Prehospital outcomes for ambulance service care: systematic review

Background: Ambulance service performance measurement has previously focused on response times and survival. We conducted a systematic review of the international literature on quality measures and outcomes relating to pre-hospital ambulance service care, aiming to identify a broad range of outcome measures to provide a more meaningful assessment of ambulance service care. Methods: We searched a number of electronic databases including CINAHL, the Cochrane Library, EMBASE, Medline, and Web of Science. For inclusion, studies had to report either research or evaluation conducted in a pre-hospital setting, published in the English language from 1982 to 2011, and reporting either outcome measures or specific outcome instruments. Results: Overall, 181 full-text articles were included: 83 (46%) studies from North America, 50 (28%) from Europe and 21 (12%) from the UK. A total of 176 articles were obtained after examining 257 full-text articles in detail from 5,088 abstracts screened. A further five papers were subsequently identified from references of the articles examined and studies known to the authors. There were 140 articles (77%) which contained at least one survival-related measure, 47 (34%) which included information about length of stay and 87 (48%) which identified at least one place of discharge as an outcome. Limitations: We encountered the problem of incomplete information, for instance studies not specifying which pain scales when these had been used or using survival without a specific time period. Conclusion and recommendations: In addition to measures relating to survival, length of stay and place of discharge, we identified 247 additional outcome measures. Few studies included patient reported or cost outcomes. By identifying a wide range of outcome measures this review will inform further research looking at the feasibility of using a wider range of outcome measures and developing new outcome measures in prehospital research and quality improvement

Market Simulation Programming As A Culminating Experience For Students Interested In Entrepreneurship And Pursuing An M.S. In Engineering Technology

Many of our students enrolled in our Master of Science in Technology program have expressed an interest in learning about entrepreneurship and the development and management of a technology driven company. Students interested in entrepreneurship can pursue a 12 credit concentration that includes classes in developing a cohesive marketing and technology strategy, comparing and contrasting technology strategies for companies within the same market niche, developing an entrepreneurial business plan and coursework in either small business management or entrepreneurial finance. One critical component of this concentration is the utilization of the Marketplace™ Venture Capital simulation game to provide students with real world management experience in running a technology driven company. Teams of students playing roles as CEO, Marketing Manager, Manufacturing Manager, Financial Manager and R and D Manager develop the technology and marketing strategies for their companies as they compete against each other in a global environment. After four quarters of operation, students are required to prepare and deliver a 15 minute presentation to venture capitalists detailing their marketing and technology strategies, performance to date and expectations in the market for the remaining two quarters in the game simulation. They are competing against the other teams for the venture capitalist’s money and must not only have a good presentation but also demonstrate conceptual understanding of what the financial and market data means. The roles of the venture capitalists are played by retired professionals in the community that have run businesses with revenues exceeding $50 M/year, have started new technology based ventures or have managed researchers in a commercial environment. We instruct the venture capitalists to play the role as tough managers who require data and not fluff before they part with their precious venture capital financing. VC and Technology business managers must negotiate on the purchase price for shares of their company with lesser performing companies giving up a greater share of their company in the negotiation. Students utilize techniques presented in the first two classes in their curriculum (Investigations in Technology and Strategic Management of Technology and Innovation) to develop their marketing and technology strategies. The students appreciate the fact that they are able to take risks and make mistakes in a simulation environment where financial disasters are made with fake money. After utilizing this simulation program for three years, we have found that non- traditional students who have been working in an engineering field typically perform better than the traditional graduate students who are entering their graduate program immediately after receiving their bachelor’s degree. Our experience is that all engineering technology students (regardless of when they enter the program) are weak in their comfort and understanding of financial data and that this is a weakness that we need to correct in both the undergraduate and graduate programs

Turbulence in the solar wind

The solar wind provides a unique natural "laboratory" in which plasma turbulence may be investigated in-situ. Turbulence is statistically reproducible. Thus, in this thesis we investigate plasma turbulence in the solar wind through the statistical study of magnetic field observations. In particular, we investigate single-satellite time-series of the magnetic field. We discuss hydrodynamic turbulence, and make parallels between hydrodynamic and magnetohydrodynamic turbulence. In hydrodynamic turbulence a unique scaling relation may be determined from dimensional analysis. Importantly, one may not derive a unique scaling relation for magnetohydrodynamic turbulence from dimensional analysis. Therefore, comparison of observations and turbulence models are key to determining the underlying physics for specific plasma parameters. The inertial range is a range of scales over which energy cascades from large to small temporal-spatial scales. This thesis will predominantly be focused on the anisotropy and scaling of the inertial range within the solar wind. We investigate how sampling a solenoid field, i.e. . B = 0, with a single satellite produces an apparent nonaxisymmetry with respect to the background magnetic field. We also investigate how time-series discontinuities produced by non-turbulent structures alter the statistical analysis of various anisotropy measures. We will find that the commonly held picture of the solar wind, that specific temporal-spatial scales have a distinct physical origin, is an over simplified model. We will show that non-turbulent structures must be removed from the observations in order to analysis the statistics of the turbulence accurately. The work in this thesis helps to constrain theories of plasma turbulence where there is a background magnetic field with a greater magnitude than the root-mean-square magnitude of the turbulent fluctuations

Encouraging Student Participation In Social Entrepreneurship Opportunities

Social entrepreneurs utilize the traits of commercial entrepreneurs; organizational abilities, opportunity identification, combining resources in novel ways, willingness to accept and manage risk and explosive growth or returns, to create enterprises that return high social value. As educators, we see opportunities where entrepreneurial skills can be applied to education, not-for-profit organizations, government offices and programs and philanthropic concerns and create service learning opportunities for students beyond the boundaries of the university. Many of us involved in higher education are frustrated with students who do not attend class, turn in assignments late or exhibit a lack of effort in classes where they pay tuition and receive a grade. It is a challenge, therefore, to gain the involvement of students in social entrepreneurship efforts where the reward (grade, pay or recognition) is not immediate or minimal and the trade-off (time management for their schedule) may be more fun or financially rewarding. This paper discusses the evolution for the process of enlisting student involvement in two distinct social entrepreneurship programs at our university. The first program involves linking university skill sets in the arts, digital media, technology and project management to the planning, implementation and evaluation of a regional arts and music festival held in the city where our university operates. Students involved in this social entrepreneurial venture work with community volunteers, city government officials and local business owners for a period of nine to ten months. In the first two years of sponsoring this program the strategy has evolved from enlisting the help of a student technology club (Edge Club, Digital Media) to working with a small volunteer student team (3 to 4 students). In each case, the organization or student team that worked on the project received no academic credit for the work involved beyond enhancement of their resume. Initial enthusiasm was high but tended to decline as the time horizon for finishing the project extended beyond the current semester and other activities or demands competed for the students’ participation. The second program also utilizes a student organization (Students In Free Enterprise, SIFE) to work on social entrepreneurship projects. In SIFE we have found that the students prefer projects that entail an afternoon of preparation for a short presentation, or service within a 3-4 day period. In that this group is involved in a “competition” with SIFE teams from other institutions at the end of the year, it is important that they seek projects that will differentiate themselves. The short-term projects that they prefer do little to accomplish this differentiation. The projects that truly differentiate are those that require a high degree of preparation for an event that culminates at the end of the semester, or even the following year. To that end, all students of this select team are required to create a long-term project that they will spearhead throughout the year. This leads to an escalation of commitment due to their “ownership” of that project. They are also required to assist another team member on their long-term project. Their efforts on these projects tend to be greater in that they realize that the other members will be assisting them on their project and they want to receive a conscientious effort from their teammates. This synergistic performance enhances both the number and quality of the projects. Using this method, we typically create 5 to 6 viable projects each year. Most teams that we compete with tend to have one major project per year. Using this system our university team has completed an average of 10 projects per year for presentation, of which 2 to 3 have been major projects

Acute military psychiatric casualties from the war in Iraq

Background: The view that most military personnel evacuated from war zones are suffering from combat stress reactions, or are otherwise traumatised by the horrors of war, has an impact on all aspects of military psychiatry. Aims: To delineate the reasons for psychiatric aeromedical evacuation from Iraq from the start of build-up of UK forces in January 2003 until the end of October that year, 6 months after the end of formal hostilities. Method: A retrospective study was conducted of field and in-patient psychiatric assessments of 116 military personnel evacuated to the UK military psychiatric in-patient facility in Catterick Garrison. Results: Evacuees were mainly non-combatants (69%). A significant proportion were in reserve service (21%) and had a history of contact with mental health services (37%). Only 3% had a combat stress reaction. In over 85% of cases evacuation was for low mood attributed to separation from friends or family, or difficulties adjusting to the environment. Conclusions: These findings have implications especially for screening for suitability for deployment, and for understanding any longer-term mental health problems arising in veterans from Iraq

Gravitational Lensing Signature of Long Cosmic Strings

The gravitational lensing by long, wiggly cosmic strings is shown to produce a large number of lensed images of a background source. In addition to pairs of images on either side of the string, a number of small images outline the string due to small-scale structure on the string. This image pattern could provide a highly distinctive signature of cosmic strings. Since the optical depth for multiple imaging of distant quasar sources by long strings may be comparable to that by galaxies, these image patterns should be clearly observable in the next generation of redshift surveys such as the Sloan Digital Sky Survey.Comment: 4 pages, revtex with 3 postscript figures include

Embedding Innovation Process And Methodology In Engineering Technology And Business Management And Marketing Courses

For many business segments, true “out of the box” innovation occurs in entrepreneurial companies where the founders aren’t hindered with the research paradigms established by mainstream businesses. The founders of these companies, many times technologists and scientists, see the application of the technology long before potential customers develop an understanding of the capabilities that the new technology can bring to the marketplace. Many times these “new technology ideas” have been developed though modifying an existing dominant design (product or service) to meet an unforeseen market need or through the development of a new design that may become the new industry standard. The competitors of tomorrow may reside in radically different markets yet have the insight to envision the application or modification of an existing technology to a market segment that they are currently not involved in. Teaching engineering technology students techniques and visioning tactics related to the innovation process has been difficult. Several of the authors have experienced, both in the classroom and in industrial settings, that many engineering and engineering technology students see innovation as the application of engineering principals resulting in small incremental changes in a process. Although these changes may result in a more efficient process through increased productivity, reduced waste, faster cycle times, etcetera; continuous improvement projects many times do not generate the dramatic market changes seen with a new dominant design. In fact in many established industries, disruptive innovation is discouraged in favor of continuous innovation because of the uncertainty of the risk/reward quotient and the impact that failed experimentation (increased research and development costs) can have on Wall Street’s perception of a company. Our university recently merged the colleges of Business and Technology and Applied Sciences resulting in a cross-pollinated faculty and the establishment of courses in the graduate and undergraduate curriculum where business and engineering technology student’s work together on class projects, many of which involve an innovation component. It is interesting that many of the faculty who incorporate a discussion or exercise related to the innovation process in their classroom have had extensive experience in an industrial setting prior to joining the university faculty. Industry seasoned faculty bring their “real-world” experience to the classroom and challenge students to move beyond continuous improvement projects. In several cases, ideas generated in the classroom or through collaborative efforts between the business and technology faculty have resulted in prototypes being built in the laboratory for further testing of the prospective innovation. The presence of a technology-centered business incubator located within walking distance from campus provides students the opportunity to observe several high technology businesses that have developed new technology niches in established market segments. These businesses provide consulting opportunities for cross-disciplinary graduate student teams to observe the challenges of introducing a new technology to address previously met market needs through introduction of a superior product. The business incubator is further linked to a sister technology-centered business incubator in Europe providing students (graduate and undergraduate) the opportunity to evaluate if a new technology should be launched initially in the United States or Europe. The creation of these learning opportunities mimic the industrial setting where graduates will be required to operate in cross-disciplinary teams that may address global manufacturing and marketing decisions. This paper discusses the pedagogical approaches several faculty members have developed to introduce and cultivate a creative innovation process to undergraduate and graduate students enrolled in technology engineering and business marketing and management classes. These approaches include identifying unmet market niche opportunities, identifying technologies utilized in alternative markets that could be utilized for different market segments, classroom exercises to compel students to search existing patent literature, ideation and brainstorming exercises and researching business entities to identify their technology strategy and implementation plans

An examination of the precipitation delivery mechanisms for Dolleman Island, eastern Antarctic Peninsula

Copyright @ 2004 Wiley-BlackwellThe variability of size and source of significant precipitation events were studied at an Antarctic ice core drilling site: Dolleman Island (DI), located on the eastern coast of the Antarctic Peninsula. Significant precipitation events that occur at DI were temporally located in the European Centre for Medium-Range Weather Forecasting (ECMWF) reanalysis data set, ERA-40. The annual and summer precipitation totals from ERA-40 at DI both show significant increases over the reanalysis period. Three-dimensional backwards air parcel trajectories were then run for 5 d using the ECMWF ERA-15 wind fields. Cluster analyses were performed on two sets of these backwards trajectories: all days in the range 1979–1992 (the climatological time-scale) and a subset of days when a significant precipitation event occurred. The principal air mass sources and delivery mechanisms were found to be the Weddell Sea via lee cyclogenesis, the South Atlantic when there was a weak circumpolar trough (CPT) and the South Pacific when the CPT was deep. The occurrence of precipitation bearing air masses arriving via a strong CPT was found to have a significant correlation with the southern annular mode (SAM); however, the arrival of air masses from the same region over the climatological time-scale showed no such correlation. Despite the dominance in both groups of back trajectories of the westerly circulation around Antarctica, some other key patterns were identified. Most notably there was a higher frequency of lee cyclogenesis events in the significant precipitation trajectories compared to the climatological time-scale. There was also a tendency for precipitation trajectories to come from more northerly latitudes, mostly from 50–70°S. The El Niño Southern Oscillation (ENSO) was found to have a strong influence on the mechanism by which the precipitation was delivered; the frequency of occurrence of precipitation from the east (west) of DI increased during El Niño (La Niña) events