Development of a standard sign-out procedure for clinicians in a pediatric intensive care unit

Background: Poor communication among health care providers is cited as the most common cause of sentinel events involving patients. Sign-out of patient data at the change of clinician shifts is a component of communication that is especially vulnerable to errors. Sign-outs are particularly extensive and complex in intensive care units (ICUs). There is a paucity of validated tools to assess ICU sign-outs. ^ Objective: To design a valid and reliable survey tool to assess the perceptions of Pediatric ICU (PICU) clinicians about sign-out. ^ Design: Cross-sectional, web-based survey ^ Setting: Academic hospital, 31-bed PICU ^ Subjects: Attending faculty, fellows, nurse practitioners and physician assistants. ^ Interventions: A survey was designed with input from a focus group and administered to PICU clinicians. Test-retest reliability, internal consistency and validity of the survey tool were assessed. ^ Measurements and Main Results: Forty-eight PICU clinicians agreed to participate. We had 42(88%) and 40(83%) responses in the test and retest phases. The mean scores for the ten survey items ranged from 2.79 to 3.67 on a five point Likert scale with no significant test-retest difference and a Pearson correlation between pre and post answers of 0.65. The survey item scores showed internal consistency with a Cronbach's Alpha of 0.85. Exploratory factor analysis revealed three constructs: efficacy of sign-out process, recipient satisfaction and content applicability. Seventy eight % clinicians affirmed the need for improvement of the sign-out process and 83% confirmed the need for face- to-face verbal sign-out. A system-based sign-out format was favored by fellows and advanced level practitioners while attendings preferred a problem-based format (p=0.003). ^ Conclusions: We developed a valid and reliable survey to assess clinician perceptions about the ICU sign-out process. These results can be used to design a verbal template to improve and standardize the sign-out process.^

Self -management behavior in patients with cystic fibrosis

Self-management is being promoted in cystic fibrosis (CF). However, it has not been well studied. Principal aims of this research were (1) to evaluate psychometric properties of a CF disease status measure, the NIH Clinical Score; (2) to develop and validate a measure of self-management behavior, the SMQ-CF scale, and (3) to examine the relation between self-management and disease status in CF patients over two years.^ In study 1, NIH Clinical Scores for 200 patients were used. The scale was examined for internal consistency, interrater reliability, and content validity using factor analysis. The Cronbach's alpha (.81) and interrater reliability (.90) for the total scale were high. General scale items were less reliable. Factor analysis indicated that most of the variance in disease status is accounted for by Factor 1 which consists of pulmonary disease items.^ The SMQ-CF measures the performance of CF self-management. Pilot testing was done with 98 CF primary caregivers. Internal consistency reliability, social desirability bias, and content validity using factor analysis were examined. Internal consistency was good (alpha =.95). Social desirability correlation was low (r =.095). Twelve factors identified were consistent with conceptual groupings of behaviors. Around two hundred caregivers from two CF centers were surveyed and multivariate analysis of variance was used to assess construct validity. Results confirmed expected relations between self-management, patient age, and disease status. Patient age accounted for 50% and disease status 18% of the variance in the SMQ-CF scale.^ It was hypothesized that self-management would positively affect future disease status. Data from 199 CF patients (control and education intervention groups) were examined. Models of hypothesized relations were tested using LISREL structural equation modeling. Results indicated that the relations between baseline self-management and Time 1 disease status were not significant. Significant relations were observed in self-management behaviors from time 1 to time 2 and patterns of significant relations differed between the two groups.^ This research has contributed to refinements in the ability to measure self-management behavior and disease status outcomes in cystic fibrosis. In addition, it provides the first steps in exploratory behavioral analysis with regard to self-management in this disease. ^

Early Cenozoic Atlantic and Pacific benthic foraminiferal isotopes from 12 sites

Oxygen and carbon isotope records are important tools used to reconstruct past ocean and climate conditions, with those of benthic foraminifera providing information on the deep oceans. Reconstructions are complicated by interspecies isotopic offsets that result from microhabitat preferences (carbonate precipitation in isotopically distinct environments) and vital effects (species-specific metabolic variation in isotopic fractionation). We provide correction factors for early Cenozoic benthic foraminifera commonly used for isotopic measurements (Cibicidoides spp., Nuttallides truempyi, Oridorsalis spp., Stensioina beccariiformis, Hanzawaia ammophila, and Bulimina spp.), showing that most yield reliable isotopic proxies of environmental change. The statistical methods and larger data sets used in this study provide more robust correction factors than do previous studies. Interspecies isotopic offsets appear to have changed through the Cenozoic, either (1) as a result of evolutionary changes or (2) as an artifact of different statistical methods and data set sizes used to determine the offsets in different studies. Regardless of the reason, the assumption that isotopic offsets have remained constant through the Cenozoic has introduced an 1-2°C uncertainty into deep sea paleotemperature calculations. In addition, we compare multiple species isotopic data from a western North Atlantic section that includes the Paleocene-Eocene thermal maximum to determine the most reliable isotopic indicator for this event. We propose that Oridorsalis spp. was the most reliable deepwater isotopic recorder at this location because it was best able to withstand the harsh water conditions that existed at this time; it may be the best recorder at other locations and for other extreme events also.

Reliability issues related to the usage of Cloud Computing in Critical Infrastructures

The use of cloud computing is extending to all kind of systems, including the ones that are part of Critical Infrastructures, and measuring the reliability is becoming more difficult. Computing is becoming the 5th utility, in part thanks to the use of cloud services. Cloud computing is used now by all types of systems and organizations, including critical infrastructure, creating hidden inter-dependencies on both public and private cloud models. This paper investigates the use of cloud computing by critical infrastructure systems, the reliability and continuity of services risks associated with their use by critical systems. Some examples are presented of their use by different critical industries, and even when the use of cloud computing by such systems is not widely extended, there is a future risk that this paper presents. The concepts of macro and micro dependability and the model we introduce are useful for inter-dependency definition and for analyzing the resilience of systems that depend on other systems, specifically in the cloud model.

Design and Test of a High QoS Radio Network for CBTC Systems in Subway Tunnels

Communications Based Train Control Systems require high quality radio data communications for train signaling and control. Actually most of these systems use 2.4GHz band with proprietary radio transceivers and leaky feeder as distribution system. All them demand a high QoS radio network to improve the efficiency of railway networks. We present narrow band, broad band and data correlated measurements taken in Madrid underground with a transmission system at 2.4 GHz in a test network of 2 km length in subway tunnels. The architecture proposed has a strong overlap in between cells to improve reliability and QoS. The radio planning of the network is carefully described and modeled with narrow band and broadband measurements and statistics. The result is a network with 99.7% of packets transmitted correctly and average propagation delay of 20ms. These results fulfill the specifications QoS of CBTC systems.

Digital Control Implementation to Reduce the Cost and Improve the Performance of the Control Stage of an Industrial Switched-Mode Power Supply

The main objective of this work is the design and implementation of the digital control stage of a 280W AC/DC industrial power supply in a single low-cost microcontroller to replace the analog control stage. The switch-mode power supply (SMPS) consists of a PFC boost converter with fixed frequency operation and a variable frequency LLC series resonant DC/DC converter. Input voltage range is 85VRMS-550VRMS and the output voltage range is 24V-28V. A digital controller is especially suitable for this kind of SMPS to implement its multiple functionalities and to keep the efficiency and the performance high over the wide range of input voltages. Additional advantages of the digital control are reliability and size. The optimized design and implementation of the digital control stage it is presented. Experimental results show the stable operation of the controlled system and an estimation of the cost reduction achieved with the digital control stage.

Ensayos acelerados de fiabilidad de células solares de concentración

SUMMARY Concentration Photovoltaic Systems (CPV) have been proposed as an alternative to conventional systems. During the last years, there has been a boom of the CPV industry caused by the technological progress in all the elements of the system. and mainly caused by the use of multijunction solar cells based on III-V semiconductors, with efficiencies exceeding to 43%. III-V solar cells have been used with high reliability results in a great number of space missions without concentration. However, there are no previous results regarding their reliability in concentration terrestrial applications, where the working conditions are completely different. This lack of experience, together with the important industrial interest, has generated the need to evaluate the reliability of the cells. For this reason, nowadays there are several research centers around the undertaking this task. The evaluation of the reliability of this type of devices by means of accelerated tests is especially problematic when they work at medium or high concentration, because it is practically impossible to emulate real working conditions of the cell inside climatic chambers. In fact, as far as we know, the results that appear in this Thesis are the first estimating the Activation Energy of the failure mechanism involved, as well as the warranty of the III-V concentrator solar cells tested here. To evaluate the reliability of III-V very high concentrator solar cells by means of accelerated tests, a variety of activities, described in this Thesis have been carried out. The First Part of the memory presents the theoretical part of the Doctoral Thesis. After the Introduction, chapter 2 presents the state of the art in degradation and reliability of CPV systems and solar cells. Chapter 3 introduces some reliability definitions and the application of specific statistical functions to the evaluation of the reliability and parameters. From these functions, important parameters will be calculated to be used later in the experimental results of Thesis. The Second Part of the memory contains the experimental. Chapter 4 shows the types of accelerated tests and the main goals pursuit with them when carried out over CPV systems and solar cells. In order to evaluate quantitatively the reliability of the III-V concentrator solar cells used in these tests, some modifications have been introduced which discussion will be tackled here. Based on this analysis the working plan of the tests carried out in this Doctoral Thesis is presented. Chapter 5 presents a new methodology as well as the necessary instrumentation to carry out the tests described here. This new methodology takes into account the adaptation, improvement and novel techniques needed to test concentrator solar cells. The core of this memory is chapter 6, which presents the results of the characterization of the cells during the accelerated life tests and the analysis of the aforementioned results with the purpose of getting quantitative values of reliability in real working conditions. The acceleration factor of the accelerated life tests, under nominal working conditions has been calculated. Accordingly, the validity of the methodology as well as the calculations based on the reliability assessment, have also been demonstrated. Finally, quantitative values of degradation, reliability and warranty of the solar cells under field nominal working conditions have been calculated. With the development of this Doctoral Thesis the reliability of very high concentrator GaAs solar cells of small area has been evaluated. It is very interesting to generalize the procedures described up to this point to III-V multijunction solar cells of greater area. Therefore, chapter 7 develops this generalization and introduces also a useful thermal modeling by means of finite elements of the test cells’ circuits. In the last chapter, the summary of the results and the main contributions of this Thesis are outlined and future research activities are identified. RESUMEN Los Sistemas Fotovoltaicos de Concentración (SFC) han sido propuestos como una alternativa a los sistemas convencionales de generación de energía. Durante los últimos años ha habido un auge de los SFC debido a las mejoras tecnológicas en todos los elementos del sistema, y principalmente por el uso de células multiunión III-V que superan el 43% de rendimiento. Las células solares III-V han sido utilizadas con elevada fiabilidad en aplicaciones espaciales sin concentración, pero no existe experiencia de su fiabilidad en ambiente terrestre a altos niveles de concentración solar. Esta falta de experiencia junto al gran interés industrial ha generado la necesidad de evaluar la fiabilidad de las células, y actualmente hay un significativo número de centros de investigación trabajando en esta área. La evaluación de la fiabilidad de este tipo de dispositivos mediante ensayos acelerados es especialmente problemática cuando trabajan a media o alta concentración por la casi imposibilidad de emular las condiciones de trabajo reales de la célula dentro de cámaras climáticas. De hecho, que sepamos, en los resultados de esta Tesis se evalúa por primera vez la Energía de Activación del mecanismo de fallo de las células, así como la garantía en campo de las células de concentración III-V analizadas. Para evaluar la fiabilidad de células solares III-V de muy alta concentración mediante ensayos de vida acelerada se han realizado diversas actividades que han sido descritas en la memoria de la Tesis. En la Primera Parte de la memoria se presenta la parte teórica de la Tesis Doctoral. Tras la Introducción, en el capítulo 2 se muestra el estado del arte en degradación y fiabilidad de células y Sistemas Fotovoltaicos de Concentración. En el capítulo 3 se exponen de forma resumida las definiciones de fiabilidad y funciones estadísticas que se utilizan para la evaluación de la fiabilidad y sus parámetros, las cuales se emplearán posteriormente en los ensayos descritos en este Tesis. La Segunda Parte de la memoria es experimental. En el capítulo 4 se describen los tipos y objetivos de los ensayos acelerados actualmente aplicados a SFC y a las células, así como las modificaciones necesarias que permitan evaluar cuantitativamente la fiabilidad de las células solares de concentración III-V. En base a este análisis se presenta la planificación de los trabajos realizados en esta Tesis Doctoral. A partir de esta planificación y debido a la necesidad de adaptar, mejorar e innovar las técnicas de ensayos de vida acelerada para una adecuada aplicación a este tipo de dispositivos, en el capítulo 5 se muestra la metodología empleada y la instrumentación necesaria para realizar los ensayos de esta Tesis Doctoral. El núcleo de la memoria es el capítulo 6, en él se presentan los resultados de caracterización de las células durante los ensayos de vida acelerada y el análisis de dichos resultados con el objetivo de obtener valores cuantitativos de fiabilidad en condiciones reales de trabajo. Se calcula el Factor de Aceleración de los ensayos acelerados con respecto a las condiciones nominales de funcionamiento a partir de la Energía de Activación obtenida, y se demuestra la validez de la metodología y cálculos empleados, que son la base de la evaluación de la fiabilidad. Finalmente se calculan valores cuantitativos de degradación, fiabilidad y garantía de las células en condiciones nominales en campo durante toda la vida de la célula. Con el desarrollo de esta Tesis Doctoral se ha evaluado la fiabilidad de células III-V de área pequeña, pero es muy interesante generalizar los procedimientos aquí desarrollados para las células III-V comerciales de área grande. Por este motivo, en el capítulo 7 se analiza dicha generalización, incluyendo el modelado térmico mediante elementos finitos de los circuitos de ensayo de las células. En el último capítulo se realiza un resume del trabajo y las aportaciones realizadas, y se identifican las líneas de trabajo a emprender en el futuro.

Methodological Proposal for Teamwork Evaluation in the field of training Project Management.

Teamwork, is one of the abilities that today is highly valued in the professional arena with a great importance for various personal and interpersonal skills associated with it. In this context, the Technical University of Madrid, is developing a coordinated educational innovation project, which main objective is to develop methodological and assessment tools for the acquisition of personal skills necessary to improve the employability of graduates and their skills for project management. Within this context, this paper proposes a methodology composed of various activities and indicators, as well as specific assessment instruments linked to the teamwork competence. Through a series of systematic steps it was allowed the design of an instrument and construction of a scale for measuring the competence of teamwork. The practical application of the methodology has been carried out in Projects lectures from different Schools of Engineering at the Technical University of Madrid, which results are presented in this document as a pilot experience. Results show the various aspects and methods that teachers should consider in evaluating the competence of the work, including analysis of the quality of results, through reliability and construct validity. On the other hand, show the advantages of applying this methodology in the field of project management teaching.

Diagnosing Causes of Water Scarcity in Complex Water Resources Systems and Identifying Risk Management Actions

From the water management perspective, water scarcity is an unacceptable risk of facing water shortages to serve water demands in the near future. Water scarcity may be temporary and related to drought conditions or other accidental situation, or may be permanent and due to deeper causes such as excessive demand growth, lack of infrastructure for water storage or transport, or constraints in water management. Diagnosing the causes of water scarcity in complex water resources systems is a precondition to adopt effective drought risk management actions. In this paper we present four indices which have been developed to evaluate water scarcity. We propose a methodology for interpretation of index values that can lead to conclusions about the reliability and vulnerability of systems to water scarcity, as well as to diagnose their possible causes and to propose solutions. The described methodology was applied to the Ebro river basin, identifying existing and expected problems and possible solutions. System diagnostics, based exclusively on the analysis of index values, were compared with the known reality as perceived by system managers, validating the conclusions in all cases

Real time passenger information systems and quality of bus services

One of the main problems in urban areas is the steady growth in car ownership and traffic levels. Therefore, the challenge of sustainability is focused on a shift of the demand for mobility from cars to collective means of transport. For this end, buses are a key element of the public transport systems. In this respect Real Time Passenger Information (RTPI) systems help citizens change their travel behaviour towards more sustainable transport modes. This paper provides an assessment methodology which evaluates how RTPI systems improve the quality of bus services in two European cities, Madrid and Bremerhaven. In the case of Madrid, bus punctuality has increased by 3%. Regarding the travellers perception, Madrid raised its quality of service by 6% while Bremerhaven increased by 13%. On the other hand, the users ́ perception of Public Transport (PT) image increased by 14%.

A scalable SIEM correlation engine and its application to the Olympic Games IT infrastructure

The security event correlation scalability has become a major concern for security analysts and IT administrators when considering complex IT infrastructures that need to handle gargantuan amounts of events or wide correlation window spans. The current correlation capabilities of Security Information and Event Management (SIEM), based on a single node in centralized servers, have proved to be insufficient to process large event streams. This paper introduces a step forward in the current state of the art to address the aforementioned problems. The proposed model takes into account the two main aspects of this ?eld: distributed correlation and query parallelization. We present a case study of a multiple-step attack on the Olympic Games IT infrastructure to illustrate the applicability of our approach.

LED bulb lamps technical specification and testing procedure for solar home systems.

With the consolidation of the new solid state lighting LEOs devices, te5t1n9 the compliance 01 lamps based on this technology lor Solar Home Systems (SHS) have been analyzed. The definition of the laboratory procedures to be used with final products 15 a necessary step in arder to be able to assure the quality of the lamps prior to be installed [1]. As well as with CFL technology. particular attention has been given to simplicity and technical affordability in arder to facilitate the implementation of the test with basie and simple laboratory too15 even on the same SHS electrification program locations. The block of test procedures has been applied to a set of 14 low-cost lamps. They apply to lamp resistance, reliability and performance under normal, extreme and abnormal operating conditions as a simple but complete quality meter tool 01 any LEO bulb.

Variable Speed Limits. Review and development of an aggregate indicator based on floating car data.

Changing factors (mainly traffic intensity and weather conditions) affecting road conditions require a suitable optimal speed at any time. To solve this problem, variable speed limit systems (VSL) ? as opposed to fixed limits ? have been developed in recent decades. This term has included a number of speed management systems, most notably dynamic speed limits (DSL). In order to avoid the indiscriminate use of both terms in the literature, this paper proposes a simple classification and offers a review of some experiences, how their effects are evaluated and their results This study also presents a key indicator, which measures the speed homogeneity and a methodology to obtain the data based on floating cars and GPS technology applying it to a case study on a section of the M30 urban motorway in Madrid (Spain).

Evaluation of the reliability of high concentrator GaAs solar cells by means of temperature accelerated aging tests

ABSTRACT Evaluating the reliability, warranty period, and power degradation of high concentration solar cells is crucial to introducing this new technology to the market. The reliability of high concentration GaAs solar cells, as measured in temperature accelerated life tests, is described in this paper. GaAs cells were tested under high thermal accelerated conditions that emulated operation under 700 or 1050 suns over a period exceeding 10 000 h. Progressive power degradation was observed, although no catastrophic failures occurred. An Arrhenius activation energy of 1.02 eV was determined from these tests. The solar cell reliability [R(t)] under working conditions of 65°C was evaluated for different failure limits (1–10% power loss). From this reliability function, the mean time to failure and the warranty time were evaluated. Solar cell temperature appeared to be the primary determinant of reliability and warranty period, with concentration being the secondary determinant. A 30-year warranty for these 1 mm2-sized GaAs cells (manufactured according to a light emitting diode-like approach) may be offered for both cell concentrations (700 and 1050 suns) if the solar cell is operated at a working temperature of 65°C.