A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety

Patients in intensive care units (ICUs) often receive sedation for prolonged periods. In order to better understand the impact of sub-optimal sedation practice on outcomes, we performed a systematic review, including observational studies and controlled trials which were conducted in sedated patients in the ICU and which compared the impact of changes in or different protocols for sedation management on economic and patient safety outcomes

The incidence of sub-optimal sedation in the ICU: a systematic review

Patients in intensive care units (ICUs) are generally sedated for prolonged periods. Over-sedation and under-sedation both have negative effects on patient safety and resource use. We conducted a systematic review of the literature in order to establish the incidence of sub-optimal sedation (both over- and under-sedation) in ICUs

Providing healthcare for people with chronic illness: the views of Australian GPs

The document attached has been archived with permission from the editor of the Medical Journal of Australia (26 April 2007). An external link to the publisher’s copy is included.OBJECTIVES: To explore general practitioners' views on chronic-disease care: the difficulties and rewards, the needs of patients, the impact of government incentive payments, and the changes needed to improve chronic-disease management. DESIGN: Qualitative study, involving semi-structured questions administered to 10 focus groups of GPs, conducted from April to October 2002. PARTICIPANTS AND SETTING: 54 GPs from both urban and rural practices in New South Wales and South Australia. RESULTS: Consistent themes emerged about the complex nature of chronic-disease management, the tension between patients' and GPs' goals for care, the time-consuming aspects of care (exacerbated by federal government requirements), and the conflicting pressures that prevent GPs engaging in structured multidisciplinary care (ie, team-based care involving systems for patient monitoring, recall, and care planning). CONCLUSIONS: Structured multidisciplinary care for people with chronic conditions can be difficult to provide. Barriers include the lack of fit between systems oriented towards acute care and the requirements of chronic-disease care, and between bureaucratic, inflexible structures and the complex, dynamic nature of GP–patient relationships. These problems are exacerbated by administrative pressures associated with federal government initiatives to improve chronic-illness management. Changes are needed in both policies and attitudes to enable GPs to move from episodic care to providing structured long-term care as part of a multidisciplinary team.John Oldroyd, Judith Proudfoot, Fernando A Infante, Gawaine Powell Davies, Tanya Bubner, Chris Holton, Justin J Beilby and Mark F Harri

Sleight of Hand: Identifying Concealed Information by Monitoring Mouse-Cursor Movements

Organizational members who conceal information about adverse behaviors present a substantial risk to that organization. Yet the task of identifying who is concealing information is extremely difficult, expensive, error-prone, and time-consuming. We propose a unique methodology for identifying concealed information: measuring people’s mouse-cursor movements in online screening questionnaires. We theoretically explain how mouse-cursor movements captured during a screening questionnaire differ between people concealing information and truth tellers. We empirically evaluate our hypotheses using an experiment during which people conceal information about a questionable act. While people completed the screening questionnaire, we simultaneously collected mouse-cursor movements and electrodermal activity—the primary sensor used for polygraph examinations—as an additional validation of our methodology. We found that mouse-cursor movements can significantly differentiate between people concealing information and people telling the truth. Mouse-cursor movements can also differentiate between people concealing information and truth tellers on a broader set of comparisons relative to electrodermal activity. Both mouse-cursor movements and electrodermal activity have the potential to identify concealed information, yet mouse-cursor movements yielded significantly fewer false positives. Our results demonstrate that analyzing mouse-cursor movements has promise for identifying concealed information. This methodology can be automated and deployed online for mass screening of individuals in a natural setting without the need for human facilitators. Our approach further demonstrates that mouse-cursor movements can provide insight into the cognitive state of computer users

Engaging participants in a complex intervention trial in Australian General Practice

© 2008 Perkins et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Development of FTK architecture: a fast hardware track trigger for the ATLAS detector

The Fast Tracker (FTK) is a proposed upgrade to the ATLAS trigger system that will operate at full Level-1 output rates and provide high quality tracks reconstructed over the entire detector by the start of processing in Level-2. FTK solves the combinatorial challenge inherent to tracking by exploiting the massive parallelism of Associative Memories (AM) that can compare inner detector hits to millions of pre-calculated patterns simultaneously. The tracking problem within matched patterns is further simplified by using pre-computed linearized fitting constants and leveraging fast DSP's in modern commercial FPGA's. Overall, FTK is able to compute the helix parameters for all tracks in an event and apply quality cuts in approximately one millisecond. By employing a pipelined architecture, FTK is able to continuously operate at Level-1 rates without deadtime. The system design is defined and studied using ATLAS full simulation. Reconstruction quality is evaluated for single muon events with zero pileup, as well as WH events at the LHC design luminosity. FTK results are compared with the tracking capability of an offline algorithm.Comment: To be published in the proceedings of DPF-2009, Detroit, MI, July 2009, eConf C09072

The Evolution of FTK, a Real-Time Tracker for Hadron Collider Experiments

We describe the architecture evolution of the highly-parallel dedicated processor FTK, which is driven by the simulation of LHC events at high luminosity (1034 cm-2 s-1). FTK is able to provide precise on-line track reconstruction for future hadronic collider experiments. The processor, organized in a two-tiered pipelined architecture, execute very fast algorithms based on the use of a large bank of pre-stored patterns of trajectory points (first tier) in combination with full resolution track fitting to refine pattern recognition and to determine off-line quality track parameters. We describe here how the high luminosity simulation results have produced a new organization of the hardware inside the FTK processor core.Comment: 11th ICATPP conferenc

Establishing a Foundation for Automated Human Credibility Screening

Automated human credibility screening is an emerging research area that has potential for high impact in fields as diverse as homeland security and accounting fraud detection. Systems that conduct interviews and make credibility judgments can provide objectivity, improved accuracy, and greater reliability to credibility assessment practices, need to be built. This study establishes a foundation for developing automated systems for human credibility screening

CXCR2 deficient mice display macrophage-dependent exaggerated acute inflammatory responses

CXCR2 is an essential regulator of neutrophil recruitment to inflamed and damaged sites and plays prominent roles in inflammatory pathologies and cancer. It has therefore been highlighted as an important therapeutic target. However the success of the therapeutic targeting of CXCR2 is threatened by our relative lack of knowledge of its precise in vivo mode of action. Here we demonstrate that CXCR2-deficient mice display a counterintuitive transient exaggerated inflammatory response to cutaneous and peritoneal inflammatory stimuli. In both situations, this is associated with reduced expression of cytokines associated with the resolution of the inflammatory response and an increase in macrophage accumulation at inflamed sites. Analysis using neutrophil depletion strategies indicates that this is a consequence of impaired recruitment of a non-neutrophilic CXCR2 positive leukocyte population. We suggest that these cells may be myeloid derived suppressor cells. Our data therefore reveal novel and previously unanticipated roles for CXCR2 in the orchestration of the inflammatory response

A New Scintillator Tile/Fiber Preshower Detector for the CDF Central Calorimeter

A detector designed to measure early particle showers has been installed in front of the central CDF calorimeter at the Tevatron. This new preshower detector is based on scintillator tiles coupled to wavelength-shifting fibers read out by multi-anode photomultipliers and has a total of 3,072 readout channels. The replacement of the old gas detector was required due to an expected increase in instantaneous luminosity of the Tevatron collider in the next few years. Calorimeter coverage, jet energy resolution, and electron and photon identification are among the expected improvements. The final detector design, together with the R&D studies that led to the choice of scintillator and fiber, mechanical assembly, and quality control are presented. The detector was installed in the fall 2004 Tevatron shutdown and started collecting colliding beam data by the end of the same year. First measurements indicate a light yield of 12 photoelectrons/MIP, a more than two-fold increase over the design goals.Comment: 5 pages, 10 figures (changes are minor; this is the final version published in IEEE-Trans.Nucl.Sci.