An analytical compendium of the various branches of medical science, for the use and examination of students,

pt. 1. A hand-book of anatomy.--pt. 2. A hand-book of physiology.--pt. 3. A hand-book of surgery.--pt. 4. A hand-book of obstetrics.--pt. 5. A hand-book of materia medica and therapeutics.--pt. 6. A hand-book of chemistry.--pt. 7. A hand-book of the practice of medicine.

Use of the Interstate Highway System right-of-way for magnetic levitation high speed transportation systems : hearing before the Subcommittee on Water Resources, Transportation, and Infrastructure of the Committee on Environment and Public Works, United States Senate, One Hundredth Congress, second session, on S. 2072 ....

"September 28, 1988"--Pt. 2.

Africa and the challenge of development : hearings before the Subcommittee on Africa of the Committee on Foreign Affairs, Ninetieth Congress, second session, July 25, 1967 and April 24, May 8 and 14, 1968.

Examines health and medical facilities in Africa south of Sahara and considers needs and opportunities for U.S. private investment in Africa.

The Child protection act of 1966: hearings, Eighty-ninth Congress, second session on S. 3298, a bill to amend the Federal hazardous substances labeling act to ban hazardous toys and articles intended for children, and other articles so hazardous as to be dangerous in the household regardless of labeling, and to apply to unpackaged articles intended for household use, and for other purposes, August 24 and 26, 1966.

Committee Serial No. 89-79. Considers S. 3298, to ban sale of toys and other articles so hazardous as to be unsuitable for play or use, even with labeling under the Federal Hazardous Substances Labeling Act.

Hormones down under: Hormone therapy use after the women's health initiative

Aims: The primary objective was to describe the usage pattern of hormone therapy (HT) in a sample of urban Australian women in 2001 and to assess the characteristics of users vs. non-users. The second objective was to determine whether there had been any change in usage since the publication of the results of the combined oestrogen plus progestagen arm of the Women's Health Initiative (WHI) in 2002. Methods: A cohort of 374 postmenopausal women aged 50-80 years participated in this substudy of the LAW (Longitudinal Assessment of Ageing in Women) project: a 5-year multidisciplinary, observational study. Participants completed an annual medical assessment including details of the use of HT and the reasons for use, as well as demographic and psychosocial data. Results: In December 2001, 30.8% of the participants were using HT, whereas 55.4% were ever users. The management of vasomotor symptoms and mood disturbance were the primary reasons for use. Of those who had been using HT in December 2001 (24.4%) women ceased using HT in the 3 months following publication of the WHI results. The percentage of women using HT in December 2003 (13.9%) was less than half of that of December 2001. Conclusion: The rate of HT use and the reasons for use, in 2001 in Brisbane was similar to that of other Australian regions. Usage of HT decreased since the publication of the WHI results in 2002 which may reflect changing attitudes by patients and practitioners regarding HT.

Anticholinergic medication use and cognitive impairment in the older population:the Medical Research Council cognitive function and ageing study

OBJECTIVES: To determine whether the use of medications with possible and definite anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative. DESIGN: A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993. SETTING: Community-dwelling and institutionalized participants. PARTICIPANTS: Thirteen thousand four participants aged 65 and older. MEASUREMENTS: Baseline use of possible or definite anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. RESULTS: At baseline, 47% of the population used a medication with possible anticholinergic properties, and 4% used a drug with definite anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonanticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03–0.64, P=.03) than not taking anticholinergics, whereas the use of possible anticholinergics at baseline was not associated with further decline (0.02, 95% CI=-0.14–0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30–2.16; P<.001) and possible (OR=1.56; 95% CI=1.36–1.79; P<.001) anticholinergics. CONCLUSION: The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.

Use of social media to enable medical teams to work virtually (and better)

Refers to: Sophie Scott The researcher of the future…makes the most of social media The Lancet, Volume 381, Supplement 1, 27 February 2013, Pages S5-S6

Multiple component patient safety intervention in English hospitals:controlled evaluation of second phase

Objective: To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design: A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients' satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting: NHS hospitals in England. Participants: Nine hospitals participating in SPI2 and nine matched control hospitals. Intervention The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. Results: One of the scores (organisational climate) showed a significant (P=0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P=0.010) and 12 hour (2.4, 1.1 to 5.0; P=0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P=0.002), but the difference in difference was not significant (2.1, 0.4 to 11.1; P=0.236). There were no notable or significant changes in the pattern of prescribing errors, either over time or between control and SPI2 hospitals. Two items of medical history taking (exercise tolerance and occupation) showed significant improvement over time, across both control and SPI2 hospitals, but no additional SPI2 effect. The holistic review showed no significant changes in error rates either over time or between control and SPI2 hospitals. The explicit case note review of perioperative care showed that adherence rates for two of the four perioperative standards targeted by SPI2 were already good at baseline, exceeding 94% for antibiotic prophylaxis and 98% for deep vein thrombosis prophylaxis. Intraoperative monitoring of temperature improved over time in both groups, but this was not significant (1.8, 0.4 to 7.6; P=0.279), and there were no additional effects of SPI2. A dramatic rise in consumption of soap and alcohol hand rub was similar in control and SPI2 hospitals (P=0.760 and P=0.889, respectively), as was the corresponding decrease in rates of Clostridium difficile and meticillin resistant Staphylococcus aureus infection (P=0.652 and P=0.693, respectively). Mortality rates of medical patients included in the case note reviews in control hospitals increased from 17.3% (42/243) to 21.4% (24/112), while in SPI2 hospitals they fell from 10.3% (24/233) to 6.1% (7/114) (P=0.043). Fewer than 8% of deaths were classed as avoidable; changes in proportions could not explain the divergence of overall death rates between control and SPI2 hospitals. There was no significant difference in the rate of change in mortality in intensive care. Patients' satisfaction improved in both control and SPI2 hospitals on all dimensions, but again there were no significant changes between the two groups of hospitals. Conclusions: Many aspects of care are already good or improving across the NHS in England, suggesting considerable improvements in quality across the board. These improvements are probably due to contemporaneous policy activities relating to patient safety, including those with features similar to the SPI, and the emergence of professional consensus on some clinical processes. This phenomenon might have attenuated the incremental effect of the SPI, making it difficult to detect. Alternatively, the full impact of the SPI might be observable only in the longer term. The conclusion of this study could have been different if concurrent controls had not been used.

Classifying clinical decision making:interpreting nursing intuition, heuristics and medical diagnosis

This is the second of two linked papers exploring decision making in nursing. The first paper, 'Classifying clinical decision making: a unifying approach' investigated difficulties with applying a range of decision-making theories to nursing practice. This is due to the diversity of terminology and theoretical concepts used, which militate against nurses being able to compare the outcomes of decisions analysed within different frameworks. It is therefore problematic for nurses to assess how good their decisions are, and where improvements can be made. However, despite the range of nomenclature, it was argued that there are underlying similarities between all theories of decision processes and that these should be exposed through integration within a single explanatory framework. A proposed solution was to use a general model of psychological classification to clarify and compare terms, concepts and processes identified across the different theories. The unifying framework of classification was described and this paper operationalizes it to demonstrate how different approaches to clinical decision making can be re-interpreted as classification behaviour. Particular attention is focused on classification in nursing, and on re-evaluating heuristic reasoning, which has been particularly prone to theoretical and terminological confusion. Demonstrating similarities in how different disciplines make decisions should promote improved multidisciplinary collaboration and a weakening of clinical elitism, thereby enhancing organizational effectiveness in health care and nurses' professional status. This is particularly important as nurses' roles continue to expand to embrace elements of managerial, medical and therapeutic work. Analysing nurses' decisions as classification behaviour will also enhance clinical effectiveness, and assist in making nurses' expertise more visible. In addition, the classification framework explodes the myth that intuition, traditionally associated with nurses' decision making, is less rational and scientific than other approaches.

Estimation of transportation battery second life for use in electricity grid systems

This paper presents research from part of a larger project focusing on the potential development of commercial opportunities for the reuse of batteries on the electricity grid system, subsequent to their primary use in low and ultra-low carbon vehicles, and investigating the life cycle issues surrounding the batteries. The work has three main areas; examination of electric vehicle fleet data in detail to investigate usage in first life. Batteries that have passed through a battery recycler at the end of their first life have been tested within the laboratory to confirm the general assumption that remaining capacity of 80% after use in transportation is a reasonable assumption as a basis for second-life applications. The third aspect of the paper is an investigation of the equivalent usage for three different second-life applications based on connection to the electricity grid. Additionally, the paper estimates the time to cell failure of the batteries within their second-life application to estimate lifespan for use within commercial investigations. © 2014 IEEE.

The relationship between the use of Academic Text Talk and the comprehension of scientific academic language for diverse second graders

Changing demographics impact our schools as children come from more linguistically and culturally diverse backgrounds. The various social, cultural, and economic backgrounds of the students affect their early language learning experiences which expose them to the academic language needed to succeed in school. Teachers can help students acquire academic language by introducing words that are within their Zone of Proximal Development and increasing exposure to and use of academic language. This study investigated the effects of increasing structured activities for students to orally interact with informational text on their scientific academic language development and comprehension of expository text. ^ The Academic Text Talk activities, designed to scaffold verbalization of new words and ideas, included discussion, retelling, games, and sentence walls. This study also evaluated if there were differences in scientific language proficiency and comprehension between boys and girls, and between English language learners and native English speakers. ^ A quasi-experimental design was used to determine the relationship between increasing students' oral practice with academic language and their academic language proficiency. Second graders (n = 91) from an urban public school participated in two science units over an 8 week period and were pre and post tested using the Woodcock Muñoz Language Survey-Revised and vocabulary tests from the National Energy Education Project. Analysis of covariance was performed on the pre to post scores by treatment group to determine differences in academic language proficiency for students taught using Academic Text Talk compared to students taught using a text-centered method, using the initial Florida Assessment for Instruction in Reading test as a covariate. Students taught using Academic Text Talk multimodal strategies showed significantly greater increases in their pre to posttest means on the Woodcock Muñoz Language Survey-Revised Oral Language Totals and National Energy Education Development Project Vocabulary tests than students taught using the text-centered method, ps < .05. Boys did not show significantly greater increases than girls, nor did English language learners show significantly greater increases than the native English speakers. ^ This study informs the field of reading research by evaluating the effectiveness of a multimodal combination of strategies emphasizing discourse to build academic language.^

Contributions to HEVC Prediction for Medical Image Compression

Medical imaging technology and applications are continuously evolving, dealing with images of increasing spatial and temporal resolutions, which allow easier and more accurate medical diagnosis. However, this increase in resolution demands a growing amount of data to be stored and transmitted. Despite the high coding efficiency achieved by the most recent image and video coding standards in lossy compression, they are not well suited for quality-critical medical image compression where either near-lossless or lossless coding is required. In this dissertation, two different approaches to improve lossless coding of volumetric medical images, such as Magnetic Resonance and Computed Tomography, were studied and implemented using the latest standard High Efficiency Video Encoder (HEVC). In a first approach, the use of geometric transformations to perform inter-slice prediction was investigated. For the second approach, a pixel-wise prediction technique, based on Least-Squares prediction, that exploits inter-slice redundancy was proposed to extend the current HEVC lossless tools. Experimental results show a bitrate reduction between 45% and 49%, when compared with DICOM recommended encoders, and 13.7% when compared with standard HEVC.

Does video feedback analysis improve CPR performance in phase 5 medical students?

Background The use of simulation in medical education is increasing, with students taught and assessed using simulated patients and manikins. Medical students at Queen’s University of Belfast are taught advanced life support cardiopulmonary resuscitation as part of the undergraduate curriculum. Teaching and feedback in these skills have been developed in Queen’s University with high-fidelity manikins. This study aimed to evaluate the effectiveness of video compared to verbal feedback in assessment of student cardiopulmonary resuscitation performance Methods Final year students participated in this study using a high-fidelity manikin, in the Clinical Skills Centre, Queen’s University Belfast. Cohort A received verbal feedback only on their performance and cohort B received video feedback only. Video analysis using ‘StudioCode’ software was distributed to students. Each group returned for a second scenario and evaluation 4 weeks later. An assessment tool was created for performance assessment, which included individual skill and global score evaluation. Results One hundred thirty eight final year medical students completed the study. 62 % were female and the mean age was 23.9 years. Students having video feedback had significantly greater improvement in overall scores compared to those receiving verbal feedback (p = 0.006, 95 % CI: 2.8–15.8). Individual skills, including ventilation quality and global score were significantly better with video feedback (p = 0.002 and p < 0.001, respectively) when compared with cohort A. There was a positive change in overall score for cohort B from session one to session two (p < 0.001, 95 % CI: 6.3–15.8) indicating video feedback significantly benefited skill retention. In addition, using video feedback showed a significant improvement in the global score (p < 0.001, 95 % CI: 3.3–7.2) and drug administration timing (p = 0.004, 95 % CI: 0.7–3.8) of cohort B participants, from session one to session two. Conclusions There is increased use of simulation in medicine but a paucity of published data comparing feedback methods in cardiopulmonary resuscitation training. Our study shows the use of video feedback when teaching cardiopulmonary resuscitation is more effective than verbal feedback, and enhances skill retention. This is one of the first studies to demonstrate the benefit of video feedback in cardiopulmonary resuscitation teaching.

“Medical bag for General Practice” Just in Case: redesigning the doctor’s bag (2012)

This research addressed practice related problems from a medico-legal perspective and aims to provide a working tool that aids GPs to comply with best practice protocols. The resulting bag was developed in collaboration with General Practitioners, clinicians and members of the Medical Defense Union. Using proven methods developed within the Healthcare & Patient Safety Lab (e.g. DOME, Ambulance) to establish an evidence-based brief, this research used task, equipment and consumables analysis to determine minimum requirements and preferred layouts for task optimisation. The research established that clinicians require three distinct functions in their workspace: laying out, organisation and information retrieval. Feedback from clinicians indicates that this working tool allows them to access information and equipment wherever they may be and suggests an improvement from current practice. The research is now into a second year where the design of the bag will be refined and tested. Lifestyle and demographic changes such as the ageing population and increased prevalence of chronic diseases require more consistent standards of primary care, and care that is well coordinated and integrated (Imison, et al., 2011). Many guidelines exist relating to general practice and the doctor’s bag (NSLMC, 2008, RACGP, 2010, RCGP, 2008 and Hiramanek, 2004), however there is no standard in the UK that regulates the shape and materials of the bag or its contents. Doctors may use any sort of vessel to transport their equipment and consumables to a patient’s location. Furthermore, treating a patient in their own home, outside an ideal clinical environment, presents its own complications. A looks-like, works-like bag prototype and information system that will be used in clinical trials, the results of which will determine the manufacturing of a new, standardised bag for clinical treatment used by members of the Medical Defence Union.