Testing limits to airflow perturbation device (APD) measurements

<p>Abstract</p> <p>Background</p> <p>The Airflow Perturbation Device (APD) is a lightweight, portable device that can be used to measure total respiratory resistance as well as inhalation and exhalation resistances. There is a need to determine limits to the accuracy of APD measurements for different conditions likely to occur: leaks around the mouthpiece, use of an oronasal mask, and the addition of resistance in the respiratory system. Also, there is a need for resistance measurements in patients who are ventilated.</p> <p>Method</p> <p>Ten subjects between the ages of 18 and 35 were tested for each station in the experiment. The first station involved testing the effects of leaks of known sizes on APD measurements. The second station tested the use of an oronasal mask used in conjunction with the APD during nose and mouth breathing. The third station tested the effects of two different resistances added in series with the APD mouthpiece. The fourth station tested the usage of a flexible ventilator tube in conjunction with the APD.</p> <p>Results</p> <p>All leaks reduced APD resistance measurement values. Leaks represented by two 3.2 mm diameter tubes reduced measured resistance by about 10% (4.2 cmH₂O·sec/L for control and 3.9 cm H₂O·sec/L for the leak). This was not statistically significant. Larger leaks given by 4.8 and 6.4 mm tubes reduced measurements significantly (3.4 and 3.0 cm cmH₂O·sec/L, respectively). Mouth resistance measured with a cardboard mouthpiece gave an APD measurement of 4.2 cm H₂O·sec/L and mouth resistance measured with an oronasal mask was 4.5 cm H₂O·sec/L; the two were not significantly different. Nose resistance measured with the oronasal mask was 7.6 cm H₂O·sec/L. Adding airflow resistances of 1.12 and 2.10 cm H₂O·sec/L to the breathing circuit between the mouth and APD yielded respiratory resistance values higher than the control by 0.7 and 2.0 cm H₂O·sec/L. Although breathing through a 52 cm length of flexible ventilator tubing reduced the APD measurement from 4.0 cm H₂O·sec/L for the control to 3.6 cm H₂O·sec/L for the tube, the difference was not statistically significant.</p> <p>Conclusion</p> <p>The APD can be adapted for use in ventilated, unconscious, and uncooperative patients with use of a ventilator tube and an oronasal mask without significantly affecting measurements. Adding a resistance in series with the APD mouthpiece has an additive effect on resistance measurements, and can be used for qualitative calibration. A leak size of at least the equivalent of two 3.2 mm diameter tubes can be tolerated without significantly affecting APD measurements.</p

Risk Assessment Activity Worksheet for Research Data Management

Adapted from Research Data Service, University of Illinois at Urbana-Champaign. “Making Data Management Manageable: A Risk Assessment Activity for Managing Research Data.” March 2017. http://hdl.handle.net/2142/95768. Four-step risk assessment for identifying and mitigating risks in managing research data. The worksheet is suitable for use in training activities, and for individual use

Developing a viva exam to assess clinical reasoning in pre-registration osteopathy students

Background: Clinical reasoning (CR) is a core capability for health practitioners. Assessing CR requires a suite of tools to encompass a wide scope of contexts and cognitive abilities. The aim of this project was to develop an oral examination and grading rubric for the assessment of CR in osteopathy, trial it with senior students in three accredited university programs in Australia and New Zealand, and to evaluate its content and face validity. Methods: Experienced osteopathic academics developed 20 cases and a grading rubric. Thirty senior students were recruited, 10 from each university. Twelve fourth year and 18 fifth year students participated. Three members of the research team were trained and examined students at an institution different from their own. Two cases were presented to each student participant in a series of vignettes. The rubric was constructed to follow a set of examiner questions that related to each attribute of CR. Data were analysed to explore differences in examiner marking, as well as relationships between cases, institutions, and different year levels. A non-examining member of the research team acted as an observer at each location. Results: No statistical difference was found between the total and single question scores, nor for the total scores between examiners. Significant differences were found between 4th and 5th students on total score and a number of single questions. The rubric was found to be internally consistent. Conclusions: A viva examination of clinical reasoning, trialled with senior osteopathy students, showed face and content validity. Results suggested that the viva exam may also differentiate between 4th and 5th year students’ capabilities in CR. Further work is required to establish the reliability of assessment, to further refine the rubric, and to train examiners before it is implemented as a high-stakes assessment in accredited osteopathy programs

Understanding clinical reasoning in osteopathy: a qualitative research approach.

Background Clinical reasoning has been described as a process that draws heavily on the knowledge, skills and attributes that are particular to each health profession. However, the clinical reasoning processes of practitioners of different disciplines demonstrate many similarities, including hypothesis generation and reflective practice. The aim of this study was to understand clinical reasoning in osteopathy from the perspective of osteopathic clinical educators and the extent to which it was similar or different from clinical reasoning in other health professions. Methods This study was informed by constructivist grounded theory. Participants were clinical educators in osteopathic teaching institutions in Australia, New Zealand and the UK. Focus groups and written critical reflections provided a rich data set. Data were analysed using constant comparison to develop inductive categories. Results According to participants, clinical reasoning in osteopathy is different from clinical reasoning in other health professions. Osteopaths use a two-phase approach: an initial biomedical screen for serious pathology, followed by use of osteopathic reasoning models that are based on the relationship between structure and function in the human body. Clinical reasoning in osteopathy was also described as occurring in a number of contexts (e.g. patient, practitioner and community) and drawing on a range of metaskills (e.g. hypothesis generation and reflexivity) that have been described in other health professions. Conclusions The use of diagnostic reasoning models that are based on the relationship between structure and function in the human body differentiated clinical reasoning in osteopathy. These models were not used to name a medical condition but rather to guide the selection of treatment approaches. If confirmed by further research that clinical reasoning in osteopathy is distinct from clinical reasoning in other health professions, then osteopaths may have a unique perspective to bring to multidisciplinary decision-making and potentially enhance the quality of patient care. Where commonalities exist in the clinical reasoning processes of osteopathy and other health professions, shared learning opportunities may be available, including the exchange of scaffolded clinical reasoning exercises and assessment practices among health disciplines

A Mid-Infrared Study of the Class 0 Cluster in LDN 1448

We present ground-based mid-infrared observations of Class 0 protostars in LDN 1448. Of the five known protostars in this cloud, we detected two, L1448N:A and L1448C, at 12.5, 17.9, 20.8, and 24.5 microns, and a third, L1448 IRS 2, at 24.5 microns. We present high-resolution images of the detected sources, and photometry or upper limits for all five Class 0 sources in this cloud. With these data, we are able to augment existing spectral energy distributions (SEDs) for all five objects and place them on an evolutionary status diagram.Comment: Accepted by the Astronomical Journal; 26 pages, 9 figure

Energy Gradients Structure Microbial Communities Across Sediment Horizons in Deep Marine Sediments of the South China Sea

The deep marine subsurface is a heterogeneous environment in which the assembly of microbial communities is thought to be controlled by a combination of organic matter deposition, electron acceptor availability, and sedimentology. However, the relative importance of these factors in structuring microbial communities in marine sediments remains unclear. The South China Sea (SCS) experiences significant variability in sedimentation across the basin and features discrete changes in sedimentology as a result of episodic deposition of turbidites and volcanic ashes within lithogenic clays and siliceous or calcareous ooze deposits throughout the basin\u27s history. Deep subsurface microbial communities were recently sampled by the International Ocean Discovery Program (IODP) at three locations in the SCS with sedimentation rates of 5, 12, and 20 cm per thousand years. Here, we used Illumina sequencing of the 16S ribosomal RNA gene to characterize deep subsurface microbial communities from distinct sediment types at these sites. Communities across all sites were dominated by several poorly characterized taxa implicated in organic matter degradation, including Atribacteria, Dehalococcoidia, and Aerophobetes. Sulfate-reducing bacteria comprised only 4% of the community across sulfate-bearing sediments from multiple cores and did not change in abundance in sediments from the methanogenic zone at the site with the lowest sedimentation rate. Microbial communities were significantly structured by sediment age and the availability of sulfate as an electron acceptor in pore waters. However, microbial communities demonstrated no partitioning based on the sediment type they inhabited. These results indicate that microbial communities in the SCS are structured by the availability of electron donors and acceptors rather than sedimentological characteristics

Understanding clinical reasoning in osteopathy: a qualitative research approach.

BACKGROUND: Clinical reasoning has been described as a process that draws heavily on the knowledge, skills and attributes that are particular to each health profession. However, the clinical reasoning processes of practitioners of different disciplines demonstrate many similarities, including hypothesis generation and reflective practice. The aim of this study was to understand clinical reasoning in osteopathy from the perspective of osteopathic clinical educators and the extent to which it was similar or different from clinical reasoning in other health professions. METHODS: This study was informed by constructivist grounded theory. Participants were clinical educators in osteopathic teaching institutions in Australia, New Zealand and the UK. Focus groups and written critical reflections provided a rich data set. Data were analysed using constant comparison to develop inductive categories. RESULTS: According to participants, clinical reasoning in osteopathy is different from clinical reasoning in other health professions. Osteopaths use a two-phase approach: an initial biomedical screen for serious pathology, followed by use of osteopathic reasoning models that are based on the relationship between structure and function in the human body. Clinical reasoning in osteopathy was also described as occurring in a number of contexts (e.g. patient, practitioner and community) and drawing on a range of metaskills (e.g. hypothesis generation and reflexivity) that have been described in other health professions. CONCLUSIONS: The use of diagnostic reasoning models that are based on the relationship between structure and function in the human body differentiated clinical reasoning in osteopathy. These models were not used to name a medical condition but rather to guide the selection of treatment approaches. If confirmed by further research that clinical reasoning in osteopathy is distinct from clinical reasoning in other health professions, then osteopaths may have a unique perspective to bring to multidisciplinary decision-making and potentially enhance the quality of patient care. Where commonalities exist in the clinical reasoning processes of osteopathy and other health professions, shared learning opportunities may be available, including the exchange of scaffolded clinical reasoning exercises and assessment practices among health disciplines

Analisis Kerentanan Pantai Pulau Bengkalis Berbasis Sistem Imformasi Geografis

Coastal area has an important role for the people who live nearby but it is prone to damage. The damage to the coastal area require countermeasures so that its impact can be minimised or eliminated. Prior to countermeasure, vulnerability analysis needs to be done by specifying coastal vulnerability index (CVI). This research was conducted along the northern coast of Bengkalis Island which is directly adjacent to Malacca Strait. Coastal vulnerability index is calculated with the value of the physical variables such as shoreline changes, visual observation, the length and width of the damage, the width of the green belt, lithology, wave height, tidal range, land use, and coastal slope. The required data for the research are landsat imagery, hydro-oceanography, bathymetry, and visual observation of damage. Results of anaysis showed that Simpang Ayam Village, Jangkang Village, Teluk Papal Village, Bantan Air Village, Teluk Pambang Village have very high coastal vulnerability. Sekodi Village has high coastalvulnerability. Area that has a moderate coastal vulnerability is Prapat Tunggal Village. Selat Baru Village, Teluk Kembung Luar Village, dan Teluk Lancar Village have low vulnerability.Keys word: Coastal vulnerablity Index (CVI), Landsat Imagery, Prone to damag

Giant Molecular Outflows Powered by Protostars in L1448

We present sensitive, large-scale maps of the CO J=1-0 emission of the L1448 dark cloud. These maps were acquired using the On-The-Fly capability of the NRAO 12-meter telescope. CO outflow activity is seen in L1448 on parsec-scales for the first time. Careful comparison of the spatial and velocity distribution of our high-velocity CO maps with previously published optical and near-infrared images and spectra has led to the identification of six distinct CO outflows. We show the direct link between the heretofore unknown, giant, highly-collimated, protostellar molecular outflows and their previously discovered, distant optical manifestations. The outflows traced by our CO mapping generally reach the projected cloud boundaries. Integrated intensity maps over narrow velocity intervals indicate there is significant overlap of blue- and red-shifted gas, suggesting the outflows are highly inclined with respect to the line-of-sight, although the individual outflow position angles are significantly different. The velocity channel maps also show that the outflows dominate the CO line cores as well as the high-velocity wings. The magnitude of the combined flow momenta, as well as the combined kinetic energy of the flows, are sufficient to disperse the 50 solar mass NH3 cores in which the protostars are currently forming, although some question remains as to the exact processes involved in redirecting the directionality of the outflow momenta to effect the complete dispersal of the parent cloud.Comment: 11 pages, 9 figures, to be published in the Astronomical Journa