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Chong S.-L.,National University of Singapore | Chew S.Y.,National University of Singapore | Feng J.X.Y.,KK Womens and Childrens Hospital | Teo P.Y.L.,National University of Singapore | And 3 more authors.
BMJ Open | Year: 2016

Objective: To study the causes of head injuries among the paediatric population in Singapore, and the association between causes and mortality, as well as the need for airway or neurosurgical intervention. Design: This is a prospective observational study utilising data from the trauma surveillance system from January 2011 to March 2015. Setting: Paediatric emergency departments (EDs) of KK Women's and Children's Hospital and the National University Health System. Participants: We included children aged <16 years presenting to the paediatric EDs with head injuries who required a CT scan, admission for monitoring of persistent symptoms, or who died from the head injury. We excluded children who presented with minor mechanisms and those whose symptoms had spontaneously resolved. Primary and secondary outcome measures: Primary composite outcome was defined as death or the need for intubation or neurosurgical intervention. Secondary outcomes included length of hospital stay and type of neurosurgical intervention. Results: We analysed 1049 children who met the inclusion criteria. The mean age was 6.7 (SD 5.2) years. 260 (24.8%) had a positive finding on CT. 17 (1.6%) children died, 52 (5.0%) required emergency intubation in the ED and 58 (5.5%) underwent neurosurgery. The main causes associated with severe outcomes were motor vehicle crashes (OR 7.2, 95% CI 4.3 to 12.0) and non-accidental trauma (OR 5.8, 95% CI 1.8 to 18.6). This remained statistically significant when we stratified to children aged <2 years and performed a multivariable analysis adjusting for age and location of injury. For motor vehicle crashes, less than half of the children were using restraints. Conclusions: Motor vehicle crashes and nonaccidental trauma causes are particularly associated with poor outcomes among children with paediatric head injury. Continued vigilance and compliance with injury prevention initiatives and legislature are vital.


PubMed | Singapore General Hospital, National University Hospital Singapore, Singapore Health Services, General Systems Research, LLC and Singapore Civil Defence Force
Type: | Journal: Resuscitation | Year: 2016

Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is effective in increasing bystander CPR in out-of-hospital cardiac arrests (OHCA). Singapore has recently implemented a DA-CPR program. We aimed to characterize barriers to commencement of chest compressions by callers in Singapore.We analyzed dispatch recordings of OHCA cases received by the ambulance call center between July 2012 and March 2015. Audio recordings of poor quality were excluded. Trained reviewers noted the sequential stages of the dispatchers recognition of CPR, delivering CPR instructions and caller performing CPR. Time taken to reach these milestones was noted. Barriers to chest compressions were identified.A total of 4897 OHCA occurred during the study period, overall bystander CPR rate was 45.7%. 1885 dispatch recordings were reviewed with 1157 cases qualified for dispatcher CPR. In 1128 (97.5%) cases, the dispatcher correctly recognized the need for CPR. CPR instructions were delivered in 1056 (91.3%) cases. Of these, 1007 (87.0%) callers performed CPR to instruction. One or more barriers to chest compressions were identified in 430 (37.2%) cases. The commonest barrier identified was could not move patient (27%). Cases where barriers were identified were less likely to have the need for CPR recognized by the dispatcher (94.9% vs. 99.0%, p<0.001), CPR instructions given (79.3% vs. 98.3%, p<0.001) and CPR started (67.9% vs. 98.3%, p<0.001), while the time taken to reach each of these stages were significantly longer (p<0.001).Barriers were present in 37% of cases. They were associated with lower proportion of CPR started and longer delay to CPR.


PubMed | KK Womens and Childrens Hospital, National University of Singapore, Quantitative Medicine and General Systems Research, LLC
Type: Journal Article | Journal: BMJ open | Year: 2016

To study the causes of head injuries among the paediatric population in Singapore, and the association between causes and mortality, as well as the need for airway or neurosurgical intervention.This is a prospective observational study utilising data from the trauma surveillance system from January 2011 to March 2015.Paediatric emergency departments (EDs) of KK Womens and Childrens Hospital and the National University Health System.We included children aged <16 years presenting to the paediatric EDs with head injuries who required a CT scan, admission for monitoring of persistent symptoms, or who died from the head injury. We excluded children who presented with minor mechanisms and those whose symptoms had spontaneously resolved.Primary composite outcome was defined as death or the need for intubation or neurosurgical intervention. Secondary outcomes included length of hospital stay and type of neurosurgical intervention.We analysed 1049 children who met the inclusion criteria. The mean age was 6.7 (SD 5.2) years. 260 (24.8%) had a positive finding on CT. 17 (1.6%) children died, 52 (5.0%) required emergency intubation in the ED and 58 (5.5%) underwent neurosurgery. The main causes associated with severe outcomes were motor vehicle crashes (OR 7.2, 95% CI 4.3 to 12.0) and non-accidental trauma (OR 5.8, 95% CI 1.8 to 18.6). This remained statistically significant when we stratified to children aged <2 years and performed a multivariable analysis adjusting for age and location of injury. For motor vehicle crashes, less than half of the children were using restraints.Motor vehicle crashes and non-accidental trauma causes are particularly associated with poor outcomes among children with paediatric head injury. Continued vigilance and compliance with injury prevention initiatives and legislature are vital.


PubMed | Laerdal Medical., Kokushikan University, General Systems Research, LLC, Emory University and Seoul National University
Type: | Journal: Annals of emergency medicine | Year: 2016

We study the effect of a nationwide dispatcher-assisted cardiopulmonary resuscitation (CPR) program on out-of-hospital cardiac arrest outcomes by arrest location (public and private settings).All emergency medical services (EMS)-treated adults in Korea with out-of-hospital cardiac arrests of cardiac cause were enrolled between 2012 and 2013, excluding cases witnessed by EMS providers and those with unknown outcomes. Exposure was bystander CPR categorized into 3 groups: bystander CPR with dispatcher assistance, bystander CPR without dispatcher assistance, and no bystander CPR. The endpoint was good neurologic recovery at discharge. Multivariable logistic regression analysis was performed. The final model with an interaction term was evaluated to compare the effects across settings.A total of 37,924 patients (31.1% bystander CPR with dispatcher assistance, 14.3% bystander CPR without dispatcher assistance, and 54.6% no bystander CPR) were included in the final analysis. The total bystander CPR rate increased from 30.9% in quarter 1 (2012) to 55.7% in quarter 4 (2014). Bystander CPR with and without dispatcher assistance was more likely to result in higher survival with good neurologic recovery (4.8% and 5.2%, respectively) compared with no bystander CPR (2.1%). The adjusted odds ratios for good neurologic recovery were 1.50 (95% confidence interval [CI] 1.30 to 1.74) in bystander CPR with dispatcher assistance and 1.34 (95% CI 1.12 to 1.60) in bystander CPR without it compared with no bystander CPR. For arrests in private settings, the adjusted odds ratios were 1.58 (95% CI 1.30 to 1.92) in bystander CPR with dispatcher assistance and 1.28 (95% CI 0.98 to 1.67) in bystander CPR without it; in public settings, the adjusted odds ratios were 1.41 (95% CI 1.14 to 1.75) and 1.37 (95% CI 1.08 to 1.72), respectively.Bystander CPR regardless of dispatcher assistance was associated with improved neurologic recovery after out-of-hospital cardiac arrest. However, for out-of-hospital cardiac arrest cases in private settings, bystander CPR wasassociated with improved neurologic recovery only when dispatcher assistance was provided.


Hicks S.,General Systems Research, LLC | Peltonen S.,Peikko Group Corporation
Composite Construction in Steel and Concrete VII - Proceedings of the 2013 International Conference on Composite Construction in Steel and Concrete | Year: 2013

Deltabeam is a hollow slim floor beam made from welded steel plates with regular web penetrations. Due to the long spanning capabilities of this product, the Deltabeam technology has recently been used in a prestigious shopping centre in the UK. As the floor would be subject to continuous walking activities the main contractor, Bovis Lend Lease, was concerned with occupant-induced vibrations. This paper presents the results from vibration tests conducted by the University of Sheffield, which can be compared directly with the requirements given in ISO 10137. Through extending the scope of the test results by numerical modelling and applying the design rules given in SCI P354, a methodology has been developed to estimate the vibration performance for this floor type and is presented. © ASCE.


Tess A.,Beth Israel Deaconess Medical Center | Vidyarthi A.,General Systems Research, LLC | Yang J.,Beth Israel Deaconess Medical Center | Myers J.S.,University of Pennsylvania
Academic Medicine | Year: 2015

Integrating the quality and safety mission of teaching hospitals and graduate medical education (GME) is a necessary step to provide the next generation of physicians with the knowledge, skills, and attitudes they need to participate in health system improvement. Although many teaching hospital and health system leaders have made substantial efforts to improve the quality of patient care, few have fully included residents and fellows, who deliver a large portion of that care, in their efforts. Despite expectations related to the engagement of these trainees in health care quality improvement and patient safety outlined by the Accreditation Council for Graduate Medical Education in the Clinical Learning Environment Review program, a structure for approaching this integration has not been described. In this article, the authors present a framework that they hope will assist teaching hospitals in integrating residents and fellows into their quality and safety efforts and in fostering a positive clinical learning environment for education and patient care. The authors define the six essential elements of this framework - organizational culture, teaching hospital-GME alignment, infrastructure, curricular resources, faculty development, and interprofessional collaboration. They then describe the organizational characteristics required for each element and offer concrete strategies to achieve integration. This framework is meant to be a starting point for the development of robust national models of infrastructure, alignment, and collaboration between GME and health care quality and safety leaders at teaching hospitals. © 2015 by the Association of American Medical Colleges.


Drake M.C.,General Systems Research, LLC
Lasers and Electro-Optics/Quantum Electronics and Laser Science Conference: 2010 Laser Science to Photonic Applications, CLEO/QELS 2010 | Year: 2010

Imaging techniques (laser Mie scattering, particle image velocimetry, spectrally-resolved spark and combustion luminosity, and laser induced fluorescence) with high repetition rate lasers and multiple CMOS cameras allow fuel injection, fuel/air mixing, ignition, and combustion to be followed within one engine cycle. This aids the design of advanced gasoline direct injection engines by avoiding intermittent poor burning engine cycles. Improvements in tunable uv high repetition rate lasers would expand the range of possible in-cylinder experiments. ©2010 Optical Society of America.


PubMed | General Systems Research, LLC
Type: Journal Article | Journal: Journal of dental education | Year: 2016

Temporomandibular disorders and orofacial pain (TMD/OFP) conditions are challenging to diagnose for predoctoral dental students due to the multifactorial etiology, complexity, and controversial issues surrounding these conditions. The aim of this study was to determine if patients in the clinic of one U.S. dental school reported existing signs and symptoms of TMD/OFP, whether the dental students diagnosed the condition based on the reported signs and symptoms, and if the condition was then treated. The study was based on a retrospective analysis of electronic health record data over a three-year period. The results showed that, during the study period, 21,352 patients were treated by student providers. Of those patients, 5.33% reported signs or symptoms associated with TMD/OFP; 5.99% received a TMD/OFP diagnosis; and 0.26% received at least one form of TMD/OFP treatment that had either a diagnosis or signs/symptoms of TMD/OFP. In addition, a small percentage (0.24%) of patients with no documented diagnosis received some sort of TMD/OFP-related treatment. A randomly selected sample of 90 patient charts found that no diagnoses of TMD/OFP were recorded in any of them. The results suggested that students had only marginally diagnosed the problems. Training for students including comprehensive didactic courses and clinical experiences to gain knowledge, context, and skill may be required to ensure they reach the required level of competence and prepare them to face the diagnostic challenges of TMD/OFP after graduation.


Grant
Agency: Environmental Protection Agency | Branch: | Program: SBIR | Phase: Phase I | Award Amount: 80.00K | Year: 2011

"This proposal addresses challenges in algae biomass production for cost-competitive biofuel production. A critical hurdle in terms of large scale biomass production and a big economic barrier in the production of algae oil is the cost-efficiency involved in producing algae biomass. The principal objective of this project is to demonstrate that a low cost algal biomass production for oil is possible by integrating the system with wastewater treatment such as dairy farm manure, brewery wastewater, and producing valued by-products such as feedstock for biogas. The nutrient rich wastewater from biodigesters or farm runoff is mostly organic material that algae can digest and utilize the nutrients (mainly nitrogen and phosphorus), which otherwise is a threat to natural water bodies. However, to grow oil rich algae in such a media could be a challenge and no robust system exists. Unlike expensive algal closed systems (photobioreactors) under research, our system will be based on establishing a symbiotic relation between oil-rich algae and bacterial system in open ponds. We will test natural algal assemblage, oil-rich algal stain(s), and well know strain of Chlorella vulgaris in dairy farm and brewery wastewaters. The harvest will be tested for oil/lipids content, and the water quality parameters including nutrient concentrations of Nitrogen and Phosphorus will be analyzed and the Agricultural Lab at UVM. The algae cake left after il extraction will be assessed for its possible use as a commercial organic fertilizer. In United States diesel fuel demand is growing annually. By initiating a process for commercially viable algal production, this Phase I offers broad and significant impact on quality of life and environment by moving the energy, the wastewater treatment and rural sectors forward. Publications, presentation and interdisciplinary collaborations are anticipated. "


PubMed | General Systems Research, LLC and Eisai Co.
Type: | Journal: Behavioural brain research | Year: 2016

Corticotropin-releasing factor (CRF) is a hormone secreted by the hypothalamus in response to stress, and CRF antagonists may be effective for the treatment of stress-related disorders including major depressive and anxiety disorders. Here, we investigated the in vivo pharmacological profile of N-cyclopropylmethyl-7-(2,6-dimethoxy-4-methoxymethylphenyl)-2-ethyl-N-(tetrahydro-2H-pyran-4-ylmethyl)pyrazolo[1,5-a]pyridin-3-amine tosylate (E2508), a recently synthesized, orally active CRF1 receptor antagonist. Oral administration of a single dose of E2508 (3 or 10mg/kg), but not fluoxetine (30mg/kg), a selective serotonin reuptake inhibitor (SSRI), significantly shortened immobility time in rats in the forced swim test. E2508 (10, 30, or 100mg/kg) also showed an antidepressant-like effect in the forced swim test in mice, with no sedative or muscle relaxant effects for doses up to 100mg/kg. Moreover, E2508 (5 or 20mg/kg) significantly reduced anxiety-like behavior in the rat defensive burying test. Diazepam, a benzodiazepine anxiolytic agent, also showed an anxiolytic effect in the defensive burying test at the same dose that induced a muscle relaxant effect in mice. Administration of E2508 (30mg/kg) for 14 consecutive days did not affect sexual behavior. By contrast, fluoxetine (30mg/kg) administration for 7 consecutive days decreased sexual behavior. These results indicate that E2508 has both potent antidepressant-like and anxiolytic-like effects in rodent models, and is well tolerated compared with a commonly prescribed therapeutic SSRI or benzodiazepine.

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