Simulated case management of home telemonitoring to assess the impact of different alert algorithms on work-load and clinical decisions

© 2017 The Author(s). Background: Home telemonitoring (HTM) of chronic heart failure (HF) promises to improve care by timely indications when a patient's condition is worsening. Simple rules of sudden weight change have been demonstrated to generate many alerts with poor sensitivity. Trend alert algorithms and bio-impedance (a more sensitive marker of fluid change), should produce fewer false alerts and reduce workload. However, comparisons between such approaches on the decisions made and the time spent reviewing alerts has not been studied. Methods: Using HTM data from an observational trial of 91 HF patients, a simulated telemonitoring station was created and used to present virtual caseloads to clinicians experienced with HF HTM systems. Clinicians were randomised to either a simple (i.e. an increase of 2 kg in the past 3 days) or advanced alert method (either a moving average weight algorithm or bio-impedance cumulative sum algorithm). Results: In total 16 clinicians reviewed the caseloads, 8 randomised to a simple alert method and 8 to the advanced alert methods. Total time to review the caseloads was lower in the advanced arms than the simple arm (80 ± 42 vs. 149 ± 82 min) but agreements on actions between clinicians were low (Fleiss kappa 0.33 and 0.31) and despite having high sensitivity many alerts in the bio-impedance arm were not considered to need further action. Conclusion: Advanced alerting algorithms with higher specificity are likely to reduce the time spent by clinicians and increase the percentage of time spent on changes rated as most meaningful. Work is needed to present bio-impedance alerts in a manner which is intuitive for clinicians

Fixed-Base Simulator Studies of the Ability of the Human Pilot to Provide Energy Management Along Abort and Deep-Space Entry Trajectories

A simulation study has been made to determine a pilot's ability to control a low L/D vehicle to a desired point on the earth with initial conditions ranging from parabolic orbits to abort conditions along the boost phase of a deep-space mission. The program was conducted to develop procedures which would allow the pilot to perform the energy management functions required while avoiding the high deceleration or skipout region and to determine the information display required to aid the pilot in flying these procedures. The abort conditions studied extend from a region of relatively high flight-path angles at suborbital velocities while leaving the atmosphere to a region between orbital and near-escape velocity outside the atmosphere. The conditions studied included guidance from suborbital and superorbital aborts as well as guidance following return from a deepspace mission. In this paper, the role of the human pilot?s ability to combine safe return abort procedures with guidance procedures has been investigated. The range capability from various abort and entry conditions is also presented

General aviation approach and landing practices

The characteristics of air traffic patterns at uncontrolled airports and techniques used by a group of general aviation pilots in landing light airplanes are documented. The results of some 1,600 radar tracks taken at four uncontrolled airports and some 600 landings made by 22 pilots in two, four place, single engine light airplanes show that the uncontrolled traffic pattern is highly variable. The altitudes, distances, and piloting procedures utilized may affect the ability for pilots to see-and-avoid in this environment. Most landing approaches were conducted at an airspeed above recommended, resulting in significant floating during flare and touchdowns that were relatively flat and often nose-low

Mens Rea in Corpore Reo: An Exploration of the Rapists Charter

The issue of rape has long been at the forefront of the feminist movement. Legal doctrine and legal procedure relevant to rape have been strongly attacked by a variety of critics.\u27 The most obvious recent trend has been a movement from the traditional liberal concern with the protection of the accused from unjustified conviction, to victim-oriented efforts which are designed to ensure that the number of guilty offenders who evade responsibility for rape is reduced as much as possible. 2 The bases of calls for victim orientation have ranged from the view, most eloquently expressed by Susan Brownmiller, that the fact of rape is a pattern of conduct by which all men keep all women in a state of fearful subjection, 3 to the view that present rape laws, suitable amended, will provide as much protection from rape as can reasonably be expecte

Impact of Tennessee\u27s Value-added Assessment System on School Superintendents\u27 Decision-making

The problem related to this study was to develop a clearer understanding of the impact of Tennessee\u27s Value-Added Assessment System (TVAAS) on school superintendents\u27 decision-making responsibilities in view of school reform efforts at both the national and state levels during the last decade. The purpose of this study was to identify relationships between three independent variables (superintendents\u27 years of experience, superintendents\u27 perceived degree of personnel acceptance, and superintendents\u27 perceived technical assistance availability for data analysis and interpretation of results) and superintendents perceptions of the system on eight aspects (student learning; teacher performance; school system success; educational accountability; educational equality; assessment decisions; personnel decisions; and, curriculum and professional development decisions). Superintendents in the 139 Tennessee school systems were surveyed using an instrument containing 51 response items. The return rate was 81% (N = 112). Six research questions were answered by analyzing 24 null hypotheses using the chi square test, with Kendall\u27s Tau-B for determining strength of relationships. Hypotheses were tested at the.05 level of significance. All null hypotheses related to superintendents\u27 perceived degree of school personnel acceptance were rejected, with the exception of personnel decisions. All null hypotheses related to superintendents\u27 years of experience were retained. The null hypothesis related to superintendents\u27 perceived TVAAS technical assistance received and educational accountability was rejected. All other null hypotheses related to superintendents\u27 perceived technical assistance availability regarding data analysis and interpretation of value-added assessment results were retained. Results indicated the practice of participatory leadership among Tennessee superintendents. Recommendations included further research to determine possible differences between rural and urban school systems and between elected and appointed superintendents across Tennessee

The Law Reform Commission of Canada, Barnes and Marlin, and the Value-Consensus Model: More about Ideology

Barnes and Marlin have attacked the original paper written by me about the Law Reform Commission of Canada and the ideology of criminal process reform. The discussion which follows is not limited to being my response to their response: such a discussion would be fruitless and introverted to the point of boredom. Thus, although some of the discussion begins with Barnes and Marlin, it is not intended to end there, for indeed Barnes and Marlin have not really discussed much of the original comment at all. Their paper contains some discussion of the notion of consensus although, it is submitted, their discussion is largely a product of misunderstanding. However, Barnes and Marlin have not discussed any other attribute of the value-consensus model at all, nor have they dealt with the specific examples and criticisms raised in the original paper. Barnes and Marlin do not deal with the quite substantial body of literature, referred to and discussed in the original paper, which has surrounded the debate concerning the ideology of the criminal process and the criminal law, both as it is and as it should be

FIELD TRIALS AS AN EXTENSION TECHNIQUE: THE CASE OF SWAZILAND

One potentially serious problem in evaluating the effectiveness of extension programs is that participants are not picked at random. Self-selection can be a problem, and it can be compounded if extension officials concentrate on the most progressive farms. This study explores the relationships between adoption of maize high-yielding varieties (HYVs) and participation in field trials intended to foster HYV usage, drawing on data from Swaziland. Results indicate that it is impossible to say if field trials had any effect on adoption. Participating farms used more HYVs, but this could have been due to self-selection or the government's selection process.Teaching/Communication/Extension/Profession,