Rapid Response Team Utilization of Modified Early Warning Scores to Improve Patient Outcomes

This retrospective, descriptive study was designed to (a) determine if the Modified Early Warning Score risk assessment tool identified moderate to high risk patients prior to the activation of the Rapid Response Team (b) determine how much time occurred from the onset of clinical deterioration until activation of the Rapid Response Team. A Modified Early Warning Score (MEWS) was applied to the documented vital signs in the medical records of a convenience sample of 108 adult patients between the ages of 19 and 99 years of age who had experienced an activation of the Rapid Response Team (RRT). A risk assessment score was given for the time of the RRT activation as well as every previously documented instance of vital signs prior to the RRT call until the MEWS score reached a low risk score of 0 to 1. Of the 108 subjects, 36 subjects had a low risk (score 0 to 1) MEWS at the time of the RRT activation; 72 subjects had a moderate (score of 2 to 3) or high (score 4 or greater) risk MEWS score at the time of the RRT activation. Ten (10.14) hours was the average amount of time earlier deterioration could have been detected if a MEWS system had been in place. The data from this study indicate a need for more frequent observation and documentation of vital signs by nursing staff as the overall average length of time between vital signs collected (MEWS applied) was 291.60 minutes (4.86 hours) when clinical deterioration was evident. These data show that there is a delay in activation of the Rapid Response Team and that implementation of the MEWS system would increase RRT awareness of patients with critically abnormal vital signs so that they can be assessed and clinical deterioration treated to prevent a catastrophic event from occurring

Visual comparative case analytics

Criminal Intelligence Analysis (CIA) faces a challenging task in handling high-dimensional data that needs to be investigated with complex analytical processes. State-of-the-art crime analysis tools do not fully support interactive data exploration and fall short of computational transparency in terms of revealing alternative results. In this paper we report our ongoing research into providing the analysts with such a transparent and interactive system for exploring similarities between crime cases. The system implements a computational pipeline together with a visual platform that allows the analysts to interact with each stage of the analysis process and to validate the result. The proposed Visual Analytics (VA) workflow iteratively supports the interpretation of obtained clustering results, the development of alternative models, as well as cluster verification. The visualizations offer a usable way for the analyst to provide feedback to the system and to observe the impact of their interaction

Hydrogeology, geology & engineering aspects of surficial materials on the Lake Michigan shore in Illinois

Other titles: Geologic, Hydrogeologic, and engineering aspects of surficial materials on the Lake Michigan shore in IllinoisOpe

Making machine intelligence less scary for criminal analysts: reflections on designing a visual comparative case analysis tool

A fundamental task in Criminal Intelligence Analysis is to analyze the similarity of crime cases, called CCA, to identify common crime patterns and to reason about unsolved crimes. Typically, the data is complex and high dimensional and the use of complex analytical processes would be appropriate. State-of-the-art CCA tools lack flexibility in interactive data exploration and fall short of computational transparency in terms of revealing alternative methods and results. In this paper, we report on the design of the Concept Explorer, a flexible, transparent and interactive CCA system. During this design process, we observed that most criminal analysts are not able to understand the underlying complex technical processes, which decrease the users' trust in the results and hence a reluctance to use the tool}. Our CCA solution implements a computational pipeline together with a visual platform that allows the analysts to interact with each stage of the analysis process and to validate the result. The proposed Visual Analytics workflow iteratively supports the interpretation of the results of clustering with the respective feature relations, the development of alternative models, as well as cluster verification. The visualizations offer an understandable and usable way for the analyst to provide feedback to the system and to observe the impact of their interactions. Expert feedback confirmed that our user-centred design decisions made this computational complexity less scary to criminal analysts

Spherical similarity explorer for comparative case analysis

Comparative Case Analysis (CCA) is an important tool for criminal investigation and crime theory extraction. It analyzes the commonalities and differences between a collection of crime reports in order to understand crime patterns and identify abnormal cases. A big challenge of CCA is the data processing and exploration. Traditional manual approach can no longer cope with the increasing volume and complexity of the data. In this paper we introduce a novel visual analytics system, Spherical Similarity Explorer (SSE) that automates the data processing process and provides interactive visualizations to support the data exploration. We illustrate the use of the system with uses cases that involve real world application data and evaluate the system with criminal intelligence analysts

Schmerzmanagement bei Kindern in der Schweiz

Zusammenfassung: Hintergrund: Schmerzen bei stationär aufgenommenen Kindern werden häufig unzureichend behandelt. Bisher gab es keine Informationen zum Schmerzmanagement von Kinderkrankenhäusern in der Schweiz. Ziel der vorliegenden Studie war, den aktuellen Stand der Schmerzerfassung, -interpretation und -behandlung zu bestimmen. Studiendesign: Ein Fragebogen wurde an alle pädiatrischen Krankenhäuser in der Schweiz gesendet. Ergebnisse: Insgesamt antworteten 27 von 45Einheiten (Antwortrate: 60%). Die meisten Abteilungen verwenden Schmerzerfassungstools (96%) und führten diesbezügliche Leitlinien ein (78%). Die Behandlung von Schmerzen erfolgt ebenfalls meist nach hausinterner Leitlinie (78%). Prozedurale und postoperative Schmerzen werden stets (100%) analgetisch behandelt. Bei Frühgeborenen und Kindern auf Intensivpflegestationen werden bei invasiven Eingriffen häufig Analgetika (> 87%) verwendet. Auf Intensivstationen liegen in 44% diesbezügliche Leitlinien vor. Resümee: Der Nutzen eines effektiven Schmerzmanagements bei Kindern ist eindeutig belegt. Viele Ansätze zur Verbesserung werden in der Schweiz gut umgesetzt. Vor allem im internationalen Vergleich verbesserte sich das Schmerzmanagement. Es gibt aber noch Optimierungsmöglichkeiten. Beispielsweise besitzen weniger als die Hälfte aller schweizerischen Intensivstationen eine Leitlinie für die Behandlung von Schmerzen bei invasiven Eingriffe

Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature

Objective: To describe the surgical aspects potentially contributing to hardware failure of cephalomedullary nails. Data Sources: A search of the Embase, PubMed (MEDLINE), Web of Science, and the Cochrane library for reports of hardware failures after intramedullary fixation of proximal femur fractures. Issues of cut out and cut through phenomena related to technique were excluded. Expert opinion of 3 surgeons, each trained on several fixation systems at Level | trauma centers is reported. Data Extraction: Three authors extracted data using a predesigned form. Implant type, reported failure mechanism, and associated factors with implant failure were recorded as well as potential bias. Results: Of 2182 search results screened, 64 articles were deemed relevant for our research question and were included. The authors identified factors associated with implant failure: preoperative patient and fracture characteristics, intraoperative reduction, implant handling, and postoperative nonunion. Issues were identified as independent modifiable intraoperative risk factors: inadequate fracture reduction, varus position of femoral neck, direct damage of the cephalomedullary nail aperture by eccentric drilling related to guide sleeve handling, and implant design mechanism failures. Conclusions: Multiple factors associated with intraoperative handling can influence the healing of proximal femur fractures. Although many of these have been well described and are taught in fracture courses, surgeons should be aware of subtle intraoperative complications reported in the literature that can weaken implants and add to the likelihood of early failure

Preliminary measurements of lumbar spine kinematics and stiffness

The purpose of the presented study was the experimental measurement of lumbar spine stiffness and its range of motion. The dependence of torsion moment of lumbar spine segment on deflection of flexion, extension and torsion was observed during experiments. Stiffness of spine segment was determined from measured data. Human lumbar spine was used for verification of the experimental technique. The sample consisted of one lumbar vertebrae composed by five vertebral bodies and four intervertebral discs. All muscles were removed, however all ligaments were preserved. Experiments were ca rried out on the test system MTS 858.2 MiniBionix, where loading by axial force and torsion moment is possible at the same time. Special Modular Bionix Spine Test Fixator, attached to the test system was used for the measurements. Loading was controlled kinematically (gradual turning) by keeping the axial force equal zero. Measurement was timedependent. The results of these experiments are going to be used as input data for creating a model of artificial lumbar spine and new type of artificial disc replacement