An adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation

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 2009 were analysed. The number of children in each triage category (red (emergency), orange (urgent or priority) and green (non-urgent)) and their disposal were evaluated. Results. 1. The October 2007 series: 902 children aged 5 days - 15 years were evaluated. Their median age was 20 (interquartile range (IQR) 7 - 50) months, and 58.8% (n=530) were triaged green, 37.5% (n=338) orange and 3.8% (n=34) red. Over 90% of children in the green category were discharged (478/530), while 32.5% of children triaged orange (110/338) and 52.9% of children triaged red (18/34) were admitted. There was a significant increase in admission rate for each triage colour change from green through orange to red after adjustment for age category (risk ratio (RR) 2.6; 95% confidence interval (CI) 2.2 - 3.1). 2. The July 2009 cohort: 407 children with a median age of 22 months (IQR 7 - 53 months) were enrolled. Twelve children (2.9%) were triaged red, 187 (45.9%) orange and 208 (51.1%) green. A quarter (101/407) of the children triaged were admitted: 91.7% (11/12) from the red category and 36.9% (69/187) from the orange category were admitted, while 89.9% of children in the green category (187/208) were discharged. After adjusting for age category, admissions increased by more than 300% for every change in triage acuity (RR 3.2; 95% CI 2.5 - 4.1). Conclusions. The adapted ETAT process may serve as a reliable triage tool for busy paediatric medical emergency units in resource-constrained countries and could be evaluated further in community emergency settings

An adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation

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 2009 were analysed. The number of children in each triage category (red (emergency), orange (urgent or priority) and green (non-urgent)) and their disposal were evaluated. Results. 1. The October 2007 series: 902 children aged 5 days - 15 years were evaluated. Their median age was 20 (interquartile range (IQR) 7 - 50) months, and 58.8% (n=530) were triaged green, 37.5% (n=338) orange and 3.8% (n=34) red. Over 90% of children in the green category were discharged (478/530), while 32.5% of children triaged orange (110/338) and 52.9% of children triaged red (18/34) were admitted. There was a significant increase in admission rate for each triage colour change from green through orange to red after adjustment for age category (risk ratio (RR) 2.6; 95% confidence interval (CI) 2.2 - 3.1). 2. The July 2009 cohort: 407 children with a median age of 22 months (IQR 7 - 53 months) were enrolled. Twelve children (2.9%) were triaged red, 187 (45.9%) orange and 208 (51.1%) green. A quarter (101/407) of the children triaged were admitted: 91.7% (11/12) from the red category and 36.9% (69/187) from the orange category were admitted, while 89.9% of children in the green category (187/208) were discharged. After adjusting for age category, admissions increased by more than 300% for every change in triage acuity (RR 3.2; 95% CI 2.5 - 4.1). Conclusions. The adapted ETAT process may serve as a reliable triage tool for busy paediatric medical emergency units in resource-constrained countries and could be evaluated further in community emergency settings

In Nightingale's footsteps: A qualitative analysis of the impact of leadership development within the clinical learning environment

Aim To identify and describe the impact areas of a newly developed leadership development programme focussed on positioning leaders to improve the student experience of the clinical learning environment. Background There is a need to consider extending traditional ways of developing leaders within the clinical learning in order to accommodate an increased number of students and ensure their learning experience is fulfilling and developmental. The Florence Nightingale Foundation implemented a bespoke leadership development programme within the clinical learning environment. Identifying the areas of impact will help to inform organisational decision making regarding the benefits of encouraging and supporting emerging leaders to undertake this type of programme. Method For this qualitative descriptive study, eight health care professionals who took part in a bespoke leadership development programme were interviewed individually and then collectively. The Florence Nightingale Foundation fellowship/scholarship programme is examined to determine impact. Results Two key themes were described in relation to impact of the programme. These were ‘Personal Development’ and ‘Professional Impact’. The two key themes comprised several subthemes. The notion of time and space to think was subsumed within each theme. Conclusion Data highlights that the Florence Nightingale Foundation programme had a distinct impact on participants by transforming thinking and increasing self-confidence to enable changes to make improvements both within their organisations and at national level. Implications for Nursing Management Health care managers must continue to invest in building leadership capacity and capability through programmes that can help position individuals to realize their potential to positively influence health outcomes and wider society

Influence of mismatch on the defects in relaxed epitaxial InGaAs/GaAs(100) films grown by molecular beam epitaxy

Thick (∼3 μm) films of InxGa1−xAs grown on GaAs(100) substrates, across the whole composition range, have been examined by transmission electron microscopy and double‐crystal x‐ray diffraction. The results were compared with the observed growth mode of the material determined by in situ reflection high‐energy electron diffraction in the molecular beam epitaxy growth system. The quality of the material degraded noticeably for compositions up to x∼0.5 associated with an increased density of dislocations and stacking faults. In contrast, improvements in quality as x approached 1.0 were correlated with the introduction of an increasingly more regular array of edge dislocations

Neural Coding of Movement Direction in the Healthy Human Brain

Neurophysiological studies in monkeys show that activity of neurons in primary cortex (M1), pre-motor cortex (PMC), and cerebellum varies systematically with the direction of reaching movements. These neurons exhibit preferred direction tuning, where the level of neural activity is highest when movements are made in the preferred direction (PD), and gets progressively lower as movements are made at increasing degrees of offset from the PD. Using a functional magnetic resonance imaging adaptation (fMRI-A) paradigm, we show that PD coding does exist in regions of the human motor system that are homologous to those observed in non-human primates. Consistent with predictions of the PD model, we show adaptation (i.e., a lower level) of the blood oxygen level dependent (BOLD) time-course signal in M1, PMC, SMA, and cerebellum when consecutive wrist movements were made in the same direction (0° offset) relative to movements offset by 90° or 180°. The BOLD signal in dorsolateral prefrontal cortex adapted equally in all movement offset conditions, mitigating against the possibility that the present results are the consequence of differential task complexity or attention to action in each movement offset condition

Indentation-based characterization of creep and hardness behavior of magnesium carbon nanotube nanocomposites at room temperature

The time-dependent plastic deformation response of magnesium/carbon nanotube (CNT) nanocomposites containing 0.25, 0.5, and 0.75 vol% of carbon nanotubes is investigated through depth nanoindentation tests against monolithic pure magnesium in the present study. The Mg-CNT nanocomposite materials were successfully synthesized via a powder metallurgy technique coupled with microwave sintering followed by hot extrusion to produce 8-mm diameter, long solid bars. All depth-sensing indentation creep tests were conducted at ambient (room) temperature employing a diamond Berkovich pyramidal indenter. These tests are dual-stage, i.e., loading to a prescribed peak load of 50 mN, holding the peak load constant for a dwell period of 500 s, and finally unloading. Various strain rates of 0.01, 0.1, 1, and 10 s−1were performed to assess the effects of strain rate and dwell time on the ambient temperature creep response of the Mg-CNT nanocomposites. The outcomes of these tests are explained through material hardness, microstructure, the extent of CNT content in each material, and strain rate sensitivity. Upon analyzing the nanoindentation creep tests, the dominant creep mechanism at room temperature was found to be a dislocation creep mechanism. It is also found that CNTs increase the creep resistance of magnesium. Findings of this study can be used as a starting point for a high-temperature creep study on Mg-CNT nanocomposites. This paper is a continued study from our group on time-dependent plastic deformation of Mg nanocomposites (i.e., see Haghshenas et al., Journal of Composite Materials, https://doi.org/10.1177/0021998318808358). The short-term goal is to provide a compressive picture of the controlling creep mechanisms and their dependency upon, time, temperature, strain rate, volume fraction of the nanoparticles, and the type of the nanoparticles. Mg, in general, is a notorious material for high-temperature application; therefore, the long-term objective is to propose Mg nanocomposite as reliable replacements for Mg when lightweight and creep resistance are needed. However, to be able to confidently suggest such a replacement detailed understanding on the controlling phenomena, mention as short-term goals, are required

\u3ci\u3eMedicine Meets Virtual Reality 17\u3c/i\u3e

Chapter, A Virtual Reality Training Program for Improvement of Robotic Surgical Skills, co-authored by Mukul Mukherjee and Nicholas Stergiou, UNO faculty members. Chapter, Consistency of Performance of Robot-Assisted Surgical Tasks in Virtual Reality, co-authored by Mukul Mukherjee and Nicholas Stergiou, UNO faculty members. The 17th annual Medicine Meets Virtual Reality (MMVR17) was held January 19-22, 2009, in Long Beach, CA, USA. The conference is well established as a forum for emerging data-centered technologies for medical care and education. Each year, it brings together an international community of computer scientists and engineers, physicians and surgeons, medical educators and students, military medicine specialists and biomedical futurists. MMVR emphasizes inter-disciplinary collaboration in the development of more efficient and effective physician training and patient care. The MMVR17 proceedings collect 108 papers by conference lecture and poster presenters. These papers cover recent developments in biomedical simulation and modeling, visualization and data fusion, haptics, robotics, sensors and other related information-based technologies. Key applications include medical education and surgical training, clinical diagnosis and therapy, physical rehabilitation, psychological assessment, telemedicine and more. From initial vision and prototypes, through assessment and validation, to clinical and academic utilization and commercialization - MMVR explores the state-of-the-art and looks toward healthcare’s future. The proceedings volume will interest physicians, surgeons and other medical professionals interested in emerging and future tools for diagnosis and therapy; educators responsible for training the next generation of doctors and scientists; IT and medical device engineers creating state-of-the-art and next-generation simulation, imaging, robotics and communication systems; data technologists creating systems for gathering, processing and distributing medical intelligence; military medicine specialists addressing the challenges of warfare and defense health needs; and biomedical futurists and investors who want to understand where the field is headed.https://digitalcommons.unomaha.edu/facultybooks/1233/thumbnail.jp

Noninvasive rapid cardiac magnetic resonance for the assessment of cardiomyopathies in low-middle income countries

INTRODUCTION: Cardiac Magnetic Resonance (CMR) is a crucial diagnostic imaging test that redefines diagnosis and enables targeted therapies, but the access to CMR is limited in low-middle Income Countries (LMICs) even though cardiovascular disease is an emergent primary cause of mortality in LMICs. New abbreviated CMR protocols can be less expensive, faster, whilst maintaining accuracy, potentially leading to a higher utilization in LMICs. AREAS COVERED: This article will review cardiovascular disease in LMICs and the current role of CMR in cardiac diagnosis and enable targeted therapy, discussing the main obstacles to prevent the adoption of CMR in LMICs. We will then review the potential utility of abbreviated, cost-effective CMR protocols to improve cardiac diagnosis and care, the clinical indications of the exam, current evidence and future directions. EXPERT OPINION: Rapid CMR protocols, provided that they are utilized in potentially high yield cases, could reduce cost and increase effectiveness. The adoption of these protocols, their integration into care pathways, and prioritizing key treatable diagnoses can potentially improve patient care. Several LMIC countries are now pioneering these approaches and the application of rapid CMR protocols appears to have a bright future if delivered effectively