Comparability of non-destructive moisture measurement techniques on masonry during simulated wetting

Detecting the presence of moisture in historical masonry is essential to understanding how a structure interacts with the environment, and diagnosing the potential for damage from a range of physical, chemical, and biological processes. In-situ, non-invasive diagnostic techniques have been developed in preference to methods that require irreversible modifications to a structure. These techniques include: electrical resistivity, microwaves, and infrared thermography. Independently, these approaches provide limited snapshots of surficial and internal moisture regimes; this project sought to assess the comparability of multiple techniques. Simulated post-rain spell drying was monitored over 48 h on limestone and sandstone monoliths in a controlled laboratory environment and also in ambient conditions on purpose-built masonry located in Oxfordshire, UK. Repeat measurements were taken using electrical resistance tomography (ERT), electrical and microwave moisture meters, and infrared thermography. Three aspects of comparability are discussed: i) data transformations and geological comparability, ii) depth-resolving meter readings, iii) the localised benefits of employing multiple technologies and instruments

Evaluation of emergency department performance:A systematic review on recommended performance and quality-in-care measures

BACKGROUND: Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. AIM: To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance. METHODS: Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level. RESULTS: A number of articles addresses this study’s objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, “patients left without being seen” (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles. CONCLUSIONS: A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study’s results allow for advancement towards improved performance measurement and standardised assessment across EDs

Intensivists' base specialty of training is associated with variations in mortality and practice patterns

YesFunding provided by the Open Access Authors Fund

An ‘isolated diffusion’ gravimetric calibration procedure for radar and microwave moisture measurement in porous building stone

Information about the presence and movement of water is crucial to understanding stone deterioration and rock weathering but hard to obtain. Non-destructive, non-invasive measurements of electromagnetic phenomena can provide proxy data on water contents within porous stone and rock. Commercial geophysical devices, such as radar and microwave moisture sensors, produce raw data or readings in arbitrary units, but can be related to absolute water contents through gravimetric calibration. Calibration procedures typically either equilibrate samples to a set of relative humidities (RH%) using salt solutions or environmental chambers (requiring specialised equipment), or monitor ambient drying which yields less homogenous moisture distributions and takes time. This study proposes and tests a cost- and time-effective ‘isolated diffusion’ gravimetric calibration procedure in which a set of samples are sealed at specific water contents and equilibrated. The procedure is compared to ambient drying over 120 h for three United Kingdom building stones and evaluated with modelled reflection coefficients and relative permittivities. The calibrations determined from isolated diffusion more closely follow modelled behaviour than those from ambient drying, as the calibrations developed from the latter were affected by uneven distributions of moisture. Calibrations for radar measurements developed from two types of back interfaces (air and metal) were very similar to one another, suggesting that measurements are consistent regardless of the type of back interface used. The isolated diffusion calibration procedure provides a cost-effective and simple method to facilitate comparison between different non-destructive testing methods and enables accurate measurement of water contents in porous geomaterials

How risky is caring for emergency patients at risk of malpractice litigation: a population based epidemiological study of Taiwan's experiences

<p>Abstract</p> <p>Background</p> <p>Emergency medicine has generally been considered a high risk specialty. The purpose of this study is to assess the risk of being sued in the district courts for caring emergency room (ER) patients from the perspective of epidemiology.</p> <p>Methods</p> <p>This research was designed to be a retrospective population based cohort study. We intended to find out the incidence of litigations arising from ER patients and that of birth inpatients in Taiwan, and computed their relative risks. The inclusion criterion was set to be incidents transpired in the time period of 1998 to 2002. The study materials included the reimbursement claim dataset of the National Health Insurance from 1998 to 2002, and the district court decision database of the Judicial Yuan from 1999 to 2006.</p> <p>Results</p> <p>The average annual incidence rate of becoming a plaintiff for ER patients is 0.86 per million, and for birth patients is 33.5 per million. There is a statistically significant difference between birth patients and ER patients. The relative risk comparing ER patients against birth inpatients is 0.03.</p> <p>Conclusion</p> <p>The findings of this population based study indicate that the patient population emergency physicians are facing in Taiwan have relatively lower risks of developing litigation in comparison with the patients that come to give birth. Due to the large volume of ER patients, malpractice still pose a major threat in the emergency department, and misdiagnosis remains the major complaint of plaintiffs in subsequent litigations.</p

Comparative Analysis of Cervical Spine Management in a Subset of Severe Traumatic Brain Injury Cases Using Computer Simulation

BACKGROUND: No randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI) at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit and a computerized tomogram of the cervical spine excludes the possibility of fracture of cervical vertebrae. The study's goal is to determine cervical spine management strategies that maximize brain injury functional survival while minimizing quadriplegia. METHODS/FINDINGS: The severity of TBI is categorized as unstable, high risk and stable based on intracranial hypertension, hypoxemia, hypotension, early ventilator associated pneumonia, admission Glasgow Coma Scale (GCS) and age. Complications resulting from cervical spine management are simulated using three decision trees. Each case starts with an amount of primary and secondary brain injury and ends as a functional survivor, severely brain injured, quadriplegic or dead. Cervical spine instability is studied with one-way and two-way sensitivity analyses providing rankings of cervical spine management strategies for probabilities of management complications based on QALYs. Early collar removal received more QALYs than the alternative strategies in most arrangements of these comparisons. A limitation of the model is the absence of testing against an independent data set. CONCLUSIONS: When clinical logic and components of cervical spine management are systematically altered, changes that improve health outcomes are identified. In the absence of controlled clinical studies, the results of this comparative computer assessment show that early collar removal is preferred over a wide range of realistic inputs for this subset of traumatic brain injury. Future research is needed on identifying factors in projecting awakening from coma and the role of delirium in these cases