25 research outputs found
Mixed-methods pilot study exploring the influence of the novel Paediatric Anaesthetic Drug Solution tool on clinician cognitive load during simulated paediatric rapid sequence intubation in the emergency department
Aim: Rapid sequence intubation (RSI) in children is a low-incidence, high-risk event associated with cognitive overload and potential errors producing unfavourable outcomes. Cognitive aids, such as charts, algorithms and flow diagrams, are prompts that externalise and structure mental processes to reduce cognitive load, thereby reducing errors. The Paediatric Anaesthetic Emergency Drug Solution (PAEDS) approach combines a colour-coded chart and medication box with a simplified mathematical system of volume-based dosing; the effect of which on cognitive load during a simulated RSI has not previously been described.Methods: A randomised, cross-over trial was conducted with 26 multi-disciplinary emergency medicine clinicians (doctors and nurses) allocated to four groups, performing four high-fidelity RSI simulations, two mandating the use of the PAEDS approach. This mixed methods study followed the pragmatic ontology using grounded theory methodology. Qualitative data were collected from nine individual interviews by a process of thematic analysis via an inductive approach, to allow for appropriate open and axial coding to occur. Quantitative data collected included cognitive loading using the raw NASA-Task Load Index as well as time to intubation and drug dosage details to assess for safety.Results: Qualitative results showed that the PAEDS approach reduced cognitive loading through the use of both the labelled medication box and colour-coded medication charts. The PAEDS approach also showed improved perceived time pressure without feeling rushed, and with no recorded drug errors. Differences in the quantitative data for total cognitive load, error and time were not statistically significant, likely due to sample size.Conclusion: The PAEDS approach is a multifaceted system which is not inferior to current practice, with some components described as an improvement. Further research on a larger sample size needs to be conducted to assess the aspects of the PAEDS approach both collectively and independently.</p
Directive 02-14: Tax Obligations of Persons Purchasing Cigarettes in Interstate Commerce for which the Massachusetts Cigarette Excise Has Not Been Paid
The development of accurate clinical biomarkers has been challenging in part due to the diversity between patients and diseases. One approach to account for the diversity is to use multiple markers to classify patients, based on the concept that each individual marker contributes information from its respective subclass of patients. Here we present a new strategy for developing biomarker panels that accounts for completely distinct patient subclasses. Marker State Space (MSS) defines "marker states" based on all possible patterns of high and low values among a panel of markers. Each marker state is defined as either a case state or a control state, and a sample is classified as case or control based on the state it occupies. MSS was used to define multi-marker panels that were robust in cross validation and training-set/test-set analyses and that yielded similar classification accuracy to several other classification algorithms. A three-marker panel for discriminating pancreatic cancer patients from control subjects revealed subclasses of patients based on distinct marker states. MSS provides a straightforward approach for modeling highly divergent subclasses of patients, which may be adaptable for diverse applications.</p
The Marker State Space (MSS) Method for Classifying Clinical Samples
The development of accurate clinical biomarkers has been challenging in part due to the diversity between patients and diseases. One approach to account for the diversity is to use multiple markers to classify patients, based on the concept that each individual marker contributes information from its respective subclass of patients. Here we present a new strategy for developing biomarker panels that accounts for completely distinct patient subclasses. Marker State Space (MSS) defines "marker states" based on all possible patterns of high and low values among a panel of markers. Each marker state is defined as either a case state or a control state, and a sample is classified as case or control based on the state it occupies. MSS was used to define multi-marker panels that were robust in cross validation and training-set/test-set analyses and that yielded similar classification accuracy to several other classification algorithms. A three-marker panel for discriminating pancreatic cancer patients from control subjects revealed subclasses of patients based on distinct marker states. MSS provides a straightforward approach for modeling highly divergent subclasses of patients, which may be adaptable for diverse applications. © 2013 Fallon et al
Standardised profiling for tinnitus research: The European School for Interdisciplinary Tinnitus Research Screening Questionnaire (ESIT-SQ)
Background: The heterogeneity of tinnitus is substantial. Its numerous pathophysiological mechanisms
and clinical manifestations have hampered fundamental and treatment research significantly. A decade
ago, the Tinnitus Research Initiative introduced the Tinnitus Sample Case History Questionnaire, a case history instrument for standardised collection of information about the characteristics of the tinnitus
patient. Since then, a number of studies have been published which characterise individuals and groups
using data collected with this questionnaire. However, its use has been restricted to a clinical setting and
to the evaluation of people with tinnitus only. In addition, it is limited in the ability to capture relevant
comorbidities and evaluate their temporal relationship with tinnitus.
Method: Here we present a new case history instrument which is comprehensive in scope and can be
answered by people with and without tinnitus alike. This ‘European School for Interdisciplinary Tinnitus
Research Screening Questionnaire’ (ESIT-SQ) was developed with specific attention to questions about
potential risk factors for tinnitus (including demographics, lifestyle, general medical and otological
histories), and tinnitus characteristics (including perceptual characteristics, modulating factors, and associations
with co-existing conditions). It was first developed in English, then translated into Dutch,
German, Italian, Polish, Spanish, and Swedish, thus having broad applicability and supporting international
collaboration.
Conclusions: With respect to better understanding tinnitus profiles, we anticipate the ESIT-SQ to be a
starting point for comprehensive multi-variate analyses of tinnitus. Data collected with the ESIT-SQ can
allow establishment of patterns that distinguish tinnitus from non-tinnitus, and definition of common
sets of tinnitus characteristics which might be indicated by the presence of otological or comorbid
systemic diseases for which tinnitus is a known symptom
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The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe
The preponderance of matter over antimatter in the early Universe, the
dynamics of the supernova bursts that produced the heavy elements necessary for
life and whether protons eventually decay --- these mysteries at the forefront
of particle physics and astrophysics are key to understanding the early
evolution of our Universe, its current state and its eventual fate. The
Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed
plan for a world-class experiment dedicated to addressing these questions. LBNE
is conceived around three central components: (1) a new, high-intensity
neutrino source generated from a megawatt-class proton accelerator at Fermi
National Accelerator Laboratory, (2) a near neutrino detector just downstream
of the source, and (3) a massive liquid argon time-projection chamber deployed
as a far detector deep underground at the Sanford Underground Research
Facility. This facility, located at the site of the former Homestake Mine in
Lead, South Dakota, is approximately 1,300 km from the neutrino source at
Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino
charge-parity symmetry violation and mass ordering effects. This ambitious yet
cost-effective design incorporates scalability and flexibility and can
accommodate a variety of upgrades and contributions. With its exceptional
combination of experimental configuration, technical capabilities, and
potential for transformative discoveries, LBNE promises to be a vital facility
for the field of particle physics worldwide, providing physicists from around
the globe with opportunities to collaborate in a twenty to thirty year program
of exciting science. In this document we provide a comprehensive overview of
LBNE's scientific objectives, its place in the landscape of neutrino physics
worldwide, the technologies it will incorporate and the capabilities it will
possess.Comment: Major update of previous version. This is the reference document for
LBNE science program and current status. Chapters 1, 3, and 9 provide a
comprehensive overview of LBNE's scientific objectives, its place in the
landscape of neutrino physics worldwide, the technologies it will incorporate
and the capabilities it will possess. 288 pages, 116 figure
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Comanaging fresh produce for nature conservation and food safety.
In 2006, a deadly Escherichia coli O157:H7 outbreak in bagged spinach was traced to California's Central Coast region, where >70% of the salad vegetables sold in the United States are produced. Although no definitive cause for the outbreak could be determined, wildlife was implicated as a disease vector. Growers were subsequently pressured to minimize the intrusion of wildlife onto their farm fields by removing surrounding noncrop vegetation. How vegetation removal actually affects foodborne pathogens remains unknown, however. We combined a fine-scale land use map with three datasets comprising ∼250,000 enterohemorrhagic E. coli (EHEC), generic E. coli, and Salmonella tests in produce, irrigation water, and rodents to quantify whether seminatural vegetation surrounding farmland is associated with foodborne pathogen prevalence in California's Central Coast region. We found that EHEC in fresh produce increased by more than an order of magnitude from 2007 to 2013, despite extensive vegetation clearing at farm field margins. Furthermore, although EHEC prevalence in produce was highest on farms near areas suitable for livestock grazing, we found no evidence of increased EHEC, generic E. coli, or Salmonella near nongrazed, seminatural areas. Rather, pathogen prevalence increased the most on farms where noncrop vegetation was removed, calling into question reforms that promote vegetation removal to improve food safety. These results suggest a path forward for comanaging fresh produce farms for food safety and environmental quality, as federal food safety reforms spread across ∼4.5 M acres of US farmland
Comanaging fresh produce for nature conservation and food safety.
In 2006, a deadly Escherichia coli O157:H7 outbreak in bagged spinach was traced to California's Central Coast region, where >70% of the salad vegetables sold in the United States are produced. Although no definitive cause for the outbreak could be determined, wildlife was implicated as a disease vector. Growers were subsequently pressured to minimize the intrusion of wildlife onto their farm fields by removing surrounding noncrop vegetation. How vegetation removal actually affects foodborne pathogens remains unknown, however. We combined a fine-scale land use map with three datasets comprising ∼250,000 enterohemorrhagic E. coli (EHEC), generic E. coli, and Salmonella tests in produce, irrigation water, and rodents to quantify whether seminatural vegetation surrounding farmland is associated with foodborne pathogen prevalence in California's Central Coast region. We found that EHEC in fresh produce increased by more than an order of magnitude from 2007 to 2013, despite extensive vegetation clearing at farm field margins. Furthermore, although EHEC prevalence in produce was highest on farms near areas suitable for livestock grazing, we found no evidence of increased EHEC, generic E. coli, or Salmonella near nongrazed, seminatural areas. Rather, pathogen prevalence increased the most on farms where noncrop vegetation was removed, calling into question reforms that promote vegetation removal to improve food safety. These results suggest a path forward for comanaging fresh produce farms for food safety and environmental quality, as federal food safety reforms spread across ∼4.5 M acres of US farmland
Data from: Comanaging fresh produce for nature conservation and food safety
Fresh produce has become the primary cause of foodborne illness in the United States. A widespread concern that wildlife vector foodborne pathogens onto fresh produce fields has led to strong pressure on farmers to clear noncrop vegetation surrounding their farm fields. We combined three large datasets to demonstrate that pathogen prevalence in fresh produce is rapidly increasing, that pathogens are more common on farms closer to land suitable for livestock grazing, and that vegetation clearing is associated with increased pathogen prevalence over time. These findings contradict widespread food safety reforms that champion vegetation clearing as a pathogen mitigation strategy. More generally, our work indicates that achieving food safety and nature conservation goals in produce-growing landscapes is possible