Pathophysiology of Sepsis

Sepsis is a life-threatening medical emergency. In the United States, over 1.6 million hospitalizations and 250,000 deaths are attributed to sepsis each year. It is important that healthcare providers are aware of the signs/symptoms of sepsis because effective treatment depends on rapid recognition and treatment. Current quality improvement measures were used to investigate sepsis treatment recommendations. The Centers for Medicare & Medicaid Services (CMS) and Joint Commision (JC) recommend the use of Severe Sepsis/Septic Shock Early Management Bundle (SEP-1). The American College of Emergency Physicians (ACEP) launched the Emergency Quality Network (E-QUAL) Sepsis Initiative as an addition to the SEP1 to address patient outcomes specific to the emergency room. Finally, the Centers for Disease Control and Prevention (CDC) launched the Surviving Sepsis campaign. This campaign uses the same treatments introduced by the SEP-1 Bundle but emphasizes the importance of rapid treatment. Decreasing initial treatment timeframe from 3 hours to 1 hour. In addition to improving sepsis treatment, quality initiatives are used to improve “door to treatment” times. EQUAL initiatives recommend the use of a nursing sepsis screening, the use of a sepsis alert team, and rapid initiation of a sepsis protocol. Early recognition and treatment are the key to improving patient outcomes. Adherence to quality initiatives and sepsis interventions is the best way to improve morbidity and mortality rates related to sepsis

Gates to Gregg High Voltage Transmission Line Study

The usefulness of LANDSAT data in the planning of transmission line routes was assessed. LANDSAT digital data and image processing techniques, specifically a multi-date supervised classification aproach, were used to develop a land cover map for an agricultural area near Fresno, California. Twenty-six land cover classes were identified, of which twenty classes were agricultural crops. High classification accuracies (greater than 80%) were attained for several classes, including cotton, grain, and vineyards. The primary products generated were 1:24,000, 1:100,000 and 1:250,000 scale maps of the classification and acreage summaries for all land cover classes within four alternate transmission line routes

Development and application of an antibiotic spectrum index for benchmarking antibiotic selection patterns across hospitals

Standard metrics for antimicrobial use consider volume but not spectrum of antimicrobial prescribing. We developed an antibiotic spectrum index (ASI) to classify commonly used antibiotics based on activity against important pathogens. The application of this index to hospital antibiotic use reveals how this tool enhances current antimicrobial stewardship metrics.Infect Control Hosp Epidemiol 2017;38:993–997</jats:p

Variability in antifungal and antiviral use in hospitalized children

We analyzed antifungal and antiviral prescribing among high-risk children across freestanding children’s hospitals. Antifungal and antiviral days of therapy varied across hospitals. Benchmarking antifungal and antiviral use and developing antimicrobial stewardship strategies to optimize use of these high cost agents is needed.Infect Control Hosp Epidemiol2017;38:743–746</jats:p

A mobile phone text messaging intervention to manage fatigue for people with multiple sclerosis, spinal cord injury, and stroke: Development and usability testing

BACKGROUND: Fatigue significantly affects daily functioning in persons with disabilities. Fatigue management can be challenging, and the information provided during routine physician visits to manage fatigue can be overwhelming. One way to address fatigue is to increase knowledge, skills, and confidence for self-management (ie, patient activation). Self-management programs have shown promising effects in targeting fatigue in persons with disabilities. However, satisfaction with self-management programs is low for persons with disabilities, and tailoring interventions to personalized needs has been recommended. SMS text messaging is increasingly being used to implement health behavior change interventions in a person\u27s natural environment. Little has been done to link mobile health approaches with patient activation and self-management to address fatigue in persons with disabilities. OBJECTIVE: This study aimed to develop and test a mobile phone-based fatigue self-management SMS text messaging intervention targeting patient activation in 3 groups of persons with disabilities: persons with multiple sclerosis, persons who had a stroke, and persons with a spinal cord injury. METHODS: We used evidence-based resources and input from a consumer advisory board (CAB; composed of 2 participants from each of the 3 disability groups) and a neurologist to develop the intervention. The study was conducted using a 4-step process: development of the initial SMS text messaging library and categorization of the content into 9 content areas, review and modification of the SMS text messages by the neurologist and CAB, integration of the content library into a digital platform, and utility testing by CAB members. RESULTS: A total of 6 CAB participants rated SMS text messages covering 9 domain areas of fatigue self-management with good clarity (mean ratings=3.5-5.0 out of 5) and relevance (mean ratings=3.2-5.0 out of 5). Overall, SMS text messaging content was reported by CAB participants as helpful, clear, and well suited for a mobile health intervention. The CAB reached consensus on the time of day that SMS text messages should be sent (morning) and their frequency (once per day). This feedback led the research team to narrow down the program to deliver 48 SMS text messages, 1 per day, Monday through Thursday only, a total of 4 SMS text messages per week, over a 12-week period. The final set of SMS text messages was programmed into a digital platform with a predefined delivery schedule. The usability of the intervention was high, with 55 (83%) out of 66 responses endorsing the highest rating. CONCLUSIONS: This study demonstrates a step-by-step process for developing a fatigue self-management SMS text messaging intervention for persons with disabilities. For this population, whose access to health services is often limited, this intervention provides an alternative delivery model to increase access to fatigue information and deliver content that aligns with the person\u27s needs

Level Crossing Analysis of Burgers Equation in 1+1 Dimensions

We investigate the average frequency of positive slope $\nu_{\alpha}^{+}$, crossing the velocity field $u(x)- \bar u = \alpha$ in the Burgers equation. The level crossing analysis in the inviscid limit and total number of positive crossing of velocity field before creation of singularities are given. The main goal of this paper is to show that this quantity, $\nu_{\alpha}^{+}$, is a good measure for the fluctuations of velocity fields in the Burgers turbulence.Comment: 5 pages, 3 figure

Synthesis of accelerograms compatible with the Chinese GB 50011-2001 design spectrum via harmonic wavelets: artificial and historic records

A versatile approach is employed to generate artificial accelerograms which satisfy the compatibility criteria prescribed by the Chinese aseismic code provisions GB 50011-2001. In particular, a frequency dependent peak factor derived by means of appropriate Monte Carlo analyses is introduced to relate the GB 50011-2001 design spectrum to a parametrically defined evolutionary power spectrum (EPS). Special attention is given to the definition of the frequency content of the EPS in order to accommodate the mathematical form of the aforementioned design spectrum. Further, a one-to-one relationship is established between the parameter controlling the time-varying intensity of the EPS and the effective strong ground motion duration. Subsequently, an efficient auto-regressive moving-average (ARMA) filtering technique is utilized to generate ensembles of non-stationary artificial accelerograms whose average response spectrum is in a close agreement with the considered design spectrum. Furthermore, a harmonic wavelet based iterative scheme is adopted to modify these artificial signals so that a close matching of the signals’ response spectra with the GB 50011-2001 design spectrum is achieved on an individual basis. This is also done for field recorded accelerograms pertaining to the May, 2008 Wenchuan seismic event. In the process, zero-phase high-pass filtering is performed to accomplish proper baseline correction of the acquired spectrum compatible artificial and field accelerograms. Numerical results are given in a tabulated format to expedite their use in practice

Advanced Fourier-based Model of Bouncing Loads

This is the author accepted manuscript. The final version is available from Springer via the DOI in this record36th IMAC, A Conference and Exposition on Structural Dynamics 2018Contemporary design guideline pertinent to vibration serviceability of entertaining venues describes bouncing forces as a deterministic and periodic process presentable via Fourier series. However, fitting the Fourier harmonics to a comprehensive database of individual bouncing force records established in this study showed that such a simplification is far too radical, thus leading to a significant loss of information. Building on the conventional Fourier force model, this study makes the harmonics specific to each individual and takes into account imperfections in the bouncing process. The result is a numerical generator of stochastic bouncing force time histories which represent reliably the experimentally recorded bouncing force signals.The authors would like to acknowledge the financial support provided by PRIN 2015-2018 “Identification and monitoring of complex structural systems” and National Natural Science Foundation of China 347 (51478346) and State Key Laboratory for Disaster Reduction of Civil Engineering (SLDRCE14-B-16)