Triage Process in Emergency Departments: an Indonesian Study

Background: Triage process has rapidly developed in some countries in the last three decades in order to respond to the demand for emergency services by growing population and emergency health needs. However, this development does not appear to match in Indonesian hospitals. The triage process in Indonesia remains obscure.Purpose: This study aimed to describe triage process in Indonesia from a range of different perspectives.Methods: The research design of this study was descriptive qualitative using semistructured interviews of 12 policy makers or persons responsible from 5 different organizations which informed triage practice in Indonesia. The data were analyzed using a three step content analysis.Results: The result produced 3 themes. First, four steps of triage process ranging from receiving to prioritizing were reported as the triaging procedures in Indonesia which were almost similar to the International literature except for a re-triage step. Second,primary and secondary triage processes were also applied in all emergency departments in Indonesia. Last, no prolonged waiting time in Indonesia could be assumed whether the triage process was effective and efficient or it was only a quick process of sorting to rapidly increase the number of patients in the treatment rooms. Out of the themes, the result also indicated that the involvement of nurses in health policy development inIndonesia needed supportConclusion: Triage process in Indonesia still needs improvements. Patient\u27s re-triage and evaluating secondary triage should be given more frameworks in the future. An effective and efficient triage process in Indonesia will best manage the number of patients in the treatment rooms and therefore further observational researches on patterns and trends are needed. Moreover, including the role of nurses as policy makers in the curriculum of nursing undergraduate and post-graduate degrees would give nurses the evidence to seek out policy making positions in the futur

Movement in Cats

Feral cats (Felis catus) are listed as one of the \u27100 world\u27s worst invasive alien species\u27. There are as many as 70-100 million feral cats in the United States as well as an estimated 117-157 million domestic indoor and outdoor cats. Management efforts include a nonlethal feeding and sterilization program known as trap-neuter-release (TNR) where cats are surgically sterilized and returned to the environment. Population size and structure, immigration rates, spay/neuter rates, and data on spatial use all play a role in whether TNR is a viable management option. This study focuses on population structure and spatial use. To infer the population structure of a population of campus free-roaming cats at the individual level I used pairwise maximum likelihood estimates of relatedness and relationship category (unrelated, half-sib, full-sib, parent-offspring). Home range and movement patterns of domestic free-roaming indoor/outdoor cats were estimated with 100% and 50% adaptive local convex hull and 100% minimum convex polygon for comparison with previous studies. No differences in home range were found between sex, age, and season

Harnessing autophagy to overcome mitogen‐activated protein kinase kinase inhibitor‐induced resistance in metastatic melanoma

Background Patients with malignant melanoma often relapse after treatment with BRAF and/or mitogen‐activated protein kinase kinase (MEK) inhibitors (MEKi) owing to development of drug resistance. Objectives To establish the temporal pattern of CD271 regulation during development of resistance by melanoma to trametinib, and determine the association between development of resistance to trametinib and induction of prosurvival autophagy. Methods Immunohistochemistry for CD271 and p62 was performed on human naevi and primary malignant melanoma tumours. Western blotting was used to analyse expression of CD271, p62 and LC3 in melanoma subpopulations. Flow cytometry and immunofluorescence microscopy was used to evaluate trametinib‐induced cell death and CD271 expression. MTS viability assays and zebrafish xenografts were used to evaluate the effect of CD271 and autophagy modulation on trametinib‐resistant melanoma cell survival and invasion, respectively. Results CD271 and autophagic signalling are increased in stage III primary melanomas vs. benign naevi. In vitro studies demonstrate MEKi of BRAF‐mutant melanoma induced cytotoxic autophagy, followed by the emergence of CD271‐expressing subpopulations. Trametinib‐induced CD271 reduced autophagic flux, leading to activation of prosurvival autophagy and development of MEKi resistance. Treatment of CD271‐expressing melanoma subpopulations with RNA interference and small‐molecule inhibitors to CD271 reduced the development of MEKi resistance, while clinically applicable autophagy modulatory agents – including Δ9‐tetrahydrocannabinol and Vps34 – reduced survival of MEKi‐resistant melanoma cells. Combined MEK/autophagy inhibition also reduced the invasive and metastatic potential of MEKi‐resistant cells in an in vivo zebrafish xenograft. Conclusions These results highlight a novel mechanism of MEKi‐induced drug resistance and suggest that targeting autophagy may be a translatable approach to resensitize drug‐resistant melanoma cells to the cytotoxic effects of MEKi

Molecular Model for Ice Clusters in a Supersaturated Vapor

A molecular model previously applied to prenucleation water clusters is used to examine ice Ih, embryos. The canonical partition function is evaluated for clusters having from 6 to 64 water molecules. The intermolecular vibrational free energies are extrapolated to clusters containing up to 120 molecules and free energies of formation, nucleation rates, and critical supersaturation ratios are calculated and compared with experiment. For the clusters studied, the ice Ih structure appears to be much less stable at all temperatures than the more spherical clathratelike cluster

Molecular Model for Prenucleation Water Clusters

A molecular model applicable to prenucleation water clusters is described. As an illustration the model is applied to water clusters having clathrate-like structures composed of five-menibered rings. This work was motivated by the apparent inadequacies of the corrected liquid drop model which (in addition to applying bulk properties to small clusters) predicts nucleation rates which may be as much as 1017 larger than experiment. We present the energy of formation at a temperature of 277°K for our molecular model for clusters ranging in size from 5 to 57 molecules. These results agree qualitatively with experiment and, we believe, provide a motivation for further development of the molecular approach

Performance analysis of a new energy-efficient variable supply pressure electro-hydraulic motion control system

Electro-hydraulic actuation is used in many motion control applications due to its high power density, excellent dynamic response and good durability. However fluid power actuation has been shown to be very energy inefficient, with an average efficiency for fluid power systems across all industries of 22% in the USA. This is a very significant problem, given that 3% of the energy used by mankind is transmitted in this way.The key challenge for researchers is to reduce energy losses in hydraulic actuation systems without increasing weight, size, and noise, and without reducing speed of response. Conventional high performance electro-hydraulic motion control systems use a fixed supply pressure with valve-controlled actuators (FPVC). This is inherently inefficient due to the need to use a valve to throttle the flow required by each actuator in the system down to match its load pressure. In this paper, a new load-prediction based method is proposed, in which the supply pressure is varied to track the pressure required by any actuator branch. By implementing this model-based approach using a high response servomotor-driven pump, it is shown that the dynamic response remains excellent. The load model not only allows feedforward control for servomotor speed based on the motion demand, but also feedforward for the control valves to supplement conventional proportional-integral feedback control.The new variable supply pressure valve-controlled (VPVC) method is investigated in simulation and experimentally using a two-axis hydraulic robot arm supplied by an axial piston pump. The performance has been rigorously compared with the same robot arm using a fixed supply pressure and proportional-integral joint position control. Experimental results showed that up to 70% hydraulic power saving was achieved, and that the dynamic tracking errors for VPVC were about half that for FPVC as a result of using feedforward control.</p

Understanding the social in a digital age

Datafication, algorithms, social media and their various assemblages enable massive connective processes, enriching personal interaction and amplifying the scope and scale of public networks. At the same time, surveillance capitalists and the social quantification sector are committed to monetizing every aspect of human communication, all of which threaten ideal social qualities, such as togetherness and connection. This Special Issue brings together a range of voices and provocations around ‘the social’, all of which aim to critically interrogate mediated human connection and their contingent socialities. Conventional methods may no longer be adequate, and we must rethink not only the fabric of the social but the very tools we use to make sense of our changing social formations. This Special Issue raises shared concerns with what the social means today, unpicking and rethinking the seams between digitization and social life that characterize today’s digital age

Transition from film boiling to nucleate boiling in forced convection vertical flow

The mechanism of collapse of forced cnnvection annular vertical flow film boiling, with liquid core, is investigated using liquid nitrogen at low pressures. The report includes the effect of heat flux from the buss bar. Tests include runs with mass fluxes varying from 44,000 lbm/hr-ft2 2 2 to 186,000 lbm/hr-ft , and buss bar heat fluxes from 0 to 107,000 BTU/hr-ft The channel was a 0.4 inch I. D. by 0.5 inch O.D. by 8 feet long Inconel 600 tube. Two modes of collapse were isolated, in the absence of rewet by dispersed cooling within the mist flow region. These were axial conduction controlled collapse originating at the entrance to the test section for zero or negative buss bar heat flux; and impulse cooling collapse originating downstream of the entrance for heat into the test section from the buss bar. Collapse heat flux was found to be a function of mass flux, but the collapse wall temperature difference (T - T ) was independent w S of mass flux and could be successfully predicted within 6% by pool boiling minimum transition correlation (e.g. Berenson [5]).Sponsored by the National Science Foundation DSR Projec

Occupational Therapists’ Perspectives During the COVID-19 Pandemic

On March 11, 2020, the World Health Organization declared the outbreak of the coronavirus disease 2019 (COVID-19) as a global pandemic. Hospitals, nursing homes, and communities worldwide were flooded with patients diagnosed with COVID-19, resulting in the increased need for medical care and treatment by health care professionals, such as occupational therapists. This study analyzes output from a quantitative online survey design, which was created on SurveyMonkey and included 43 questions. Data from the survey were collected, categorized, and measured through the SurveyMonkey computer system and included information gathered from 204 occupational therapists from October 2020 to February 2020. Based on the survey results, occupational therapists believe that their profession has an ethical duty to provide skilled interventions to patients diagnosed with COVID-19. The majority of the occupational therapists were worried about their health and their family’s health as a result of COVID-19. In addition, many of the. therapists reported a close contact and subsequent positive test for COVID-19. Health care administrators and leaders should use the common perspectives among health care workers to guide them as they provide additional support and implement changes during the COVID-19 pandemic. Interventions that could be implemented by health care administrators include self-care training, psychological support, and safe opportunities to engage in meaningful activities