NDM-523: USE OF AN UNMANNED AERIAL VEHICLE (UAV) TO ASSESS TRANSPORTATION INFRASTRUCTURE, IMMEDIATELY AFTER A CATASTROPHIC STORM EVENT

From September 29 to October 1, 2015 over 200 mm of rain deluged parts of southern New Brunswick. The catastrophic rain event washed away bridge size culverts and conventional bridges, including the surrounding soil and asphaltic concrete pavement. Also erosion encroached on the driving lane of road and highway embankments at over 100 locations. Several homes and businesses were left stranded. A fast and efficient means was required to assess the impact on infrastructure after the storm. This paper presents the procedure and outcomes of using digital imagery captured with Unmanned Aerial Vehicles (UAVs) for post-disaster assessment. The use of a UAV to gather site images, at hard to access locations, allowed for the timely prioritization of needs and allocation of limited resources to areas most urgently in demand of emergency repairs. High quality aerial images were processed using commercial software specifically designed for the creation of 3D models and orthomosaics from aerial photos. This information, along with ground-level panoramas communicated the current condition of assets and roads. It provided engineers with the ability to complete initial assessment, create 3D models for design, and provide highly qualitative evaluation records. The successful use of a UAV for this storm event was preceded by other uses of UAVs for asset management within the New Brunswick Department of Transportation and Infrastructure

Do actions occur inside the body?

The paper offers a critical examination of Jennifer Hornsby's view that actions are internal to the body. It focuses on three of Hornsby's central claims: (P) many actions are bodily movements (in a special sense of the word “movement”) (Q) all actions are tryings; and (R) all actions occur inside the body. It is argued, contra Hornsby, that we may accept (P) and (Q) without accepting also the implausible (R). Two arguments are first offered in favour of the thesis (Contrary-R): that no actions occur inside the body. Three of Hornsby's arguments in favour of R are then examined. It is argued that we need to make a distinction between the causes and the causings of bodily movements (in the ordinary sense of the word “movement”) and that actions ought to be identified with the latter rather than the former. This distinction is then used to show how Hornsby's arguments for (R) may be resisted

Healthcare provider perceptions of clinical prediction rules

Objectives: To examine internal medicine and emergency medicine healthcare provider perceptions of usefulness of specific clinical prediction rules. Setting: The study took place in two academic medical centres. A web-based survey was distributed and completed by participants between 1 January and 31 May 2013. Participants: Medical doctors, doctors of osteopathy or nurse practitioners employed in the internal medicine or emergency medicine departments at either institution. Primary and secondary outcome measures: The primary outcome was to identify the clinical prediction rules perceived as most useful by healthcare providers specialising in internal medicine and emergency medicine. Secondary outcomes included comparing usefulness scores of specific clinical prediction rules based on provider specialty, and evaluating associations between usefulness scores and perceived characteristics of these clinical prediction rules. Results: Of the 401 healthcare providers asked to participate, a total of 263 (66%), completed the survey. The CHADS2 score was chosen by most internal medicine providers (72%), and Pulmonary Embolism Rule-Out Criteria (PERC) score by most emergency medicine providers (45%), as one of the top three most useful from a list of 24 clinical prediction rules. Emergency medicine providers rated their top three significantly more positively, compared with internal medicine providers, as having a better fit into their workflow (p=0.004),helping more with decision-making (p= 0.037), better fitting into their thought process when diagnosing patients (p= 0.001) and overall, on a 10-point scale, more useful (p= 0.009). For all providers, the perceived qualities of useful at point of care, helps with decision making, saves time diagnosing, fits into thought process, and should be the standard of clinical care correlated highly (\u3e= 0.65) with overall 10-point usefulness scores. Conclusions: Healthcare providers describe clear preferences for certain clinical prediction rules, based on medical specialty

Towards open data blockchain analytics: a Bitcoin perspective

Bitcoin is the first implementation of a technology that has become known as a ‘public permissionless’ blockchain. Such systems allow public read/write access to an append-only blockchain database without the need for any mediating central authority. Instead, they guarantee access, security and protocol conformity through an elegant combination of cryptographic assurances and game theoretic economic incentives. Not until the advent of the Bitcoin blockchain has such a trusted, transparent, comprehensive and granular dataset of digital economic behaviours been available for public network analysis. In this article, by translating the cumbersome binary data structure of the Bitcoin blockchain into a high fidelity graph model, we demonstrate through various analyses the often overlooked social and econometric benefits of employing such a novel open data architecture. Specifically, we show: (i) how repeated patterns of transaction behaviours can be revealed to link user activity across the blockchain; (ii) how newly mined bitcoin can be associated to demonstrate individual accumulations of wealth; (iii) through application of the naïve quantity theory of money that Bitcoin's disinflationary properties can be revealed and measured; and (iv) how the user community can develop coordinated defences against repeated denial of service attacks on the network. Such public analyses of this open data are exemplary benefits unavailable to the closed data models of the ‘private permissioned’ distributed ledger architectures currently dominating enterprise-level blockchain development owing to existing issues of scalability, confidentiality and governance

Measures of User experience in a Streptococcal pharyngitis and Pneumonia Clinical Decision Support Tools

Objective: To understand clinician adoption of CDS tools as this may provide important insights for the implementation and dissemination of future CDS tools. Materials and Methods: Clinicians (n=168) at a large academic center were randomized into intervention and control arms to assess the impact of strep and pneumonia CDS tools. Intervention arm data were analyzed to examine provider adoption and clinical workflow. Electronic health record data were collected on trigger location, the use of each component and whether an antibiotic, other medication or test was ordered. Frequencies were tabulated and regression analyses were used to determine the association of tool component use and physician orders. Results: The CDS tool was triggered 586 times over the study period. Diagnosis was the most frequent workflow trigger of the CDS tool (57%) as compared to chief complaint (30%) and diagnosis/antibiotic combinations (13%). Conversely, chief complaint was associated with the highest rate (83%) of triggers leading to an initiation of the CDS tool (opening the risk prediction calculator). Similar patterns were noted for initiation of the CDS bundled ordered set and completion of the entire CDS tool pathway. Completion of risk prediction and bundled order set components were associated with lower rates of antibiotic prescribing (OR 0.5; CI 0.2-1.2 and OR 0.5; CI 0.3-0.9, respectively). Discussion: Different CDS trigger points in the clinician user workflow lead to substantial variation in downstream use of the CDS tool components. These variations were important as they were associated with significant differences in antibiotic ordering. Conclusions: These results highlight the importance of workflow integration and flexibility for CDS success

Spectral bounds for the Hellmann potential

The method of potential envelopes is used to analyse the bound state spectrum of the Schroedinger Hamiltonian H=-\Delta+V(r), where the Hellmann potential is given by V(r) = -A/r + Be^{-Cr}/r, A and C are positive, and B can be positive or negative. We established simple formulas yielding upper and lower bounds for all the energy eigenvalues.Comment: 9 pages, 2 figures, typos correcte

Novel colours and the content of experience

I propose a counterexample to naturalistic representational theories of phenomenal character. The counterexample is generated by experiences of novel colours reported by Crane and Piantanida. I consider various replies that a representationalist might make, including whether novel colours could be possible colours of objects and whether one can account for novel colours as one would account for binary colours or colour mixtures. I argue that none of these strategies is successful and therefore that one cannot fully explain the nature of the phenomenal character of perceptual experiences using a naturalistic conception of representation

Adaptive design of a clinical decision support tool: What the impact on utilization rates means for future CDS research

© The Author(s) 2019. OBJECTIVE: We employed an agile, user-centered approach to the design of a clinical decision support tool in our prior integrated clinical prediction rule study, which achieved high adoption rates. To understand if applying this user-centered process to adapt clinical decision support tools is effective in improving the use of clinical prediction rules, we examined utilization rates of a clinical decision support tool adapted from the original integrated clinical prediction rule study tool to determine if applying this user-centered process to design yields enhanced utilization rates similar to the integrated clinical prediction rule study. MATERIALS & METHODS: We conducted pre-deployment usability testing and semi-structured group interviews at 6 months post-deployment with 75 providers at 14 intervention clinics across the two sites to collect user feedback. Qualitative data analysis is bifurcated into immediate and delayed stages; we reported on immediate-stage findings from real-time field notes used to generate a set of rapid, pragmatic recommendations for iterative refinement. Monthly utilization rates were calculated and examined over 12 months. RESULTS: We hypothesized a well-validated, user-centered clinical decision support tool would lead to relatively high adoption rates. Then 6 months post-deployment, integrated clinical prediction rule study tool utilization rates were substantially lower than anticipated based on the original integrated clinical prediction rule study trial (68%) at 17% (Health System A) and 5% (Health System B). User feedback at 6 months resulted in recommendations for tool refinement, which were incorporated when possible into tool design; however, utilization rates at 12 months post-deployment remained low at 14% and 4% respectively. DISCUSSION: Although valuable, findings demonstrate the limitations of a user-centered approach given the complexity of clinical decision support. CONCLUSION: Strategies for addressing persistent external factors impacting clinical decision support adoption should be considered in addition to the user-centered design and implementation of clinical decision support