Validation and reclassification of MGAP and GAP in hospital settings using data from the Trauma Audit and Research Network.

BACKGROUND Recently, two simple clinical scores were published to predict survival in trauma patients. Both scores may successfully guide major trauma triage, but neither has been independently validated in a hospital setting. METHODS This is a cohort study with 30-day mortality as the primary outcome to validate two new trauma scores-Mechanism, Glasgow Coma Scale (GCS), Age, and Pressure (MGAP) score and GCS, Age and Pressure (GAP) score-using data from the UK Trauma Audit and Research Network. First, an assessment of discrimination, using the area under the receiver operating characteristic (ROC) curve, and calibration, comparing mortality rates with those originally published, were performed. Second, we calculated sensitivity, specificity, predictive values, and likelihood ratios for prognostic score performance. Third, we propose new cutoffs for the risk categories. RESULTS A total of 79,807 adult (≥16 years) major trauma patients (2000-2010) were included; 5,474 (6.9%) died. Mean (SD) age was 51.5 (22.4) years, median GCS score was 15 (interquartile range, 15-15), and median Injury Severity Score (ISS) was 9 (interquartile range, 9-16). More than 50% of the patients had a low-risk GAP or MGAP score (1% mortality). With regard to discrimination, areas under the ROC curve were 87.2% for GAP score (95% confidence interval, 86.7-87.7) and 86.8% for MGAP score (95% confidence interval, 86.2-87.3). With regard to calibration, 2,390 (3.3%), 1,900 (28.5%), and 1,184 (72.2%) patients died in the low, medium, and high GAP risk categories, respectively. In the low- and medium-risk groups, these were almost double the previously published rates. For MGAP, 1,861 (2.8%), 1,455 (15.2%), and 2,158 (58.6%) patients died in the low-, medium-, and high-risk categories, consonant with results originally published. Reclassifying score point cutoffs improved likelihood ratios, sensitivity and specificity, as well as areas under the ROC curve. CONCLUSION We found both scores to be valid triage tools to stratify emergency department patients, according to their risk of death. MGAP calibrated better, but GAP slightly improved discrimination. The newly proposed cutoffs better differentiate risk classification and may therefore facilitate hospital resource allocation. LEVEL OF EVIDENCE Prognostic study, level II.

Air pollution data classification by SOM Neural Network

Over the last ten years, Salamanca has been considered among the most polluted cities in México. This paper presents a Self-Organizing Maps (SOM) Neural Network application to classify pollution data and automatize the air pollution level determination for Sulphur Dioxide (SO2) in Salamanca. Meteorological parameters are well known to be important factors contributing to air quality estimation and prediction. In order to observe the behavior and clarify the influence of wind parameters on the SO2 concentrations a SOM Neural Network have been implemented along a year. The main advantages of the SOM is that it allows to integrate data from different sensors and provide readily interpretation results. Especially, it is powerful mapping and classification tool, which others information in an easier way and facilitates the task of establishing an order of priority between the distinguished groups of concentrations depending on their need for further research or remediation actions in subsequent management steps. The results show a significative correlation between pollutant concentrations and some environmental variables.

Air sampling network:

Mode of access: Internet.

WDM sensor network approach:bridging the gap towards POF-based photonic sensing

In this work a self-referenced technique for fiberoptic intensity sensors using virtual lock-in amplifiers is proposed and discussed. The topology is compatible with WDM networks so multiple remote sensors can simultaneously be interrogated. A hybrid approach combining both silica fiber Bragg gratings and polymer optical fiber Bragg gratings is analyzed. The feasibility of the proposed solution for potential medical environments and biomedical applications is shown and tested using a selfreferenced configuration based on a power ratio parameter.

Closing the cultural distance gap: managing value-based knowledge in MNC by using MEP

Today more than ever, generating and managing knowledge is an essential source of competitive advantage for every organization, and particularly for Multinational corporations (MNC). However, despite the undisputed agreement about the importance of creating and managing knowledge, there are still a large number of corporations that act unethically or illegally. Clearly, there is a lack of attention in gaining more knowledge about the management of ethical knowledge in organizations. This paper refers to value-based knowledge, as the process of recognise and manage those values that stand at the heart of decision-making and action in organizations. In order to support MNCs in implementing value-based knowledge process, the managerial ethical profile (MEP) has been presented as a valuable tool to facilitate knowledge management process at both the intra-organizational network level and at the inter-organizational network level.

Optimization problems for controlled mechanical systems : bridging the gap between theory and application

Mechanical control systems have become a part of our everyday life. Systems such as automobiles, robot manipulators, mobile robots, satellites, buildings with active vibration controllers and air conditioning systems, make life easier and safer, as well as help us explore the world we live in and exploit it’s available resources. In this chapter, we examine a specific example of a mechanical control system; the Autonomous Underwater Vehicle (AUV). Our contribution to the advancement of AUV research is in the area of guidance and control. We present innovative techniques to design and implement control strategies that consider the optimization of time and/or energy consumption. Recent advances in robotics, control theory, portable energy sources and automation increase our ability to create more intelligent robots, and allows us to conduct more explorations by use of autonomous vehicles. This facilitates access to higher risk areas, longer time underwater, and more efficient exploration as compared to human occupied vehicles. The use of underwater vehicles is expanding in every area of ocean science. Such vehicles are used by oceanographers, archaeologists, geologists, ocean engineers, and many others. These vehicles are designed to be agile, versatile and robust, and thus, their usage has gone from novelty to necessity for any ocean expedition.

Flight testing of an augmented separation management system providing separation protection during failure of the central communication network

Future air traffic management concepts often involve the proposal of automated separation management algorithms that replaces human air traffic controllers. This paper proposes a new type of automated separation management algorithm (based on the satisficing approach) that utilizes inter-aircraft communication and a track file manager (or bank of Kalman filters) that is capable of resolving conflicts during periods of communication failure. The proposed separation management algorithm is tested in a range of flight scenarios involving during periods of communication failure, in both simulation and flight test (flight tests were conducted as part of the Smart Skies project). The intention of the conducted flight tests was to investigate the benefits of using inter-aircraft communication to provide an extra layer of safety protection in support air traffic management during periods of failure of the communication network. These benefits were confirmed.

The development of a conceptual framework for a district 4-Year Pavement Management Plan, implementation of network-level project screening process

The Texas Department of Transportation (TxDOT) is concerned about the widening gap between preservation needs and available funding. Funding levels are not adequate to meet the preservation needs of the roadway network; therefore projects listed in the 4-Year Pavement Management Plan must be ranked to determine which projects should be funded now and which can be postponed until a later year. Currently, each district uses locally developed methods to prioritize projects. These ranking methods have relied on less formal qualitative assessments based on engineers’ subjective judgment. It is important for TxDOT to have a 4-Year Pavement Management Plan that uses a transparent, rational project ranking process. The objective of this study is to develop a conceptual framework that describes the development of the 4-Year Pavement Management Plan. It can be largely divided into three Steps; 1) Network-Level project screening process, 2) Project-Level project ranking process, and 3) Economic Analysis. A rational pavement management procedure and a project ranking method accepted by districts and the TxDOT administration will maximize efficiency in budget allocations and will potentially help improve pavement condition. As a part of the implementation of the 4-Year Pavement Management Plan, the Network-Level Project Screening (NLPS) tool including the candidate project identification algorithm and the preliminary project ranking matrix was developed. The NLPS has been used by the Austin District Pavement Engineer (DPE) to evaluate PMIS (Pavement Management Information System) data and to prepare a preliminary list of candidate projects for further evaluation.

Social network media and political activism: a growing challenge for law enforcement

The use of the internet for political purposes is not new; however, the introduction of social media tools has opened new avenues for political activists. In an era where social media has been credited as playing a critical role in the success of revolutions (Earl & Kimport, 2011; Papic & Noonan, 2011; Wooley, Limperos & 10 Beth, 2010), governments, law enforcement and intelligence agencies need to develop a deeper understanding of the broader capabilities of this emerging social and political environment. This can be achieved by increasing their online presence and through the application of proactive social media strategies to identify and manage potential threats. Analysis of current literature shows a gap 15 in the research regarding the connection between the theoretical understanding and practical implications of social media when exploited by political activists,and the efficacy of existing strategies designed to manage this growing challenge. This paper explores these issues by looking specifically at the use of three popular social media tools: Facebook; Twitter; and YouTube. Through the examination of 20 recent political protests in Iran, the UK and Egypt from 2009�2011, these case studies and research in the use of the three social media tools by political groups, the authors discuss inherent weaknesses in online political movements and discuss strategies for law enforcement and intelligence agencies to monitor these activities.

Smart grid-demand side response model for optimization air conditioning

The growing demand of air-conditioning is one of the largest contributors to Australia’s overall electricity consumption. This has started to create peak load supply problems for some electricity utilities particularly in Queensland. This research aimed to develop consumer demand side response model to assist electricity consumers to mitigate peak demand on the electrical network. The model developed demand side response model to allow consumers to manage and control air conditioning for every period, it is called intelligent control. This research investigates optimal response of end-user toward electricity price for several cases in the near future, such as: no spike, spike and probability spike price cases. The results indicate the potential of the scheme to achieve energy savings, reducing electricity bills (costs) to the consumer and targeting best economic performance for electrical generation distribution and transmission.

Development of network-level project screening methods supporting the 4-Year pavement management plan in Texas

The Texas Department of Transportation (TxDOT) is concerned about the widening gap between pavement preservation needs and available funding. Thus, the TxDOT Austin District Pavement Engineer (DPE) has investigated methods to strategically allocate available pavement funding to potential projects that improve the overall performance of the District and Texas highway systems. The primary objective of the study presented in this paper is to develop a network-level project screening and ranking method that supports the Austin District 4-year pavement management plan development. The study developed candidate project selection and ranking algorithms that evaluated pavement conditions of each project candidate using data contained in the Pavement Management Information system (PMIS) database and incorporated insights from Austin District pavement experts; and implemented the developed method and supporting algorithm. This process previously required weeks to complete, but now requires about 10 minutes including data preparation and running the analysis algorithm, which enables the Austin DPE to devote more time and resources to conducting field visits, performing project-level evaluation and testing candidate projects. The case study results showed that the proposed method assisted the DPE in evaluating and prioritizing projects and allocating funds to the right projects at the right time.

National Institute for Clinical Studies Report for Phase 1, Evidence Uptake Network : Best Practice Community Care for Clients with Chronic Venous Leg Ulcers

Chronic leg ulcers cause significant pain, cost, decreased quality of life and morbidity for a considerable segment of the older population (Graham et al., 2003a). At any given time the prevalence of patients with open leg ulcers receiving treatment is between 0.11% - 0.18% (Briggs & Closs 2003). Chronic leg ulcers occur in approximately 1 - 2% of the over 60 population in the US, UK, Europe and Australia (Baker & Stacey 1994; Johnson 1995; Lees & Lambert 1992; Margolis et al. 2002). Considerable research has been undertaken to determine the best treatment practices that will aid in the management and the healing of these ulcers, and practical and effective strategies and techniques for healing venous leg ulcers have been trialled to demonstrate their beneficial effects (Nelson et al. 2004; Cullum et al. 2001)...

Network governance in US airport taxicab planning activities

This thesis examines the use of network governance in US airport transportation planning activities involving taxicab services for airport patrons. The research provides US airports with new insights whereby they can successfully engage with both transportation regulatory agencies and taxicab service providers in developing mutually agreeable policies that foster the development of supply-side taxicab service improvements. A mix of quantitative and qualitative research methods is used to unearth how US airports interact with these actors, and to identify attitudes held by airport staff in their engagements involving airport taxicab planning matters. The research may ultimately lead to the achievement of sustainable increases in the air passenger ground transportation modal share at US airports, resulting in both desirable long-term operational and environmental benefits for airport management, those involved with the provision of airport taxicab services, and the traveling public.