Prediction of Critical Illness During Out-of-Hospital Emergency Care

CONTEXT: Early identification of nontrauma patients in need of critical care services in the emergency setting may improve triage decisions and facilitate regionalization of critical care. OBJECTIVES: To determine the out-of-hospital clinical predictors of critical illness and to characterize the performance of a simple score for out-of-hospital prediction of development of critical illness during hospitalization. DESIGN AND SETTING: Population-based cohort study of an emergency medical services (EMS) system in greater King County, Washington (excluding metropolitan Seattle), that transports to 16 receiving facilities. PATIENTS: Nontrauma, non-cardiac arrest adult patients transported to a hospital by King County EMS from 2002 through 2006. Eligible records with complete data (N = 144,913) were linked to hospital discharge data and randomly split into development (n = 87,266 [60%]) and validation (n = 57,647 [40%]) cohorts. MAIN OUTCOME MEASURE: Development of critical illness, defined as severe sepsis, delivery of mechanical ventilation, or death during hospitalization. RESULTS: Critical illness occurred during hospitalization in 5% of the development (n = 4835) and validation (n = 3121) cohorts. Multivariable predictors of critical illness included older age, lower systolic blood pressure, abnormal respiratory rate, lower Glasgow Coma Scale score, lower pulse oximetry, and nursing home residence during out-of-hospital care (P < .01 for all). When applying a summary critical illness prediction score to the validation cohort (range, 0-8), the area under the receiver operating characteristic curve was 0.77 (95% confidence interval [CI], 0.76-0.78), with satisfactory calibration slope (1.0). Using a score threshold of 4 or higher, sensitivity was 0.22 (95% CI, 0.20-0.23), specificity was 0.98 (95% CI, 0.98-0.98), positive likelihood ratio was 9.8 (95% CI, 8.9-10.6), and negative likelihood ratio was 0.80 (95% CI, 0.79- 0.82). A threshold of 1 or greater for critical illness improved sensitivity (0.98; 95% CI, 0.97-0.98) but reduced specificity (0.17; 95% CI, 0.17-0.17). CONCLUSIONS: In a population-based cohort, the score on a prediction rule using out-of-hospital factors was significantly associated with the development of critical illness during hospitalization. This score requires external validation in an independent populationPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85143/1/Seymour - JAMA-2010-747-54.pdf11

Automatic semigroups

AbstractThe area of automatic groups has been one in which significant advances have been made in recent years. While it is clear that the definition of an automatic group can easily be extended to that of an automatic semigroup, there does not seem to have been a systematic investigation of such structures. It is the purpose of this paper to make such a study.We show that certain results from the group-theoretic situation hold in this wider context, such as the solvability of the word problem in quadratic time, although others do not, such as finite presentability. There are also situations which arise in the general theory of semigroups which do not occur when considering groups; for example, we show that a semigroup S is automatic if and only if S with a zero adjoined is automatic, and also that S is automatic if and only if S with an identity adjoined is automatic. We use this last result to show that any finitely generated subsemigroup of a free semigroup is automatic

Risky Behavior in Online Social Media: Protection Motivation and Social Influence

Online Social Media (OSM) websites have attracted millions of users by enabling them to socially interact in ways that were not possible before. While the explosion of OSM use has had many benefits, it also has a darker side where an individual\u27s personal information can potentially be misused. This study develops and tests an empirical model based on a theoretical lens provided by Protection Motivation Theory (PMT) to examine the salient factors that influence an individual\u27s perceptions of threat and their intention to use OSM websites. We investigate this model with a data set representing survey responses from 197 OSM users. Results suggest that rewards, which are largely overlooked in the IS PMT literature, are the primary influence in the perceived threat calculation in the OSM context. In addition, social influence was found to significantly influence behavioral intentions to share information on OSM websites

Comparative biochemical analysis of three members of the Schistosoma mansoni TAL family: Differences in ion and drug binding properties.

The tegumental allergen-like (TAL) proteins from Schistosoma mansoni are part of a family of calcium binding proteins found only in parasitic flatworms. These proteins have attracted interest as potential drug or vaccine targets, yet comparatively little is known about their biochemistry. Here, we compared the biochemical properties of three members of this family: SmTAL1 (Sm22.6), SmTAL2 (Sm21.7) and SmTAL3 (Sm20.8). Molecular modelling suggested that, despite similarities in domain organisation, there are differences in the three proteins' structures. SmTAL1 was predicted to have two functional calcium binding sites and SmTAL2 was predicted to have one. Despite the presence of two EF-hand-like structures in SmTAL3, neither was predicted to be functional. These predictions were confirmed by native gel electrophoresis, intrinsic fluorescence and differential scanning fluorimetry: both SmTAL1 and SmTAL2 are able to bind calcium ions reversibly, but SmTAL3 is not. SmTAL1 is also able to interact with manganese, strontium, iron(II) and nickel ions. SmTAL2 has a different ion binding profile interacting with cadmium, manganese, magnesium, strontium and barium ions in addition to calcium. All three proteins form dimers and, in contrast to some Fasciola hepatica proteins from the same family; dimerization is not affected by calcium ions. SmTAL1 interacts with the anti-schistosomal drug praziquantel and the calmodulin antagonists trifluoperazine, chlorpromazine and W7. SmTAL2 interacts only with W7. SmTAL3 interacts with the aforementioned calmodulin antagonists and thiamylal, but not praziquantel. Overall, these data suggest that the proteins have different biochemical properties and thus, most likely, different in vivo functions

Design of Low Cost Modular Robotic Manipulator Joints

The goal of this project was to design and manufacture robotic joints that are inexpensive and capable of being used in a variety of applications. In order to maximize the number of applications in which our design could be utilized, research was done on optimal strength, size, communications, modularity, and price. This project includes the research and design development necessary to engineer such a joint, including part selection, motor control, manufacturing processes, and strength analysis. Two Joints were constructed and tested: a rotator joint and a elbow-joint. The joints performed well under testing conditions and overall prices were kept low. With future development, these joints could be used in fields where size and price are critical

MARS, the MAGIC Analysis and Reconstruction Software

With the commissioning of the second MAGIC gamma-ray Cherenkov telescope situated close to MAGIC-I, the standard analysis package of the MAGIC collaboration, MARS, has been upgraded in order to perform the stereoscopic reconstruction of the detected atmospheric showers. MARS is a ROOT-based code written in C++, which includes all the necessary algorithms to transform the raw data recorded by the telescopes into information about the physics parameters of the observed targets. An overview of the methods for extracting the basic shower parameters is presented, together with a description of the tools used in the background discrimination and in the estimation of the gamma-ray source spectra.Comment: 4 pages, 0 figures, submitted to the 31st International Cosmic Ray Conference, {\L}odz 200

The impact of increased food availability on reproduction in a long-distance migratory songbird: implications for environmental change?

Many populations of migratory songbirds are declining or shifting in distribution. This is likely due to environmental changes that alter factors such as food availability that may have an impact on survival and/or breeding success. We tested the impact of experimentally supplemented food on the breeding success over three years of northern wheatears (Oenanthe oenanthe), a species in decline over much of Europe. The number of offspring fledged over the season was higher for food-supplemented birds than for control birds. The mechanisms for this effect were that food supplementation advanced breeding date, which, together with increased resources, allowed further breeding attempts. While food supplementation did not increase the clutch size, hatching success or number of chicks fledged per breeding attempt, it did increase chick size in one year of the study. The increased breeding success was greater for males than females; males could attempt to rear simultaneous broods with multiple females as well as attempting second broods, whereas females could only increase their breeding effort via second broods. Multiple brooding is rare in the study population, but this study demonstrates the potential for changes in food availability to affect wheatear breeding productivity, primarily via phenotypic flexibility in the number of breeding attempts. Our results have implications for our understanding of how wheatears may respond to natural changes in food availability due to climate changes or changes in habitat management