The Distance Between Us

Chapbook published be D Presshttps://digitalcommons.cwu.edu/hmvla_jampa/1022/thumbnail.jp

A Ring in the Air

Chapbook published by D Presshttps://digitalcommons.cwu.edu/hmvla_jampa/1023/thumbnail.jp

Levels of Arousal: A Comparison of Conditions of Interest and Boredom

The principal concern of this thesis was an attempt to investigate the physiological and psychological correlates of the related constructs of monotony arid boredom and to define them in terms of levels of arousal. While quite a bit of performance data was available from vigilance studies, there was a definite lack of psychophysiological information regarding boredom which often accompanies monotonous vigilance-type tasks. Since boredom is an unpleasant state produced by monotony, which is insufficient stimulation, a condition expected to produce interest was devised against which to test both constructs. The problem of devising a task which would prove to be interesting for two hours was probably the most difficult chore that I encountered in designing the experiment and success in that endeavor was limited. A rapidly expanding technology is reducing many previously active tasks into passive vigilance-type tasks. In industry, machine operators have become machine monitors; in business, highly skilled clerical work is done automatically and requires minimal but necessary attention; and the field of education is rapidly being invaded by all manner of machinery. Such then is the present and future and here we are with just a smattering of the knowledge we need to cope with the problem. I hope that the information presented herein is an appropriate step in the right direction.Educational Psycholog

The Impact of a Material’s Inherent and Process Stress on Meeting Specification and Tolerances: A Six Sigma Case Study

This Six-Sigma Case Study was conducted in a local aerospace company that produces high quality precision-machined jet engine components.  These complex turbine components have thin walls that must meet tight tolerances. Disks, shafts, rotating seals, plates, and cases range in size from 3" to 80" in diameter.  This case focused on a 16” (diameter) rear cooling plate whose production required 18 machining processes.  The objective was to determine if it was possible to eliminate the final manual lathing process. Manual lathing was used as the last step because the material characteristics of the plate and the stress induced by the previous processes caused the final product to expand. Stress can cause unsatisfactory changes in the plate’s dimensions. Stress is not only inherent in the material’s internal properties but is also induced during machining.    It is critical that the operator’s cut is precise and does not remove too much material.  During the two most critical steps of 18, measurements were taken.  It was theorized that relaxing the first process tolerances could allow later processes to be numerically machine controlled to conform closer to the prescribed tolerance of the final product.  Plates were tested using these revised tolerances.  After the plate was shot peened (a stress redistribution process) measurements confirmed that non-conformance had been eliminated and the final machining process could be discontinued.  Cost savings for eliminating the last machining and inspection process was $268 per plate or an annual saving of approximately 11% of total cost for the item studied

Safety and Efficacy of Hospital Utilization of Tranexamic Acid in Civilian Adult Trauma Resuscitation

Introduction: Patients with trauma-induced coagulopathies may benefit from the use of antifibrinolytic agents, such as tranexamic acid (TXA). This study evaluated the safety and efficacy of TXA in civilian adults hospitalized with traumatic hemorrhagic shock.Methods: Patients who sustained blunt or penetrating trauma with signs of hemorrhagic shock from June 2014 through July 2018 were considered for TXA treatment. A retrospective control group was formed from patients seen in the same past five years who were not administered TXA and matched based on age, gender, Injury Severity Score (ISS), and mechanism of injury (blunt vs penetrating trauma). The primary outcome of this study was mortality measured at 24 hours, 48 hours, and 28 days. Secondary outcomes included total blood products transfused, hospital length of stay (LOS), intensive care unit LOS, and adverse events. We conducted three pre-specified subgroup analyses to assess outcomes of patients, including (1) those who were severely injured (ISS >15), (2) those who sustained significant blood loss (≥10 units of total blood products transfused), and (3) those who sustained blunt vs penetrating trauma.Results: Propensity matching yielded two cohorts: the hospital TXA group (n = 280) and a control group (n = 280). The hospital TXA group had statistically lower mortality at 28 days (1.1% vs 5%, odds ratio [OR] [0.21], (95% confidence interval [CI], 0.06, 0.72)) and used fewer units of blood products (median = 4 units, interquartile range (IQR) = [1, 10] vs median=7 units, IQR = [2, 12.5] for the hospital TXA and control groups, respectively, (95% CI for the difference in median, -3 to -1). There were no statistically significant differences between groups with regard to 24-hour mortality (1.1% vs 1.1%, OR = 1, 95% CI, 0.20, 5.00), 48-hour mortality (1.1% vs 1.4%, OR [0.74], 95% CI, 0.17, 3.37), hospital LOS (median= 9 days, IQR = (5, 16) vs median =12 days IQR = (6, 22.5) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-5 to 0)), and incidence of thromboembolic events (eg, deep vein thrombosis, pulmonary embolism) during hospital stay (0.7% vs 0.7% for the hospital TXA and control group, respectively, OR [1], 95% CI, 0.14 to 7.15). We conducted subgroup analyses on patients with ISS>15, patients transfused with ≥10 units of blood products, and blunt vs penetrating trauma. The results indicated lower 28-day mortality for ISS>15 (1.8% vs 7.1%, OR [0.23], 95% CI, 0.06 to 0.81) and blunt trauma  (0.6% vs 6.3%, OR [0.09], 95% CI, 0.01 to 0.75); fewer units of blood products for penetrating trauma (median = 2 units, IQR = (1, 8) vs median = 8 units, IQR = (5, 15) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-6 to -3)), and ISS>15 (median = 7 units, IQR = (2, 14) vs median = 8.5 units, IQR = (4, 16) for the hospital TXA and control groups, respectively, 95% CI for the difference in median, -3 to 0).Conclusion: The current study demonstrates a statistically significant reduction in mortality after TXA administration at 28 days, but not at 24 and 48 hours, in patients with traumatic hemorrhagic shock

Epilepsy and the risk of COVID-19-related hospitalization and death: A population study

ObjectivePeople with epilepsy (PWE) may be at an increased risk of severe COVID-19. It is important to characterize this risk to inform PWE and for future health and care planning. We assessed whether PWE were at higher risk of being hospitalized with, or dying from, COVID-19.MethodsWe performed a retrospective cohort study using linked, population-scale, anonymized electronic health records from the SAIL (Secure Anonymised Information Linkage) databank. This includes hospital admission and demographic data for the complete Welsh population (3.1 million) and primary care records for 86% of the population. We identified 27 279 PWE living in Wales during the study period (March 1, 2020 to June 30, 2021). Controls were identified using exact 5:1 matching (sex, age, and socioeconomic status). We defined COVID-19 deaths as having International Classification of Diseases, 10th Revision (ICD-10) codes for COVID-19 on death certificates or occurring within 28 days of a positive SARS-CoV-2 polymerase chain reaction (PCR) test. COVID-19 hospitalizations were defined as having a COVID-19 ICD-10 code for the reason for admission or occurring within 28 days of a positive SARS-CoV-2 PCR test. We recorded COVID-19 vaccinations and comorbidities known to increase the risk of COVID-19 hospitalization and death. We used Cox proportional hazard models to calculate hazard ratios.ResultsThere were 158 (.58%) COVID-19 deaths and 933 (3.4%) COVID-19 hospitalizations in PWE, and 370 (.27%) deaths and 1871 (1.4%) hospitalizations in controls. Hazard ratios for COVID-19 death and hospitalization in PWE compared to controls were 2.15 (95% confidence interval [CI] = 1.78–2.59) and 2.15 (95% CI = 1.94–2.37), respectively. Adjusted hazard ratios (adjusted for comorbidities) for death and hospitalization were 1.32 (95% CI = 1.08–1.62) and 1.60 (95% CI = 1.44–1.78).SignificancePWE are at increased risk of being hospitalized with, and dying from, COVID-19 when compared to age-, sex-, and deprivation-matched controls, even when adjusting for comorbidities. This may have implications for prioritizing future COVID-19 treatments and vaccinations for PWE

Incidence, Prevalence, and Health Care Outcomes in Idiopathic Intracranial Hypertension

Objective: To characterise trends in incidence, prevalence, and healthcare outcomes in the idiopathic intracranial hypertension (IIH) population in Wales using routinely collected healthcare data.Methods: We used and validated primary and secondary care IIH diagnosis codes within the Secure Anonymised Information Linkage databank, to ascertain IIH cases and controls, in a retrospective cohort study between 2003 and 2017. We recorded body mass index (BMI), deprivation quintile, CSF diversion surgery and unscheduled hospital admissions in case and control cohorts.Results: We analysed 35 million patient years of data. There were 1765 cases of IIH in 2017 (85% female). The prevalence and incidence of IIH in 2017 was 76/100,000 and 7.8/100,000/year, a significant increase from 2003 (corresponding figures=12/100,000 and 2.3/100,000/year) (p<0.001). IIH prevalence is associated with increasing BMI and increasing deprivation. The odds ratio for developing IIH in the least deprived quintile compared to the most deprived quintile, adjusted for gender and BMI, was 0.65 (95% CI 0.55 to 0.76). 9% of IIH cases had CSF shunts with less than 0.2% having bariatric surgery. Unscheduled hospital admissions were higher in the IIH cohort compared to controls (rate ratio=5.28, p<0.001) and in individuals with IIH and CSF shunts compared to those without shunts (rate ratio=2.02, p<0.01).Conclusions: IIH incidence and prevalence is increasing considerably, corresponding to population increases in BMI, and is associated with increased deprivation. This has important implications for healthcare professionals and policy makers given the comorbidities, complications and increased healthcare utilization associated with II

Health care utilization and mortality for people with epilepsy during <scp>COVID</scp>‐19: A population study

ObjectiveThis study was undertaken to characterize changes in health care utilization and mortality for people with epilepsy (PWE) during the COVID-19 pandemic.MethodsWe performed a retrospective study using linked, individual-level, population-scale anonymized health data from the Secure Anonymised Information Linkage databank. We identified PWE living in Wales during the study “pandemic period” (January 1, 2020–June 30, 2021) and during a “prepandemic” period (January 1, 2016–December 31, 2019). We compared prepandemic health care utilization, status epilepticus, and mortality rates with corresponding pandemic rates for PWE and people without epilepsy (PWOE). We performed subgroup analyses on children (65 years old), those with intellectual disability, and those living in the most deprived areas. We used Poisson models to calculate adjusted rate ratios (RRs).ResultsWe identified 27 279 PWE who had significantly higher rates of hospital (50.3 visits/1000 patient months), emergency department (55.7), and outpatient attendance (172.4) when compared to PWOE (corresponding figures: 25.7, 25.2, and 87.0) in the prepandemic period. Hospital and epilepsy-related hospital admissions, and emergency department and outpatient attendances all reduced significantly for PWE (and all subgroups) during the pandemic period. RRs [95% confidence intervals (CIs)] for pandemic versus prepandemic periods were .70 [.69–.72], .77 [.73–.81], .78 [.77–.79], and .80 [.79–.81]. The corresponding rates also reduced for PWOE. New epilepsy diagnosis rates decreased during the pandemic compared with the prepandemic period (2.3/100 000/month cf. 3.1/100 000/month, RR = .73, 95% CI = .68–.78). Both all-cause deaths and deaths with epilepsy recorded on the death certificate increased for PWE during the pandemic (RR = 1.07, 95% CI = .997–1.145 and RR = 2.44, 95% CI = 2.12–2.81). When removing COVID deaths, RRs were .88 (95% CI = .81–.95) and 1.29 (95% CI = 1.08–1.53). Status epilepticus rates did not change significantly during the pandemic (RR = .95, 95% CI = .78–1.15).SignificanceAll-cause non-COVID deaths did not increase but non-COVID deaths associated with epilepsy did increase for PWE during the COVID-19 pandemic. The longer term effects of the decrease in new epilepsy diagnoses and health care utilization and increase in deaths associated with epilepsy need further research.Key PointsPeople with epilepsy have increased rates of hospital, emergency department, and outpatient attendance when compared to people without epilepsy.These rates (and rates of new epilepsy diagnoses) reduced significantly during our pandemic study period (January 1, 2020–June 30, 2021).Rates of status epilepticus did not change during the pandemic period.All-cause non-COVID deaths did not increase for people with epilepsy.There was a small increase in non-COVID deaths with epilepsy listed as a cause for people with epilepsy