Intuitive versus Algorithmic Triage

2018 ◽  
Vol 33 (4) ◽  
pp. 355-361 ◽  
Author(s):  
Alexander Hart ◽  
Elias Nammour ◽  
Virginia Mangolds ◽  
John Broach
Keyword(s):  
Vital Signs ◽  
Mass Casualty ◽  
Publication Type ◽  
Local Police ◽  
Triage Category ◽  
Government Leadership ◽  
Cluster Randomized ◽  
High Degree ◽  
Adult Volunteers ◽  
Very High

AbstractIntroductionThe most commonly used methods for triage in mass-casualty incidents (MCIs) rely upon providers to take exact counts of vital signs or other patient parameters. The acuity and volume of patients which can be present during an MCI makes this a time-consuming and potentially costly process.HypothesisThis study evaluates and compares the speed of the commonly used Simple Triage and Rapid Treatment (START) triage method with that of an “intuitive triage” method which relies instead upon the abilities of an experienced first responder to determine the triage category of each victim based upon their overall first-impression assessment. The research team hypothesized that intuitive triage would be faster, without loss of accuracy in assigning triage categories.MethodsLocal adult volunteers were recruited for a staged MCI simulation (active-shooter scenario) utilizing local police, Emergency Medical Services (EMS), public services, and government leadership. Using these same volunteers, a cluster randomized simulation was completed comparing START and intuitive triage. Outcomes consisted of the time and accuracy between the two methods.ResultsThe overall mean speed of the triage process was found to be significantly faster with intuitive triage (72.18 seconds) when compared to START (106.57 seconds). This effect was especially dramatic for Red (94.40 vs 138.83 seconds) and Yellow (55.99 vs 91.43 seconds) patients. There were 17 episodes of disagreement between intuitive triage and START, with no statistical difference in the incidence of over- and under-triage between the two groups in a head-to-head comparison.Conclusion:Significant time may be saved using the intuitive triage method. Comparing START and intuitive triage groups, there was a very high degree of agreement between triage categories. More prospective research is needed to validate these results.HartA, NammourE, MangoldsV, BroachJ. Intuitive versus algorithmic triagePrehosp Disaster Med.2018;33(4):355–361.

Prehospital Interventions During Mass-Casualty Events in Afghanistan: A Case Analysis

2017 ◽  
Vol 32 (4) ◽  
pp. 465-468 ◽  
Author(s):  
Steven G. Schauer ◽  
Michael D. April ◽  
Erica Simon ◽  
Joseph K. Maddry ◽  
Robert Carter ◽  
...  
Keyword(s):  
Trauma Registry ◽  
Vital Signs ◽  
Case Analysis ◽  
Medication Administration ◽  
Mass Casualty ◽  
Data Sets ◽  
Publication Type ◽  
Combat Casualty ◽  
Mass Casualty Events ◽  
Wide Range

AbstractBackgroundMass-casualty (MASCAL) events are known to occur in the combat setting. There are very limited data at this time from the Joint Theater (Iraq and Afghanistan) wars specific to MASCAL events. The purpose of this report was to provide preliminary data for the development of prehospital planning and guidelines.MethodsCases were identified using the Department of Defense (DoD; Virginia USA) Trauma Registry (DoDTR) and the Prehospital Trauma Registry (PHTR). These cases were identified as part of a research study evaluating Tactical Combat Casualty Care (TCCC) guidelines. Cases that were designated as or associated with denoted MASCAL events were included.DataFifty subjects were identified during the course of this project. Explosives were the most common cause of injuries. There was a wide range of vital signs. Tourniquet placement and pressure dressings were the most common interventions, followed by analgesia administration. Oral transmucosal fentanyl citrate (OTFC) was the most common parenteral analgesic drug administered. Most were evacuated as “routine.” Follow-up data were available for 36 of the subjects and 97% were discharged alive.ConclusionsThe most common prehospital interventions were tourniquet and pressure dressing hemorrhage control, along with pain medication administration. Larger data sets are needed to guide development of MASCAL in-theater clinical practice guidelines.SchauerSG, AprilMD, SimonE, MaddryJK, CarterR III, DelorenzoRA. Prehospital interventions during mass-casualty events in Afghanistan: a case analysis. Prehosp Disaster Med. 2017;32(4):465–468.

Electron Microscopy in Molecular Biology

1967 ◽  
Vol 25 ◽  
pp. 2-3
Author(s):  
Cecil E. Hall
Keyword(s):  
Electron Microscopy ◽  
Molecular Biology ◽  
Noise Level ◽  
Molecular Structures ◽  
Material Structure ◽  
The Arts ◽  
Shadow Casting ◽  
Electron Image ◽  
High Degree ◽  
Very High

The visualization of organic macromolecules such as proteins, nucleic acids, viruses and virus components has reached its high degree of effectiveness owing to refinements and reliability of instruments and to the invention of methods for enhancing the structure of these materials within the electron image. The latter techniques have been most important because what can be seen depends upon the molecular and atomic character of the object as modified which is rarely evident in the pristine material. Structure may thus be displayed by the arts of positive and negative staining, shadow casting, replication and other techniques. Enhancement of contrast, which delineates bounds of isolated macromolecules has been effected progressively over the years as illustrated in Figs. 1, 2, 3 and 4 by these methods. We now look to the future wondering what other visions are waiting to be seen. The instrument designers will need to exact from the arts of fabrication the performance that theory has prescribed as well as methods for phase and interference contrast with explorations of the potentialities of very high and very low voltages. Chemistry must play an increasingly important part in future progress by providing specific stain molecules of high visibility, substrates of vanishing “noise” level and means for preservation of molecular structures that usually exist in a solvated condition.

A Low-Noise, High-Gain Quasi-Millimeter-Wave Receiver MMIC with a Very High Degree of Integration Using 3D-MMIC Technology

2011 ◽  
Vol E94-C (10) ◽  
pp. 1548-1556 ◽  
Author(s):  
Takana KAHO ◽  
Yo YAMAGUCHI ◽  
Kazuhiro UEHARA ◽  
Kiyomichi ARAKI
Keyword(s):  
Millimeter Wave ◽  
High Gain ◽  
Low Noise ◽  
High Degree ◽  
Very High ◽  
Millimeter Wave Receiver

scholarly journals Multi-Locus Selection and the Structure of Variation at the white Gene of Drosophila melanogaster

Genetics ◽  
1996 ◽  
Vol 144 (2) ◽  
pp. 635-645 ◽  
Author(s):  
David A Kirby ◽  
Wolfgang Stephan
Keyword(s):  
Drosophila Melanogaster ◽  
White Gene ◽  
Transcriptional Unit ◽  
North American Population ◽  
Evolutionary Mechanisms ◽  
Locus Selection ◽  
Neutral Equilibrium ◽  
History Of ◽  
High Degree ◽  
Very High

Abstract We surveyed sequence variation and divergence for the entire 5972-bp transcriptional unit of the white gene in 15 lines of Drosophila melanogaster and one line of D. simulans. We found a very high degree of haplotypic structuring for the polymorphisms in the 3′ half of the gene, as opposed to the polymorphisms in the 5′ half. To determine the evolutionary mechanisms responsible for this pattern, we sequenced a 1612-bp segment of the white gene from an additional 33 lines of D. melanogaster from a European and a North American population. This 1612-bp segment encompasses an 834bp region of the white gene in which the polymorphisms form high frequency haplotypes that cannot be explained by a neutral equilibrium model of molecular evolution. The small number of recombinants in the 834bp region suggests epistatic selection as the cause of the haplotypic structuring, while an investigation of nucleotide diversity supports a directional selection hypothesis. A multi-locus selection model that combines features from both-hypotheses and takes the recent history of D. melanogaster into account may be the best explanation for these data.

Continuous DNA replication in the nucleus of the dinoflagellate Prorocentrum micans (Ehrenberg)

1977 ◽  
Vol 27 (1) ◽  
pp. 81-90
Author(s):  
S.A. Filfilan ◽  
D.C. Sigee
Keyword(s):  
Electron Microscope ◽  
Dna Synthesis ◽  
Nuclear Dna ◽  
Continuous Process ◽  
Prorocentrum Micans ◽  
Interphase Nuclei ◽  
Electron Microscope Autoradiography ◽  
Dividing Cells ◽  
High Degree ◽  
Very High

The uptake of tritiated thymine into cells of a heterogeneous population of Prorocentrum micans was investigated using light-microscope and electron-microscope autoradiography. Specificity of thymine uptake into DNA was demonstrated by the specific removal of label from wax-embedded material using DNase and by the high degree of localization of nuclear label to chromosomes in the electron-microscope autoradiographs. All nuclei, including both dividing and non-dividing cells, showed a substantial uptake of label, indicating that nuclear DNA synthesis in Prorocentrum micans is a continuous process. The level of DNA synthesis does show considerable variation, however, with very high levels in some interphase nuclei. The continuous replication of nuclear DNA provides further evidence of dinoflagellate affinity to the prokaryotes, and indicates that Prorocentrum micans is a very primitive eukaryote cell.

Decision Support System Based on Fuzzy Logic for Assessment of Expected Corporate Income Performance

2021 ◽  
pp. 2150009
Author(s):  
Arthur Yosef ◽  
Eli Shnaider ◽  
Rimona Palas ◽  
Amos Baranes
Keyword(s):  
Fuzzy Logic ◽  
Decision Support ◽  
Operating Income ◽  
Explanatory Variables ◽  
Section Model ◽  
Evaluation Mechanism ◽  
One Year ◽  
High Degree ◽  
Decision Support Method ◽  
Very High

This study presents a decision-support method to estimate the next year performance of corporate Operating Income Margin (OIM). It is based on a unique combination of cross-section model and the rules-based evaluation mechanism. The estimate is done in terms of broad categories, and not precise numerical values. The model is constructed as follows: its dependent variable (OIM) is one year ahead vs. the corresponding explanatory variables. This structure of the model allows us to view explanatory variables as reflecting financial potential of corporations. The evaluation component consists of a set of rules designed to identify the companies whose “potential” clearly points to an opportunity to invest. For the method presented here to succeed, it is necessary to utilize a highly reliable modeling method, even if it is “Fuzzy”. We apply Soft Regression (SR), which is a Soft Computing modeling tool based on Fuzzy Logic, and utilize all available proxy variables by creating intervals of values. Advantages of utilizing SR, and the intervals’-based modeling are extensively discussed. Modeling results for five consecutive years are consistent and stable, thus indicating high degree of reliability. Testing indicates very high success rate for the stock market related domain, the lowest being 87.9%.

scholarly journals CYTOPLASMIC DNA SYNTHESIS IN AMOEBA PROTEUS

1962 ◽  
Vol 15 (3) ◽  
pp. 525-534 ◽  
Author(s):  
M. Rabinovitch ◽  
W. Plaut
Keyword(s):  
Dna Synthesis ◽  
Tritiated Thymidine ◽  
Amoeba Proteus ◽  
Living Cells ◽  
Large Numbers ◽  
Cytoplasmic Dna ◽  
Basic Dyes ◽  
Nuclease Digestion ◽  
High Degree ◽  
Very High

The incorporation of tritiated thymidine in Amoeba proteus was reinvestigated in order to see if it could be associated with microscopically detectable structures. Staining experiments with basic dyes, including the fluorochrome acridine orange, revealed the presence of large numbers of 0.3 to 0.5 µ particles in the cytoplasm of all cells studied. The effect of nuclease digestion on the dye affinity of the particles suggests that they contain DNA as well as RNA. Centrifugation of living cells at 10,000 g leads to the sedimentation of the particles in the centrifugal third of the ameba near the nucleus. Analysis of centrifuged cells which had been incubated with H3-thymidine showed a very high degree of correlation between the location of the nucleic acid-containing granules and that of acid-insoluble, deoxyribonuclease-sensitive labeled molecules and leads to the conclusion that cytoplasmic DNA synthesis in Amoeba proteus occurs in association with these particles.

Social Pathology and Personality in Attempted Suicide

1967 ◽  
Vol 113 (505) ◽  
pp. 1405-1406 ◽  
Author(s):  
A. E. Philip ◽  
J. W. McCulloch
Keyword(s):  
Juvenile Delinquency ◽  
Ecological Study ◽  
Attempted Suicide ◽  
Local Authority ◽  
Suicidal Attempt ◽  
Social Pathology ◽  
Psychological Measures ◽  
High Degree ◽  
Very High

An ecological study by Philip and McCulloch (1966) demonstrated very high correlations between the incidence of attempted suicide and the rates of incidence for repeated attempted suicide, overcrowding, having been taken into care by the local authority, having had contact as a child with the Royal Scottish Society for the Prevention of Cruelty to Children, and juvenile delinquency. McCulloch and Philip (1968) showed that persons admitted to hospital following a suicidal attempt manifested these variables to a high degree. In this latter study “juvenile delinquency” was replaced by “all offences” as a variable. The present paper reports on the relationships between a scale based on these variables and a number of psychological measures gathered from 84 of the 95 patients in the latter study.

Evaluational Reactions to Erotic Literature

1965 ◽  
Vol 16 (3) ◽  
pp. 985-994 ◽  
Author(s):  
Leon A. Jakobovits
Keyword(s):  
Short Stories ◽  
Hard Core ◽  
Cumulative Effect ◽  
Sampling Bias ◽  
Male And Female ◽  
Warm Up ◽  
Erotic Literature ◽  
High Degree ◽  
Very High

On the basis of analysis of a variety of erotic literature Kronhausen and Kronhausen (1959) have suggested that there seem to be two general types: erotic realism ( ER) and hard-core obscenity ( O). Using three of the distinguishing criteria which were identified (context, exaggeration, and anti-eroticism), 20 short stories were specifically written in such a way that 10 had the characteristics of ER and the others had the characteristics of O. Study I showed a very high degree of agreement between judges in their classification of these stories as either ER or O. Study II revealed that male and female readers react differentially to the two types of stories. Females consistently rate O as more interesting and sexually stimulating than males do, the latter finding ER as more arousing than O. Other evaluational reactions are also described. A “warm-up” cumulative effect with successive reading was found with both sexes. The possibility of sampling bias affecting the data was noted.

scholarly journals Family’s Role in Achieving Language Affiliation among Children: A Comparative Study Applied to Some Families

2021 ◽  
Vol 12 (3) ◽  
pp. 111-128
Author(s):  
Aljohara Fahad Al Saud
Keyword(s):  
Social Media ◽  
Saudi Arabia ◽  
Comparative Study ◽  
Analytical Approach ◽  
Kingdom Of Saudi Arabia ◽  
Language Identity ◽  
Study Population ◽  
High Degree ◽  
Very High

Identifying language affiliation among children for family immigrants is crucial for one’s language identity. This study aimed to determine the role played by Arab families in the Kingdom of Saudi Arabia, Austria, and Britain to attain language affiliation among their children. It also aims to identify the challenges facing families living in these countries in achieving language affiliation among their children. The study population consisted of all the families that live in the Kingdom of Saudi Arabia, in addition to all the Arab families that live in Austria and Britain and the study sample included (120) parents. The researcher adopted the descriptive-analytical approach and used the questionnaire as the study tool. The study reached several results; first, the role played by families in the Kingdom of Saudi Arabia, Austria, and United Kingdom to attain language affiliation among their children got a high degree of response. Second, the challenges facing activating the family’s role in attaining language affiliation of their children in the Kingdom of Saudi Arabia and Austria have got a high degree of response, while in Britain, they obtained a very high degree of response. The study recommended involving all family members in accessing different and creative ways of practicing their native language and activating the role of social media in developing the language affiliation of children.

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