Physicians' perspectives on the treatment of patients with eating disorders in the acute setting

Abstract Background Hospitalisation for an eating disorder is rare, however treatment in the acute medical setting can be a life-saving admission. While the multidisciplinary team delivers overall patient care, medical decisions are the responsibility of the treating physicians. Treatment decisions directly impact on patient care and outcomes. This study aimed to explore the considerations that influence the medical decisions of physicians when treating patients with eating disorders in the acute setting. Method Semi-structured interviews were conducted with ten medical physicians who had previously treated eating disorders on a general medical unit in two Australian tertiary hospitals. An interview schedule, based on the literature and four relevant domains from the Consolidated Framework for Implementation Research, was developed. Interviews were audio recorded, transcribed verbatim and analyzed thematically. Coding and interim themes and sub-themes were developed by two dietitian researchers; these were further refined through researcher discussion and triangulation with two additional dietitian researchers. Results Ten doctors were interviewed (3 consultants (1 adult general medical and 2 paediatricians: 13–16 years medical experience), 2 registrars (4–7 years experience), 1 resident (1 year experience), and 4 interns (< 1 year experience). Doctors described memorable patient cases, related to hospital stays over several weeks. Interviews ranged in length from 58 min to 91 min. Four themes (with five sub-themes) were developed: 1) navigating uncertainty (focusing on processes and goals and seeking information), 2) being “the good doctor” (doing the right thing), 3) seeing the big picture (depending on key players and considering short and long-term), and 4) involving family and patient. Conclusions Non-specialist physicians described challenges in the treatment of eating disorders in the inpatient setting. They take a holistic approach that considers both short and longer-term goals, relying on specialist colleagues, the wider multidisciplinary team and sometimes family members to guide treatment decisions during admissions on general medical wards. Additional support, education and training centered on the key themes may increase physicians’ confidence and ability to make effective treatment decisions for this patient group. The results are relevant to all health professionals working in this field to better understand the priorities of medical physicians and to support them to achieve positive outcomes in the inpatient treatment of patients with eating disorders

Future enhancements to ground-based microburst detection

This set of viewgraphs presents the results of the Cockpit Weather Information (CWI) program at M.I.T. Lincoln Laboratory. The CWI program has been funded through NaSA Langley Research Center by the joint NASA/FAA Integrated Airborne Wind Shear Program for the past four years. During this time, over 120 microburst penetrations by research aircraft have been conducted under Terminal Doppler Weather Radar (TDWR) testbed radar surveillance at Orlando, FL. The results of these in-situ measurements have been compared with ground-based detection methods. Several valuable insights were gained from this research activity. First, it was found that the current TDWR microburst shapes do not permit accurate characterization of microburst hazard in terms of the F factor hazard index, because they are based on loss value rather than shear. Second, it was found that the horizontal component of the F factor can be accurately estimated from shear, provided compensation is made for the dependence of outflow strength on altitude. Third, it was found that a simple continuity assumption for estimating the vertical component of the F factor yielded poor results. However, further research has shown that downdraft strength is correlated with features aloft detected by the TDWR radar scan strategy. The outcome of the CWI program is to move from the loss-based wind shear detection algorithm used in the TDWR to a shear-based detection scheme as proposed in the Integrated Terminal Weather System (ITWS)

Wake Vortex Field Measurement Program at Memphis, Tennessee: Data Guide

Eliminating or reducing current restrictions in the air traffic control system due to wake vortex considerations would yield increased capacity, decreased delays, and cost savings. Current wake vortex separation standards are widely viewed as very conservative under most conditions. However, scientific uncertainty about wake vortex behavior under different atmospheric conditions remains a barrier to development of an adaptive vortex spacing system. The objective of the wake vortex field measurement efforts during December, 1994 and August, 1995 at Memphis, TN were to record wake vortex behavior for varying atmospheric conditions and types of aircraft. This effort is part of a larger effort by the NASA Langley Research Center to develop an Aircraft Vortex Spacing System (AVOSS) as an element of the Terminal Area Productivity (TAP) program. The TAP program is being performed in concert with the FAA Terminal Air Traffic Control Automation (TATCA) program and ATC Automation. Wake vortex behavior was observed using a mobile continuous-wave (CW) coherent laser Doppler radar (lidar) developed at Lincoln Laboratory. This lidar features a number of improvements over previous systems, including the first-ever demonstration of an automatic wake vortex detection and tracking algorithm

Mechanisms and strategies of power regulation in wind turbines

The modelling and simulation of wind turbines is becoming more important as the penetration levels of wind turbines are increasing. This means that the effects the various types of wind turbines have on electrical grids and possible ways to control power output quality should be understood in order to facilitate wind energy expansion and to ensure minimal negative effects on local and wider area grids. Chapter 2 provides a literature review of the current research related to constant speed turbines (both passive and active stall) and the variable speed DFIG turbine. Although the latter is not examined further in this thesis, it is mentioned to provide a point of comparison with the constant speed technology. The literature review also enabled to results of previous simulation and the results of this thesis to be successfully validated. The Chapter 3 deals with the constant speed turbine as a steady state simulation. The steady state simulation showed that the chosen turbine characteristic would have a power generation design point of 2MW, and was designed for optimum output at an average wind velocity of 15m/s. The steady state simulations also showed that effect a change in frequency would have on the power output. Comparing the simulations of the passive stall of Chapter 4 and the active stall control of Chapter 5 it was shown that with the addition of pitch control there was still a significant overshoot of design output power of 0.06-0.08p.u, along with a high frequency variation of 0.05p.u. While the pitch actuators were engaged, this did not provide any significant reduction in design point overshoot or turbine behaviour The advantage of the active stall control was explored in Chapter 6, demonstrating the active stall control turbine can be used successfully in providing primary, secondary and high frequency support. A new set point could be reached within the required 10sec, and the output remained relatively steady. Though this power output is of course still reliant, and varies slightly depending on the wind velocity behaviour

Iatrogenic spinal epidural abscess

Background : Iatrogenic epidural abscess complicating neuro-axial blockade is rare, but carries significant morbidity and mortality if diagnosis is delayed. First documented in 1974, this disorder is now well described in the literature, and is increasing in incidence. Methods : A literature review was undertaken using Medline, all relevant papers on this rare, but important, complication of spinal epidural anesthesia or analgesia were used. Results : Widespread use of neuro-axial techniques in the peri-operative period such as epidural analgesia has probably contributed to improved surgical outcome but has also led to an increased incidence of complications. Epidural abscess or epidural catheter sepsis has previously been thought to occur rarely but recent publications suggest that it may be more frequent. Predisposing factors include old age, diabetes mellitus, alcoholism, cancer, and acquired immuno-deficiency syndrome. The signs and symptoms of epidural abscess may be nonspecific : including back pain, sepsis, with varying neurological deficits, which may present late. Magnetic resonance imaging (MRI) provides the most accurate definitive diagnosis. The treatment of choice in most patients is early neurosurgical decompression and antibiotic therapy. The most common causative organism in spinal epidural abscess is Staphylococcus aureus. Prompt diagnosis and specific therapy are the most important prognostic factors for a successful outcome. Conclusion : Iatrogenic spinal epidural abscess is a rare but serious complication which should be brought to the attention of all surgeons and anesthetists.link_to_subscribed_fulltex

Mechanisms and strategies of power regulation in wind turbines

The modelling and simulation of wind turbines is becoming more important as the penetration levels of wind turbines are increasing. This means that the effects the various types of wind turbines have on electrical grids and possible ways to control power output quality should be understood in order to facilitate wind energy expansion and to ensure minimal negative effects on local and wider area grids. Chapter 2 provides a literature review of the current research related to constant speed turbines (both passive and active stall) and the variable speed DFIG turbine. Although the latter is not examined further in this thesis, it is mentioned to provide a point of comparison with the constant speed technology. The literature review also enabled to results of previous simulation and the results of this thesis to be successfully validated. The Chapter 3 deals with the constant speed turbine as a steady state simulation. The steady state simulation showed that the chosen turbine characteristic would have a power generation design point of 2MW, and was designed for optimum output at an average wind velocity of 15m/s. The steady state simulations also showed that effect a change in frequency would have on the power output. Comparing the simulations of the passive stall of Chapter 4 and the active stall control of Chapter 5 it was shown that with the addition of pitch control there was still a significant overshoot of design output power of 0.06-0.08p.u, along with a high frequency variation of 0.05p.u. While the pitch actuators were engaged, this did not provide any significant reduction in design point overshoot or turbine behaviour The advantage of the active stall control was explored in Chapter 6, demonstrating the active stall control turbine can be used successfully in providing primary, secondary and high frequency support. A new set point could be reached within the required 10sec, and the output remained relatively steady. Though this power output is of course still reliant, and varies slightly depending on the wind velocity behaviour