Tarasoff and the Psychotherapist\u27s Duty to Warn

This Comment will highlight the issues of the therapist\u27s duty to warn potential victims and the duty to confine dangerous patients. A more detailed emphasis is placed on confidentiality and privilege in the therapist-patient relationship and on the predictability of violence. These issues provide a background for an analysis of the potential effects of Tarasoff on the psychiatric profession and the practical problems arising from the decision

GPU Modeling of Ship Operations in Pack Ice

The paper explores the use of an event-mechanics approach to assess vessel performance in pack ice. The methodology is developed using massively parallel programming strategies on a GPU enabled workstation. A set of simulation domains, each containing hundreds of discrete and interacting ice floes is modeled. A simple vessel is modeled as it navigates through the domains. Each ship-ice collision is modeled, as is every ice-ice contact. Time histories of resistance, speed and position are presented along with the parametric sensitivities. The results are compared to published data from analytical, numerical and scale model tests. The work is part of a large research project at Memorial University called STePS2 (Sustainable Technology for Polar Ships and Structures)

Analytic Description of Critical Point Actinides in a Transition from Octupole Deformation to Octupole Vibrations

An analytic collective model in which the relative presence of the quadrupole and octupole deformations is determined by a parameter (phi_0), while axial symmetry is obeyed, is developed. The model [to be called the analytic quadrupole octupole axially symmetric model (AQOA)] involves an infinite well potential, provides predictions for energy and B(EL) ratios which depend only on phi_0, draws the border between the regions of octupole deformation and octupole vibrations in an essentially parameter-independent way, and describes well 226-Th and 226-Ra, for which experimental energy data are shown to suggest that they lie close to this border. The similarity of the AQOA results with phi_0=45 degrees for ground state band spectra and B(E2) transition rates to the predictions of the X(5) model is pointed out. Analytic solutions are also obtained for Davidson potentials, leading to the AQOA spectrum through a variational procedure.Comment: LaTeX, 27 pages, including 14 postscript figure

The Lantern Vol. 64, No. 1, Fall 1996

• Sleepwalk • Icky • Hauling the Load • Between Days • First Day • Slipping • College Roommates • Full Moon in Scorpio • Summer Madness • Learning French • nEverglades • The Way Around • Rain • Solacehttps://digitalcommons.ursinus.edu/lantern/1149/thumbnail.jp

Vision Analysis of Pack Ice for Potential Use in a Hazard Warning and Avoidance System

Ships travelling through pack ice are exposed to collisions that can result in structural damage to the hull. The GEM project at Memorial University has developed ice-ship interaction simulation software that allows study of the impact forces applied on a ship when it maneuvers through pack ice [1]. Such capability is useful in order to predict the collisions that would potentially affect the structural integrity and operational performance of ships and floating offshore structures. GEM is capable of simulating transit through complex pack ice formations at a rate much faster than real time. If hyper-real time simulation were available in a real operational setting, with actual ice, it would permit a variety of benefits, including general operational planning. If the near field ice information were sufficiently accurate, GEM could also be used in a “feed forward” near-field hazard warning and avoidance system (HWAS)

Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis

<p>Abstract</p> <p>Background</p> <p>Tuberculosis is a leading cause of death worldwide, yet the determinants of death are not well understood. We sought to determine risk factors for mortality during treatment of drug-susceptible pulmonary tuberculosis under program settings.</p> <p>Methods</p> <p>Retrospective chart review of patients with drug-susceptible tuberculosis reported to the San Francisco Tuberculosis Control Program from 1990-2001.</p> <p>Results</p> <p>Of 565 patients meeting eligibility criteria, 37 (6.6%) died during the study period. Of 37 deaths, 12 (32.4%) had tuberculosis listed as a contributing factor. In multivariate analysis controlling for follow-up time, four characteristics were independently associated with mortality: HIV co-infection (HR = 2.57, p = 0.02), older age at tuberculosis diagnosis (HR = 1.52 per 10 years, p = 0.001); initial sputum smear positive for acid fast bacilli (HR = 3.07, p = 0.004); and experiencing an interruption in tuberculosis therapy (HR = 3.15, p = 0.002). The association between treatment interruption and risk of death was due to non-adherence during the intensive phase of treatment (HR = 3.20, p = 0.001). The median duration of treatment interruption did not differ significantly in either intensive or continuation phases between those who died and survived (23 versus 18 days, and 37 versus 29 days, respectively). No deaths were directly attributed to adverse drug reactions.</p> <p>Conclusions</p> <p>In addition to advanced age, HIV and characteristics of advanced tuberculosis, experiencing an interruption in anti-tuberculosis therapy, primarily due to non-adherence, was also independently associated with increased risk of death. Improving adherence early during treatment for tuberculosis may both improve tuberculosis outcomes as well as decrease mortality.</p

Data-driven approach for creating synthetic electronic medical records

<p>Abstract</p> <p>Background</p> <p>New algorithms for disease outbreak detection are being developed to take advantage of full electronic medical records (EMRs) that contain a wealth of patient information. However, due to privacy concerns, even anonymized EMRs cannot be shared among researchers, resulting in great difficulty in comparing the effectiveness of these algorithms. To bridge the gap between novel bio-surveillance algorithms operating on full EMRs and the lack of non-identifiable EMR data, a method for generating complete and synthetic EMRs was developed.</p> <p>Methods</p> <p>This paper describes a novel methodology for generating complete synthetic EMRs both for an outbreak illness of interest (tularemia) and for background records. The method developed has three major steps: 1) synthetic patient identity and basic information generation; 2) identification of care patterns that the synthetic patients would receive based on the information present in real EMR data for similar health problems; 3) adaptation of these care patterns to the synthetic patient population.</p> <p>Results</p> <p>We generated EMRs, including visit records, clinical activity, laboratory orders/results and radiology orders/results for 203 synthetic tularemia outbreak patients. Validation of the records by a medical expert revealed problems in 19% of the records; these were subsequently corrected. We also generated background EMRs for over 3000 patients in the 4-11 yr age group. Validation of those records by a medical expert revealed problems in fewer than 3% of these background patient EMRs and the errors were subsequently rectified.</p> <p>Conclusions</p> <p>A data-driven method was developed for generating fully synthetic EMRs. The method is general and can be applied to any data set that has similar data elements (such as laboratory and radiology orders and results, clinical activity, prescription orders). The pilot synthetic outbreak records were for tularemia but our approach may be adapted to other infectious diseases. The pilot synthetic background records were in the 4-11 year old age group. The adaptations that must be made to the algorithms to produce synthetic background EMRs for other age groups are indicated.</p