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Maintaining fitness and a healthy bodyweight can enhance police officer safety, de-escalation, and subsequently survivability in addition to overall health and wellness. Within a law enforcement agency, it can be difficult to implement a health and wellness program without the support of the police chief and command staff. However, support for health and wellness programs and the perceived impact on the job by law enforcement police chiefs is not well known. This article analyzes police chiefs’ perspectives on police officer physical fitness and bodyweight, and their impact on multiple aspects of the job, as well as barriers to implementing health and wellness programs. A survey of 425 Texas police chiefs indicated 99.5% of respondents believed it was important or somewhat important for officers to be at a healthy bodyweight. The top potential barriers to officers’ physical fitness represented by police chiefs were individual unwillingness and laziness. A more thorough understanding of perceptions and beliefs by law enforcement leadership can help enhance the alignment of programs, impact habits, and ultimately influence daily choices that officers make. These perceptions can also assist in the development of programs to further support officer readiness, safety, and survivability, as well as overall health.

IsoPSA is a blood-based test that assesses prostate cancer (CaP) risk by partitioning and detecting cancer-specific structural isoforms of prostate specific antigen (PSA) with an aqueous 2- phase system.To validate the diagnostic performance of IsoPSA for High-Grade CaP and Any CaP risk on biopsy in men age ≥ 50 with total PSA ≥ 4 ng/ml.Prospective, multicenter study of 888 men scheduled for prostate biopsy at 8 academic and community sites between August 2015 and August 2020.IsoPSA test.Receiver operating characteristic and likelihood ratio analysis used to validate diagnostic performance for previously established IsoPSA Index cutoffs for High-Grade CaP (Gleason Score ≥ 7) and Any CaP (Gleason Score ≥ 6), compare IsoPSA to total PSA and % free PSA, and evaluate subgroups (total PSA 4-10 ng/ml, total PSA10 ng/ml, biopsy naïve, prior negative biopsy).The disease prevalence was 35.6% (High-Grade CaP) and 58.9% (Any CaP). The area under the receiver operating characteristic curve was 0.783 (High-Grade CaP) and 0.770 (Any CaP). IsoPSA outperformed total PSA and % free PSA on area under the receiver operating characteristic curve, specificity, positive and negative predictive value at similar sensitivity. Using selected IsoPSA Index cutoffs, an estimated 46% (High-Grade CaP) and 42% (Any CaP) of biopsies could be avoided in low-risk patients. IsoPSA displayed statistically informative likelihood ratio-based predictive characteristics. IsoPSA maintained accuracy in clinically relevant subgroups.IsoPSA diagnostic performance and predictive value is validated for High-Grade CaP and Any CaP in men age ≥ 50 with total PSA ≥ 4 ng/ml undergoing diagnostic biopsy. IsoPSA outperforms total and % free PSA in discriminating the risk of prostate cancer on biopsy.IsoPSA has the potential to reduce unnecessary biopsies and improve the risk-benefit ratio for CaP early detection.

The temptation, as ever, is to begin with a pithy quote about our subject matter, time. But giving in to that temptation does not really narrow our options much, or lead to a clear and perfect open...

Hamlet’s first encounter with the Ghost serves principally, in narrative terms at least, to deliver the news, both to the play’s protagonist and its audience, that Claudius is a treasonous,...

Background Free Open-Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations. Objectives We assessed the AAT's usability in a diverse population of practicing emergency medicine (EM) physicians, residents, and medical students; solicited feedback; and developed a revised tool. Methods As part of the Medical Education Translational Resources: Impact and Quality (METRIQ) study, we recruited medical students, EM residents, and EM attendings to evaluate five FOAM posts with the AAT and provide quantitative and qualitative feedback via an online survey. Two independent analysts performed a qualitative thematic analysis with discrepancies resolved through discussion and negotiated consensus. This analysis informed development of an initial revised AAT, which was then further refined after pilot testing among the author group. The final tool was reassessed for reliability. Results Of 330 recruited international participants, 309 completed all ratings. The Best Evidence in Emergency Medicine (BEEM) score was the component most frequently reported as difficult to use. Several themes emerged from the qualitative analysis: for ease of use-understandable, logically structured, concise, and aligned with educational value. Limitations include deviation from questionnaire best practices, validity concerns, and challenges assessing evidence-based medicine. Themes supporting its use include evaluative utility and usability. The author group pilot tested the initial revised AAT, revealing a total score average measure intraclass correlation coefficient (ICC) of moderate reliability (ICC = 0.68, 95% confidence interval [CI] = 0 to 0.962). The final AAT's average measure ICC was 0.88 (95% CI = 0.77 to 0.95). Conclusions We developed the final revised AAT from usability feedback. The new score has significantly increased usability, but will need to be reassessed for reliability in a broad population.

Many approaches that have been proposed that allow users to create a Web Ontology Language (OWL) ontology from a relational database fail to include metadata that are inherent to the database tables. Without metadata, the resulting ontology lacks annotation properties. These properties are key when performing ontology alignment. This paper proposes a method to include relevant metadata through annotation properties to OWL ontologies, which furthers the ability to integrate and use data from multiple unique ontologies. The described method is applied to geospatial data collected from The National Map, a data source hosted by the U. S. Geological Survey. Following that method, an ontology was manually created that used the metadata from The National Map. Because a manual approach is prone to human error, an automated approach to storing and converting metadata into annotation properties is discussed.

Particulate gas filters are a critical element in the purification systems used to ensure defect-free manufacturing in semiconductor industry. In atomic layer deposition (ALD) processes, these filters are typically operated under sub-atmospheric pressure conditions, but their filtration characteristics are, often, only known at atmospheric pressure. In this study, performance of a metal filter that is typically used in low-pressure ALD precursor delivery systems is studied experimentally and theoretically down to 4.5 kPa. The experimental procedure was designed to minimize the presence of multiply charged particles in the test aerosol for different operating pressures and flowrates. The experimental results suggest that most penetrating particle size only slightly varies with pressure, but the shape of the penetration curve and the maximum value of the penetration changes significantly with pressure. The experimental data are used to test predictions of filter performance at low pressures made using classical theory. The comparison results suggest that the combination of classical theory and manufacturer-specified parameters results in large errors in calculated penetration values at low pressures. Accurate predictions are seen to be possible for particle Stokes numbers less than 0.1, when an inhomogenous filtration model is used in combination with effective filter parameters that are obtained from experimental measurements of filter efficiency and pressure drop at atmospheric pressures. Copyright © 2016 American Association for Aerosol Research

Rabey’s book displays an impressive erudition and offers multiple contributions to the ways in which we might think about time, performance, and the relationships between the two. Like its subject, the book is sometimes disjointed and dissipative, but it is nonetheless a strong and enjoyable addition to the field.

Blockchains are used to perform state agreement in a distributed system. However, there is no way to validate off-chain actions, such as physical actions, in the current architecture. This paper proposes a new blockchain architecture which features locally physically-verified transactions. From this new architecture, this paper presents a protocol for securing vehicular ad-hoc networks (VANETs) without the need to constantly communicate with roadside units (RSUs) or other infrastructure components. However, issues such as privacy in VANETs and Blockchains are left to future work. This paper shows the results from simulations of the current system in order to note its weaknesses. In particular, this paper can be used as a benchmark to show that ideas such as Proof-of-Work and full blockchain validation cannot work in a purely peer-to-peer VANET.

Study objective Online educational resources such as blogs are increasingly used for education by emergency medicine clinicians. The Social Media Index was developed to quantify their relative impact. The Medical Education Translational Resources: Indicators of Quality (METRIQ) study was conducted in part to determine the association between the Social Media Index score and quality as measured by gestalt and previously derived quality instruments. Methods Ten blogs were randomly selected from a list of emergency medicine and critical care Web sites. The 2 most recent clinically oriented blog posts published on these blogs were evaluated with gestalt, the Academic Life in Emergency Medicine Approved Instructional Resources (ALiEM AIR) score, and the METRIQ-8 score. Volunteer raters (including medical students, emergency medicine residents, and emergency medicine attending physicians) were identified with a multimodal recruitment methodology. The Social Media Index was calculated in February 2016, November 2016, April 2017, and December 2017. Pearson's correlations were calculated between the Social Media Index and the average rater gestalt, ALiEM AIR score, and METRIQ-8 score. Results A total of 309 of 330 raters completed all ratings (93.6%). The Social Media Index correlated moderately to strongly with the mean rater gestalt ratings (range 0.69 to 0.76) and moderately with the mean rater ALiEM AIR score (range 0.55 to 0.61) and METRIQ-8 score (range 0.53 to 0.57) during the month of the blog post's selection and for 2 years after. Conclusion The Social Media Index's correlation with multiple quality evaluation instruments over time supports the hypothesis that it is associated with overall Web site quality. It can play a role in guiding individuals to high-quality resources that can be reviewed with critical appraisal techniques.

We evaluated hospitalized patients with a history of methicillin-resistant Staphylococcus aureus (MRSA) for persistent colonization and need for contact precautions. Up to 3 daily cultures of nares, skin, and any present wounds were compared with a single nasal polymerase chain reaction (PCR) assay. Most patients (76.2%) were no longer colonized with MRSA. A single PCR assay was sufficient to exclude persistent colonization and environmental contamination and remove the contact precautions.

To describe the incidence of difficult and failed intubations in obstetric patients during a 6 year period monitored by a quality assurance program together with American Society of Anesthesiologists Physical Status (ASA PS) scores, and obesity (body mass index30 kg/mFollowing Institutional Review Board approval, data about obstetric patients who experienced unanticipated difficult or failed intubations from 2010 to 2015 was obtained from the quality assurance database of a large, community-based anesthesiology group practice. The database employs standardized definitions for difficult intubation (3 laryngoscopic attempts by experienced providers) and failed intubation (inability to intubate leading to surgical airway or waking up the patient). ASA PS scores and comorbidities were also identified for obstetric general anesthetics using an internally developed quality assurance program, Quantum Clinical Navigation System.There were 2802 obstetric general anesthetics in the database of which 1085 (38.7%) were deemed as emergencies. There were no cases of failed intubation and seven cases of unanticipated difficult intubations (1:400 cases, 0.25% of all obstetric general anesthetics, 95% confidence interval 0.1-0.5%), six of which occurred during emergency surgery. There was an increase in obesity (p = .003) and ASA PS (p = .02) over the period of the study. The incidence of difficult intubation was not found to be significantly changed (p = .68).Despite an increase in ASA PS score and obesity, there was no increase in the incidence of difficult intubation in obstetric patients. Limitations of the study include its retrospective design, and the small number of difficult intubation cases identified.

In this paper, we propose a version of RSA encryption that uses the Chinese Remainder Theorem (CRT) for the purpose of concealing multiple plain-texts in one cipher-text. This scheme allows the sender to possibly send different information to multiple receivers, and each receiver is only able to decrypt the message intended for them. We prove the algorithm mathematically. Furthermore, we prove our algorithm secure against the chosen plain-text (CPA) attack. We also compare textbook RSA against our algorithm and show the security and size advantages. The new algorithm can also take advantage of current methods that speed up the decryption process of RSA. This scheme will become a basis for further one to many public key cryptosystems.

Study objective Open educational resources such as blogs are increasingly used for medical education. Gestalt is generally the evaluation method used for these resources; however, little information has been published on it. We aim to evaluate the reliability of gestalt in the assessment of emergency medicine blogs. Methods We identified 60 English-language emergency medicine Web sites that posted clinically oriented blogs between January 1, 2016, and February 24, 2016. Ten Web sites were selected with a random-number generator. Medical students, emergency medicine residents, and emergency medicine attending physicians evaluated the 2 most recent clinical blog posts from each site for quality, using a 7-point Likert scale. The mean gestalt scores of each blog post were compared between groups with Pearson's correlations. Single and average measure intraclass correlation coefficients were calculated within groups. A generalizability study evaluated variance within gestalt and a decision study calculated the number of raters required to reliably (>0.8) estimate quality. Results One hundred twenty-one medical students, 88 residents, and 100 attending physicians (93.6% of enrolled participants) evaluated all 20 blog posts. Single-measure intraclass correlation coefficients within groups were fair to poor (0.36 to 0.40). Average-measure intraclass correlation coefficients were more reliable (0.811 to 0.840). Mean gestalt ratings by attending physicians correlated strongly with those by medical students (r=0.92) and residents (r=0.99). The generalizability coefficient was 0.91 for the complete data set. The decision study found that 42 gestalt ratings were required to reliably evaluate quality (>0.8). Conclusion The mean gestalt quality ratings of blog posts between medical students, residents, and attending physicians correlate strongly, but individual ratings are unreliable. With sufficient raters, mean gestalt ratings provide a community standard for assessment.

Total joint arthroplasty (TJA) is one of the most successful operations. There is little in the literature regarding weight change following TJA, particularly in a young cohort.Retrospective analysis of 181 primary total hip arthroplasty (THA) and 185 primary total knee arthroplasty (TKA) patients was conducted. We reviewed preoperative and post-operative weights and post-operative body mass index at 3 and 6 months, 1 year, 2 and 3 years. We evaluated expected versus actual weight gain, and performed subgroup analyses of obese versus non-obese patients and active duty versus civilian patients. We used a minimal clinically meaningful weight change from baseline of ≥5%.One hundred and fifty-one (41.3%) patients were active duty military service members with the mean age of 53 ± 11.1 years. In TKA patients, statistically significant differences were found in mean weights at 3 months (-1.8%, P ≤ 0.0001) and 2 years (+1.9%, P = 0.0006). In THA patients, statistically significant weight gains were found at 6 months (+1.1%, P = 0.006). For obese TKA patients, significant weight changes were observed at 3 months (-2.5%, P ≤ 0.0001), and none in the obese THA group. There were no statistical or clinically meaningful weight changes in the non-obese TKA or THA groups. There was a clinically meaningful weight gain in active duty TKA patients at 3 years (5.18%, P = 0.17).Despite a theoretical ability to lose weight following TJA, patients maintain their preoperative weight following TJA. We found a clinically meaningful weight gain at 3 years post-operatively only in active duty TKA patients. Overall, however, we found no clinically significant weight changes following TJA at 3-year follow-up.

Objective: To present the case of recurrent rhabdomyolysis in an active female Background: A healthy 21 year old female developed severe fatigue and peripheral edema in the upper extremities after an extreme exercise workout session. 4 ½ months later she participated in a similar exercise session with a personal trainer and experienced the same symptoms. Differential Diagnosis: In the initial case, upon physical examination and review of blood work a diagnosis of rhabdomyolysis was made. After the second exercise session athlete was diagnosed with recurrent rhabdomyolysis and was advised to seek treatment at the local emergency room. Treatment: In the initial case the athlete was told by medical personnel to increase fluid intake and rest. In the second case athlete was treated at the emergency room with IV fluids. Uniqueness: The athlete was female, and most cases of rhabdomyolysis occur in males. Athlete was treated for rhabdomyolysis and recurrent rhabdomyolysis, however these diagnosis were made 4 ½ months apart. Also, both cases appear to be the result of the same type of exercise session. Conclusion: There does not appear to be a definitive protocol for an accurate diagnosis of rhabdomyolysis. Guidelines for return to activity should be evaluated on a case by case basis, and a conservative increase in intensity of exercise is warranted to prevent a case of recurrent rhabdomyolysis.

Filter media exhibit strong particle-size dependent capture characteristics that have a complicated dependence to filter properties and operating conditions. As simulation-based determination of the filtration characteristics of real media is very challenging, accurate experimental approaches are critically necessary. Conventionally, filter penetration measurements were made using test particles extracted from a differential mobility analyzer (DMA) and measuring the ratio of particle counts downstream of the filter to that upstream. Size-dependent filter penetration can be directly determined from these measurements if the DMA was operated at high resolution and the contribution of multiply charged particles was negligible. The accuracy of this well-established approach has, however, never been fully assessed. In this study, the influence of multiply charged particles to the filter efficiency measurements is determined using a system-modeling approach. The model results suggest that the contribution of multiply charged particles could significantly influence penetration results when the mode size of the test particles entering the DMA or the most penetrating particle size (MPPS) of the test filter are larger than ∼100 nm. Under such conditions, even if multiply charged particles constitute a small fraction of the test aerosol, they can significantly skew filter penetration results. For accurate calculation of filter penetration, two approaches are proposed: an improved filter test protocol and a new multiple-charge correction approach for calculation of size-dependent filter penetration from mobility-based measurements. The validity of the proposed approaches is established with experimental data.Copyright 2015 American Association for Aerosol Research

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