1,693 research outputs found

    Priority 1

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    The CNL theme I have targeted is the development and use of Informatics and Healthcare Technologies. My project developed a method of measuring KPIs within a new EHR specifically tailored for jail health populations. The development of a Jail Health Services dashboard is modeled after the dashboard developed by California Correctional Health Care Services for the California prison population. The clinicians requested the ability to measure how many Priority 1 visits were seen within 24 hours so it could be determined whether the jail was meeting the NCCHC benchmark of 85%. Previously, Jail Health Services had no way to measure this indicator for access to care. The baseline measurement turned out to be 84.55% with an average of 87.5% over the next five months. We then wished to see if our increase in Priority 1 percentages correlated with a decrease in unscheduled ED visits. The January to June ED visits in 2015 showed a significant decline when compared to the January to June ED visits in 2014. However, a direct correlation was unable to be established because we did not have KPI measurements in 2014 as the EHR was not implemented until late November, 2014. The Triage and Intake training nurses also received extensive training and education regarding the assessment and rejection of prisoner-patients at Triage until evaluated further and receiving clearance from SFGH. The increased rejection of acutely ill patients may have had a much greater impact on the subsequent decrease in unscheduled ED visits in 2015. The establishment of a quantitative method of inquiry into KPI measures created a significant positive impact on the clinicians and nurses with greatly enhanced motivation for further study of care provision aided by the use of our new EHR

    A new design method for industrial portal frames in fire

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    For single-storey steel portal frames in fire, especially when they are situated close to a site perimeter, it is imperative that the boundary walls stay close to vertical, so that fires which occur are not allowed to spread to adjacent properties. A current UK fire design guide requires either that the whole frame be protected as a single element, or that the rafter may be left unprotected if column bases and foundations are designed to resist the forces and moments generated by rafter collapse, in order to ensure the lateral stability of the boundary walls. This can lead to very uneconomical foundation design and base-plate detailing. In previous studies carried out at the University of Sheffield it was found that a fundamental aspect of the collapse of a portal frame rafter is that it usually loses stability in a “snap-through” mechanism, but is capable of re-stabilising at high deflections, when the roof has inverted but the columns remain close to vertical. Numerical tests performed using the new model show that the strong base connections recommended by the current design method do not always lead to a conservative design. It is also found that initial collapse of the rafter is always caused by a plastic hinge mechanism based on the frame’s initial configuration. If the frame can then re-stabilize when the roof is substantially inverted, a second mechanism relying on the re-stabilized configuration can lead to failure of the whole frame. In this paper, a portal frame with different bases is simulated numerically using Vulcan, investigating the effect of different base strength on the collapse behaviour. The test results are compared with the failure mode assumed by the current design method. A new method for the estimation of re-stabilized positions of single-span frames in fire, using the second failure mechanism, is discussed and calibrated against the numerical test results

    How To Interpret, Understand, and Predict Stratal Geometries Using Stratal-Control Spaces and Stratal-Control-Space Trajectories

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    Interpreting and predicting basin-margin stratal geometries requires understanding of controls such as variations in supply and accommodation, ideally based on independent quantitative evidence. Stratal-control spaces are a new tool to analyze controls on strata. A stratal-control space is an area, volume, or perhaps a higher-dimensional space, defined by a range of values of the controlling processes subsidence, sediment supply, and eustasy. A three-dimensional stratal-control volume with axes of subsidence, sediment supply, and eustatic rates of change can be populated with probabilities derived from analysis of time series of subsidence, supply, and eustasy. These empirical or theoretical probabilities indicate the likelihood of occurrence of any particular combination of control rates defined by any point in the volume. The stratal-control volume can then be analyzed to determine which parts of the volume represent relative sea-level fall and rise, where in the volume particular stacking patterns will occur, and how probable those stacking patterns are. For outcrop and subsurface analysis, using a stratal-control area with eustasy and subsidence combined on a relative sea-level axis allows similar analysis, and may be preferable. A stratal-control trajectory is a history of supply and accommodation rates, interpreted from outcrop or subsurface data, or observed in analogue and numerical experiments, and plotted as a series of linked points forming a trajectory through a stratal-control space. Two theoretical and one actual outcrop example are presented to demonstrate how stratal-control trajectories can be analyzed to determine which controls are dominant. The accommodation supply trajectory range ratio (ASTRR) is a useful metric to characterize trajectory geometry. Trajectories with ASTRR > 1 can be considered accommodation-dominated, and ASTRR < 1 indicates a supply-dominated trajectory. Calculating the range of stratal-control probabilities along the trajectory indicates the probability of the rates of change of subsidence, supply, and eustasy required to form the interpreted stratal geometry. Both types of stratal-control-trajectory analyses can provide important additional understanding and prediction of how, why, and where stratal geometries form

    Randomised, Controlled, Assessor Blind Trial Comparing 4% Dimeticone Lotion with 0.5% Malathion Liquid for Head Louse Infestation

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    BACKGROUND:Malathion 0.5% has been the most prescribed pediculicide in the United Kingdom for around 10 years, and is widely used in Europe and North America. Anecdotal reports suggest malathion treatments are less effective than formerly, but this has not been confirmed clinically. This study was designed to determine whether malathion is still effective and if 4% dimeticone lotion is a more effective treatment for head louse infestation. METHODOLOGY/PRINCIPAL FINDINGS:We designed this study as an assessor blinded, randomised, controlled, parallel group trial involving 58 children and 15 adults with active head louse infestation. Each participant received two applications 7 days apart of either 4% dimeticone lotion, applied for 8 hours or overnight, or 0.5% malathion liquid applied for 12 hours or overnight. All treatment and check-up visits were conducted in participants' homes. Cure of infestation was defined as no evidence of head lice after the second treatment. Some people were found free from lice but later reinfested. Worst case, intention to treat, analysis found dimeticone was significantly more effective than malathion, with 30/43 (69.8%) participants cured using dimeticone compared with 10/30 (33.3%) using malathion (p<0.01, difference 36.4%, 95% confidence interval 14.7% to 58.2%). Per protocol analysis showed cure rates of 30/39 (76.9%) and 10/29 (34.5%) respectively. Irritant reactions were observed in only two participants, both treated with malathion. CONCLUSIONS/SIGNIFICANCE:We concluded that, although malathion liquid is still effective for some people, dimeticone lotion offers a significantly more effective alternative treatment for most people. TRIAL REGISTRATION:Controlled-Trials.com ISRCTN47755726

    Novelty and anxiolytic drugs dissociate two components of hippocampal theta in behaving rats

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    Hippocampal processing is strongly implicated in both spatial cognition and anxiety and is temporally organized by the theta rhythm. However, there has been little attempt to understand how each type of processing relates to the other in behaving animals, despite their common substrate. In freely moving rats, there is a broadly linear relationship between hippocampal theta frequency and running speed over the normal range of speeds used during foraging. A recent model predicts that spatial-translation-related and arousal/anxiety-related mechanisms of hippocampal theta generation underlie dissociable aspects of the theta frequency–running speed relationship (the slope and intercept, respectively). Here we provide the first confirmatory evidence: environmental novelty decreases slope, whereas anxiolytic drugs reduce intercept. Variation in slope predicted changes in spatial representation by CA1 place cells and novelty-responsive behavior. Variation in intercept predicted anxiety-like behavior. Our findings isolate and doubly dissociate two components of theta generation that operate in parallel in behaving animals and link them to anxiolytic drug action, novelty, and the metric for self-motion

    Treatment of head lice with dimeticone 4% lotion: comparison of two formulations in a randomised controlled trial in rural Turkey

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    <p>Abstract</p> <p>Background</p> <p>Dimeticone 4% lotion was shown to be an effective treatment for head louse infestation in two randomised controlled trials in England. It is not affected by insecticide resistance but efficacy obtained (70-75%) was lower than expected. This study was designed to evaluate efficacy of dimeticone 4% lotion in a geographically, socially, and culturally different setting, in rural Turkey and, in order to achieve blinding, it was compared with a potential alternative formulation.</p> <p>Methods</p> <p>Children from two village schools were screened for head lice by detection combing. All infested students and family members could participate, giving access to treatment for the whole community. Two investigator applied treatments were given 7 days apart. Outcome was assessed by detection combing three times between treatments and twice the week following second treatment.</p> <p>Results</p> <p>In the intention to treat group 35/36 treated using dimeticone 4% had no lice after the second treatment but there were two protocol violators giving 91.7% treatment success. The alternative product gave 30/36 (83.3%) treatment success, a difference of 8.4% (95% CI -9.8% to 26.2%). The cure rates per-protocol were 33/34 (97.1%) and 30/35 (85.7%) respectively. We were unable to find any newly emerged louse nymphs on 77.8% of dimeticone 4% treated participants or on 66.7% of those treated with the alternative formulation. No adverse events were identified.</p> <p>Conclusion</p> <p>Our results confirm the efficacy of dimeticone 4% lotion against lice and eggs and we found no detectable difference between this product and dimeticone 4% lotion with nerolidol 2% added. We believe that the high cure rate was related to the lower intensity of infestation in Turkey, together with the level of community engagement, compared with previous studies in the UK.</p> <p>Trial Registration</p> <p>Current Controlled Trials ISRCTN10431107</p

    A novel targeted/untargeted GC-Orbitrap metabolomics methodology applied to Candida albicans and Staphylococcus aureus biofilms

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    Introduction: Combined infections from Candida albicans and Staphylococcus aureus are a leading cause of death in the developed world. Evidence suggests that Candida enhances the virulence of Staphylococcus—hyphae penetrate through tissue barriers, while S. aureus tightly associates with the hyphae to obtain entry to the host organism. Indeed, in a biofilm state, C. albicans enhances the antimicrobial resistance characteristics of S. aureus. The association of these microorganisms is also associated with significantly increased morbidity and mortality. Due to this tight association we hypothesised that metabolic effects were also in evidence. Objectives: To explore the interaction, we used a novel GC-Orbitrap-based mass spectrometer, the Q Exactive GC, which combines the high peak capacity and chromatographic resolution of gas chromatography with the sub-ppm mass accuracy of an Orbitrap system. This allows the capability to leverage the widely available electron ionisation libraries for untargeted applications, along with expanding accurate mass libraries and targeted matches based around authentic standards. Methods: Optimised C. albicans and S. aureus mono- and co-cultured biofilms were analysed using the new instrument in addition to the fresh and spent bacterial growth media. Results: The targeted analysis experiment was based around 36 sugars and sugar phosphates, 22 amino acids and five organic acids. Untargeted analysis resulted in the detection of 465 features from fresh and spent medium and 405 from biofilm samples. Three significantly changing compounds that matched to high scoring library fragment patterns were chosen for validation. Conclusion: Evaluation of the results demonstrates that the Q Exactive GC is suitable for metabolomics analysis using a targeted/untargeted methodology. Many of the results were as expected: e.g. rapid consumption of glucose and fructose from the medium regardless of the cell type. Modulation of sugar-phosphate levels also suggest that the pentose phosphate pathway could be enhanced in the cells from co-cultured biofilms. Untargeted metabolomics results suggested significant production of cell-wall biosynthesis components and the consumption of non-proteinaceous amino-acids

    Complex circular subsidence structures in tephra deposited on large blocks of ice: Varða tuff cone, Öræfajökull, Iceland

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    Several broadly circular structures up to 16 m in diameter, into which higher strata have sagged and locally collapsed, are present in a tephra outcrop on southwest Öræfajökull, southern Iceland. The tephra was sourced in a nearby basaltic tuff cone at Varða. The structures have not previously been described in tuff cones, and they probably formed by the melting out of large buried blocks of ice emplaced during a preceding jökulhlaup that may have been triggered by a subglacial eruption within the Öræfajökull ice cap. They are named ice-melt subsidence structures, and they are analogous to kettle holes that are commonly found in proglacial sandurs and some lahars sourced in ice-clad volcanoes. The internal structure is better exposed in the Varða examples because of an absence of fluvial infilling and reworking, and erosion of the outcrop to reveal the deeper geometry. The ice-melt subsidence structures at Varða are a proxy for buried ice. They are the only known evidence for a subglacial eruption and associated jökulhlaup that created the ice blocks. The recognition of such structures elsewhere will be useful in reconstructing more complete regional volcanic histories as well as for identifying ice-proximal settings during palaeoenvironmental investigations
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