An Evaluation of Risk Attitudes and Risk Tolerance in Emergency Medicine Residents

An underlying issue to our current healthcare system is how decisions made in the emergency department affect patients. This is paramount for underserved populations, which are more likely to have poor physical and mental health, lack of primary care, greater use of health services, and be generally dissatisfied with their medical care.1,2 What should the emergency physician (EP) do for these patients? These decisions are largely based upon individual risk tolerance. While risk is a indelible part of emergency medicine (EM), a risk profile of EM residents has not been compiled. Knowledge of risk taking tendencies among this niche of medical professionals could be critical. If EM residents have great risk aversion, they might practice defensive medicine, thereby incurring crippling costs4. On the other hand, if emergency medicine residents are greatly risk tolerant, they may make decisions that lead to significant morbidity and mortality. It is essential to establish a baseline risk profile before any corrective measures can be advanced. This study attempted to accomplish precisely that using Risk Type CompassTM.https://jdc.jefferson.edu/cwicposters/1023/thumbnail.jp

Group Decision Making in Conditions of Uncertainty using Fermat’s Weak Fuzzy Graphs and Beal’s Weak Fuzzy Graphs

Decision making is a process of solving problems for choosing the best alternative. The best way to illustrate the alternatives and relation between them is a graph. Developing a fuzzy graph is the convenient way of illutration if there is uncertainty in alternatives or in their relation. In group decision making problems, according to a group of experts, the relation between alternatives involves measure of preference and non preference. Intuitionistic fuzzy graph has limitations to model such problems. In n- Pythagorean fuzzy graphs the hesitancy degree and other decision tools are restricted to second degree.To overcome the flaws of intuitionistic fuzzy graphs and n- Pythagorean fuzzy graphs, we introduced Fermat’s Fuzzy Graphs in 2022. In this  paper the decision tools are generalized for Fermat’s Fuzzy Graphs. A practical example of selection of investement scheme is illustrated. Finally, Beal’s Fuzzy graphs is developed as generalization of Fermat’s Fuzzy Graphs

Functional outcome following open reduction and internal fixation of proximal humerus fractures with locking compression plate

Background: Proximal humerus fractures (PHFs) are common upper extremity fractures representing break in humerus bone. Incidences of PHFs increased in last few years due to life style changes and increased road accidents. Appropriate management strategy for PHFs is still uncertain. The aim of current study is to assess the functional outcome following open reduction and internal fixation of proximal humerus fractures using locking compression plates.Methods: Current study is a descriptive investigation conducted on 31 PHFs patients admitted to baby memorial hospital, calicut, between January 2013 to June 2014. Surgical management of PHFs was done by open reduction and internal fixation using locking compression plates and functional outcomes and complications of the employed treatment modality were investigated.Results: PHFs were observed to be common in 41-60 years age group, with 65% males being affected. Road accidents and domestic falls were observed to be the most common causes of PHFs in younger and elderly populations respectively. Three parts PHFs were observed to be more prevalent, followed by two and four parts fractures. Results of current study revealed that majority of PHFs united by 8-10 weeks duration with 22.58% cases with excellent and 41.93%, 16.12% and 19.35% cases with good, moderate and poor constant and Murley score respectively. Two patients reported post-operative complication of shoulder stiffness, while one patient each reported plate impingement, varus maluion, infection and varus malunion with intraarticular screw cut-out.  Conclusions: Locking compression plates (PHILOS/PHLP) is an efficient treatment modality for proximal humerus fractures allowing early mobilization and good functional outcome

Analysis of Punch-Through Breakdown Voltages in 3C-Sic Schottky Barrier Diode Using Gaussian Profile for 200µm Thick Wafer

ABSTRACT: The punch through breakdown voltage of 3C-SiC Schottky Barrier Diode has been analysed in this paper using Gaussian profile. It is observed that 3C-SiC Schottky barrier diode yield high punch through breakdown voltage with higher values of peak doping concentration and lower values of constant m with increasing depletion region width. So, thinner wafers of 3C-SiC can be used to fabricate Schottky barrier diode to provide higher breakdown voltage using Gaussian profile

A case report on Kawasaki disease

Kawasaki disease (KD) is an acute vasculitis of children that leads to coronary artery aneurysms in ≈ 25 of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disorder in children in developed countries. The diagnosis of KD is made on basis on the clinical findings. Atypical KD includes patients who don't meet all the criteria for opinion. The main complication of Kawasaki complaint is coronary aneurysm, and the treatment is intravenous immunoglobulin and aspirin. Another dose of immunoglobulin is given if the patient doesn't ameliorate, and several other treatment options have been proposed over the last many years as alternate and third line options. The AHA criteria, which incorporate suggestions for laboratory tests and early echocardiography, are helpful for diagnosing incomplete KD. Diagnosis is based on the presence of fever lasting longer than 5 days and four of five specific clinical criteria. In Japan, at least five of six criteria (fever and five other clinical criteria) should be fulfilled for the determination of KD. From the Japanese circulation society joint working groups criteria (JCS 2008, Guidelines for diagnosis and management of cardiovascular sequela in KD), KD can be diagnosed indeed when fever lasts lesser than 5 days. Though, according to the American heart association (AHA) criteria, fever lasting more than 5 days is essential for KD diagnosis. The use of intravenous immunoglobulin is well established in KD. Aspirin has been used in KD for anti-inflammatory effect, and low-dose aspirin is recommended to reduce the risk of thrombosis

High-Temperature Organic Rankine Cycle Utilizing Novel Scroll Expander and Pump

Organic Rankine Cycles (ORC) are widely employed to extracting work from different heat sources to improve the operational efficiency of thermal systems. High-temperature ORCs (\u3e 250 – 300 °C) are still particularly challenging especially when hydrocarbons cannot be used as the working fluids. Generators for Small Electric and Thermal Systems (GENSETs) are one example of systems where ORCs can be used as a bottoming cycle. A 1 kWe ORC has been previously constructed to evaluate the feasibility of designing an ORC with a heat source inlet temperature of approximately 500 °C. The test stand utilizes microtube evaporator, an air-cooled microchannel condenser, a plate heat exchanger as regenerator, scroll rotating machines as both expander and pump. To increase the efficiency of the ORC, novel scroll pump design and Oldham Ring scroll expander were installed. An extensive experimental campaign was carried out to map the performance of the expander and the pump along with the overall system performance using R245fa as the working fluid. In addition, thermocouple mesh has been inserted at the upstream and downstream of the evaporator to study the temperature maldistribution from the heat source. The performance was mapped at steady state over a range of operating conditions. The mapped performance has been used to develop a charge-sensitive dynamic model of the ORC system to be predict performance at off-design conditions and develop a control strategy. A discussion on the degradation of the lubricant oil in the system has also been included

Strength Differential Measured in Inconel 718: Effects of Hydrostatic Pressure Studied

Aeropropulsion components, such as disks, blades, and shafts, are commonly subjected to multiaxial stress states at elevated temperatures. Experimental results from loadings as complex as those experienced in service are needed to help guide the development of accurate viscoplastic, multiaxial deformation models that can be used to improve the design of these components. During a recent study on multiaxial deformation (ref. 1) on a common aerospace material, Inconel 718, it was shown that the material in the aged state exhibits a strength differential effect (SDE), whereby the uniaxial compressive yield and subsequent flow behavior are significantly higher than those in uniaxial tension. Thus, this material cannot be described by a standard von Mises yield formulation. There have been other formulations postulated (ref. 2) that involve other combinations of the stress invariants, including the effect of hydrostatic stress. The question remained as to which invariants are necessary in the flow model. To capture the physical mechanisms occurring during deformation and reflect them in the plasticity formulation, researchers examined the flow of Inconel 718 under various amounts of hydrostatic stress to determine whether or not hydrostatic stress is needed in the formulation. Under NASA Grant NCC3-464, monitored by the NASA Glenn Research Center, a series of tensile tests were conducted at Case Western Reserve University on aged (precipitation hardened) Inconel 718 at 650 C and with superimposed hydrostatic pressure. Dogbone shaped tensile specimens (3-mm-diameter gauge by 16-mm gauge length) and cylindrical compression specimens (3-mm-diameter gauge by 6-mm gauge length) were strain gauged and loaded in a high-pressure testing apparatus. Hydrostatic pressures were obtained with argon and ranged from 210 to 630 MPa. The aged Inconel 718 showed a pronounced difference in the tension and compression yield strength (i.e., an SDE), as previously observed. Also, there were no significant effects of hydrostatic pressure on either the tensile and compressive yield strength (see the graph) or on the magnitude of the SDE. This behavior is not consistent with the pressure-dependent theory of the SDE, which postulates that the SDE is associated with pressure-dependent and/or internal friction dependent deformation associated with non-Schmid effects at the crystal level (refs. 3 and 4). Flow in Inconel 718 appears to be independent of hydrostatic pressure, suggesting that this invariant may be removed from the phenomenological constitutive model. As part of an ongoing effort to develop advanced constitutive models, Glenn s Life Prediction Branch coordinated this work with that of research on the multiaxial deformation behavior of Inconel 718 being conducted at Pennsylvania State University under NASA Grant NCC597

High-fidelity parallel entangling gates on a neutral atom quantum computer

The ability to perform entangling quantum operations with low error rates in a scalable fashion is a central element of useful quantum information processing. Neutral atom arrays have recently emerged as a promising quantum computing platform, featuring coherent control over hundreds of qubits and any-to-any gate connectivity in a flexible, dynamically reconfigurable architecture. The major outstanding challenge has been to reduce errors in entangling operations mediated through Rydberg interactions. Here we report the realization of two-qubit entangling gates with 99.5% fidelity on up to 60 atoms in parallel, surpassing the surface code threshold for error correction. Our method employs fast single-pulse gates based on optimal control, atomic dark states to reduce scattering, and improvements to Rydberg excitation and atom cooling. We benchmark fidelity using several methods based on repeated gate applications, characterize the physical error sources, and outline future improvements. Finally, we generalize our method to design entangling gates involving a higher number of qubits, which we demonstrate by realizing low-error three-qubit gates. By enabling high-fidelity operation in a scalable, highly connected system, these advances lay the groundwork for large-scale implementation of quantum algorithms, error-corrected circuits, and digital simulations.Comment: 5 pages, 4 figures. Methods: 13 pages, 10 figure