The Effects of an Educational Program on Recognition of Atypical Signs and Symptoms of Acute Coronary Syndrome in Women in the Emergency Room

According to the American Heart Association (2010), in the United States every 36 seconds someone dies from heart and blood vessel disease. The Centers for Disease Control and Prevention (2007) estimate that one in six deaths in the US is related to coronary artery disease. When diagnosed with acute coronary syndrome, which is an acute event, resulting from CAD, appropriate treatment greatly reduces the risk of refractory ischemia, need for urgent revascularization, and death. Women are less likely to be urgently diagnosed with acute coronary syndrome, receive thrombolytic therapy, or undergo percutaneous coronary intervention than men, thereby increasing their mortality and morbidity (Bell et al., 1999). There is a need to educate the providers in a rural hospital\u27s emergency department on the atypical signs and symptoms of acute coronary syndrome in women that present to the ED to facilitate emergent treatment. The objectives of the educational program were to increase provider knowledge about the atypical signs and symptoms of ACS with which women present to the ED as measured by an increase in CORE measures: TNKase in less than 30 minutes from arrival in the ED, number of women who received ASA in the ED, and EKG in less than 10 minutes from arrival at the ED.;This capstone project used a one group pretest -- posttest quasi-experimental design with a convenience sample of ED providers. The total number of eligible provider participants was 75. Fifty-four (72%) participated in the 39 minute educational intervention and completed both the pre and post-test. There was a 30% increase in provider knowledge from pre to post test, p\u3c0.001. There were 23,385 patients seen in the ED during the intervention time frame. Of those, 1,182 met criteria for inclusion. There was a 52% increase in women who received TNKase in less than 30 minutes from their arrival time in the ED, a 0.8% increase in the number of women who received ASA in the ED and a 4% decrease in obtaining an EKG in less than 10 minutes. The intervention proved to be successful in increasing the knowledge of providers in the recognition of atypical signs and symptoms of ACS, increasing the number of women who received ASA in less than 10 minutes, increasing TNKase administration in less than 30 minutes, and minimally increasing EKG administration. Further follow-up is warranted on the impact of the intervention longitudinally

On the use of IR lidar and K(sub a)-band radar for observing cirrus clouds

Advances in lidar and radar technology have potential for providing new and better information on climate significant parameters of cirrus. Consequently, the NOAA Wave Propagation Lab. is commencing CLARET (Cloud Lidar And Radar Exploratory Test) to evaluate the promise of these new capabilities. Parameters under study include cloud particle size distribution, height of cloud bases, tops, and multiple layers, and cloud dynamics revealed through measurement of vertical motions. The first phase of CLARET is planned for Sept. 1989. The CO2 coherent Doppler lidar and the sensitive K sub a band radar hold promise for providing valuable information on cirrus that is beyond the grasp of current visible lidars

Underwater glider observations and the representation of western boundary currents in numerical models

Author Posting. © The Oceanography Society, 2017. This article is posted here by permission of The Oceanography Society for personal use, not for redistribution. The definitive version was published in Oceanography 30, no. 2 (2017): 88–89, doi:10.5670/oceanog.2017.225.Western boundary currents are important oceanic components of Earth’s climate system. In the subtropics, the Gulf Stream, Kuroshio, East Australian Current, Agulhas Current, and Brazil Current contribute to poleward heat transport. Low-latitude western boundary currents, such as the Somali Current, Mindanao Current, and New Guinea Coastal Undercurrent, are key connections between the subtropical gyres and equatorial current systems. Western boundary currents are generally narrow (O(100) km wide) with strong currents (O(1) m s–1) and large property gradients, making them a challenge to both observe and simulate.Funding for Spray glider operations in the Gulf Stream has been provided by the National Science Foundation (OCE-0220769,OCE-1633911), the Office of Naval Research (N000141713040), the National Oceanic and Atmospheric Administration’s Climate Observation Division (NA14OAR4320158), Eastman Chemical Company, Woods Hole Oceanographic Institution’s Oceans and Climate Change Institute, and the W. Van Alan Clark Jr. Chair for Excellence in Oceanography at WHOI (awarded to Breck Owens)

Effect of examiner position and prism orientation on near point alternating cover test procedure

This study was designed to resolve uncertainty concerning whether the position of the examiner is associated with variability in the results of the nearpoint alternate cover test (NACT). Two previous studies have shown that when the examiner is positioned to the side of the patient, rather than directly in front of the patient, the NACT shows greater exophoria in the range of 1.3 to 4.4 prism diopters. In the current study, we sought to determine if proximal cues or effective prism power might be the source of the apparent exo shift associated with examiner position. NACT was performed on 52 subjects, with each subject measured under three conditions. 1. Examiner directly in front of the subject, measuring prism held in the frontal position. 2. Examiner 30 degrees right of subject, measuring prism held in the frontal position. 3. Examiner 30 degrees right of subject, measuring prism rotated 30 degrees toward the examiner. Results showed a small significant increase in measured exophoria when the examiner administers the NACT from a position to the side of the subject. The magnitude of the increase, 0.98 prism diopter, was less than in the previous studies. Intentionally rotating the measuring prism had a nominal effect on the measured phoria value consistent with error induced due to effective prism power. It appears that examiner position does affect the outcome of the NACT, but that the magnitude of the effect may be only clinically significant with neutralization of large heterophorias. A change in proximal cues may contribute to the effect

Nonlinear Matroid Optimization and Experimental Design

We study the problem of optimizing nonlinear objective functions over matroids presented by oracles or explicitly. Such functions can be interpreted as the balancing of multi-criteria optimization. We provide a combinatorial polynomial time algorithm for arbitrary oracle-presented matroids, that makes repeated use of matroid intersection, and an algebraic algorithm for vectorial matroids. Our work is partly motivated by applications to minimum-aberration model-fitting in experimental design in statistics, which we discuss and demonstrate in detail