Search results for: Paul Prior

Authors: Priyanka Gupta, Paul Verma, Kerry Hourigan, Jayesh Bellare, Sameer Jadhav

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Understanding the consumption and production of various metabolites of fibroblast conditioned media is needed for its proper and optimized use in expansion of pluripotent stem cells. For this purpose, we have used the HPLC method to analyse the consumption of glucose and the production of lactate over time by mouse embryonic fibroblasts. The experimental data have also been compared with mathematical model fits. 0.025 moles of lactate was produced after 72 hrs while the glucose concentration decreased from 0.017 moles to 0.011 moles. The mathematical model was able to predict the trends of glucose consumption and lactate production.

Keywords: Conditioned media, HPLC, metabolite analysis, mouse embryonic fibroblast.

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Authors: Chaiwat Tantarangsee

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The purposes of this study are 1) to study the effects of participatory error correction process and 2) to find out the students’ satisfaction of such error correction process. This study is a Quasi Experimental Research with single group, in which data is collected 5 times preceding and following 4 experimental studies of participatory error correction process including providing coded indirect corrective feedback in the students’ texts with error treatment activities. Samples include 52 2nd year English Major students, Faculty of Humanities and Social Sciences, Suan Sunandha Rajabhat University. Tool for experimental study includes the lesson plan of the course; Reading and Writing English for Academic Purposes II, and tools for data collection include 5 writing tests of short texts and a questionnaire. Based on formative evaluation of the students’ writing ability prior to and after each of the 4 experiments, the research findings disclose the students’ higher scores with statistical difference at 0.00. Moreover, in terms of the effect size of such process, it is found that for mean of the students’ scores prior to and after the 4 experiments; d equals 0.6801, 0.5093, 0.5071, and 0.5296 respectively. It can be concluded that participatory error correction process enables all of the students to learn equally well and there is improvement in their ability to write short texts. Finally the students’ overall satisfaction of the participatory error correction process is in high level (Mean = 4.39, S.D. = 0.76).

Keywords: Coded indirect corrective feedback, participatory error correction process, error treatment.

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Authors: M. Ungurean, F. Fitigau, C. Paul, A. Ursoiu, F. Peter

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Pretreatment of lignocellulosic biomass materials from poplar, acacia, oak, and fir with different ionic liquids (ILs) containing 1-alkyl-3-methyl-imidazolium cations and various anions has been carried out. The dissolved cellulose from biomass was precipitated by adding anti-solvents into the solution and vigorous stirring. Commercial cellulases Celluclast 1.5L and Accelerase 1000 have been used for hydrolysis of untreated and pretreated lignocellulosic biomass. Among the tested ILs, [Emim]COOCH3 showed the best efficiency, resulting in highest amount of liberated reducing sugars. Pretreatment of lignocellulosic biomass using glycerol-ionic liquids combined pretreatment and dilute acid-ionic liquids combined pretreatment were evaluated and compared with glycerol pretreatment, ionic liquids pretreatment and dilute acid pretreatment.

Keywords: Cellulase, enzymatic hydrolysis, lignocellulosicbiomass, pretreatment.

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Authors: Ana Bobirca, Paul-Gabriel Miclaus

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The purpose of the article is to illustrate the main characteristics of the corporate governance challenge facing the countries of South-Eastern Europe (SEE) and to subsequently determine and assess the extensiveness and effectiveness of corporate governance regulations in these countries. Therefore, we start with an overview on the subject of the key problems of corporate governance in transition. We then address the issue of corporate governance measurement for SEE countries. To this end, we include a review of the methodological framework for determining both the extensiveness and the effectiveness of corporate governance legislation. We then focus on the actual analysis of the quality of corporate governance codes, as well as of legal institutions effectiveness and provide a measure of corporate governance in Romania and other SEE emerging markets. The paper concludes by emphasizing the corporate governance enforcement gap and by identifying research issues that require further study.

Keywords: corporate governance, effectiveness, extensiveness, South-Eastern Europe

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Authors: Dawit Mengistu, Lars Lundberg, Paul Davidsson

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A major requirement for Grid application developers is ensuring performance and scalability of their applications. Predicting the performance of an application demands understanding its specific features. This paper discusses performance modeling and prediction of multi-agent based simulation (MABS) applications on the Grid. An experiment conducted using a synthetic MABS workload explains the key features to be included in the performance model. The results obtained from the experiment show that the prediction model developed for the synthetic workload can be used as a guideline to understand to estimate the performance characteristics of real world simulation applications.

Keywords: Grid computing, Performance modeling, Performance prediction, Multi-agent simulation.

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Authors: Verónica Díaz

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A Cartesian graph, as a mathematical object, becomes a tool for configuration of change. Its best comprehension is done through everyday life problem-solving associated with its representation. Despite this, the current educational framework favors general graphs, without consideration of their argumentation. Students are required to find the mathematical function without associating it to the development of graphical language. This research describes the use made by students of configurations made prior to Cartesian graphs with regards to an everyday life problem related to a time and distance variation phenomenon. The theoretical framework describes the function conditions of study and their modeling. This is a qualitative, descriptive study involving six undergraduate case studies that were carried out during the first term in 2016 at University of Los Lagos. The research problem concerned the graphic modeling of a real person’s movement phenomenon, and two levels of analysis were identified. The first level aims to identify local and global graph interpretations; a second level describes the iconicity and referentiality degree of an image. According to the results, students were able to draw no figures before the Cartesian graph, highlighting the need for students to represent the context and the movement of which causes the phenomenon change. From this, they managed Cartesian graphs representing changes in position, therefore, achieved an overall view of the graph. However, the local view only indicates specific events in the problem situation, using graphic and verbal expressions to represent movement. This view does not enable us to identify what happens on the graph when the movement characteristics change based on possible paths in the person’s walking speed.

Keywords: Cartesian graphs, higher education, movement modeling, problem solving.

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Authors: Mahmood Q.K. Ghaznavi, Martin Perry, Paul Toulson, Keri Logan

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The importance of nurturing, accumulating, and efficiently deploying knowledge resources through formal structures and organisational mechanisms is well understood. Recent trends in knowledge management (KM) highlight that the effective creation and transfer of knowledge can also rely upon extra-organisational channels, such as, informal networks. The perception exists that the role of informal networks in knowledge creation and performance has been underestimated in the organisational context. Literature indicates that many managers fail to comprehend and successfully exploit the potential role of informal networks to create value for their organisations. This paper investigates: 1) whether managers share work-specific knowledge with informal contacts within and outside organisational boundaries; and 2) what do they think is the importance of this knowledge collaboration in their learning and work outcomes.

Keywords: Informal network, knowledge management, knowledge sharing, performance.

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Authors: V. I. Thajudin Ahamed, P. Dhanasekaran, Paul Joseph K.

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Analysis of heart rate variability (HRV) has become a popular non-invasive tool for assessing the activities of autonomic nervous system. Most of the methods were hired from techniques used for time series analysis. Currently used methods are time domain, frequency domain, geometrical and fractal methods. A new technique, which searches for pattern repeatability in a time series, is proposed for quantifying heart rate (HR) time series. These set of indices, which are termed as pattern repeatability measure and pattern repeatability ratio are able to distinguish HR data clearly from noise and electroencephalogram (EEG). The results of analysis using these measures give an insight into the fundamental difference between the composition of HR time series with respect to EEG and noise.

Keywords: Approximate entropy, heart rate variability, noise, pattern repeatability, and sample entropy.

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Authors: B. Chandra, P. Paul Varghese

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Crypto System Identification is one of the challenging tasks in Crypt analysis. The paper discusses the possibility of employing Neural Networks for identification of Cipher Systems from cipher texts. Cascade Correlation Neural Network and Back Propagation Network have been employed for identification of Cipher Systems. Very large collection of cipher texts were generated using a Block Cipher (Enhanced RC6) and a Stream Cipher (SEAL). Promising results were obtained in terms of accuracy using both the Neural Network models but it was observed that the Cascade Correlation Neural Network Model performed better compared to Back Propagation Network.

Keywords: Back Propagation Neural Networks, CascadeCorrelation Neural Network, Crypto systems, Block Cipher, StreamCipher.

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Authors: Brian A. Smith, Ronald W. McClendon, Gerrit Hoogenboom

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The mitigation of crop loss due to damaging freezes requires accurate air temperature prediction models. Previous work established that the Ward-style artificial neural network (ANN) is a suitable tool for developing such models. The current research focused on developing ANN models with reduced average prediction error by increasing the number of distinct observations used in training, adding additional input terms that describe the date of an observation, increasing the duration of prior weather data included in each observation, and reexamining the number of hidden nodes used in the network. Models were created to predict air temperature at hourly intervals from one to 12 hours ahead. Each ANN model, consisting of a network architecture and set of associated parameters, was evaluated by instantiating and training 30 networks and calculating the mean absolute error (MAE) of the resulting networks for some set of input patterns. The inclusion of seasonal input terms, up to 24 hours of prior weather information, and a larger number of processing nodes were some of the improvements that reduced average prediction error compared to previous research across all horizons. For example, the four-hour MAE of 1.40°C was 0.20°C, or 12.5%, less than the previous model. Prediction MAEs eight and 12 hours ahead improved by 0.17°C and 0.16°C, respectively, improvements of 7.4% and 5.9% over the existing model at these horizons. Networks instantiating the same model but with different initial random weights often led to different prediction errors. These results strongly suggest that ANN model developers should consider instantiating and training multiple networks with different initial weights to establish preferred model parameters.

Keywords: Decision support systems, frost protection, fruit, time-series prediction, weather modeling

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Authors: Hai Huu Le, Paul Junor, Moshi Geso, Graeme O’Keefe

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In this paper, the authors propose a personal wearable directionally-sensitive radiation dosimeter using multiple semiconductor CdZnTe detectors. The proposed dosimeter not only measures the real-time dose rate but also provide the direction of the radioactive source. A linear relationship between radioactive source direction and the radiation intensity measured by each detectors is established and an equation to determine the source direction is derived by the authors. The efficiency and accuracy of the proposed dosimeter is verified by simulation using Geant4 package. Results have indicated that in a measurement duration of about 7 seconds, the proposed dosimeter was able to estimate the direction of a 10μCi 137/55Cs radioactive source to within 2 degrees.

Keywords: Dose rate, Geant4 package, radiation detectors, radioactive source direction.

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Authors: Paul Lajbcygier, Seng Lee

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Co-integration models the long-term, equilibrium relationship of two or more related financial variables. Even if cointegration is found, in the short run, there may be deviations from the long run equilibrium relationship. The aim of this work is to forecast these deviations using neural networks and create a trading strategy based on them. A case study is used: co-integration residuals from Australian Bank Bill futures are forecast and traded using various exogenous input variables combined with neural networks. The choice of the optimal exogenous input variables chosen for each neural network, undertaken in previous work [1], is validated by comparing the forecasts and corresponding profitability of each, using a trading strategy.

Keywords: Artificial neural networks, co-integration, forecasting, trading rule.

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Authors: Paul B. Stone, Subhashini Ganapathy, Mary E. Fendley, Layla Akilan

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As notifications become more common through mobile devices, it is important to understand the impact of wearable devices for improved user experience of man-machine interfaces. This study examined the use of a wearable device for a real-time system using a computer simulated petrochemical system. The key research question was to determine how using information provided by the wearable device can improve human performance through measures of situational awareness and decision making. Results indicate that there was a reduction in response time when using the watch and there was no difference in situational awareness. Perception of using the watch was positive, with 83% of users finding value in using the watch and receiving haptic feedback.

Keywords: computer applications, haptic feedback, petrochemical systems, situational awareness, wearable technology

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Authors: Muhammad E. Rahman, Paul J. Fanning

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Many single or multispan arch bridges are strengthened with the addition of some kind of structural support between adjacent arches of multispan or beside the arch barrel of a single span to increase the strength of the overall structure. It was traditionally formed by either placing loose rubble masonry blocks between the arches and beside the arches or using mortar or concrete to construct a more substantial structural bond between the spans. On the other hand backing materials are present in some existing bridges. Existing arch assessment procedures generally ignore the effects of backing materials. In this paper an investigation of the effects of backing on ratings for masonry arch bridges is carried out. It is observed that increasing the overall lateral stability of the arch system through the inclusion of structural backing results in an enhanced failure load by reducing the likelihood of any tension occurring at the top of the arch.

Keywords: Arch, Backing, Bridge, Masonry

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Authors: Robert L. Burdett, Bayan Bevrani

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Analytical techniques for measuring and planning railway capacity expansion activities have been considered in this article. A preliminary mathematical framework involving track duplication and section sub divisions is proposed for this task. In railways, these features have a great effect on network performance and for this reason they have been considered. Additional motivations have also arisen from the limitations of prior models that have not included them.

Keywords: Capacity analysis, capacity expansion, railways.

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Authors: Sajed A. Habib

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Problem-based learning (PBL) is a student-centered pedagogy that originated in the medical field and has also been used extensively in other knowledge disciplines with recognized advantages and limitations. PBL has been used in various undergraduate engineering programs with mixed outcomes. The current fourth industrial revolution (digital era or Industry 4.0) has made it essential for many science and engineering students to receive effective training in advanced courses such as industrial automation and robotics. This paper presents a case study at Assumption University of Thailand, where a PBL-like approach was used to teach some aspects of automation and robotics to selected groups of undergraduate engineering students. These students were given some basic level training in automation prior to participating in a subsequent training session in order to solve technical problems with increased complexity. The participating students’ evaluation of the training sessions in terms of learning effectiveness, skills enhancement, and incremental knowledge following the problem-solving session was captured through a follow-up survey consisting of 14 questions and a 5-point scoring system. From the most recent training event, an overall 70% of the respondents indicated that their skill levels were enhanced to a much greater level than they had had before the training, whereas 60.4% of the respondents from the same event indicated that their incremental knowledge following the session was much greater than what they had prior to the training. The instructor-facilitator involved in the training events suggested that this method of learning was more suitable for senior/advanced level students than those at the freshmen level as certain skills to effectively participate in such problem-solving sessions are acquired over a period of time, and not instantly.

Keywords: Automation, industry 4.0, model-based design training, problem-based learning.

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Authors: Iris Käppler, Paul Matthäi, Chokri Cherif

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In the scope of application of technical textiles, Non- Crimp Fabrics are increasingly used. In general, NCF exhibit excellent load bearing properties, but caused by the manufacturing process, there are some remaining disadvantages which have to be reduced. Regarding to this, a novel technique of processing NCF was developed substituting the binding-thread by an adhesive. This stitchfree method requires new manufacturing concept as well as new basic methods to prove adhesion of glue at fibres and textiles. To improve adhesion properties and the wettability of carbon-fibres by the adhesive, oxy-fluorination was used. The modification of carbonfibres by oxy-fluorination was investigated via scanning electron microscope, X-ray photoelectron spectroscopy and single fibre tensiometry. Special tensile tests were developed to determine the maximum force required for detachment.

Keywords: Non-Crimp Fabric, adhesive, stitch-free, high-performance fibre.

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Authors: P. Sankar, P. James Daniel Paul, Siddhant Sahu

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A brief review of the empirical studies on the methodology of the stock market decision support would indicate that they are at a threshold of validating the accuracy of the traditional and the fuzzy, artificial neural network and the decision trees. Many researchers have been attempting to compare these models using various data sets worldwide. However, the research community is on the way to the conclusive confidence in the emerged models. This paper attempts to use the automotive sector stock prices from National Stock Exchange (NSE), India and analyze them for the intra-sectorial support for stock market decisions. The study identifies the significant variables and their lags which affect the price of the stocks using OLS analysis and decision tree classifiers.

Keywords: Indian Automotive Sector, Stock Market Decisions, Equity Portfolio Analysis, Decision Tree Classifiers, Statistical Data Analysis.

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Authors: N. W. Paul, M. Banerjee

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Discussing the nexus between global health policy and local practices, this article addresses the recent Ebola outbreak as a role model for narrative co-constructions of epidemic risk. We will demonstrate in how far a theory-driven and methodologically rooted analysis of narrativity can help to improve mechanisms of prevention and intervention whenever epidemic risk needs to be addressed locally in order to contribute to global health. Analyzing the narrative transformation of Ebola, we will also address issues of transcultural problem-solving and of normative questions at stake. In this regard, we seek to contribute to a better understanding of a key question of global health and justice as well as to the underlying ethical questions. By highlighting and analyzing the functions of narratives, this paper provides a translational approach to refine our practices by which we address epidemic risk, be it on the national, the transnational or the global scale.

Keywords: Ebola, Epidemic Risk, Medical Ethics, Medical Humanities.

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Authors: Paul Dallyn, Ashraf El-Hamalawi, Alessandro Palmeri, Bob Knight

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In order to better understand the long term implications of the grout wear failure mode in large-diameter plainsided grouted connections, a numerical model has been developed and calibrated that can take advantage of existing operational plant data to predict the wear accumulation for the actual load conditions experienced over a given period, thus limiting the requirement for expensive monitoring systems. This model has been derived and calibrated based on site structural condition monitoring (SCM) data and supervisory control and data acquisition systems (SCADA) data for two operational wind turbine generator substructures afflicted with this challenge, along with experimentally derived wear rates.

Keywords: Grouted Connection, Numerical Model, Offshore Structure, Wear, Wind Energy.

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Authors: Subha D. Puthankattil, Paul K. Joseph

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Analyzing brain signals of the patients suffering from the state of depression may lead to interesting observations in the signal parameters that is quite different from a normal control. The present study adopts two different methods: Time frequency domain and nonlinear method for the analysis of EEG signals acquired from depression patients and age and sex matched normal controls. The time frequency domain analysis is realized using wavelet entropy and approximate entropy is employed for the nonlinear method of analysis. The ability of the signal processing technique and the nonlinear method in differentiating the physiological aspects of the brain state are revealed using Wavelet entropy and Approximate entropy.

Keywords: EEG, Depression, Wavelet entropy, Approximate entropy, Relative Wavelet energy, Multiresolution decomposition.

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Authors: Hadeel Salim Alkutubi

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The objective of this study is to introduce estimators to the parameters and survival function for Weibull distribution using three different methods, Maximum Likelihood estimation, Standard Bayes estimation and Modified Bayes estimation. We will then compared the three methods using simulation study to find the best one base on MPE and MSE.

Keywords: Maximum Likelihood estimation , Bayes estimation, Jeffery prior information, Simulation study

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Authors: Paul Crowther, Richard Hill

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Much has been written about the difficulties students have with producing traditional dissertations. This includes both native English speakers (L1) and students with English as a second language (L2). The main emphasis of these papers has been on the structure of the dissertation, but in all cases, even when electronic versions are discussed, the dissertation is still in what most would regard as a traditional written form. Master of Science Degrees in computing disciplines require students to gain technical proficiency and apply their knowledge to a range of scenarios. The basis of this paper is that if a dissertation is a means of showing that such a student has met the criteria for a pass, which should be based on the learning outcomes of the dissertation module, does meeting those outcomes require a student to demonstrate their skills in a solely text based form, particularly in a highly technical research project? Could it be possible for a student to produce a series of related artifacts which form a cohesive package that meets the learning out comes of the dissertation?

Keywords: Computing, Masters dissertation, thesis, portfolio

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Authors: Raúl González Muñoz, Essam Shehab, Martin Weinitzke, Chris Fowler, Paul Baguley

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Software applications have become crucial for the aerospace industry, providing a wide range of functionalities and capabilities. However, due to the considerable time difference between aircraft and software life cycles, obsolescence has turned into a major challenge for industry in last decades. This paper aims to provide a view on the different causes of software obsolescence within aerospace industry, as well as a perception on the importance of each of them. The key research question addressed is what drives software obsolescence in the aerospace industry, managing large software application portfolios. This question has been addressed by conducting firstly an in depth review of current literature and secondly by arranging an industry workshop with professionals from aerospace and consulting companies. The result is a set of drivers of software obsolescence, distributed among three different environments and several domains. By incorporating monitoring methodologies to assess those software obsolescence drivers, benefits in maintenance efforts and operations disruption avoidance are expected.

Keywords: Aerospace industry, obsolescence drivers, software lifecycle, software obsolescence.

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Authors: Ana Bobirca, Paul-Gabriel Miclaus

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International competitiveness receives much attention nowadays, but up to now its assessment has been heavily based on manufacturing industry statistics. This paper addresses the need for competitiveness indicators that cover the service sector and sets out a multilevel framework for measuring international services trade competitiveness. The approach undertaken here aims at comparatively examining the international competitiveness of the EU-25 (the twenty-five European Union member states before the 1st of January 2007), Romanian and Bulgarian services trade, as well as the last two countries- structure of specialization on the EU-25 services market. The primary changes in the international competitiveness of three major services sectors – transportation, travel and other services - are analyzed. This research attempts to determine the ability of the two recent European Union (EU) member states to contend with the challenges that might arise from the hard competition within the enlarged EU, in the field of services trade.

Keywords: Bulgaria, EU-25, international competitiveness, international services trade, Romania.

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Authors: Yungchien Cheng, Chienmin Chu

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Address Matching is an important application of Geographic Information System (GIS). Prior to Address Matching working, obtaining X,Y coordinates is necessary, which process is calling Address Geocoding. This study will illustrate the effective address geocoding process of using household registry database, and the check system for geocoded address.

Keywords: GIS, Address Geocoding, HouseHold Registry Database

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Authors: Patricia M. Boechler, Heather M. Gautreau

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In this research study, postsecondary students completed an information learning task in an avatar-based 3D virtual learning environment. Three factors were of interest in relation to learning; 1) the influence of collaborative vs. independent conditions, 2) the influence of the spatial arrangement of the virtual environment (linear, random and clustered), and 3) the relationship of individual differences such as spatial skill, general computer experience and video game experience to learning. Students completed pretest measures of prior computer experience and prior spatial skill. Following the premeasure administration, students were given instruction to move through the virtual environment and study all the material within 10 information stations. In the collaborative condition, students proceeded in randomly assigned pairs, while in the independent condition they proceeded alone. After this learning phase, all students individually completed a multiple choice test to determine information retention. The overall results indicated that students in pairs did not perform any better or worse than independent students. As far as individual differences, only spatial ability predicted the performance of students. General computer experience and video game experience did not. Taking a closer look at the pairs and spatial ability, comparisons were made on pairs high/matched spatial ability, pairs low/matched spatial ability and pairs that were mismatched on spatial ability. The results showed that both high/matched pairs and mismatched pairs outperformed low/matched pairs. That is, if a pair had even one individual with strong spatial ability they would perform better than pairs with only low spatial ability individuals. This suggests that, in virtual environments, the specific individuals that are paired together are important for performance outcomes. The paper also includes a discussion of trends within the data that have implications for virtual environment education.

Keywords: Avatar-based, virtual environment, paired learning, individual differences.

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Authors: Nihal Esam Abuzinadah, Areej Abbas Malibari, Arwa Abdulaziz Allinjawi, Paul Krause

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Deaf and hearing-impaired students face many obstacles throughout their education, especially with learning applied sciences such as computer programming. In addition, there is no clear signs in the Arabic Sign Language that can be used to identify programming logic terminologies such as while, for, case, switch etc. However, hearing disabilities should not be a barrier for studying purpose nowadays, especially with the rapid growth in educational technology. In this paper, we develop an Avatar based system to teach computer programming to deaf and hearing-impaired students using Arabic Signed language with new signs vocabulary that is been developed for computer programming education. The system is tested on a number of high school students and results showed the importance of visualization in increasing the comprehension or understanding of concepts for deaf students through the avatar.

Keywords: Hearing-impaired students, isolation, self-esteem, learning difficulties.

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Authors: L. Melzerová, T. Janda, M. Šejnoha, J. Šejnoha

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Two finite element (FEM) models are presented in this paper to address the random nature of the response of glued timber structures made of wood segments with variable elastic moduli evaluated from 3600 indentation measurements. This total database served to create the same number of ensembles as was the number of segments in the tested beam. Statistics of these ensembles were then assigned to given segments of beams and the Latin Hypercube Sampling (LHS) method was called to perform 100 simulations resulting into the ensemble of 100 deflections subjected to statistical evaluation. Here, a detailed geometrical arrangement of individual segments in the laminated beam was considered in the construction of two-dimensional FEM model subjected to in fourpoint bending to comply with the laboratory tests. Since laboratory measurements of local elastic moduli may in general suffer from a significant experimental error, it appears advantageous to exploit the full scale measurements of timber beams, i.e. deflections, to improve their prior distributions with the help of the Bayesian statistical method. This, however, requires an efficient computational model when simulating the laboratory tests numerically. To this end, a simplified model based on Mindlin’s beam theory was established. The improved posterior distributions show that the most significant change of the Young’s modulus distribution takes place in laminae in the most strained zones, i.e. in the top and bottom layers within the beam center region. Posterior distributions of moduli of elasticity were subsequently utilized in the 2D FEM model and compared with the original simulations.

Keywords: Bayesian inference, FEM, four point bending test, laminated timber, parameter estimation, prior and posterior distribution, Young’s modulus.

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Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

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A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: Critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team.

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