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Training emergency department (ED) personnel in the care of victims of mass-casualty incidents (MCIs) is a highly challenging task requiring unique and innovative approaches. The purpose of this study was to retrospectively explore the value of high-fidelity simulators in an exercise that incorporates time and resource limitation as an optimal method of training health care personnel in mass-casualty care.
Mass-casualty injury patterns from an explosive blast event were simulated for 12 victims using high-fidelity computerized simulators (HFCS). Programmed outcomes, based on the nature of injuries and conduct of participants, ranged from successful resuscitation and survival to death. The training exercise was conducted five times with different teams of health care personnel (n = 42). The exercise involved limited time and resources such as blood, ventilators, and imaging capability. Medical team performance was observed and recorded. Following the exercise, participants completed a survey regarding their training satisfaction, quality of the exercise, and their prior experiences with MCI simulations. The Likert scale responses from the survey were evaluated using mean with 95% confidence interval, as well as median and inter-quartile range. For the categorical responses, the frequency, proportions, and associated 95% confidence interval were calculated.
The mean rating on the quality of experiences related trainee survey questions (n = 42) was between 4.1 and 4.6 on a scale of 5.0. The mean ratings on a scale of 10.0 for quality, usefulness, and pertinence of the program were 9.2, 9.5, and 9.5, respectfully. One hundred percent of respondents believed that this type of exercise should be required for MCI training and would recommend this exercise to colleagues. The five medical team (n = 5) performances resulted in the number of deaths ranging from two (including the expectant victims) to six. Eighty percent of medical teams attempted to resuscitate the “expectant” infant and exhausted the O- blood supply. Sixty percent of medical teams depleted the supply of ventilators. Forty percent of medical teams treated “delayed” victims too early.
A training exercise using HFCS for mass casualties and employing limited time and resources is described. This exercise is a preferred method of training among participating health care personnel.
AU in days of therapy per 1,000 patient days and microbiologic data from 2015 and 2016 were collected from 26 hospitals. The prevalences of Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL)–producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) were calculated and compared to the average prevalence of all hospitals in the network. This proportion was used to calculate the adjusted AU (a-AU) for various categories of antimicrobials. For example, a-AU of antipseudomonal β-lactams (APBL) was the AU of APBL divided by (prevalence of P. aeruginosa at that hospital divided by the average prevalence of P. aeruginosa). Hospitals were categorized by bed size and ranked by AU and a-AU, and the rankings were compared.
Most hospitals in 2015 and 2016, respectively, moved ≥2 positions in the ranking using a-AU of APBL (15 of 24, 63%; 22 of 26, 85%), carbapenems (14 of 23, 61%; 22 of 25; 88%), anti-MRSA agents (13 of 23, 57%; 18 of 26, 69%), and anti-VRE agents (18 of 24, 75%; 15 of 26, 58%). Use of a-AU resulted in a shift in quartile of hospital ranking for 50% of APBL agents, 57% of carbapenems, 35% of anti-MRSA agents, and 75% of anti-VRE agents in 2015 and 50% of APBL agents, 28% of carbapenems, 50% of anti-MRSA agents, and 58% of anti-VRE agents in 2016.
The a-AU considerably changes how hospitals compare among each other within a network. Adjusting AU by microbiological burden allows for a more balanced comparison among hospitals with variable baseline rates of resistant bacteria.
Virtual Engineering (VE), also known as Model-Based Systems Engineering (MBSE), is necessary in both current operational engineering qualifications and to help reduce the costs of future vertical lift design and analysis. As computational power continues to provide increasing capability to the rotorcraft engineering community to perform simulations in both real time and off line, it is imperative that the community develop verification and validation protocols and processes to certify these methods so that they can be reliably used to help reduce engineering cost and schedule. Computational Fluid Dynamics (CFD) has become a major Computational Science and Engineering (CSE) tool in the fixed wing and vertical lift communities, but it has not been developed to the point where it is accepted as a replacement for testing in certification of new or existing systems or vehicles. Since the rise of modern CFD in the 1980s, the promise of CFD’s capabilities has been met or exceeded, but its role in certification arguably remains less prominent than projected. The ability to implement transformative technologies further drives the need for CFD in design. To meet CFD’s role in certification, several goals must be met to provide a true “numerical experiment” from which accuracies (error estimates), sensitivities, and consistent application results can be extracted. This paper discusses the progress and direction towards developing CFD strategies for certification.
Trypanosomes and Leishmania are vector-borne parasites associated with high morbidity and mortality. Trypanosoma lewisi, putatively introduced with black rats and fleas, has been implicated in the extinction of two native rodents on Christmas Island (CI) and native trypanosomes are hypothesized to have caused decline in Australian marsupial populations on the mainland. This study investigated the distribution and prevalence of Trypanosoma spp. and Leishmania spp. in two introduced pests (cats and black rats) for three Australian locations. Molecular screening (PCR) on spleen tissue was performed on cats from CI (n = 35), Dirk Hartog Island (DHI; n = 23) and southwest Western Australia (swWA) (n = 58), and black rats from CI only (n = 46). Despite the continued presence of the intermediate and mechanical hosts of T. lewisi, there was no evidence of trypanosome or Leishmania infection in cats or rats from CI. Trypanosomes were not identified in cats from DHI or swWA. These findings suggest T. lewisi is no longer present on CI and endemic Trypanosoma spp. do not infect cats or rats in these locations.
To report a case of sebaceoma of the auricle, and to discuss the differential diagnosis, histopathological features, surgical management and genetic associations of this entity.
Case report and review of the medical literature.
A 79-year-old man presented with a slowly growing lesion of his auricle. Excision of the mass and histopathological review revealed a benign, basaloid, adnexal neoplasm consistent with sebaceoma. Due to its association with Muir–Torre syndrome and increased risk of visceral malignancy, the patient was followed closely for signs of malignancy. At 36 months post-excision, there were no signs of recurrence; thereafter, the patient continued to receive routine cancer surveillance follow up.
Sebaceoma is a rarely encountered, benign, adnexal neoplasm which can occur in the head and neck. The treatment is surgical excision, and recurrence is rare. Sebaceoma can occur as part of Muir–Torre syndrome, and in these patients there is an increased risk of other sebaceous lesions and visceral malignancy; thus, genetic testing and surveillance should be strongly considered.
Associations between early life maltreatment, social information processing (SIP) and aggression in childhood and adolescence have been widely documented. Few studies have examined the importance of childhood maltreatment independent of SIP in the etiology of adult aggression. Furthermore, moderating effects of childhood maltreatment on the SIP–aggression links have not been explored.
Hierarchical, multi-level models were fitted to data from n=2752 twins aged 20–55 years from the PennTwins Cohort. Adult aggression was assessed with the Life History of Aggression questionnaire. Childhood maltreatment was measured using the Childhood Trauma Questionnaire. Two aspects of SIP were examined: hostile attribution biases (HAB); negative emotional responses (NER).
Childhood maltreatment was positively correlated with adult aggression, independently of HAB and NER. In addition, childhood maltreatment moderated the relationships between both aspects of SIP and adult aggression. Specifically, the relationship between NER and aggression was stronger among individuals with higher levels of childhood maltreatment and NER was not associated with aggression for adults who experienced low levels of childhood maltreatment. Moderating effects of childhood maltreatment on the NER–aggression link were supported for total childhood maltreatment, emotional neglect and emotional abuse. In contrast, HAB was more strongly associated with adult aggression at lower levels of emotional abuse and physical neglect.
The current study provides insight into the mechanisms by which early life experiences influence adult aggression. Our findings suggest that childhood maltreatment may not only lead to increased levels of aggression in adulthood but may also modify the associations between SIP and adult aggression.
The main goal of the Working Group was to gather astrometric observations made during the triennum as well as old observations not yet published in the data base. The WG encouraged the making of new observations. A Spring School was organized in China in order to teach the observational techniques of natural satellites to students and young astronomers. New theoretical models of the motion of the satellites and fit of the current models to new observations were used in order to make ephemerides of all the planetary satellites with tools useful for observations such as configurations. These ephemerides named MULTISAT are available at <www.imcce.fr/sat> or at <lnfm1.sai.msu.ru/neb/nss/nssephme.htm>.
We compare water adsorption and desorption on ferroelectric copolymer poly(vinylidene fluoride-trifluoroethylene), and the dipole ordered polymer poly(methylvinylidene cyanide). The angle-resolved thermal desorption spectra prove that the absorbed water species interacts more strongly with poly(vinylidene fluoride-trifluoroethylene) than with poly(methylvinylidene cyanide). The angle resolved thermal desorption spectra shows large deviations from the cosine distribution for light illuminated poly(vinylidene fluoride-trifluoroethylene). Water desorption from poly(methylvinylidene cyanide) deviates from the cosine distribution without illumination.
Recent studies have reported cognitive asymmetries in patients with
Alzheimer's disease (AD) and in individuals with apolipoprotein E
ε4 (APOE ε4) genotype who are in the preclinical phase of AD.
This increased frequency of cognitive asymmetry, typically defined as a
significant discrepancy (in either direction) between verbal and spatial
abilities, often occurs despite an absence of differences on traditional
measures of central tendency (i.e., mean test scores). We prospectively
studied the relationship between APOE genotype and two modality-specific
executive-function tasks: The Verbal Fluency and Design Fluency tests of
the Delis-Kaplan Executive Function System (D-KEFS) in 52 normal
functioning older adult participants who were grouped according to the
presence (n = 24) or absence (n = 28) of the APOE
ε4 allele. Nondemented older adults with the APOE ε4 allele
demonstrated a greater frequency of cognitive asymmetric profile on the
new switching conditions of the Verbal and Design Fluency measures than
the APOE non-ε4 individuals. This study further supports the utility
of assessing cognitive asymmetry for the detection of subtle cognitive
differences in individuals at-risk for AD, and suggests that dual-task
executive function tests (i.e., fluency plus switching) may serve as a
useful preclinical marker of AD. (JINS, 2005, 11,
Memory tests that are in a recall format have almost universally
measured accuracy in terms of the number of target items reported by the
examinee. However, this traditional scoring method can, in certain cases,
result in artificially inflated memory accuracy scores. That is, just as a
“yes” response bias and high false-positive rate on
recognition testing can artificially inflate a patient's hit rate,
so, too, a liberal response bias and high intrusion rate on recall testing
can artificially inflate a patient's level of target recall.
Recognition tests correct for this problem by using a discriminability
measure that provides a single score of hit rate relative to
false-positive rate; however, recall tests rarely provide a single score
of recall accuracy that corrects for intrusion rate. In the present study,
we examined the utility of a new recall discriminability measure that
analyzes target recall relative to intrusion rate. Patients with
Alzheimer's disease (AD) or Huntington's disease (HD) were
administered the CVLT–II, which provides both the traditional
measure of target recall and a new measure of recall discriminability. The
results indicate that the new recall discriminability measure was superior
to the traditional level of target recall measure in distinguishing the
recall performance of AD and HD patients. Implications of these results
for clinical practice and theories of memory disorder in dementia are
discussed. (JINS, 2005, 11, 708–715.)
In a recent study, we empirically demonstrated limitations
in traditional ways that psychologists have used factor analysis to
define cognitive constructs (Delis et al.,
2003). Our criticism of factor analysis was not directed at this
statistical method per se, but rather at how it has often been employed
by psychologists to test cognitive constructs. Specifically, we pointed
out shortcomings in using this technique with normal or mixed
clinical populations. We argued that the factor-analytic studies
of memory tests with normal or mixed clinical populations often yielded
solutions in which measures of immediate and delayed memory loaded on
the same factor. This particular use of factor analysis can mask
important distinctions between critical cognitive functions that have
been demonstrated using other research methods, such as experimental
manipulations or case studies. We then conducted a factor-analytic
study that empirically demonstrated that, whereas immediate and delayed
memory measures load on the same factor when using normal or mixed
clinical samples, these measures load on separate factors when
using a homogenous population of patients with Alzheimer's disease
(AD). We drew the conclusion that factor analytic techniques can still
be used as one method for exploring conceptual relationships,
but only if these methods are used as part of a systematic,
programmatic exploration involving separate confirmatory factor
analyses using multiple homogenous patient populations. In the first
published reply to our study, Larrabee (2003)
pointed out other limitations, stating that application of factor-analytic
techniques to a single test that yields multiple measures may result in
global, simplistic solutions due to method variance, which is the tendency
of different variables from the same test to correlate significantly.
The roles of genetic and environmental influences on stressful life events were examined in 3938 twin pairs (MZ, same-sex DZ, and opposite-sex DZ) using a sex-limitation model. Life events were assessed by personal interview, and were categorized as being either personal (i.e., events that occur directly to the individual) or network (i.e., events that occur to someone within the individual's social network, thus affecting the individual indirectly). Consistent with previous reports, genetic factors were found to exert more influence on personal events than network events. Genetic correlations between males and females suggest that many of the same genetic factors are acting within both genders.
Homoepitaxial films of 4H-SiC(1120) and 8° off-axis 4H-SiC(0001) have been grown and characterized. The number of domains and the range of full-width half-maxima values of the x-ray rocking curves of the -oriented wafers were smaller than the analogous values acquired from the (0001) materials. Hydrogen etching of the former surface for 5 and 30 minutes reduced the RMS roughness from 0.52 nm to 0.48 nm and to 0.28 nm, respectively; the RMS roughness for a 30 μm (1120) film was 0.52 nm. Micropipes in the substrates did not thread beyond the film-substrate interface. The separation distance between stacking faults was determined to be 10 μm by transmission electron microscopy. Hall mobilities and carrier concentrations of 12,200 cm2/Vs and 3.1×1014 cm−3 and 800 cm2/Vs and 7.4×1014 cm−3 were measured at 100°K and 300°K, respectively. Photoluminescence indicated high purity. 4H-SiC(1120) PiN devices exhibited average blocking voltages to 1344 V and a minimum average forward voltage drop of 3.94 V.
For nearly a century, the primary method employed by psychologists to define and test the validity of constructs evaluated by assessment instruments has been shared-variance techniques such as intervariable correlations or factor analysis with large normative or mixed clinical samples. To illustrate the shortcomings of this approach, we conducted (1) correlational analyses of immediate- and delayed-memory measures separately in normal participants and in homogeneous samples of patients with either Alzheimer's disease or Huntington's disease; and (2) factor analysis of immediate and delayed-recall and recognition measures in a large, homogeneous sample of patients with Alzheimer's disease. The findings revealed that cognitive measures that share variance in the intact brain—thereby giving the facade of assessing a unitary construct—can dissociate and contribute to unique variance in the damaged brain, but only if the pathology occurs in brain regions known to disrupt vital cognitive processes tapped by those measures. The results illustrate that shared-variance procedures applied to normal or mixed clinical populations can mask some of the most vital cognitive constructs, such as the classic distinction between short- and long-term memory. Implications of these findings for research and clinical practice are discussed. (JINS, 2003, 9, 936–946.)
Ordered surface adlayers of diacetylene-containing molecules were formed using amide hydrogen-bonding interactions with a pre-formed self-assembled monolayer on gold. Photopolymerization of the diacetylene molecules in the adlayer results in enhanced solvent and processing stability of the adlayer. Patterning of the base monolayer using soft lithography techniques allows patterning of the adlayer as well, and may lead to methods for templating soluble two-dimensional monolayer sheets.
Ruthenium sulfide samples were prepared by flowing pure hydrogen sulfide into an aqueous solution of ruthenium chloride followed by further sulfidation in hydrogen sulfide. The final products were characterized by X-ray diffraction and crystallite-sizes were estimated from line broadening. The specific surface areas of catalysts were measured using the multipoint BET method and compositions were determined by thermogravimetric analysis. Ruthenium sulfide loaded gas diffusion electrodes were fabricated by a spraying technique and their electrochemical behavior studied. The electrochemical oxidation of hydrogen was investigated in a three -electrode cell using a ruthenium sulfide loaded gas diffusion electrode as the working electrode with humidified hydrogen containing small amounts of carbon monoxide. Results on the activity and the effects of carbon monoxide with reference to a standard platinum electrode measured at the same conditions show that ruthenium sulfide has a lower activity for hydrogen oxidation but is not susceptible to CO poisoning.