Application of clustering techniques to multispectral optical data over the ocean

MERIS, on Envisat, provides high-resolution radiometric data at nine discrete channels in the visible band. This paper looks at the potential of an unsupervised classification technique for utilizing these multi-spectral data to provide better discrimination between water masses according to their optical properties, and in particular whether phytoplankton groups can be distinguished. Although the majority of data do show a spectral peak associated with chlorophyll's red fluorescence line, clustering using only the red bands was found to separate out coastal waters according to their sediment content. Red-end classification also appeared to identify sub-pixel cloud, and demonstrate that the smile correction had not removed all the striping from the data. Classification using bands from the blue-green end showed a response to changes in chlorophyll concentration, but also indicated other variations. However, without in situ data no firm conclusions can be drawn on which phytoplankton groupings are present

An Analysis of Stem-Haul Wholesale Milk Route Costs inside and Outside the Federal Order No. 2 70-Mile Zone

A.E. Res. 83-

School Counselors as Leaders in School Turnaround

This study examined the role of professional school counselors in the school turnaround process. Themes from a qualitative case study analysis suggest that school counselors used leadership to develop data-driven programs and activities congruent with the ASCA National Model. Additionally, school counselors sought greater collaboration, partnership, and relationships with teachers, students, families, and the community at larger. Finally, the role of school counselors was heavily shaped by the expectations of school principals. Implications are explored for school counseling practice

The dawn phenomenon in type 2 diabetes: How to assess it in clinical practice?

International audienceAIM : The study was aimed at determining whether the dawn phenomenon in type 2 diabetes (T2D) can be predicted and quantified using simple and easily accessible glucose determinations.METHODS : A total of 210 non-insulin-treated persons with T2D underwent continuous glucose monitoring (CGM). The dawn phenomenon was quantified as the absolute increment from the nocturnal glucose nadir to the pre-breakfast value (Δdawn, mg/dL). Pre-lunch (preL) and pre-dinner (preD) glucose, and their averaged values (preLD), were compared with the nocturnal nadir. These pre-meal values were subtracted from the pre-breakfast values. The differences obtained (Δpre-mealL, Δpre-meal D and Δpre-meal LD) were correlated with Δdawn values. The receiver operating characteristic (ROC) curve was used to select the optimal Δpre-meal value that best predicted a dawn phenomenon, set at a threshold of 20mg/dL.RESULTS : All pre-meal glucose levels and differences from pre-breakfast values (Δpre-meal) significantly correlated (P<0.0001) with the nocturnal nadir and Δdawn values, respectively. The strongest correlations were observed for the parameters averaged at preL and preD time points: r=0.83 for preLD and r=0.58 for Δpre-meal LD. ROC curve analysis indicated that the dawn phenomenon at a threshold of 20mg/dL can be significantly predicted by a Δpre-meal LD cut off value of 10mg/dL. The relationship between Δdawn (Y, mg/dL) and Δpre-meal LD (X, mg/dL) was Y=0.49 X+15.CONCLUSION : The self-monitoring of preprandial glucose values at the three main mealtimes can predict the presence/absence of the dawn phenomenon, and permits reliable assessment of its magnitude without requiring continuous overnight glucose monitoring

Clinical Influences in the Multidisciplinary Management of Small Renal Masses at a Tertiary Referral Center

Introduction We designed a multidisciplinary Small Renal Mass Center to help patients decide among treatment options and individualize therapy for small renal masses. In this model physicians and support staff from multiple specialties work as a team to evaluate and devise a treatment plan for patients at the same organized visit. Methods We retrospectively reviewed the records of 263 patients seen from 2009 to 2014. Monitored patient characteristics included age, Charlson comorbidity index, body mass index, nephrometry score, tumor size and estimated glomerular filtration rate. Univariate and multivariate analyses were performed to identify patient characteristics associated with each treatment choice. Results Of the cohort 88 patients elected active surveillance, 64 underwent ablation and 111 were treated with surgery, including partial and radical nephrectomy in 74 and 37, respectively. There were significant associations between treatment modality and age, Charlson comorbidity index, tumor size and estimated glomerular filtration rate. Mean patient age at presentation was 61.1 years. Patients with a high Charlson comorbidity index score (greater than 5) or a decreased estimated glomerular filtration rate (less than 60 ml/minute/1.73 m2) were more likely to undergo active surveillance (41.6% and 35%) and ablative therapy (29.6% and 34%) vs partial nephrectomy (10.6% and 9%, respectively, each p \u3c0.001). On multivariable analysis age, tumor size and estimated glomerular filtration rate remained significantly associated with modality after adjustment for all other factors (each p \u3c0.001). Conclusions The Small Renal Mass Center enables patients to assess the various treatment modalities for a small renal mass in a single setting. By providing simultaneous access to the various specialists it provides an invaluable opportunity for informed patient decision making. © 2016 American Urological Association Education and Research, Inc

A complex interprofessional intervention to improve the management of painful procedures in neonates

During hospitalization, neonates are exposed to a stressful environment and a high number of painful procedures. If pain is not treated adequately, short- and long-term complications may develop. Despite evidence about neonatal pain and available guidelines, procedural pain remains undertreated. This gap between research and practice is mostly due to limited implementation of evidence-based knowledge and time constraints. This study describes in detail the development process of a complex interprofessional intervention to improve the management of procedural pain in neonates called NEODOL© (NEOnato DOLore). The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used as a methodological guide for the design of the NEODOL© intervention. The development of the intervention is based on several steps and multiple methods. To report this process, we used the Criteria for Reporting the Development of Complex Interventions in Healthcare (CReDECI 2). Additionally, we evaluated the content of the intervention using a Delphi method to obtain consensus from experts, stakeholders, and parents. The complex interprofessional intervention, NEODOL©, is developed and designed for three groups: healthcare professionals, parents, and neonates for a level IIb neonatal unit at a regional hospital in southern Switzerland. A total of 16 panelists participated in the Delphi process. At the end of the Delphi process, the panelists endorsed the NEODOL© intervention as important and feasible. Following the MRC guidelines, a multimethod process was used to develop a complex interprofessional intervention to improve the management of painful procedures in newborns. Complex interprofessional interventions need theoretical bases, careful development, and integration of stakeholders to provide a comprehensive approach. The NEODOL intervention consists of promising components and has the potential to improve the management of painful procedures and should facilitate the knowledge translation into practice. KEYWORDS bundle of care, complex interventions, interprofessional relations, knowledge translation, neonate, procedural pai

Have I just pressed something? The effects of everyday cold temperatures on dexterity

This paper details work on the effect of physical context of use on inclusive product interaction. Context of use refers to a set of circumstances which relate to the Users, Tasks, Equipment/Tools and Environment (both Physical and Social) (ISO, 1997). In particular, the physical context of use refers to factors such as lighting levels, temperature, weather conditions, vibration, noise, the built environment, etc. Consideration of the context of use is an integral, although sometimes implicit, part of any product design process. When a mismatch between context and a product occurs, it is unlikely that the benefits of a product will be realised (Maguire, 2001). Recent evidence suggests context of use can have a multi-faceted impact on product use (e.g. increasing or decreasing user capability and/or increasing product demand) particularly with older adults who have significantly reduced capability due to their age (Elton et al, 2008). Specifically, it is the physical environment that significantly affects capability. The vast majority of product interactions make demands on the visual and dexterous (arm, hand and finger) capabilities of the user. Whilst other capabilities are also used, it is these that are most common. Several studies (Riley and Cochran, 1984; Havenith et al, 1995; Boyce, 2003) have reported the effect of the physical environment on vision and dexterity. However, such studies focus on the body’s physiological response to such conditions and generally investigate extremes, e.g. freezing temperatures. Whilst these studies indicate the extent to which the physical environment can affect capability, they have very little relevance to everyday scenarios where products are used. Previous research investigated the effect of everyday lighting levels on visual capabilities (Elton and Nicolle, 2009). This paper reports the findings from a pilot study that investigated the effect of an everyday winter temperature on dexterity and how this can affect product interaction

Investigating the observed sensitivities of air-quality extremes to meteorological drivers via quantile regression

Air pollution variability is strongly dependent on meteorology. However, quantifying the impacts of changes in regional climatology on pollution extremes can be difficult due to the many non-linear and competing meteorological influences on the production, transport, and removal of pollutant species. Furthermore, observed pollutant levels at many sites show sensitivities at the extremes that differ from those of the overall mean, indicating relationships that would be poorly characterized by simple linear regressions. To address this challenge, we apply quantile regression to observed daily ozone (O[subscript 3]) and fine particulate matter (PM[subscript 2.5]) levels and reanalysis meteorological fields in the USA over the past decade to specifically identify the meteorological sensitivities of higher pollutant levels. From an initial set of over 1700 possible meteorological indicators (including 28 meteorological variables with 63 different temporal options), we generate reduced sets of O[subscript 3] and PM[subscript 2.5] indicators for both summer and winter months, analyzing pollutant sensitivities to each for response quantiles ranging from 2 to 98 %. Primary covariates connected to high-quantile O[subscript 3] levels include temperature and relative humidity in the summer, while winter O[subscript 3] levels are most commonly associated with incoming radiation flux. Covariates associated with summer PM[subscript 2.5] include temperature, wind speed, and tropospheric stability at many locations, while stability, humidity, and planetary boundary layer height are the key covariates most frequently associated with winter PM[subscript 2.5]. We find key differences in covariate sensitivities across regions and quantiles. For example, we find nationally averaged sensitivities of 95th percentile summer O[subscript 3] to changes in maximum daily temperature of approximately 0.9 ppb °C[superscript −1], while the sensitivity of 50th percentile summer O[subscript 3] (the annual median) is only 0.6 ppb °C[superscript −1]. This gap points to differing sensitivities within various percentiles of the pollutant distribution, highlighting the need for statistical tools capable of identifying meteorological impacts across the entire response spectrum.United States. Environmental Protection Agency (Grant/Cooperative Agreement RD-83522801

Addressing Positive Suicide Screens in the Emergency Department: The Importance of Post-Discharge Follow-up

Suicide is the tenth leading cause of death and many of those who die by suicide have visited an emergency department (ED) in the months prior to their death. Thus, identification and treatment of suicidal ideation (SI) in the ED is essential to suicide prevention efforts. Although a recent effort to implement universal SI screening has identified more patients with suicide risk, there are still barriers to further risk assessment and intervention, including: patients being too ill, language differences, physician caseload, length of SI evaluation and intervention, staff availability and communication with emergency mental health (EMH) services, and stigma surrounding risk responsibility. To address these issues following the Zero Suicide Model, in November 2017 the pre-existing Behavioral Health Service (BHS) expanded their care to this population, improved communication with EMH to reduce patient burden, and implemented a follow-up call system to contact patients within 48 hours post-discharge. Since November, 61 patients were identified as not receiving further SI evaluation or resources while in the ED. Twenty-four (39.3%) of these patients were successfully contacted by phone, with 15 (62.5%) receiving resources and 9 (37.5%) declining resources due to existing services. All patients with available addresses (86.8%) were sent Caring Contact Cards with information on suicide hotlines and psychiatric emergency services. By attempting calls multiple times, mailing resources, and being brief, yet detailed when evaluating, more patients\u27 SI needs are being treated. The ultimate goal is to provide services to all patients who screen positive for suicide risk presenting to the ED