scholarly journals P055: EMS boot camp: a real-world, real-time educational experience for emergency medicine residents

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S96-S97
Author(s):  
C. Farrell ◽  
S. Teed ◽  
N. Costain ◽  
M.A. Austin ◽  
A. Willmore ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Patient Care ◽  
Real Time ◽  
Real World ◽  
Large Scale ◽  
Clinical Care ◽  
Dynamic Environment ◽  
Educational Experience ◽  
Boot Camp ◽  
Medical Control

Introduction/Innovation Concept: In 2014, Eastern Ontario paramedic services, their medical director staff and area community colleges developed an EMS Boot Camp experience to orient Queen’s University and the University of Ottawa emergency medicine residents to the role of paramedics and the challenges they face in the field. Current EMS ride-alongs and didactic classroom sessions were deemed ineffective at adequately preparing residents to provide online medical control. From those early discussions came the creation of a real-world, real-time (RWRT) educational experience. Methods: Specific challenges unique to paramedicine are difficult to communicate to a medical control physician at the other end of a telephone. The goal of this one-day educational experience is for residents to gain insight into the complexity and time sensitive nature of delivering medical care in the field. Residents are immersed as responding paramedics in a day of intense RWRT simulation exercises reflecting the common paramedic logistical challenges to delivering patient care in an uncontrolled and dynamic environment. Curriculum, Tool, or Material: Scenarios, run by paramedic students, are overseen by working paramedics from participating paramedic services. Residents learn proper use of key equipment found on an Ontario ambulance while familiarize themselves with patient care standards and medical directives. Scenarios focus on prehospital-specific clinical care issues; performing dynamic CPR in a moving vehicle, extricating a bariatric patient with limited personnel, large scale multi-casualty triage as well as other time sensitive, high risk procedures requiring online medical control approval (i.e. chest needle thoracostomy). Conclusion: EMS Boot Camp dispels preconceived biases regarding “what it’s really like” to deliver high quality prehospital clinical care. When providing online medical control in the future, the residents will be primed to understand and expect certain challenges that may arise. The educational experience fosters collaboration between prehospital and hospital-based providers. The sessions provide a reproducible, standardized experience for all participants; something that cannot be guaranteed with traditional EMS ride-alongs. Future sessions will evaluate participant satisfaction and self-efficacy with the use of a standard evaluation form including pre/post self-evaluations.

scholarly journals Heart Snapshot: a broadly validated smartphone measure of VO2max for collection of real world data

2020 ◽  
Author(s):  
Dan E. Webster ◽  
Meghasyam Tummalacherla ◽  
Michael Higgins ◽  
David Wing ◽  
Euan Ashley ◽  
...  
Keyword(s):  
Real World ◽  
Gold Standard ◽  
Large Scale ◽  
Digital Health ◽  
Clinical Care ◽  
Skin Pigmentation ◽  
Epidemiologic Studies ◽  
Step Test ◽  
Real World Data ◽  
Laboratory Equipment

AbstractExpanding access to precision medicine will increasingly require that patient biometrics can be measured in remote care settings. VO2max, the maximum volume of oxygen usable during intense exercise, is one of the most predictive biometric risk factors for cardiovascular disease, frailty, and overall mortality.1,2 However, VO2max measurements are rarely performed in clinical care or large-scale epidemiologic studies due to the high cost, participant burden, and need for specialized laboratory equipment and staff.3,4 To overcome these barriers, we developed two smartphone sensor-based protocols for estimating VO2max: a generalization of a 12-minute run test (12-MRT) and a submaximal 3-minute step test (3-MST). In laboratory settings, Lins concordance for these two tests relative to gold standard VO2max testing was pc=0.66 for 12-MRT and pc=0.61 for 3-MST. Relative to “silver standards”5 (Cooper/Tecumseh protocols), concordance was pc=0.96 and pc=0.94, respectively. However, in remote settings, 12-MRT was significantly less concordant with gold standard (pc=0.25) compared to 3-MST (pc=0.61), though both had high test-retest reliability (ICC=0.88 and 0.86, respectively). These results demonstrate the importance of real-world evidence for validation of digital health measurements. In order to validate 3-MST in a broadly representative population in accordance with the All of Us Research Program6 for which this measurement was developed, the camera-based heart rate measurement was investigated for potential bias. No systematic measurement error was observed that corresponded to skin pigmentation level, operating system, or cost of the phone used. The smartphone-based 3-MST protocol, here termed Heart Snapshot, maintained fidelity across demographic variation in age and sex, across diverse skin pigmentation, and between iOS and Android implementations of various smartphone models. The source code for these smartphone measurements, along with the data used to validate them,6 are openly available to the research community.

scholarly journals MG-DVD: A Real-time Framework for Malware Variant Detection Based on Dynamic Heterogeneous Graph Learning

2021 ◽  
Author(s):  
Chen Liu ◽  
Bo Li ◽  
Jun Zhao ◽  
Ming Su ◽  
Xu-Dong Liu
Keyword(s):  
Real Time ◽  
Real World ◽  
Large Scale ◽  
State Of The Art ◽  
Evolutionary Patterns ◽  
Graph Learning ◽  
Fine Grained ◽  
Variant Detection ◽  
Effectiveness And Efficiency ◽  
The Cost

Detecting the newly emerging malware variants in real time is crucial for mitigating cyber risks and proactively blocking intrusions. In this paper, we propose MG-DVD, a novel detection framework based on dynamic heterogeneous graph learning, to detect malware variants in real time. Particularly, MG-DVD first models the fine-grained execution event streams of malware variants into dynamic heterogeneous graphs and investigates real-world meta-graphs between malware objects, which can effectively characterize more discriminative malicious evolutionary patterns between malware and their variants. Then, MG-DVD presents two dynamic walk-based heterogeneous graph learning methods to learn more comprehensive representations of malware variants, which significantly reduces the cost of the entire graph retraining. As a result, MG-DVD is equipped with the ability to detect malware variants in real time, and it presents better interpretability by introducing meaningful meta-graphs. Comprehensive experiments on large-scale samples prove that our proposed MG-DVD outperforms state-of-the-art methods in detecting malware variants in terms of effectiveness and efficiency.

scholarly journals 590. Vancomycin Infusion: Algorithmic Analysis of Unstructured Real-World Data Captured from Automated Infusion Devices

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S358-S358
Author(s):  
David L Bostick ◽  
Kalvin Yu ◽  
Cynthia Yamaga ◽  
Ann Liu-Ferrara ◽  
Didier Morel ◽  
...  
Keyword(s):  
Real Time ◽  
Real World ◽  
Large Scale ◽  
Scale Up ◽  
Patient Specific ◽  
Care Practice ◽  
Becton Dickinson ◽  
Real World Data ◽  
Large Patient ◽  
Infusion Devices

Abstract Background Large scale research on antimicrobial usage in real-world populations traditionally does not consist of infusion data. With automation, detailed infusion events are captured in device systems, providing opportunities to harness them for patient safety studies. However, due to the unstructured nature of infusion data, the scale-up of data ingestion, cleansing, and processing is challenging. Figure 1. Illustration of dosing complexity Methods We applied algorithmic techniques to quantitate and visualize vancomycin administration data captured in real-time by automated infusion devices from 3 acute care hospitals. The device data included timestamped infusion events – infusion started, paused, restarted, alarmed, and stopped. We used time density-based segmentation algorithms to depict infusion sessions as bursts of event activity. We examined clinical interpretability of the cluster-defined sessions in defining infusion events, dosing intensity, and duration. Results The algorithms identified 13,339 vancomycin infusion sessions from 2,417 unique patients (mean = 5.5 sessions per patient). Clustering captured vancomycin infusion sessions consistently with correct event labels in >98% of cases. It disentangled ambiguity associated with unexpected events (e.g. multiple stopped/started events within a single infusion session). Segmentation of vancomycin infusion events on an example patient timeline is illustrated in Figure 1. The median duration of infusion sessions was 1.55 (1st, 3rd quartiles: 1.14, 2.02) hours, demonstrating clinical plausibility. Conclusion Passively captured vancomycin administration data from automated infusion device systems provide ramifications for real-time bed-side patient care practice. With large volume of data, temporal event segmentation can be an efficient approach to generate clinically interpretable insights. This method scales up accuracy and consistency in handling longitudinal dosing data. It can enable real-time population surveillance and patient-specific clinical decision support for large patient populations. Better understanding of infusion data may also have implications for vancomycin pharmacokinetic dosing. Disclosures David L. Bostick, PhD, Becton, Dickinson and Co. (Employee) Kalvin Yu, MD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Cynthia Yamaga, PharmD, BD (Employee) Ann Liu-Ferrara, PhD, Becton, Dickinson and Co. (Employee) Didier Morel, PhD, Becton, Dickinson and Co. (Employee) Ying P. Tabak, PhD, Becton, Dickinson and Co. (Employee)

scholarly journals Human Mobility Modelling Based on Dense Transit Areas Detection with Opportunistic Sensing

2016 ◽  
Vol 2016 ◽  
pp. 1-15 ◽  
Author(s):  
Fernando Terroso-Sáenz ◽  
Mercedes Valdes-Vela ◽  
Aurora González-Vidal ◽  
Antonio F. Skarmeta
Keyword(s):  
Real Time ◽  
Real World ◽  
Large Scale ◽  
Human Mobility ◽  
Instrumental Approach ◽  
Mobile Crowdsensing ◽  
Urban Dynamics ◽  
Opportunistic Sensing ◽  
Novel Approach

With the advent of smartphones, opportunistic mobile crowdsensing has become an instrumental approach to perceive large-scale urban dynamics. In this context, the present work presents a novel approach based on such a sensing paradigm to automatically identify and monitor the areas of a city comprising most of the human transit. Unlike previous approaches, the system performs such detection in real time at the same time the opportunistic sensing is carried out. Furthermore, a novel multilayered grill partitioning to represent such areas is stated. Finally, the proposal is evaluated by means of a real-world dataset.

scholarly journals An Optimal Rewiring Strategy for Cooperative Multiagent Social Learning

2019 ◽  
Vol 33 ◽  
pp. 10049-10050
Author(s):  
Hongyao Tang ◽  
Jianye Hao ◽  
Li Wang ◽  
Tim Baarslag ◽  
Zan Wang
Keyword(s):  
Social Learning ◽  
Multiagent Systems ◽  
Real World ◽  
Large Scale ◽  
Dynamic Environment ◽  
Multiagent Coordination ◽  
Learning Framework ◽  
Repeated Interaction ◽  
Long Run ◽  
Network Topologies

Multiagent coordination in cooperative multiagent systems (MASs) has been widely studied in both fixed-agent repeated interaction setting and static social learning framework. However, two aspects of dynamics in real-world MASs are currently missing. First, the network topologies can dynamically change during the course of interaction. Second, the interaction utilities between each pair of agents may not be identical and not known as a prior. Both issues mentioned above increase the difficulty of coordination. In this paper, we consider the multiagent social learning in a dynamic environment in which agents can alter their connections and interact with randomly chosen neighbors with unknown utilities beforehand. We propose an optimal rewiring strategy to select most beneficial peers to maximize the accumulated payoffs in long-run interactions. We empirically demonstrate the effects of our approach in large-scale MASs.

Connecting the Real-World and the Virtual World Through Dynamic Environment Rendering

2017 ◽  
Author(s):  
Kevin Lesniak ◽  
Conrad S. Tucker
Keyword(s):  
Real Time ◽  
Virtual Environment ◽  
Real World ◽  
Dynamic Environment ◽  
Team Members ◽  
Geographically Dispersed ◽  
Sense Of Presence ◽  
Realistic Representation ◽  
Internet Connections ◽  
Communication Methods

Immersive Virtual Reality (VR) systems such as the Oculus Rift or HTC Vive provide a sense of “presence” that is not available in traditional voice or video based communication methods. Without the sense of “presence” in the environment, a designer’s interpretation of the environment or design in question may be ill informed or skewed, based on the communication medium. The authors of this paper present a method to dynamically recreate a real-world environment in a virtual environment and provide an interface for physically-present individuals and geographically dispersed team members to collaborate. The method allows multiple remote users to naturally and immersively view a realistic representation of a dynamic real-world location in real time. This process incorporates consumer RGB-D sensors and VR systems into a distributed, multi-user virtual environment that has the ability to render large visual data in real-time. A case study using commodity RGB-D sensors, computing hardware, and standard TCP internet connections is presented to demonstrate the viability of the proposed method.

scholarly journals 1997. Real-World Impact of Accelerate Pheno Implementation with Antimicrobial Stewardship Intervention

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S669-S670
Author(s):  
Patrick M Kinn ◽  
Kelly M Percival ◽  
Bradley A Ford ◽  
Dilek Ince
Keyword(s):  
Quality Improvement ◽  
Real Time ◽  
Antimicrobial Stewardship ◽  
Real World ◽  
Antibiotic Susceptibility ◽  
Clinical Care ◽  
Diagnostic System ◽  
Rapid Identification ◽  
Fast Time ◽  
Group B

Abstract Background Accelerate Pheno® (AP) is a novel diagnostic system that provides rapid identification and antibiotic susceptibility results for most commonly isolated organisms within hours of blood culture (BC) positivity. There are little data on this technology’s real-world implementation with antimicrobial stewardship intervention and effect on optimal targeted therapy. Methods AP was implemented at UIHC in September 2018 and paired with antimicrobial stewardship team (AST) review. AST recommendations were provided in real time during weekday hours and through a retrospective review process for off-hours results. Microbiologic and clinical data were collected prospectively. Due to inconsistencies in instrument performance identified after the first month, two post-implementation periods (Group A = October 2018–January 2019; Group B = February 2019–mid-April 2019) were analyzed to assess quality improvement efforts during clinical roll-out. Results In the 6.5-month combined period, 690 unique BC samples were run on AP and reviewed by AST (417 in A; 273 in B). Performance of the technology improved, with 78.9% (329/417) of isolates in Grp A identified vs. 85.3% in Grp B (233/273). Percentage of runs with progression to antibiotic susceptibility improved from 76.1% to 92.3%. Over both time periods, AST intervened on 277 samples (Figure 1). Recommendations (bug-drug mismatch, de-escalation, dose optimization, and infectious disease consult) were accepted at a rate of 97.4%. Time from BC positivity to optimal therapy was 15.3 hours (Figure 2). Conclusion Implementation of AP with AST review resulted in rapid identification and antibiotic susceptibility results with early optimization of antimicrobial therapy. Highest impact was seen in the management of patients with resistant Gram-negative infections. Oversight of the implementation by a partnership of clinical microbiology and the antimicrobial stewardship team was critical in identifying real-time implementation issues and opportunities for quality improvement. Though real-world performance was slightly inferior to published trial data, the instrument’s exceedingly fast time to AS represents a significant advantage over other systems and enhances clinical care and patient safety particularly when paired with AST intervention. Disclosures All authors: No reported disclosures.

1588-P: Therapy Trends in Initial 6 Months of the First Large-Scale Longitudinal Nationwide Study on Management and Real-World Outcomes of Diabetes in India (LANDMARC)

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1588-P ◽  
Author(s):  
ROMIK GHOSH ◽  
ASHOK K. DAS ◽  
AMBRISH MITHAL ◽  
SHASHANK JOSHI ◽  
K.M. PRASANNA KUMAR ◽  
...  
Keyword(s):  
Real World ◽  
Large Scale ◽  
Nationwide Study
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