International Telemetering Conference Proceedings / October 20-23, 2003 / Riviera Hotel and Convention Center, Las Vegas, Nevada / The US Army Aberdeen Test Center (ATC) is acquiring, transferring, and databasing data during all phases of automotive testing using networked data acquisition devices. The devices are small ruggedized computer-based systems programmed with specific data acquisition tasks and then networked together with other devices in order to share information within a test item or vehicle. One of the devices is also networked to a ground-station for monitor, control and data transfer of any of the devices on the net. Application of these devices has varied from single vehicle tests in a single geographical location up to a 100-vehicle nationwide test. Each device has a primary task such as acquiring data from vehicular data busses (MIL-STD-1553, SAE J1708 bus, SAE J1939 bus, RS-422 serial bus, etc.), GPS (time and position), analog sensors and video with audio. Each device has programmable options, maintained in a configuration file, that define the specific recording methods, real-time algorithms to be performed, data rates, and triggering parameters. The programmability of the system and bi-directional communications allow the configuration file to be modified remotely after the system is fielded. The primary data storage media of each device is onboard solid-state flash disk; therefore, a continuous communication link is not critical to data gathering. Data are gathered, quality checked and loaded into a database for analysis. The configuration file, as an integral part of the database, ensures configuration identity and management. A web based graphical user interface provides preprogrammed query options for viewing, summarizing, graphing, and consolidating data. The database can also be queried for more detailed analyses. The architecture for this network approach to field data acquisition was under the Aberdeen Test Center program Versatile Information System Integrated On-Line (VISION). This paper will describe how the merging of data acquisition systems to network communications and information management tools provides a powerful resource for system engineers, analysts, evaluators and acquisition personnel.

Class of 2015 Abstract / Objectives: To compare provider acceptance rates of medication therapy management (MTM) interventions initiated by a MTM center for potential drug-related problems in 2012. Interventions included cost-savings to patients, adherence to clinical guidelines, medication adherence, and safety initiatives. Methods: This retrospective cross-sectional project measured the provider acceptance rates of MTM interventions for Medicare Part D beneficiaries. Intervention count and acceptance rates were analyzed from the center’s MTM software and database that utilizes prescription claims analysis post-intervention to determine intervention success. A chi-square test was used to assess the statistical significance between the interventions. An alpha level of 0.5 was determined a-priori. This was a quality improvement project, and Institutional Review Board approved this project as exempt status. Results: The total percent of recommendations accepted was 35% (159,795 out of 455,898). The rate of acceptance was highest for safety interventions (51%), followed by cost (35%), adherence (12%), and guidelines (8%). The acceptance rates for the four intervention types were statistically different from each other (p-value <0.0001). Within each intervention type, the most frequently accepted interventions were: removal of medications from the Beer’s Criteria (8% of safety related changes); changes from a brand name, non-oral medication like eye drops and nasal sprays, to a generic within the same class (15% of cost-saving related changes); improved adherence to hypertension and diabetic medications (29% of adherence related changes); and adding an antihypertensive agent to diabetic patients (62% of clinical guideline related changes). Conclusions: Safety initiatives had the highest acceptance percentage of all four intervention types. Approving more safety interventions with medication use may reduce the risk of morbidity and mortality. Pharmacists providing MTM services may want to increase focus on drug safety as providers are accepting more safety interventions. More research is needed to determine why providers approve the other recommendations at lower rates.

Objectives: To assess national trends of AP (acute pancreatitis) admissions, outcomes, prevalence of AKI (acute kidney injury) in AP, and impact of AKI on inpatient mortality. Methods: We queried the Nationwide Inpatient Sample database from 2003 to 2012 to identify AP admissions using ICD-9-CM codes. After excluding patients with missing information on age, gender, and inpatient mortality, we used ICD-9-CM codes to identify complications of AP, specifically AKI. We examined trends with survey-weighted multivariable regressions and analyzed predictors of AKI and inpatient mortality by multivariate logistic regression. Additionally, both AKI and non-AKI groups were propensity-matched and regressed against mortality. Results: A total of 3,466,493 patients (1.13% of all discharges) were hospitalized with AP, of which 7.9% had AKI. AP admissions increased (1.02%→1.26%) with rise in concomitant AKI cases (4.1%→11.7%) from year 2003–2012. Mortality rate decreased (1.8%→1.1%) in the AP patients with a substantial decline noted in AKI subgroup (17.4%→6.4%) during study period. Length of stay (LOS) and cost of hospitalization decreased (6.1→5.2 days and $13,654 to $10,895, respectively) in AKI subgroup. Complications such as AKI (OR: 6.08, p < 0.001), septic shock (OR: 46.52, p < 0.001), and acute respiratory failure (OR: 22.72, p < 0.001) were associated with higher mortality. AKI, after propensity matching, was linked to 3-fold increased mortality (propensity-matched OR: 3.20, P < 0.001). Conclusion: Mortality, LOS, and cost of hospitalization in AP has decreased during the study period, although hospitalization and AKI prevalence has increased. AKI is independently associated with higher mortality.

Background and Aim: Acute kidney injury (AKI) is used as a marker of severity in Clostridium difficile infection (CDI) patients. We estimated the true effect of AKI in inpatient mortality of CDI patients, as there are no large-scale, population-based, propensity-matched studies evaluating AKI's effect in this patient cohort. Methods: A retrospective observational study utilizing the National Inpatient Sample from years 2003 to 2012, including all adults with CDI, excluding cases missing data on age, inpatient mortality or gender. Trends and CDI-related complications as mortality predictors were assessed using survey-weighted multivariable regression. We estimated AKI's independent effect by propensity-matching, post-stratifying by chronic kidney disease status, allowing for multiple comorbidity adjustment. Results: A total of 2 859 599 patients with CDI were included, of which 896 122 (31.3%) had principal diagnosis of CDI. AKI prevalence was 22%. Mortality rate was 8.4%, while among AKI patients was higher (18.2%). In multivariable regression, AKI was associated with higher mortality (odds ratio [OR] = 3.16, 95% confidence interval [CI]: 3.02–3.30; P < 0.001), while after propensity matching, AKI increased mortality by 86% (OR = 1.86, 95% CI: 1.79–1.94; P < 0.001). CDI incidence increased by 1.8, together with the rate of AKI (12.6% in 2003 to 28.8% in 2012, P-trend < 0.001). Despite increasing hospitalizations, mortality over the study period decreased to 7.2% (2012) from 9.0% (2003); P-trend < 0.001. Conclusion: Hospital admissions of patients with CDI and concomitant AKI are increasing, but their inpatient mortality has improved over the study period. AKI is a significant contributor to mortality, independently of other comorbidities, complications, and hospital characteristics, emphasizing the need for early diagnosis and aggressive management in such patients.

This study does research on the Swedish media's portraying of an extraordinary crime event in Sweden - the grenades in Malmö 2015. The study focuses on how the media portrays three major participants in the media image: the public, the politicians and the police. The question examined was: How does the media portray the public and the authorities during the grenades in Malmö 2015? I made a framing analysis of 30 news articles from the summer of 2015. The result showed that the public received the role as the victim, where the media image emphasizes on fear from the public. The police received two different images - the safe image where the media emphasizes on the work the police does on preventing crime. The other image was the critical image, where the media emphasized on how the public criticized the police success rate during these incidents. The politicians received a neutral image, where a small amount of critic was portrayed. The results of the analysis diverged from previous studies and theories in the field when it came to the police and the politicians.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21005号 / 医博第4351号 / 新制||医||1028(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小西 靖彦, 教授 福原 俊一, 教授 小池 薫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

Background: It has been reported that transjugular intrahepatic portosystemic shunting (TIPS) might be utilized as a salvage option for hepatorenal syndrome (HRS), while randomized controlled trials are pending and real-world contemporary data on inpatient mortality is lacking. Methods: We conducted an observational retrospective cohort study from the National Inpatient Sample from 2005 to 2014. We included all adult patients admitted with HRS and cirrhosis, using ICD 9-CM codes. We excluded cases with variceal bleeding, Budd–Chiari, end-stage renal disease, liver transplant and transfers to acute-care facilities. TIPS’ association with inpatient mortality was assessed using multivariable mixed-effects logistic regression, as well as exact-matching, thus mitigating for TIPS selection bias. The exact-matched analysis was repeated among TIPS-only versus dialysis-only patients. Results: A total of 79,354 patients were included. Nine hundred eighteen (1.2%) underwent TIPS. Between TIPS and non-TIPS groups, mean age (58 years) and gender (65% males) were similar. Overall mortality was 18% in TIPS and 48% in dialysis-only cases (n = 10,379; 13.1%). Ninety six (10.5%) TIPS patients underwent dialysis. In-hospital mortality in TIPS patients was twice less likely than in non-TIPS patients (adjusted odds ratio [aOR] = 0.43, 95% CI 0.30–0.62; p < 0.001), with similar results in matched analysis [exact-matched (em) OR = 0.39, 95% CI 0.17–0.89; p < 0.024; groups = 96; unweighted n = 463]. Head-to-head comparison showed that TIPS-only patients were 3.3 times less likely to succumb inpatient versus dialysis-only patients (contrast aOR = 0.31, 95% CI 0.20–0.46; p < 0.001), with similar findings post-matching (emOR = 0.22, 95% CI 0.15–0.33; p < 0.001; groups = 54, unweighted n = 1457). Conclusions: Contemporary, real-world data reveal that TIPS on its own, and when compared to dialysis, is associated with decreased inpatient mortality when utilized in non-bleeders-HRS patients. Further randomized studies are needed to establish the long-term benefit of TIPS in these patients.

No description available.

Literature on transportation planning and modeling is replete with the concept of a travel time budget. According to this concept, average daily travel times tend to be relatively constant. However, evidence from the 1983 Nationwide Personal Transportation Survey and the 2001 National Household Travel Survey suggest that the average daily travel time has increased by 1.9 minutes per year. Understanding travel time expenditures is important for forecasting travel demand, especially future vehicle miles of travel. Historically, travel demand models considered vehicle availability and income as limiting factors for travel, but going forward time may be the constraint. As individuals spend more time devoted to travel, less time will be available for other activities. Therefore, future travel demand is dependent on people's willingness to spend time traveling. Growth of travel demand has been per capita based not just population based. This has been enabled by several cultural trends, including fewer children to care for; specialization of activities; multitasking during travel, for example, cell phone use can add value to travel time; seeking socialization away from home; and increases in real income enabling more activity participation. This study will report the increase in average daily travel time expenditures and analyze the increase by various demographic segments of the population. Travel time expenditures are also related to activity participation, the characteristics of the area, and many other interrelated factors at the person level. Aggregate values will be used to investigate the general relationships between daily travel time expenditures and socio-demographic characteristics. Careful consideration of the implications of the increase in travel time, as well as the changes in society that have contributed to these changes will be explored. The increase in travel time expenditures is likely to play a significant role in future travel demand growth in the United States and will impact the performance of the transportation system going forward. If travel time expenditures continue to grow, the hope for slowing VMT growth may not materialize. Understanding the mechanics of why people are traveling more will aid planners and modelers in estimating future travel demand.

Class of 2011 Abstract / OBJECTIVES: To assess the role of patient, payer, clinical and disease-related factors in charges and mortality among adult inpatient cases of polycythemia vera in the United States from 2004 to 2008. METHODS: This retrospective cohort study utilized hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) five consecutive years from 2004 to 2008. RESULTS: There were a total of 156,490 episodes of care involving polycythemia vera between 2004 and 2008. Average age upon admission was 65.94 years (±16.03), with 56% of cases being male (n=87,662). The mean length of stay was 5.14 days (±5.31) and inpatient mortality occurred in 3.1% of cases (n=4,927). The mean number of procedures performed was 1.43 (±2.08) and the mean number of diagnoses on record was 9.56 (±3.86). Charges for each episode of care averaged $32,620 (±42,801), summing to a national bill of $5.02 billion (2010 dollars) over the five-year time horizon. Higher charges were associated with longer length of stay, larger hospital bed size, urban hospital location, teaching status, increased number of diagnoses and procedures, private payer, Western U.S. region, and higher income bracket. Increased mortality was associated with increased age, increased number of diagnoses and procedures, self pay, payer other than Medicare, Medicaid, private or self, and the comorbidities of congestive heart failure, coagulopathy, and fluid/electrolyte disorders. CONCLUSION: Polycythemia vera is associated with considerable burden of illness.