scholarly journals Comparison of the Bonfils and Levitan Optical Stylets for Tracheal Intubation: A Clinical Study

2011 ◽  
Vol 39 (6) ◽  
pp. 1093-1097 ◽  
Author(s):  
A. Webb ◽  
H. Kolawole ◽  
S. Leong ◽  
T. E. Loughnan ◽  
T. Crofts ◽  
...  
Keyword(s):  
Clinical Study ◽  
Tracheal Intubation ◽  
Prior Experience ◽  
Phase 1 ◽  
The Other ◽  
Surgical Patients ◽  
Second Phase ◽  
Phase 2 ◽  
High Failure Rate ◽  
Novice Users

The Bonfils and Levitan FPS™ scopes are rigid fibreoptic stylets that may assist routine or difficult intubation. This study compared the effectiveness of each in patients with predicted normal airways when used by specialist anaesthetists with no prior experience using optical stylets. Twelve anaesthetists and 324 elective surgical patients participated. Six anaesthetists were randomised to first intubate 20 patients with the Levitan scope (Phase 1) followed by a further seven patients with the Bonfils scope (Phase 2). The other six participating anaesthetists undertook their first 20 intubations with the Bonfils (Phase 1), followed by seven intubations with the Levitan (Phase 2). Outcomes recorded were success rate, total time to intubation, number of attempts, ease of intubation score and incidence of complications. Overall failure rates were similar for the two scopes with 5.6% of patients not intubated after three attempts. Median total times to intubation were similar for the Levitan (44 seconds) and Bonfils (36 seconds) (P=0.11). Participants using the Bonfils in Phase 1 had significantly higher chance of success on first attempt (73%) compared to Levitan users during Phase 1 (57%) (P=0.008). These differences were not significant in the second phase and ease of intubation scores were similar for both scopes (P=0.9). This study showed the two scopes were comparable but the high failure rate amongst novice users demonstrated the importance of familiarity and skill development prior to their introduction to a difficult airway cart.

scholarly journals La Gestion du Risque de Micro-crédit: La Nécessité du Diagnostic Financier: Cas de la PME MIGEG Microfinance S.A.

2017 ◽  
Vol 13 (19) ◽  
pp. 292
Author(s):  
Lucas Pony
Keyword(s):  
Quantitative Data ◽  
Phase 1 ◽  
The Other ◽  
Second Phase ◽  
Phase 2 ◽  
Financial Health ◽  
Financial Lever ◽  
Diagnosis Method ◽  
Two Phases ◽  
Gestion Du Risque

The reduction of the losses related to credit outstanding payment is very necessary in the micro finance institutions in general, and the SME of micro finance MIGEG* S.A in particular. Here, we carried out a study concerning the management of micro credits risk which result to losses due to non-refund. The method that was proposed in this study is that of the financial diagnosis which operates in two phases. The first phase involves the use of the data collected during the interview to analyze the morality of the customer (Phase 1), while the second phase involves the use of the financial and accounting quantitative data to analyze the financial health of the customer (Phase 2).The diagnosis method considered is that of Dupont which allows us to considerably reduce the percentage of credits outstanding payment. Consequently, it also helps to improve the company’s funds. The proposed method will help the managers to detect the risks of application for credit. The bank will thus grant only the credit bonds related to the highest refunds. This, however, will further lead to the following results: For MIGEG S.A to be viable, it must insist on the ratio of the assets. This refers to the sales of the credits to promote refunds without risk. On the other hand, MIGEG S.A will insist on the ratio of the financial lever, debt and assets, in order to promote the prefinancing of the risk credits. Therefore, it will help to avoid credits related to the guarantees such as the land certificate, inheritance etc.

PENERAPAN MODEL QUANTUM LEARNING UNTUK MENINGKATKAN HASIL BELAJAR AUTOCAD SISWA KELAS X TEKNIK PEMESINAN SMK NEGERI 1 STABAT

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Abdul Hasan Saragih
Keyword(s):  
Positive Response ◽  
Phase 1 ◽  
First Grade ◽  
Learning Model ◽  
Second Phase ◽  
Phase 2 ◽  
Phase 3 ◽  
The Third ◽  
Third Phase ◽  
Quantum Learning

This classroom research was conducted on the autocad instructions to the first grade of mechinary class of SMK Negeri 1 Stabat aiming at : (1) improving the student’ archievementon autocad instructional to the student of mechinary architecture class of SMK Negeri 1 Stabat, (2) applying Quantum Learning Model to the students of mechinary class of SMK Negeri 1 Stabat, arising the positive response to autocad subject by applying Quantum Learning Model of the students of mechinary class of SMK Negeri 1 Stabat. The result shows that (1) by applying quantum learning model, the students’ achievement improves significantly. The improvement ofthe achievement of the 34 students is very satisfactory; on the first phase, 27 students passed (70.59%), 10 students failed (29.41%). On the second phase 27 students (79.41%) passed and 7 students (20.59%) failed. On the third phase 30 students (88.24%) passed and 4 students (11.76%) failed. The application of quantum learning model in SMK Negeri 1 Stabat proved satisfying. This was visible from the activeness of the students from phase 1 to 3. The activeness average of the students was 74.31% on phase 1,81.35% on phase 2, and 83.63% on phase 3. (3) The application of the quantum learning model on teaching autocad was very positively welcome by the students of mechinary class of SMK Negeri 1 Stabat. On phase 1 the improvement was 81.53% . It improved to 86.15% on phase 3. Therefore, The improvement ofstudent’ response can be categorized good.

scholarly journals Teaching the pronunciation of sentence final and word boundary stops to French learners of English: distracted imitation versus audio-visual explanations

2016 ◽  
Vol 14 (4) ◽  
pp. 377-388 ◽  
Author(s):  
Maelle Amand ◽  
Zakaria Touhami
Keyword(s):  
Second Language Acquisition ◽  
Language Acquisition ◽  
Phase 1 ◽  
Working Environment ◽  
The Other ◽  
Word Boundary ◽  
Second Phase ◽  
Idiomatic Expressions ◽  
No Release ◽  
French And English

Studies on stop unrelease in second language acquisition have hitherto focused on the productions of Slavic learners of English (Šimačkova & Podlipsky, 2015) and experiments on Polish learners of English; the latter show the tendency to release stops on a more regular basis depending on the type of stop combinations (Rojczyk et al. 2013). In the present study, we aim to test the efficiency of audio-visual explanations as opposed to distracted imitation in pronunciation teaching amongst French learners of English. While unreleased stops are rather frequent in French and English - especially in plosives clusters (Byrd, 1993; Davidson, 2010), unreleased plosives in final positions are less common in French (Van Dommelen, 1983). During phase 1 of the experiment, three groups of 12 native French learners of English (level A1/A2, B1/B2 and C1/C2) were asked to read idiomatic expressions containing both homogeneous and heterogeneous sequences of voiceless stops straddled between words, namely, in sequences like “that cat” [dat˺ kat˺], and stops at the end of sentences like “I told him to speak” [tə spiːk˺]. In the second phase of the experiment, one half in each group was given a different task. The first group heard recorded versions of phase 1 sentences and before reading them out loud, counted up to five in their L1. Stimuli for imitation contained no release in the contexts under scrutiny. The other half had to watch a video explaining the phenomenon of unreleased stops with a production of phase-two expressions propped up by hand gestures. They were then asked to re-read the sentences given in phase 1. Based on these results the current study makes recommendations about what working environment should be prioritized in pronunciation teaching both in class and online (Kroger et al. 2010), and suggests ways to assess students and visually keep track of their progress.

Low-level Speech Recognition of Children with Hearing Aids

2021 ◽  
Author(s):  
Jace Wolfe ◽  
Mila Duke ◽  
Sharon Miller ◽  
Erin Schafer ◽  
Christine Jones ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Speech Recognition ◽  
Word Recognition ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Phase 1 ◽  
Second Phase ◽  
Phase 2 ◽  
Low Level ◽  
Children With Hearing Loss

Background: For children with hearing loss, the primary goal of hearing aids is to provide improved access to the auditory environment within the limits of hearing aid technology and the child’s auditory abilities. However, there are limited data examining aided speech recognition at very low (40 dBA) and low (50 dBA) presentation levels. Purpose: Due to the paucity of studies exploring aided speech recognition at low presentation levels for children with hearing loss, the present study aimed to 1) compare aided speech recognition at different presentation levels between groups of children with normal hearing and hearing loss, 2) explore the effects of aided pure tone average (PTA) and aided Speech Intelligibility Index (SII) on aided speech recognition at low presentation levels for children with hearing loss ranging in degree from mild to severe, and 3) evaluate the effect of increasing low-level gain on aided speech recognition of children with hearing loss. Research Design: In phase 1 of this study, a two-group, repeated-measures design was used to evaluate differences in speech recognition. In phase 2 of this study, a single-group, repeated-measures design was used to evaluate the potential benefit of additional low-level hearing aid gain for low-level aided speech recognition of children with hearing loss. Study Sample: The first phase of the study included 27 school-age children with mild to severe sensorineural hearing loss and 12 school-age children with normal hearing. The second phase included eight children with mild to moderate sensorineural hearing loss. Intervention: Prior to the study, children with hearing loss were fitted binaurally with digital hearing aids. Children in the second phase were fitted binaurally with digital study hearing aids and completed a trial period with two different gain settings: 1) gain required to match hearing aid output to prescriptive targets (i.e., primary program), and 2) a 6-dB increase in overall gain for low-level inputs relative to the primary program. In both phases of this study, real-ear verification measures were completed to ensure the hearing aid output matched prescriptive targets. Data Collection and Analysis: Phase 1 included monosyllabic word recognition and syllable-final plural recognition at three presentation levels (40, 50, and 60 dBA). Phase 2 compared speech recognition performance for the same test measures and presentation levels with two differing gain prescriptions. Results and Conclusions: In phase 1 of the study, aided speech recognition was significantly poorer in children with hearing loss at all presentation levels. Higher aided SII in the better ear (55 dB SPL input) was associated with higher CNC word recognition at a 40 dBA presentation level. In phase 2, increasing the hearing aid gain for low-level inputs provided a significant improvement in syllable-final plural recognition at very low-level inputs and resulted in a non-significant trend toward better monosyllabic word recognition at very low presentation levels. Additional research is needed to document the speech recognition difficulties children with hearing aids may experience with low-level speech in the real world as well as the potential benefit or detriment of providing additional low-level hearing aid gain

scholarly journals 4468 Evaluating the Emerging Investigators Website as an Educational Resource for Early Career Researchers

2020 ◽  
Vol 4 (s1) ◽  
pp. 61-62
Author(s):  
Layla Fattah ◽  
Inga Peter ◽  
Jenny Lin ◽  
Janice Lynn Gabrilove
Keyword(s):  
Phase 1 ◽  
Early Career ◽  
Second Phase ◽  
Phase 2 ◽  
Web Based ◽  
Educational Value ◽  
Early Career Researchers ◽  
Content Relevance ◽  
Mount Sinai ◽  
Initial Survey

OBJECTIVES/GOALS: The aim of this project is to assess the usability and acceptance of a web-based educational resource for early career researchers. The Emerging Investigators website is designed to bring together resources, provide educational support and foster a community of early career researchers throughout the Mount Sinai Health System (MSHS). Locally designed and built, this web-based platform is developed using the principles of Community of Inquiry (COI), which considers how the design of online learning environments might best create and sustain a sense of community among learners. Developing a resource that meets the needs of this cohort of researchers requires an iterative implementation strategy guided by user feedback. A formal website roll-out strategy and accompanied evaluation aims to determine the design, navigability, content, relevance and educational value of this online resource from a user perspective. METHODS/STUDY POPULATION: In order to ensure this resource effectively meets the needs of this cohort of researchers, a mixed process of evaluation and design was utilized. An initial phase 1 survey was conducted with TL1 and KL2 scholars. Surveys consisted of standardized questions with answers arranged as Likert-type scales and additional written responses to collect valuable qualitative data. A convenience sample of early career researchers at Mount Sinai were contacted for initial survey participation (N = 10). A total of 3 junior faculty KL2 scholars, 3 TL1 post-doc and 4 TL1 pre-doc scholars responded to the survey. Participants were initially asked to comment on design, functionality and usefulness of content on a Likert scale with qualitative comments to support the given scores. They were subsequently asked to consider what key topics or resources were missing from the website. Based on the initial survey, changes were made to the format and content of the Emerging Investigators website to improve content relevance and usability. For phase 2, an evaluation rubric was developed to assess design, navigability, content, relevance, along with three key COI criteria to determine the educational value of this online resource. The rubric will be utilized to collect feedback in the wider phase 2 roll out of the website. RESULTS/ANTICIPATED RESULTS: The first phase of survey feedback shaped overall design of the resource. The second phase will comprehensively evaluate the value of the website in the context of teaching and learning for emerging investigators. Ten surveys were captured in the first phase. Data collection is ongoing for the second phase. Phase 1 feedback was primarily qualitative, and valuable in informing overall design choices and content. Overall the website was well received, with participants commenting on the value of the resource in terms of content and educational value. Participants particularly appreciated the regularly updated calendar function and the links provided to a wide range of resources. Functionality issues, such as broken links, were reported by participants and repaired for phase 2. Further topics of content were identified, and additional links and multimedia resources were added to address this feedback. The second phase evaluation is ongoing with data collection being conducted via an evaluation rubric. DISCUSSION/SIGNIFICANCE OF IMPACT: The Emerging Investigators website, developed using the principles of COI provides key learning, reading and resources for early career investigators in a format that is well received by a sample group of early career researchers at Mount Sinai. The website has aimed to address the reported need for communication, collaboration and social interaction with peers and other researchers across the MSHS through the addition of further web-based resources such as a LinkedIn page, a blog to feature research and provide a sounding board for research efforts, and a calendar of events targeted specifically at early career researchers. These were highlighted as areas of particular value by the participants. We anticipate the results of phase 2 rubric-based evaluations will provide actionable data that will lead to further refinement of the website, an optimized interface, and improved usability.

scholarly journals LO19: AED on the fly: A drone delivery feasibility study for rural and remote out-of-hospital cardiac arrest

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S13-S14
Author(s):  
I. Drennan ◽  
S. Cheskes ◽  
P. Snobelen ◽  
M. Nolan ◽  
T. Chan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Phase 1 ◽  
Sudden Cardiac Arrest ◽  
Optimal Strategies ◽  
Second Phase ◽  
Phase 2 ◽  
Rural And Remote ◽  
Automated External Defibrillators ◽  
Lift Off

Introduction: Time-to-treatment plays a pivotal role in survival from sudden cardiac arrest (SCA). Every minute delay in defibrillation results in a 7-10% reduction in survival. This is particularly problematic in rural and remote regions, where bystander and EMS response is often prolonged and automated external defibrillators (AED) are often not available. Our objective was to examine the feasibility of a novel AED drone delivery method for rural and remote SCA. A secondary objective was to compare times between AED drone delivery and ambulance response to various mock SCA resuscitations. Methods: We conducted 6 simulations in two different rural communities in southern Ontario. During phase 1 (4 simulations) a “mock” call was placed to 911 and a single AED drone and an ambulance were simultaneously dispatched from the same location to a pre-determined destination. Once on scene, trained first responders retrieved the AED from the drone and initiated resuscitative efforts on a manikin. The second phase (2 scenarios) were done in a similar manner save for the drone being dispatched from a regionally optimized location for drone response. Results: Phase 1: The distance from dispatch location to scene varied from 6.6 km to 8.8 km. Mean (SD) response time from 911 call to scene arrival was 11.2 (+/- 1.0) minutes for EMS compared to 8.1 (+/- 0.1) for AED drone delivery. In all four simulations, the AED drone arrived before EMS, ranging from 2.1 to 4.4 minutes faster. The mean time for trained responders to retrieve the AED and apply it to the manikin was 35 (+/- 5) sec. No difficulties were encountered in drone activation by dispatch, drone lift off, landing or removal of the AED from the drone by responders. Phase 2: The ambulance response distance was 20km compared to 9km for the drone. Drones were faster to arrival at the scene by 7 minutes and 8 minutes with AED application 6 and 7 minutes prior to ambulance respectively. Conclusion: This implementation study suggests AED drone delivery is feasible with improvements in response time during a simulated SCA scenario. These results suggest the potential for AED drone delivery to decrease time to first defibrillation in rural and remote communities. Further research is required to determine the appropriate distance for drone delivery of an AED in an integrated EMS system as well as optimal strategies to simplify bystander application of a drone delivered AED.

Relocation does not have a significant effect on the growth rate of Bos indicus cross steers

2008 ◽  
Vol 48 (5) ◽  
pp. 608 ◽  
Author(s):  
R. G. Holroyd ◽  
V. J. Doogan ◽  
M. R. Jeffery ◽  
J. A. Lindsay ◽  
B. K. Venus ◽  
...  
Keyword(s):  
Growth Rate ◽  
Phase 1 ◽  
Bos Indicus ◽  
Poor Performance ◽  
The Other ◽  
Control Group ◽  
Phase 2 ◽  
Treatment Groups ◽  
Normal Ranges ◽  
Native Pastures

This experiment tested the hypothesis that relocating cattle is detrimental to their growth. The study examined the effect of having relocated cattle mixed with, or segregated from, the local acclimatised cattle at the destination property. Bos indicus cross steers (120) were allocated to three groups and were relocated, in two separate cohorts, 980 km from northern Queensland to improved pastures in central Queensland. At the start of Phase 1, the control group (C) was moved 3 months before the other two groups. The remaining two groups grazed native pastures; one group was supplemented (SR) to increase growth rate similar to that expected from improved pasture in central Queensland and the other was not supplemented (R). At the end of Phase 1, C was significantly (P < 0.05) heavier than SR, which was significantly (P < 0.05) heavier than R. At the start of Phase 2, the SR and R groups were relocated and after transportation the R and SR groups lost 12 kg or 4.4% of liveweight and 18 kg or 5.7% of liveweight, respectively; this weight loss was recovered after 5 days. All steers were reallocated to segregated (SEG) or mixed (MIX) treatment groups forming six treatments (SEG.C, SEG.R and SEG.SR and MIX.C, MIX.R and MIX.SR). There were no significant differences in liveweights within the SEG treatments by 57 days or within the MIX treatments by 106 days after relocation. There were few if any significant differences in the plasma constituents and differential leucocyte counts of the steers and most results were within physiologically normal ranges. We conclude on the basis of these results and of other experiments that the anecdotal poor performance of cattle after relocation appears to be unfounded.

scholarly journals Developing Strategies to Reduce Unnecessary Services in Primary Care: Protocol for User-Centered Design Charrettes (Preprint)

2019 ◽  
Author(s):  
Mandi L Klamerus ◽  
Laura J Damschroder ◽  
Jordan B Sparks ◽  
Sarah E Skurla ◽  
Eve A Kerr ◽  
...  
Keyword(s):  
Primary Care ◽  
Design Process ◽  
Phase 1 ◽  
Primary Care Providers ◽  
Medical Services ◽  
Second Phase ◽  
Phase 2 ◽  
User Centered Design ◽  
The Impact ◽  
User Centered

BACKGROUND Overtreatment and overtesting expose patients to unnecessary, wasteful, and potentially harmful care. Reducing overtreatment or overtesting that has become ingrained in current clinical practices and is being delivered on a routine basis will require solutions that incorporate a deep understanding of multiple perspectives, particularly those on the front lines of clinical care: patients and their clinicians. Design approaches are a promising and innovative way to incorporate stakeholder needs, desires, and challenges to develop solutions to complex problems. OBJECTIVE This study aimed (1) to engage patients in a design process to develop high-level deintensification strategies for primary care (ie, strategies for scaling back or stopping routine medical services that more recent evidence reveals are not beneficial) and (2) to engage both patients and primary care providers in further co-design to develop and refine the broad deintensification strategies identified in phase 1. METHODS We engaged stakeholders in design charrettes—intensive workshops in which key stakeholders are brought together to develop creative solutions to a specific problem—focused on deintensification of routine overuse in primary care. We conducted the study in 2 phases: a 6.5-hour design charrette with 2 different groups of patients (phase 1) and a subsequent 4-hour charrette with clinicians and a subgroup of phase 1 patients (phase 2). Both phases included surveys and educational presentations related to deintensification. Phase 1 involved several design activities (mind mapping, business origami, and empathy mapping) to help patients gain a deeper understanding of the individuals involved in deintensification. Following that, we asked participants to review hypothetical scenarios where patients, clinicians, or the broader health system context posed a barrier to deintensification and then to brainstorm solutions. The deintensification themes identified in phase 1 were used to guide phase 2. This second phase primarily involved 1 design activity (<italic>WhoDo</italic>). In this activity, patients and clinicians worked together to develop concrete actions that specific stakeholders could take to support deintensification efforts. This activity included identifying barriers to the actions and approaches to overcoming those barriers. RESULTS A total of 35 patients participated in phase 1, and 9 patients and 7 clinicians participated in phase 2. The analysis of the deintensification strategies and survey data is currently underway. The results are expected to be submitted for publication in early 2020. CONCLUSIONS Health care interventions are frequently developed without input from the people who are most affected. The exclusion of these stakeholders in the design process often influences and limits the impact of the intervention. This study employed design charrettes, guided by a flexible user-centered design model, to bring clinicians and patients with differing backgrounds and with different expectations together to cocreate real-world solutions to the complex issue of deintensifying medical services.

scholarly journals The COVID-19 pandemic continues to change the way people recreate outdoors: A second preliminary report on a national survey of outdoor enthusiasts amid the COVID-19 pandemic

2020 ◽  
Author(s):  
William L. Rice ◽  
Tim Mateer ◽  
B. Derrick Taff ◽  
Ben Lawhon ◽  
Nathan Reigner ◽  
...  
Keyword(s):  
Preliminary Report ◽  
Research Effort ◽  
Phase 1 ◽  
Rapid Assessment ◽  
Public Lands ◽  
The United States ◽  
Second Phase ◽  
Phase 2 ◽  
Leave No Trace ◽  
The Way

The COVID-19 pandemic continues to alter daily life and lead to changes in the way we spend time outside. In an effort to gather timely and relevant data on national recreation patterns before, during, and after the pandemic, the Leave No Trace Center for Outdoor Ethics and its academic partner, Pennsylvania State University, have been working to conduct a study that can offer guidance to land managers, recreation providers, and outdoor enthusiasts across the United States. Phase 1 of this assessment was conducted April 9th – 11th, 2020 (Rice et al., 2020). Phase 2 of this assessment was conducted April 30th – May 2nd. This second phase of research—discussed in this preliminary report— was designed to provide additional information regarding changes in recreation trends since April 9th, which provides valuable information for managing dynamic recreational use on public lands. In total, 823 outdoor recreationists were surveyed through the Leave No Trace community in a 48-hour window beginning on the morning of April 30th. The results of this second rapid assessment—complete with comparisons to Phase 1 data—will provide valuable information for managing the changing recreation use of public lands, predicting spikes in recreation, and offering insight for land managers as they work to protect the natural world.The following tables, figures, and corresponding brief descriptions are intended to provide initial results from Phase 2 of our research effort, with comparisons to Phase 1 when appropriate. Further results are forthcoming.

Response of Multiple Bend System to Multi Phase Flow

2021 ◽  
Author(s):  
H. Pereboom ◽  
S. P. C. Belfroid ◽  
N. Gonzalez-Diez ◽  
J. Reijtenbagh
Keyword(s):  
Phase 1 ◽  
High Amplitude ◽  
Free Vibrations ◽  
Second Phase ◽  
Phase 2 ◽  
Atmospheric Conditions ◽  
Pipe System ◽  
Piping Systems ◽  
Multi Phase Flow ◽  
Multi Phase

Abstract Multiphase flow can induce high amplitude vibrations in piping systems. Several experimental campaigns focused on the force spectrum on a single bend. To evaluate the evolution of the forces from bend to bend, experiments have been done on an air-water, one inch pipe system consisting of six bends at near-atmospheric conditions. In a first phase, all individual bends were clamped to measure the phase relation and correlation of the flow-induced forces on the subsequent bends. In a second phase, all clamps were removed to measure the free vibrations. In this paper which focusses on the phase 2 results, the vibration measurements were compared to the calculated vibrations. For the excitation forces and phase relations, the measured force spectra from phase 1 are used. Damping values are based on experimental results from phase 2. The results show a good match between modeled and measured vibrations levels. Including the measured correlation between forces at multiple bends, improves the modeled results for slug flow cases. It is possible to directly use extract damping values from the measured signals, however, robustness of the damping estimation needs to be improved. Using average damping values currently leads to the best match.

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