noncompliance include patients reporting to have heard a different disposition, patients' intentions and health beliefs. Patient compliance to triage recommendations was influenced by the interactive role of patient perceptions and the quality of provider communication, both of which were mediated by access to health services. Further research is needed to clarify whether noncompliance is attributable to poor communication by the nurse or patient misinterpretation. We highlight the need for communication-skills training in a telephone-consultation context that is patient centered, and specifically addresses building active listening and active advising skills and advantages to structuring the call. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.

  2. 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.

  3. Minimizing pulling geometry errors in atomic force microscope single molecule force spectroscopy.

    Science.gov (United States)

    Rivera, Monica; Lee, Whasil; Ke, Changhong; Marszalek, Piotr E; Cole, Daniel G; Clark, Robert L

    2008-10-01

    In atomic force microscopy-based single molecule force spectroscopy (AFM-SMFS), it is assumed that the pulling angle is negligible and that the force applied to the molecule is equivalent to the force measured by the instrument. Recent studies, however, have indicated that the pulling geometry errors can drastically alter the measured force-extension relationship of molecules. Here we describe a software-based alignment method that repositions the cantilever such that it is located directly above the molecule's substrate attachment site. By aligning the applied force with the measurement axis, the molecule is no longer undergoing combined loading, and the full force can be measured by the cantilever. Simulations and experimental results verify the ability of the alignment program to minimize pulling geometry errors in AFM-SMFS studies.

  4. Motivation and Perception of Tourists as Push and Pull Factors to Visit National Park

    Science.gov (United States)

    Said, Jumrin; Maryono

    2018-02-01

    Push-pull theoretical framework is a popular theory to explain the reason why the tourists decide to visit the destination rather than other place, the kind of experience they want to get and the type of activity they want to do. In this paper, it is explained the motivation as push factors and the perception as pull factors of the tourist in deciding the destination based on previous literature and research using descriptive method. The framework asumed that tourists are motivated to fulfill their needs, including to reduce the psychological imbalance and to gain recognition of social status. National Park is one of destination based on nature or commonly knowns as ecotourism. In choosing the destination, the tourists tend to classify their alternative choice based on several criteria, such as the domination perception of tourist from one destination (pull factor), self motivation (push factor) and the available time and money (situational constraints).

  5. Motivation and Perception of Tourists as Push and Pull Factors to Visit National Park

    Directory of Open Access Journals (Sweden)

    Said Jumrin

    2018-01-01

    Full Text Available Push-pull theoretical framework is a popular theory to explain the reason why the tourists decide to visit the destination rather than other place, the kind of experience they want to get and the type of activity they want to do. In this paper, it is explained the motivation as push factors and the perception as pull factors of the tourist in deciding the destination based on previous literature and research using descriptive method. The framework asumed that tourists are motivated to fulfill their needs, including to reduce the psychological imbalance and to gain recognition of social status. National Park is one of destination based on nature or commonly knowns as ecotourism. In choosing the destination, the tourists tend to classify their alternative choice based on several criteria, such as the domination perception of tourist from one destination (pull factor, self motivation (push factor and the available time and money (situational constraints.

  6. Investigation of the influence of coolant-lubricant modification on selected effects of pull broaching

    Directory of Open Access Journals (Sweden)

    Adamczuk Krzysztof

    2017-01-01

    Full Text Available The paper presents the results of testing the wear of the tool (pull broach and a gear wheel splineway surface roughness after the friction node of pull broach/gear wheel (CuSn12Ni2 had been lubricated with metal machining oil and the same oil modified with chemically active exploitation additive. To designate the influence of modifying metal machining oil by the exploitation additive on the lubricating properties, anti-wear and antiseizure indicators have been appointed. Exploitation tests have proved purposefulness of modifying metal machining oil. Modification of the lubricant has contributed to reduction of the wear of the tools – pull broaches and to reduction of roughness of the splineway surfaces.

  7. Removal of Airborne Contaminants from a Surface Tank by a Push-Pull System

    DEFF Research Database (Denmark)

    Heiselberg, Per; Topp, Claus

    Open surface tanks are used in many industrial processes, and local exhaust systems are often designed to capture and remove toxic fumes diffused from materials in the tanks prior to their escape into the workplace environment. The push-pull system seems to be the most efficient local exhaust...... system, but proper design is required to ensure health and safety of the workers and, furthermore, it is very desirable from an energy conservation point of view to determine an optimum and -an efficient design of push-pull hoods which can exhaust all contaminants with a minimum quantity of volume flow....... The paper describes and discusses different design methods and compares designed values with results from a measurement series of push-pull system efficiency....

  8. Effect of honeybee stinger and its microstructured barbs on insertion and pull force.

    Science.gov (United States)

    Ling, Jintian; Song, Zhenhua; Wang, Jiarui; Chen, Keyun; Li, Jiyu; Xu, Shujia; Ren, Lei; Chen, Zhipeng; Jin, Dianwen; Jiang, Lelun

    2017-04-01

    Worker honeybee is well-known for its stinger with microscopic backward-facing barbs for self-defense. The natural geometry of the stinger enables painless penetration and adhesion in the human skin to deliver poison. In this study, Apis cerana worker honeybee stinger and acupuncture microneedle (as a barbless stinger) were characterized by Scanning Electron Microscope (SEM). The insertion and pull process of honeybee stinger into rabbit skin was performed by a self-developed mechanical loading equipment in comparison with acupuncture needle. In order to better understand the insertion and pull mechanisms of the stinger and its barbs in human multilayer skin, a nonlinear finite element method (FEM) was conducted. Experimental results showed that the average pull-out force of the stinger was 113.50mN and the average penetration force was only 5.75mN. The average penetration force of the stinger was about one order of magnitude smaller than that of an acupuncture microneedle while the average pull-out force was about 70 times larger than that of an acupuncture microneedle. FEM results showed that the stress concentrations were around the stinger tip and its barbs during the insertion process. The barbs were jammed in and torn the skin during the pull process. The insertion force of the stinger was greatly minimized due to its ultrasharp stinger tip and barbs while the pull force was seriously enhanced due to the mechanical interlocking of the barbs in the skin. These excellent properties are mainly a result of optimal geometry evolved by nature. Such finding may provide an inspiration for the further design of improved tissue adhesives and micro-needles for painless transdermal drug delivery and bio-signal recording. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Impact of Androstenone on Leash Pulling and Jumping Up in Dogs

    Directory of Open Access Journals (Sweden)

    Glenna Pirner

    2016-05-01

    Full Text Available Dogs are relinquished to shelters due to behavioral problems, such as leash pulling and jumping up. Interomones are chemical cues produced by one species that elicit a response in a different species. We reported earlier that androstenone, a swine sex pheromone, acts as an interomone to reduce barking in dogs. Here we report two models using 10 dogs/study: a dog jumping and a dog walking model. For the leash-pulling model, each time the dog pulled on the leash the walker either did nothing (NOT, or sprayed the dog with water (H2O, androstenone + water (ANH, androstenone 0.1 µg/mL (AND1, or androstenone 1.0 µg/mL (AND2. The number of pulls during each walk was counted. For the jumping up model, each time the dog jumped the researcher did nothing (NOT, or sprayed the dog with H2O, ANH, AND1, or AND2. The number of jumps and the time between jumps were recorded. In Study 1, ANH, AND1, and AND2 each reduced leash pulling more than NOT and H2O (p< 0.01. In Study 2, all treatments were effective in reducing jumping up behavior. Androstenone reduced jumping up, but not beyond that elicited by a spray of water alone. We conclude that androstenone in multiple delivery vehicles reduced leash pulling. The burst of air intended as a disruptive stimulus in the correction sprays may be too harsh for more sensitive dogs, and as such use of these sprays is cautioned in these animals. For other dogs, this interomone can be used to stop some behavior immediately or as a part of a training program to reduce undesirable behavior.

  10. The effect of oil pulling with pure coconut oil on Streptococcus mutans: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Varsha Komath Pavithran

    2017-01-01

    Full Text Available Introduction: Oil pulling as described in ancient Ayurveda involves the use of edible vegetable oils as oral antibacterial agents. It is a practice of swishing oil in the mouth for oral and systemic health benefits. Pure coconut oil has antimicrobial properties and is commonly available in all Indian households. Aim: This study aims to assess the effect of oil pulling therapy with pure coconut oil on Streptococcus mutans count and to compare its efficacy against sesame oil and saline. Materials and Methods: A randomized controlled concurrent parallel- triple blinded clinical trial was conducted. Thirty participants in age range of 20–23 years were randomly allocated into Group A (coconut oil, Group B (sesame oil, and Group C (saline, with 10 in each group. The participants were instructed to swish and pull 10 ml of oil on empty stomach, early morning for 10–15 min. Unstimulated saliva collected before and after oil pulling procedure was analyzed for colony forming units (CFU per ml saliva of S. mutans. The data were analyzed using paired t-test, ANOVA, and post hoc analysis using Tukey's honest significant difference. Statistical significance was set at P < 0.05. Results: A statistically significant reduction in S. mutans CFU count after oil pulling with pure coconut oil (P = 0.001 was found. There was no statistically significant difference between sesame oil and coconut oil (P = 0.97 and between sesame oil and saline (P = 0.061. When efficacy of coconut oil against saline was evaluated, a statistical significant difference (P = 0.039 was found. Conclusion: Oil pulling is an effective method for oral hygiene maintenance as it significantly reduces S. mutans count in the saliva.

  11. 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.

  12. Pulled Polymer Loops as a Model for the Alignment of Meiotic Chromosomes

    Science.gov (United States)

    Lin, Yen Ting; Frömberg, Daniela; Huang, Wenwen; Delivani, Petrina; Chacón, Mariola; Tolić, Iva M.; Jülicher, Frank; Zaburdaev, Vasily

    2015-11-01

    During recombination, the DNA of parents exchange their genetic information to give rise to a genetically unique offspring. For recombination to occur, homologous chromosomes need to find each other and align with high precision. Fission yeast solves this problem by folding chromosomes in loops and pulling them through the viscous nucleoplasm. We propose a theory of pulled polymer loops to quantify the effect of drag forces on the alignment of chromosomes. We introduce an external force field to the concept of a Brownian bridge and thus solve for the statistics of loop configurations in space.

  13. Symptom accommodation, trichotillomania-by-proxy, and interpersonal functioning in trichotillomania (hair-pulling disorder).

    Science.gov (United States)

    Falkenstein, Martha J; Haaga, David A F

    2016-02-01

    This study investigated relationship functioning in trichotillomania (TTM) as well as specific interpersonal behaviors that have received little attention in TTM research, including by-proxy pulling, symptom accommodation, and self-disclosure. The objective was to contribute data for future development of components of treatment that focus on interpersonal functioning. Data were collected through survey about relationships and related difficulties among adults who endorsed criteria consistent with DSM-5 criteria for TTM (n=670). Consistent with our hypotheses, TTM symptom severity was correlated negatively with relationship satisfaction and perceived social support, positively with perceived criticism, perceived risk in intimacy, and social interaction anxiety, though these correlations were small (absolute values r=.08 to .17). Approximately one-quarter of survey respondents had not told their closest friend about their trichotillomania, and one-fifth had not told their spouse or long-term romantic partner. TTM-by-proxy urges were reported by 54% of participants, and 37% of participants reported having actually pulled hair from other people, with the most common proxies specified as significant others (51%), parents (13%), friends (8%), siblings (8%), children (7%) and pets (5%). Higher levels of TTM-by-proxy urges were associated with "focused" pulling (d=.37) and perfectionistic thinking (d=.16 to .20), yet current by-proxy urges were not associated with, functional impairment. A small minority of individuals (7%) reported having asked other people to pull hair for them (78% of these requests were granted); there was increased endorsement of "focused" pulling among these individuals. The people who participants asked to pull hairs for them included significant others (66%), mothers (20%), siblings (11%), friends (9%) and one's children (9%). More than one-third of respondents had pulled hair from others, 7% had asked others to pull their hair, and sizable

  14. Cavity Pull Rod: Device to Promote Single Crystal Growth from the Melt

    Science.gov (United States)

    Goldsby, Jon (Inventor)

    2017-01-01

    A pull rod for use in producing a single crystal from a molten alloy is provided that includes an elongated rod having a first end and a second end, a first cavity defined at the first end and a second cavity defined at the first end and in communication with the first cavity. The first cavity receives the molten alloy and the second cavity vents a gas from the molten alloy to thereby template a single crystal when the pull rod is dipped into and extracted from the molten alloy.

  15. Implementation of a pre-hospital decision rule in general practice. Triage of patients with suspected myocardial infarction

    NARCIS (Netherlands)

    E.W.M. Grijseels (Els); J.W. Deckers (Jaap); A.W. Hoes (Arno); H. Boersma (Eric); J.A.M. Hartman; E. van der Does (Emiel); M.L. Simoons (Maarten)

    1996-01-01

    textabstractOBJECTIVE: To improve pre-hospital triage of patients with suspected acute cardiac disease. DESIGN: Prospective study. SUBJECTS. Patients with symptoms suggestive of acute cardiac pathology, who were seen by a general practitioner, for whom acute admission into hospital was requested,

  16. A novel triage approach of child preventive health assessment: an observational study of routine registry-data?

    NARCIS (Netherlands)

    Bezem, J.; Theunissen, M.; Buitendijk, E.S; Kocken, P.L.

    2014-01-01

    Background The coverage of preventive health assessments for children is pivotal to the system of preventive health screening. A novel method of triage was introduced in the Preventive Youth Health Care (PYHC) system in the Netherlands with an associated shift of tasks of professionals. Doctor’s

  17. 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.

  18. Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening

    NARCIS (Netherlands)

    Liedenbaum, Marjolein Henrieke; van Rijn, Anne Floortje; de Vries, Ayso H.; Dekker, Helena M.; Thomeer, Maarten; van Marrewijk, Corine J.; Hol, Lieke; Dijkgraaf, Marcel G.; Fockens, Paul; Bossuyt, Patrick M.; Dekker, Evelien; Stoker, Jaap

    2009-01-01

    Objective: The purpose of this study was to evaluate the effectiveness of CT colonography (CTC) as a triage technique in faecal occult blood test (FOBT)-positive screening participants. Methods: Consecutive guaiac (G-FOBT) and immunochemical (I-FOBT) FOBT-positive patients scheduled for colonoscopy

  19. Patient use and compliance with medical advice delivered by a web-based triage system in primary care

    NARCIS (Netherlands)

    Nijland, N.; Cranen, Karlijn; Cranen, Karlijn; Boer, Henk; Boer, Hendrik; van Gemert-Pijnen, Julia E.W.C.; Seydel, E.R.

    2010-01-01

    We studied a web-based triage system which was accessible to the general public in the Netherlands. In a retrospective analysis we investigated the type of complaints that were submitted and the kind of advice provided. Over a period of 15 months, 13,133 different people began using the web-based

  20. Using Functional Needs and Personal Care Assistance Rather Than Disability Status During Chronic Care Triage in Community Mass Care.

    Science.gov (United States)

    Fannin, Athena; Brannen, Donald E; Howell, Melissa; Martin, Shari

    2015-06-01

    To evaluate Medical Reserve Corps volunteers and public health workers in conducting chronic care triage by use of a rubric prior to sheltering to connect survivors with services. Participants were randomly assigned to 1 of 3 algorithms or a control group during a simulated disaster scenario and were asked to rate 20 survivors arriving at a chronic care triage station with situation-appropriate transport services. Survivors were simulated on the basis of the expected disability distributions of mobility, sensory-visual, cognition, medical devices, capacity to perform activities of daily living (ADLs), age (18 to 90 years), weight, and gender expected in the general population but expanded to 90% of those presenting. Mean percentage correct scores were assessed by using one-way analysis of variance. Accounting for personal care assistance and service methodology during chronic care triage increased efficiency by up to 8% in meeting chronic care health service needs during disaster community mass care management. A chronic care triage process as part of community mass care management that considers the availability of personal care assistance and service methodology will enhance the allocation of functional needs support services and increase compliance with Americans with Disabilities Act requirements regarding not segregating persons because of disability. (Disaster Med Public Health Preparedness. 2015;9:265-274).

  1. 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.

  2. Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial.

    Science.gov (United States)

    Samsson, Karin S; Bernhardsson, Susanne; Larsson, Maria E H

    2016-06-10

    Physiotherapist-led orthopaedic triage, where physiotherapists diagnose and determine management plans, aims to enhance effectiveness and provide the best care. However, scientific evidence for the effectiveness of this model of care remains limited, and there are few studies reporting on patients' perceptions of the care provided. The purpose of this study was to evaluate patients' perceived quality of care in a physiotherapist-led orthopaedic triage in primary care, compared with standard practice. In a randomised controlled trial, patients of working age referred for orthopaedic consultation at a primary healthcare clinic in Sweden received either physiotherapist-led triage (n = 102) or standard practice (orthopaedic surgeon assessment) (n = 101). Neither subjects nor clinicians were blinded. The questionnaire Quality from the Patient's Perspective (QPP) was used to evaluate perceived quality of care focusing on the caregivers' medical-technical competence and identity-orientated approach. Also, to what extent patients' expectations were met, and their intention to follow advice was evaluated. For this study, 163 patients (80 %) were analysed (physiotherapist-led triage (n = 83), standard practice (n = 80)). Participants perceived significantly higher quality of care with the triage than with the standard practice in regards to receiving best possible examination and treatment (medical-technical competence) (p quality of care in a physiotherapist-led orthopaedic triage compared with standard practice. Patients in both groups reported that they perceived good quality of care, with the patients in the physiotherapist-led triage reporting significantly higher perceived quality of care than those in the standard practice group. This model of care seems to meet patients' expectations and result in a greater intention to follow advice and instructions for self-management. Our findings are in line with existing literature that this model of care

  3. Development of metabolic and inflammatory mediator biomarker phenotyping for early diagnosis and triage of pediatric sepsis.

    Science.gov (United States)

    Mickiewicz, Beata; Thompson, Graham C; Blackwood, Jaime; Jenne, Craig N; Winston, Brent W; Vogel, Hans J; Joffe, Ari R

    2015-09-09

    The first steps in goal-directed therapy for sepsis are early diagnosis followed by appropriate triage. These steps are usually left to the physician's judgment, as there is no accepted biomarker available. We aimed to determine biomarker phenotypes that differentiate children with sepsis who require intensive care from those who do not. We conducted a prospective, observational nested cohort study at two pediatric intensive care units (PICUs) and one pediatric emergency department (ED). Children ages 2-17 years presenting to the PICU or ED with sepsis or presenting for procedural sedation to the ED were enrolled. We used the judgment of regional pediatric ED and PICU attending physicians as the standard to determine triage location (PICU or ED). We performed metabolic and inflammatory protein mediator profiling with serum and plasma samples, respectively, collected upon presentation, followed by multivariate statistical analysis. Ninety-four PICU sepsis, 81 ED sepsis, and 63 ED control patients were included. Metabolomic profiling revealed clear separation of groups, differentiating PICU sepsis from ED sepsis with accuracy of 0.89, area under the receiver operating characteristic curve (AUROC) of 0.96 (standard deviation [SD] 0.01), and predictive ability (Q(2)) of 0.60. Protein mediator profiling also showed clear separation of the groups, differentiating PICU sepsis from ED sepsis with accuracy of 0.78 and AUROC of 0.88 (SD 0.03). Combining metabolomic and protein mediator profiling improved the model (Q(2) =0.62), differentiating PICU sepsis from ED sepsis with accuracy of 0.87 and AUROC of 0.95 (SD 0.01). Separation of PICU sepsis or ED sepsis from ED controls was even more accurate. Prespecified age subgroups (2-5 years old and 6-17 years old) improved model accuracy minimally. Seventeen metabolites or protein mediators accounted for separation of PICU sepsis and ED sepsis with 95% confidence. In children ages 2-17 years, combining metabolomic and

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

    Science.gov (United States)

    Huibers, Linda; Moth, Grete; Carlsen, Anders H; Christensen, Morten B; Vedsted, Peter

    2016-09-01

    In the UK, telephone triage in out-of-hours primary care is mostly managed by nurses, whereas GPs perform triage in Denmark. To describe telephone contacts triaged to face-to-face contacts, GP-assessed relevance, and factors associated with triage to face-to-face contact. A prospective observational study in Danish out-of-hours primary care, conducted from June 2010 to May 2011. Information on patients was collected from the electronic patient administration system and GPs completed electronic questionnaires about the contacts. The GPs conducting the face-to-face contacts assessed relevance of the triage to face-to-face contacts. The authors performed binomial regression analyses, calculating relative risk (RR) and 95% confidence intervals. In total, 59.2% of calls ended with a telephone consultation. Factors associated with triage to a face-to-face contact were: patient age >40 years (40-64: RR = 1.13; >64: RR = 1.34), persisting problem for 12-24 hours (RR = 1.15), severe problem (RR = 2.60), potentially severe problem (RR = 5.81), and non-severe problem (RR = 2.23). Face-to-face contacts were assessed as irrelevant for 12.7% of clinic consultations and 11.7% of home visits. A statistically significantly higher risk of irrelevant face-to-face contact was found for a persisting problem of >24 hours (RR = 1.25), contact on weekday nights (RR = 1.25), and contact triage is efficient. Knowledge of the factors influencing triage can provide better education for GPs, but future studies are needed to investigate other quality aspects of GP telephone triage. © British Journal of General Practice 2016.

  5. Impact of Prehospital Triage Scales to Detect Large Vessel Occlusion on Resource Utilization and Time to Treatment.

    Science.gov (United States)

    Schlemm, Ludwig; Ebinger, Martin; Nolte, Christian H; Endres, Matthias

    2018-02-01

    Prehospital stroke severity scales may help to triage acute ischemic stroke patients with large vessel occlusion (LVO) for direct transportation to a comprehensive stroke center. The impact on resource use and time to reperfusion treatment for patients with and without LVO is unknown. Based on empirical distributions of stroke symptom severity, prehospital delay times, and stroke symptom severity-dependent likelihood of LVO, we simulate prehospital incidents of stroke-like symptoms in abstract geographical environments to estimate the impact of prehospital triage strategies based on different cutoffs of the rapid arterial occlusion evaluation scale. Compared with transporting each patient to the nearest stroke center, implementation of a prehospital triage strategy based on a rapid arterial occlusion evaluation scale cutoff score ≥5 is associated with more patients with suspected acute stroke at comprehensive stroke centers and less patients at primary stroke centers (+11.7% [95% confidence interval: +8.1% to +15.3%] and -18.4% [-19.1% to -17.7%], respectively). Mean time to groin puncture is reduced by 29.6 minutes (-35.2 to -24.7 minutes) while mean time to thrombolysis does not change significantly (±0.0 minutes [-0.3 to +0.3 minutes]). The total number of secondary transfers is reduced by 60.9% (-62.8% to -59.0%); mean time of ambulance use per patient is unchanged. Results are robust with regards to variation in model parameters. Implementation of prehospital triage based on stroke severity scales would have strong impact on patient flow and distribution. The benefit of earlier thrombectomy for patients with LVO may outweigh the harm associated with delayed access to thrombolysis for some patients without LVO. Randomized trials using clinical stroke severity scales as a triage tool are needed to confirm our findings. © 2017 American Heart Association, Inc.

  6. Capillary lactate as a tool for the triage nurse among patients with SIRS at emergency department presentation: a preliminary report.

    Science.gov (United States)

    Manzon, Cyril; Barrot, Loïc; Besch, Guillaume; Barbot, Olivier; Desmettre, Thibaut; Capellier, Gilles; Piton, Gaël

    2015-01-01

    The triage nurse is involved in the early identification of the most severe patients at emergency department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly. Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by the triage nurse among patients presenting to the ED. This was a prospective observational study, performed in the ED of a university hospital. At ED presentation, capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at presentation. Twenty-eight-day mortality and MEDS score were recorded. One hundred seventy-six patients with clinical SIRS presented to the ED. Median age was 72 years, and 28-day mortality was 16%. Capillary lactate at ED presentation was significantly higher among 28-day non-survivors than among survivors (5.7 mmol.L(-1) [3.2 to 7.4] vs 2.9 mmol.L(-1) [1.9 to 5.2], p = 0.003). A score based on mottling and capillary lactate concentration >3.6 mmol.L(-1) was significantly associated with 28-day mortality (area under curve, AUC = 0.75), independently of the MEDS score (AUC = 0.79) for the prediction of 28-day mortality (AUC global model 0.87). A high capillary lactate concentration measured by the triage nurse among patients presenting to the ED with clinical SIRS is associated with a high risk of death. A score calculated by the triage nurse, based on mottling and capillary lactate concentration, appears to be useful for identifying the most severe patients.

  7. Control and Modeling of Push-Pull Forward Three-Level Converter for Microgrid

    DEFF Research Database (Denmark)

    Yao, Zhilei; Xu, Jing; Guerrero, Josep M.

    2015-01-01

    Renewable energy sources are widely used in microgrid. Output voltage of them is often low and varies widely. Because diodes in three-level legs in traditional three-level (TL) converter are substituted by MOSFETs, the push-pull forward (PPF) TL converter is very suitable for wide and low...

  8. Pushed or Pulled? Exploring the Factors Underpinning Graduate Start-Ups and Non-Start-Ups

    Science.gov (United States)

    Nabi, G.; Walmsley, A.; Holden, R.

    2015-01-01

    The study explores the nature and mixture of push--pull factors in the journey from higher education into graduate entrepreneurship. Using longitudinal data from 15 graduates of a British university, it compares graduates who started their own business with graduates that did not. Importantly, both groups had initially indicated a strong desire to…

  9. Demography, Urbanization and Development : Rural Push, Urban Pull and ... Urban Push?

    OpenAIRE

    Jedwab, Remi; Christiaensen, Luc; Gindelsky, Marina

    2015-01-01

    Developing countries have urbanized rapidly since 1950. To explain urbanization, standard models emphasize rural-urban migration, focusing on rural push factors (agricultural modernization and rural poverty) and urban pull factors (industrialization and urban-biased policies). Using new historical data on urban birth and death rates for seven countries from Industrial Europe (1800–1910) an...

  10. Push and pull factors of three Afrikaans Arts Festivals in South Africa ...

    African Journals Online (AJOL)

    The purpose of this research was to analyse the push and pull motivations of visitors to three South African Afrikaans arts festivals (KKNK, Aardklop and Innibos), in order to understand these visitors' travel behaviour and be better able to cater for their needs. Surveys were conducted during 2011, with approximately 400 ...

  11. Affecting Factors and Outcome on Intermittent Internet Pulling Behavior in Taiwan's Undergraduate Students

    Science.gov (United States)

    Yang, Hui-Jen; Lay, Yun-Long

    2011-01-01

    Nowadays people's lives heavily rely on Internet facilities. Internet users generally have constant Internet connectivity and intermittently click on sites they want to access even amidst studying or working. In this study, we sought to examine the factors affecting intermittent Internet pulling behavior on undergraduate students. Furthermore, the…

  12. Experiential Avoidance as a Mediator of Relationships between Cognitions and Hair-Pulling Severity

    Science.gov (United States)

    Norberg, Melissa M.; Wetterneck, Chad T.; Woods, Douglas W.; Conelea, Christine A.

    2007-01-01

    Cognitive-behavioral models suggest that certain cognitions and beliefs are functionally related to hair pulling in persons with trichotillomania (TTM), but little empirical data have been collected to test such claims. This study assessed dysfunctional beliefs about appearance, shameful cognitions, and fear of negative evaluation and their…

  13. Pull Incentives for Antibacterial Drug Development: An Analysis by the Transatlantic Task Force on Antimicrobial Resistance.

    Science.gov (United States)

    Årdal, Christine; Røttingen, John-Arne; Opalska, Aleksandra; Van Hengel, Arjon J; Larsen, Joseph

    2017-10-15

    New alternative market models are needed to incentivize companies to invest in developing new antibacterial drugs. In a previous publication, the Transatlantic Task Force on Antimicrobial Resistance (TATFAR) summarized the key areas of consensus for economic incentives for antibacterial drug development. That work determined that there was substantial agreement on the need for a mixture of push and pull incentives and particularly those that served to delink the revenues from the volumes sold. Pull incentives reward successful development by increasing or ensuring future revenue. Several pull incentives have been proposed that could substantially reward the development of new antibacterial drugs. In this second article authored by representatives of TATFAR, we examine the advantages and disadvantages of different pull incentives for antibacterial drug development. It is TATFAR's hope that this analysis, combined with other related analyses, will provide actionable information that will shape policy makers' thinking on this important issue. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  14. Analytical solutions for efficient interpretation of single-well push-pull tracer tests

    Science.gov (United States)

    Single-well push-pull tracer tests have been used to characterize the extent, fate, and transport of subsurface contamination. Analytical solutions provide one alternative for interpreting test results. In this work, an exact analytical solution to two-dimensional equations descr...

  15. Choices of Destination for Transnational Higher Education: "Pull" Factors in an Asia Pacific Market

    Science.gov (United States)

    Ahmad, Syed Zamberi; Buchanan, Frederick Robert

    2016-01-01

    Traditional assumptions favouring native English language countries in transnational higher education (TNHE) overlook experiences of international students in new emerging Asian education hubs. Specifically, there has been limited research relating to international students' choice for studying in Malaysia. Drawing from the "push-pull"…

  16. Gravity's Relentless Pull : An interactive, multimedia website about black holes for Education and Public Outreach

    NARCIS (Netherlands)

    Marel, R. P. van der; Schaller, D.; Kleijn, G. V.

    2006-01-01

    Abstract: We have created a website, called "Black Holes: Gravity's Relentless Pull", which explains the physics and astronomy of black holes for a general audience. The site emphasizes user participation and is rich in animations and astronomical imagery. It won the top prize of the 2005 Pirelli

  17. Triphenylamine-Based Push-Pull Molecule for Photovoltaic Applications : From Synthesis to Ultrafast Device Photophysics

    NARCIS (Netherlands)

    Kozlov, Oleg; Liu, Xiaoming; Luponosov, Yuriy N.; Solodukhin, Alexander N.; Toropynina, Victoria Y.; Min, Jie; Buzin, Mikhail I.; Peregudova, Svetlana M.; Brabec, Christoph J.; Ponomarenko, Sergei A.; Pshenichnikov, Maxim S.

    2017-01-01

    Small push pull molecules attract much attention as prospective donor materials for organic solar cells (OSCs). By chemical engineering, it is possible to combine a number of attractive properties such as broad absorption, efficient charge separation, and vacuum and solution processabilities in a

  18. A relationship between Raman and infrared spectra: the case of push pull molecules

    Science.gov (United States)

    Del Zoppo, M.; Tommasini, M.; Castiglioni, C.; Zerbi, G.

    1998-04-01

    Vibrational spectra of push-pull polyenes show a peculiar feature namely, in infrared and Raman spectra strong, coincident bands appear, arising from vibrations localised on the polyene bridge. A simple model, based on the introduction of an effective internal field due to the charge transfer between end groups allows the infrared and Raman intensities of these bands to be related.

  19. Mechanical loading of the low back and shoulders during pushing and pulling activities.

    NARCIS (Netherlands)

    Hoozemans, M.J.M.; Kingma, I.; van Dieen, J.H.; de Vries, W.K.H.; van der Woude, L.H.V.; Veeger, H.E.J.; Frings-Dresen, M.H.W.; van der Beek, A.J.

    2004-01-01

    The objective of this study was to quantify the mechanical load on the low back and shoulders during pushing and pulling in combination with three task constraints: the use of one or two hands, three cart weights, and two handle heights. The second objective was to explore the relation between the

  20. Mechanical loading of the low back and shoulders during pushing and pulling activities

    NARCIS (Netherlands)

    Hoozemans, Marco J. M.; Kuijer, P. Paul F. M.; Kingma, Idsart; van Dieën, Jaap H.; de Vries, Wiebe H. K.; van der Woude, Luc H. V.; Veeger, Dirk Jan H. E. J.; van der Beek, Allard J.; Frings-Dresen, Monique H. W.

    2004-01-01

    The objective of this study was to quantify the mechanical load on the low back and shoulders during pushing and pulling in combination with three task constraints: the use of one or two hands, three cart weights, and two handle heights. The second objective was to explore the relation between the

  1. Kinematic and electromyographic comparisons between chin-ups and lat-pull down exercises.

    Science.gov (United States)

    Doma, Kenji; Deakin, Glen B; Ness, Kevin F

    2013-09-01

    The purpose of this study was to compare kinematics and muscle activity between chin-ups and lat-pull down exercises and between muscle groups during the two exercises. Normalized electromyography (EMG) of biceps brachii (BB), triceps brachii (TB), pectoralis major (PM), latissimus dorsi (LD), rectus abdominus (RA), and erector spinae (ES) and kinematics of back, shoulder, and seventh cervical vertebrae (C7) was analysed during chin-ups and lat-pull down exercises. Normalized EMG of BB and ES and kinematics of shoulder and C7 for chin-ups were greater than lat-pull down exercises during the concentric phase (p ups and the kinematics of C7 during chin-ups was greater than lat-pull down exercises (p ups, BB, LD, and ES were greater than PM during the concentric phase, whereas BB and LD were greater than TB, and LD was greater than RA during the eccentric phase (p ups appears to be a more functional exercise.

  2. Effect of oil pulling on halitosis and microorganisms causing halitosis: A randomized controlled pilot trial

    Directory of Open Access Journals (Sweden)

    Sharath Asokan

    2011-01-01

    Full Text Available Background: Oil pulling therapy has been used extensively as a traditional Indian folk remedy for many years for strengthening teeth, gums, and jaws and to prevent decay, oral malodor, bleeding gums and dryness of throat, and cracked lips. Aims: The aims of this study were to evaluate the effect of oil pulling with sesame oil on halitosis and the microorganisms that could be responsible for it and to compare its efficacy with chlorhexidine mouthwash. Materials and Methods: Group I (oil pulling and group II (chlorhexidine included 10 adolescents each. The following parameters were assessed: marginal gingival index, plaque index, organoleptic breath assessment (ORG 1, self-assessment of breath (ORG 2, and BANA test from tongue coating samples on days 0 and 14 of the experimental period. Results : The comparisons of the pre and post therapy values of plaque and modified gingival index score showed a statistically significant difference (P = 0.005 and 0.007, respectively in group I and II. There was a definite reduction in the ORG 1, ORG 2, scores and BANA test score in both groups I and II. Conclusions: Oil pulling therapy has been equally effective like chlorhexidine on halitosis and organisms, associated with halitosis.

  3. A push-pull system to reduce house entry of malaria mosquitoes

    NARCIS (Netherlands)

    Menger, D.J.; Otieno, B.; Rijk, de M.; Mukabana, W.R.; Loon, van J.J.A.; Takken, W.

    2014-01-01

    Background. Mosquitoes are the dominant vectors of pathogens that cause infectious diseases such as malaria, dengue, yellow fever and filariasis. Current vector control strategies often rely on the use of pyrethroids against which mosquitoes are increasingly developing resistance. Here, a push-pull

  4. Fiber pull-out test and single fiber fragmentation test - analysis and modelling

    DEFF Research Database (Denmark)

    Sørensen, Bent F.; Lilholt, Hans

    2016-01-01

    A mathematical model is developed for the analysis of the fiber debonding phase of a pull-out experiment where the matrix is supported at the same end as the fiber is loaded in tension. The mechanical properties of the fiber/matrix are described in terms of two parameters, a fracture energy for f...

  5. Voices from the "Working Lives" Project: The Push-Pull of Work and Care

    Science.gov (United States)

    Fehring, Heather; Herring, Katherine

    2012-01-01

    A recent policy direction in many OECD countries has been to increase workforce participation for women of childbearing age; a policy direction which seemingly runs counter to a need for improved work-life balance for women themselves. This article explores the impact of this somewhat contradictory "push-pull" of policy by examining some…

  6. Class II malocclusion treatment using high-pull headgear with a splint: a systematic review

    Directory of Open Access Journals (Sweden)

    Helder B. Jacob

    2013-04-01

    Full Text Available OBJECTIVE: To systematically review the scientific evidence pertaining to the effectiveness of high-pull headgear in growing Class II subjects. METHODS: A literature survey was performed by electronic database search. The survey covered the period from January 1966 to December 2008 and used Medical Subject Headings (MeSH. Articles were initially selected based on their titles and abstracts; the full articles were then retrieved. The inclusion criteria included growing subjects between 8 to 15 years of age, Class II malocclusion treatment with high-pull headgear, and a control group with Class II malocclusion. References from selected articles were hand-searched for additional publications. Selected studies were evaluated methodologically. RESULTS: Four articles were selected; none were randomized controlled trials. All of the articles clearly formulated their objectives and used appropriate measures. The studies showed that high-pull headgear treatment improves skeletal and dental relationship, distal displacement of the maxilla, vertical eruption control and upper molars distalization. One of the studies showed a slight clockwise rotation of the palatal plane; the others showed no significant treatment effect. The mandible was not affected by the treatment. CONCLUSION: While there is still a lack of strong evidence demonstrating the effects of high-pull headgear with a splint, other studies indicate that the AP relations improve due to distalization of the maxilla and upper molars, with little or no treatment effects in the mandible. Greater attention to the design should be given to improve the quality of such trials.

  7. a Hybrid Pull-Push System for Near Real-Time Notifications on Sensor Web

    Science.gov (United States)

    Huang, C. Y.; Liang, S.

    2012-08-01

    World-wide sensor web generates tremendous amount of sensor data stream allowing people to observe events that were previously unobservable. Sensor web has been wildly applied in many monitoring systems; some of them are extremely time-sensitive, e.g., disaster management systems. However, with the growing amount of sensor data, the traditional request/response communication model becomes inefficient as it is based on point-to-point pulling interactions between users and data providers. In order to address this issue, publish/subscribe communication model has been proposed and applied in many applications, e.g., web blogging. The publish/subscribe model utilizes an intermediary broker on matching predefined queries with the data pushed to the broker. However, we argue that the publish/subscribe model is hard to be directly applied to sensor web due to the fact that most sensor web services are based on pulling interaction model only. For instance, more and more sensor data providers are publishing their sensor data with the Open Geospatial Consortium (OGC) Sensor Observation Service (SOS) standards, and the OGC SOS services are based on the request/response model. Therefore, in order to address this issue, we propose a hybrid pull-push system to retrieve sensor web data in a timely manner. The preliminary experimental results indicate that the proposed system is able to fetch near real time sensor streams from pull-based sensor web services.

  8. Introduction of an electron push-pull system yields a planar Red ...

    Indian Academy of Sciences (India)

    Crystal structures of four red kaede fluorescence protein chromophore analogues are reported here. Molecules I-III adopt a non-planar geometry stabilized by π...π stacking and hydrogen bonding. Introduction of an electron push-pull ... also been studied as an organic photovoltaic material.5. The crystal structures of kaede ...

  9. Fibre reinforced concrete in flexure and single fibre pull-out test: a correlation

    Science.gov (United States)

    Manca, M.; Ciancio, D.; Dight, P.

    2017-09-01

    The aim of the present work is to assess whether a single fibre pull-out test can be related to the behaviour of multiple fibres in fibre reinforced concrete under bending condition. A simple model based on the stress block theory is described and compared with experimental results on three point bending tests with aligned fibres.

  10. From the Push of Fear, to the Pull of Hope: Learning by design ...

    African Journals Online (AJOL)

    From the Push of Fear, to the Pull of Hope: Learning by design. S Sterling. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · Creative Commons License This work is licensed under a Creative Commons Attribution 3.0 License.

  11. Evaluation of methods to assess push/pull forces in a construction task

    NARCIS (Netherlands)

    Hoozemans, M J; Van Der Beek, Allard J.; Frings-Dresena, M H; Van der Molen, Henk F.

    2001-01-01

    The objective of the present study was to determine the validity of methods to assess push/pull forces exerted in a construction task. Forces assessed using a hand-held digital force gauge were compared to those obtained using a highly accurate measuring frame. No significant differences were found

  12. What Explains the Survival Gap of Pushed and Pulled Corporate Spin-offs?

    DEFF Research Database (Denmark)

    Rocha, Vera; Carneiro, Anabela; Varum, Celeste

    2015-01-01

    Unconditionally, pushed spin-offs are found to survive longer than their pulled counterparts. Using matched employer-employee data and novel multivariate decomposition techniques, we show that pushed spin-offs’ relative survival advantage is mostly explained by their larger human capital endowments...

  13. An Event-driven, Value-based, Pull Systems Engineering Scheduling Approach

    Science.gov (United States)

    2012-03-01

    combining a services approach to systems engineering with a kanban -based scheduling system. It provides the basis for validating the approach with...agent-based simulations. Keywords-systems engineering; systems engineering process; lean; kanban ; process simulation I. INTRODUCTION AND BACKGROUND...approaches [8], [9], we are investigating the use of flow-based pull scheduling techniques ( kanban systems) in a rapid response development

  14. Fatigue life of carburized steel specimens under push-pull loading

    Czech Academy of Sciences Publication Activity Database

    Major, Štěpán; Hubálovský, Š.; Šedivý, J.; Bryscejn, Jan

    2014-01-01

    Roč. 1, č. 1 (2014), s. 99-104 ISSN 2313-0555 Institutional support: RVO:68378297 Keywords : carburizing * fatigue life * sub-surface crack * highstrength steel * push-pull loading Subject RIV: JM - Building Engineering http://www.naun.org/cms.action?id=7631

  15. The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

    Science.gov (United States)

    Varley, Anna; Warren, Fiona C.; Richards, Suzanne H.; Calitri, Raff; Chaplin, Katherine; Fletcher, Emily; Holt, Tim A.; Lattimer, Valerie; Murdoch, Jamie; Richards, David A.; Campbell, John

    2016-01-01

    Background Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings 15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants 45 nurse practitioners and practice nurse trained in the use of clinical decision support software. Methods We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more

  16. Three Levels of Push-Pull Dynamics among Chinese International Students' Decision to Study Abroad in the Canadian Context

    Science.gov (United States)

    Chen, Jun Mian

    2017-01-01

    The extant literature on student migration flows generally focus on the traditional push-pull factors of migration at the individual level. Such a tendency excludes the broader levels affecting international student mobility. This paper proposes a hybrid of three levels of push-pull dynamics (micro-individual decision-making, meso-academic…

  17. Placement of effective work-in-progress limits in route-specific unit-based pull systems

    NARCIS (Netherlands)

    Ziengs, N.; Riezebos, J.; Germs, R.

    2012-01-01

    Unit-based pull systems control the throughput time of orders in a production system by limiting the number of orders on the shop floor. In production systems where orders can follow different routings on the shop floor, route-specific pull systems that control the progress of orders on the shop

  18. Next-Practise in University Research Based Open Innovation - From Push to Pull: Case Studies from Denmark

    DEFF Research Database (Denmark)

    Rønnow Lønholdt, Jens; Wilken Bengtsson, Mille; Karlby, Lone Tolstrup

    2013-01-01

    on the pull function and the capacity development of the SMEs as this was the main lessons learned during the initial phase of the project. The paper also presents four Danish innovation projects that illustrate the use of the pull-based concept.Last but not least, the paper presents a new post...

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

    Science.gov (United States)

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

    2012-08-01

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

  20. Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis

    DEFF Research Database (Denmark)

    Edbrooke, David L; Minelli, Cosetta; Mills, Gary H

    2011-01-01

    ABSTRACT: INTRODUCTION: Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak...... and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case. Randomised studies of the effectiveness of intensive care are difficult to justify on ethical grounds; therefore, this observational study examined the cost effectiveness of ICU admission...... of admission to intensive care after ICU triage. A total of 7,659 consecutive patients referred to the intensive care unit (ICU) were divided into those accepted for admission and those not accepted. The two groups were compared in terms of cost and mortality using multilevel regression models to account...