Quantitative Blood Loss (QBL) at every delivery: a quality improvement initiative utilizing Electronic Medical Record tools

Maternal hemorrhage is a major cause of maternal morbidity and mortality in the United States and efforts are in place to eliminate preventable harm. Accurate assessment of blood lost around the time of birth is essential for timely recognition and intervention. As part of the Alliance for Innovation on Maternal Health (AIM) Obstetrical Hemorrhage Patient Safety Bundle at our institution a quantitative blood loss (QBL) calculator was created within the electronic medical record. This process allows for real-time tracking of cumulative blood loss measurements and is built with triggers to alert the care team when criteria for various hemorrhage stages are achieved along with suggested interventions and assessments. The consistency of implementation and efficacy of the QBL calculator was evaluated by following both utilization of the calculator flowsheet as well as tracking of rates of erroneous QBL values, defined by negative values and cesarean deliveries with QBL2019, 14 months after implementation and post three system-based improvements. By the end of this implementation review the calculator was in use consistently at all cesarean deliveries with improved confidence in the process by providers

Coseismic deformation and source modeling of the May 2012 Emilia (Northern Italy) earthquakes

On May 20th, 2012, an ML 5.9 earthquake (Table 1) occurred near the town of Finale Emilia, in the Central Po Plain, Northern Italy (Figure 1). The mainshock caused 7 casualties and the collapse of several historical buildings and industrial sheds. The earthquake sequence continued with diminishing aftershock magnitudes until May 29th, when an ML 5.8 earthquake occurred near the town of Mirandola, ~12 km WSW of the mainshock (Scognamiglio et al., 2012). This second mainshock started a new aftershock sequence in this area, and increased structural damage and collapses, causing 19 more casualties and increasing to 15.000 the number of evacuees. Shortly after the first mainshock, the Department of Civil Protection (DPC) activated the Italian Space Agency (ASI), which provided post-seismic SAR Interferometry data coverage with all 4 COSMO-SkyMed SAR satellites. Within the next two weeks, several SAR Interferometry (InSAR) image pairs were processed by the INGV-SIGRIS system (Salvi et al., 2012), to generate displacement maps and preliminary source models for the emergency management. These results included continuous GPS site displacement data, from private and public sources, located in and around the epicentral area. In this paper we present the results of the geodetic data modeling, identifying two main fault planes for the Emilia seismic sequence and computing the corresponding slip distributions. We discuss the implication of this seismic sequence on the activity of the frontal part of the Northern Apennine accretionary wedge by comparing the co-seismic data with the long term (geological) and present day (GPS) velocity fields.Published645-6551.1. TTC - Monitoraggio sismico del territorio nazionale1.9. Rete GPS nazionale1.10. TTC - Telerilevamento3.2. Tettonica attivaJCR Journalrestricte

Activation of the SIGRIS monitoring system for ground deformation mapping during the Emilia 2012 seismic sequence, using COSMO-SkyMed InSAR data

On May 20, 2012, at 02:03 UTC, a moderate earthquake of local magnitude, ML 5.9 started a seismic sequence in the central Po Plain of northern Italy (Figure 1) [Scognamiglio et al. 2012, this volume]. The mainshock occurred in an area where seismicity of comparable magnitude has neither been recorded nor reported in the historical record over the last 1,000 years [Rovida et al. 2011]. The aftershock sequence evolved rapidly near the epicenter, with diminishing magnitudes until May 29, 2012, when at 07:00 UTC a large earthquake of ML 5.8 occurred 12 km WSW of the mainshock, starting a new seismic sequence in the western area (Figure 1); a total of seven earthquakes with ML >5 occurred in the area between May 20 and June 3, 2012 (Figure 1). The details of the seismic sequence can be found in the report by Scognamiglio et al. [2012]. Immediately after the mainshock, the Italian Department of Civil Protection (Dipartimento di Protezione Civile; DPC) requested the Italian Space Agency (Agenzia Spaziale Italiana; ASI) to activate the Constellation of Small Satellites for Mediterranean Basin Observation (COSMOSkyMed) to provide Interferometric Synthetic Aperture Radar (InSAR) coverage of the area. COSMO-SkyMed consists of four satellites in a 16-day repeat-pass cycle, with each carrying the same SAR payload [Italian Space Agency 2007]. In the current orbital configuration, within each 16- day cycle, image pairs with temporal baselines of 1, 3, 4 and 8 days can be formed from the images acquired by the four different sensors. Combined with the availability of a wide range of electronically steered antenna beams with incidence angles ranging from about 16° to 50° at near-range [E-geos 2012], this capability allows trade-offs between temporal and spatial coverage to be exploited during acquisition planning. A joint team involving the Istituto Nazionale di Geofisica e Vulcanologia (INGV; National Institute of Geophysics and Volcanology) and the Istituto per il Rilevamento Elettromagnetico dell'Ambiente (IREA-CNR; Institute for the Electromagnetic Sensing of the Environment) was activated to generate InSAR-based scientific products to support the emergency management. In this framework, the ASI and DPC requested that INGV activated the Spacebased Monitoring System for Seismic Risk Management (SIGRIS) [Salvi et al. 2010]. SIGRIS consists of a hardware/ software infrastructure that is designed to provide the DPC with value-added information products in the different phases of the seismic cycle. During earthquake emergencies, its goal is to rapidly provide decision-support products, such as validated ground-displacement maps and seismic source models. This study reports the details of the activation of the SIGRIS system in the case of the Emilia sequence. It provides a description of the COSMO-SkyMed datasets and processing procedures, as well as selected interferometric results for the coseismic and post-seismic ground deformation. Fault modeling results for the seismic sources of the largest earthquakes, and a more detailed discussion of the observed ground deformations are reported in Pezzo et al. [2012]

Interseismic ground velocities in Central Apennines from GPS and InSAR measurements: new contributions for seismic hazard models by preliminary results of ESA CHARMING project

The contribution of space geodetic techniques to interseismic velocity estimation, and thus seismic hazard modelling, has been recognized since two decades and made possible in more recent years by the increased availability and accuracy of geodetic measurements. We present the preliminary results of a feasibility study performed within the CHARMING project (Constraining Seismic Hazard Models with InSAR and GPS), funded by the European Space Agency (ESA). For a 200 km x 200 km study area, covering the Abruzzi region (central Italy) we measure the mean surface deformation rates from Synthetic Aperture Radar and GPS, finding several local to regional deformation gradients consistent with the tectonic context. We then use a kinematic finite element model to derive the long-term strain rates, as well as earthquake recurrence relations. In turn these are input to state-of-the-art probabilistic seismic hazard models, the output of which is validated statistically using data from the Italian national accelerometric and macroseismic intensity databases.Published373-3773T. Pericolosità sismica e contributo alla definizione del rischioN/A or not JCRope

Mid-term review results of the ESA STSE Pathfinder CHARMING project (Constraining Seismic Hazard Models with InSAR and GPS)

We probe the feasibility of integrating GPS and Synthetic Aperture Radar deformation rates within the seismic hazard models of the central Apennines (Italy), exploiting data from over 100 GPS stations and the ~20- year long ERS and ENVISAT SAR image archive. We then use a kinematic finite element model to derive the long-term strain rates, as well as earthquake recurrence relations. In turn these are input to state-of-the-art probabilistic seismic hazard models, the output of which is validated statistically using data from the Italian national accelerometric and macroseismic intensity databases.Published23-273T. Pericolosità sismica e contributo alla definizione del rischioN/A or not JCRrestricte

A multiresolution approach to automated classification of protein subcellular location images

<p>Abstract</p> <p>Background</p> <p>Fluorescence microscopy is widely used to determine the subcellular location of proteins. Efforts to determine location on a proteome-wide basis create a need for automated methods to analyze the resulting images. Over the past ten years, the feasibility of using machine learning methods to recognize all major subcellular location patterns has been convincingly demonstrated, using diverse feature sets and classifiers. On a well-studied data set of 2D HeLa single-cell images, the best performance to date, 91.5%, was obtained by including a set of multiresolution features. This demonstrates the value of multiresolution approaches to this important problem.</p> <p>Results</p> <p>We report here a novel approach for the classification of subcellular location patterns by classifying in multiresolution subspaces. Our system is able to work with any feature set and any classifier. It consists of multiresolution (MR) decomposition, followed by feature computation and classification in each MR subspace, yielding local decisions that are then combined into a global decision. With 26 texture features alone and a neural network classifier, we obtained an increase in accuracy on the 2D HeLa data set to 95.3%.</p> <p>Conclusion</p> <p>We demonstrate that the space-frequency localized information in the multiresolution subspaces adds significantly to the discriminative power of the system. Moreover, we show that a vastly reduced set of features is sufficient, consisting of our novel modified Haralick texture features. Our proposed system is general, allowing for any combinations of sets of features and any combination of classifiers.</p

The Multicultural Classroom as a Comparative Law Site: A United Kingdom Perspective

This chapter studies the impact of the recent multicultural approach to comparative legal studies on comparative law teaching, with a focus on British debates and literature. I will argue that the multicultural turn of (comparative) legal teaching, reflected for example in a greater diversity of teaching techniques, a greater emphasis on minority issues and law &… disciplines, responds to a multiplicity of motivations. Pedagogically, it is a response to the increasingly diverse backgrounds of students and their differing intellectual starting-points. Pragmatically, it is a means to boost students’ employability and intellectual versality in a job market that now values “cultural awareness skills”. Finally, conceptually, it is a tool designed to unravel the pluralistic nature of law. From these diverse drivers to the multicultural turn in (comparative) legal teaching, it is possible to identify similarities with other recent trends of globalisation and internationalisation of legal education. However, this article will submit that differences remain. Having analysed these differences, I will go on to argue and reveal that in them lie the core features of a multicultural approach to legal teaching and its intrinsic connections to comparative law, as the multicultural classroom itself becomes a comparative law site

Matrix analysis of identifiability of some finite markov models

Methods developed by Bernbach [1966] and Millward [1969] permit increased generality in analyses of identifiability. Matrix equations are presented that solve part of the identifiability problem for a class of Markov models. Results of several earlier analyses are shown to involve special cases of the equations developed here. And it is shown that a general four-state chain has the same parameter space as an all-or-none model if and only if its representation with an observable absorbing state is lumpable into a Markov chain with three states.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45730/1/11336_2005_Article_BF02291365.pd

Biomechanics and the thermotolerance of development

Successful completion of development requires coordination of patterning events with morphogenetic movements. Environmental variability challenges this coordination. For example, developing organisms encounter varying environmental temperatures that can strongly influence developmental rates. We hypothesized that the mechanics of morphogenesis would have to be finely adjusted to allow for normal morphogenesis across a wide range of developmental rates. We formulated our hypothesis as a simple model incorporating time-dependent application of force to a viscoelastic tissue. This model suggested that the capacity to maintain normal morphogenesis across a range of temperatures would depend on how both tissue viscoelasticity and the forces that drive deformation vary with temperature. To test this model we investigated how the mechanical behavior of embryonic tissue (Xenopus laevis) changed with temperature; we used a combination of micropipette aspiration to measure viscoelasticity, electrically induced contractions to measure cellular force generation, and confocal microscopy to measure endogenous contractility. Contrary to expectations, the viscoelasticity of the tissues and peak contractile tension proved invariant with temperature even as rates of force generation and gastrulation movements varied three-fold. Furthermore, the relative rates of different gastrulation movements varied with temperature: the speed of blastopore closure increased more slowly with temperature than the speed of the dorsal-to-ventral progression of involution. The changes in the relative rates of different tissue movements can be explained by the viscoelastic deformation model given observed viscoelastic properties, but only if morphogenetic forces increase slowly rather than all at once. © 2014 von Dassow et al

Bullet impacts and built heritage damage 1640–1939

© 2018, The Author(s). Conflict damage to heritage has been thrust into the global spotlight during recent conflict in the Middle East. While the use of social media has heightened and enhanced public awareness of this ‘cultural terrorism’, the occurrence of this type of vandalism is not new. In fact, as this study demonstrates, evidence of the active targeting of sites, as well as collateral damage when heritage is caught in crossfire, is widely visible around Europe and further afield. Using a variety of case studies ranging from the 1640s to the 1930s, we illustrate and quantify the changing impact of ballistics on heritage buildings as weaponry and ammunition have increased in both energy and energy density potential. In the first instance, this study highlights the increasing threats to heritage in conflict areas. Second, it argues for the pressing need to quantify and map damage to the stonework in order to respond to these challenges