Natural Language Processing for Information Retrieval Roadmap What do We Mean

Natural Language Processing for Information Retrieval  Roadmap  What do We Mean www.phwiki.com

Oard College of Information Studies Roadmap IR overview NLP in consideration of monolingual IR NLP in consideration of cross-language IR What do We Mean by ?Information ? Information is data in context Databases contain data in addition so that produce information IR systems contain in addition so that provide information How is it different from ?Knowledge? Knowledge is a basis in consideration of making decisions Many ?knowledge bases? contain decision rules What Do We Mean by ?Retrieval ? Find something that you are looking in consideration of 3 general categories: Known item search Find the class home page Answer seeking Is Lexington or Louisville the capital of Kentucky Directed exploration Who makes videoconferencing systems Retrieval System Model Query Formulation Detection Delivery Selection Examination Index Docs User Indexing Query Formulation Query Formulation Detection User Detection Searches the index Not the web! Looks in consideration of words Desired Required (+) Together (?.?) Ranks the results Goal is ?best first? Query Formulation Detection Selection Index Docs Selection Detection Selection Examination Docs User About 7381 documents match your query. 1. MAHEC Videoconference Systems. Major Category. Product Type. Product. Network System. Multipoint Conference Server (MCS) PictureTel Prism – 8 port. . – size 5K – 6-Jun-97 – English – 2. VIDEOCONFERENCING PRODUCTS. Aethra offers a complete product line of multimedia in addition so that videocommunications products so that meet all the applications needs of. – size 4K – 1-Jul-97 – English – Index Relevance Feedback Query refinement based on search results Examination Delivery Selection Examination User Docs Aethra offers a complete product line of multimedia in addition so that videocommunications products so that meet all the applications needs of users. The standard product line is augmented by a bespoke service so that solve customer specific functional requirements. Standard Videoconferencing Product Line Vega 384 in addition so that Vega 128, the improved Aethra Set-top systems, can be connected so that any TV monitor in consideration of high quality videoconferencing up so that 384 Kbps. A compact in addition so that lightweight device, VEGA is very easy so that use in addition so that can be quickly installed in any officeand work environment. Voyager, is the first Videoconference briefcase designed in consideration of journalist, reporters in addition so that people on-the-go. It combines high quality video-communication (up so that 384 Kbps) alongside the necessary reliability in a small in addition so that light briefcase. Delivery Bookmark a page in consideration of later use Email as a URL or as HTML Cut in addition so that paste into a presentation Print a hardcopy in consideration of later review Delivery Examination Docs User Human-Machine Synergy Machines are good at: Doing simple things accurately in addition so that quickly Scaling so that larger collections in sublinear time People are better at: Accurately recognizing what they are looking in consideration of Evaluating intangibles such as ?quality? Humans in addition so that machines are pretty bad at: Mapping concepts into search terms Detection Component Model Comparison Function Representation Function Query Formulation Human Judgment Representation Function Retrieval Status Value Utility Query Information Need Document Query Representation Document Representation Query Processing Document Processing Controlled Vocabulary Retrieval A straightforward concept retrieval approach Works equally well in consideration of non-text materials Assign a unique ?descriptor? so that each concept Can be done by hand in consideration of collections of limited scope Assign some descriptors so that each document Practical in consideration of valuable collections of limited size Use Boolean retrieval based on descriptors Controlled Vocabulary Example Canine IN ADDITION SO THAT Fox Doc 1 Canine IN ADDITION SO THAT Political action Empty Canine OR Political action Doc 1, Doc 2 The quick brown fox jumped over the lazy dog?s back. Document 1 Document 2 Now is the time in consideration of all good men so that come so that the aid of their party. Volunteerism Political action Fox Canine 0 0 1 1 1 1 0 0 Descriptor Doc 1 Doc 2 [Canine] [Fox] [Political action] [Volunteerism] Challenges Thesaurus design is expensive Shifting concepts generate continuing expense Manual indexing is even more expensive In addition so that consistent indexing is very expensive User needs are often difficult so that anticipate Challenge in consideration of thesaurus designers in addition so that indexers End users find thesauri hard so that use Codesign problem alongside query formulation ?Bag of Words? Representation Simple strategy in consideration of representing documents Count how many times each term occurs A ?term? is any lexical item that you chose A fixed-length sequence of characters (an ?n-gram?) A word (delimited by ?white space? or punctuation) Some standard ?root form? of each word (e.g., a stem) A phrase (e.g., phrases listed in a dictionary) Counts can be recorded in any consistent order Bag of Words Example The quick brown fox jumped over the lazy dog?s back. Document 1 Document 2 Now is the time in consideration of all good men so that come so that the aid of their party. the quick brown fox over lazy dog back now is time in consideration of all good men so that come jump aid of their party 0 0 1 1 0 1 1 0 1 1 0 0 1 0 1 0 0 1 1 0 0 1 0 0 1 0 0 1 1 0 1 0 1 1 Indexed Term Document 1 Document 2 Stopword List Why Boolean Retrieval Works Boolean operators approximate natural language Find documents about a good party that is not over IN ADDITION SO THAT can discover relationships between concepts good party OR can discover alternate terminology excellent party NOT can discover alternate meanings Democratic party Proximity Operators More precise versions of IN ADDITION SO THAT ?NEAR n? allows at most n-1 intervening terms ? ALONGSIDE ? requires terms so that be adjacent in addition so that in order Easy so that implement, but less efficient Store a list of positions in consideration of each word in each doc Stopwords become very important! Perform normal Boolean computations Treat ALONGSIDE in addition so that NEAR like IN ADDITION SO THAT alongside an extra constraint Ranked Retrieval Paradigm Exact match retrieval often gives useless sets No documents at all, or way too many documents Query reformulation is one ?solution? Manually add or delete query terms ?Best-first? ranking can be superior Select every document within reason Put them in order, alongside the ?best? ones first Display them one screen at a time Similarity-Based Queries Treat the query as if it were a document Create a query bag-of-words Find the similarity of each document Using the coordination measure, in consideration of example Rank order the documents by similarity Most similar so that the query first Surprisingly, this works pretty well! Especially in consideration of very short queries Document Similarity How similar are two documents In particular, how similar is their bag of words 1 1 1 1: Nuclear fallout contaminated Siberia. 2: Information retrieval is interesting. 3: Information retrieval is complicated. 1 1 1 1 1 1 nuclear fallout siberia contaminated interesting complicated information retrieval 1 1 2 3 Coordination Measure Example 1 1 1 1 1 1 1 1 1 nuclear fallout siberia contaminated interesting complicated information retrieval 1 1 2 3 Query: complicated retrieval Result: 3, 2 Query: information retrieval Result: 2, 3 Query: interesting nuclear fallout Result: 1, 2 Incorporating Term Frequency High term frequency is evidence of meaning In addition so that high IDF is evidence of term importance Recompute the bag-of-words Compute TF * IDF in consideration of every element TF*IDF Example 4 5 6 3 1 3 1 6 5 3 4 3 7 1 nuclear fallout siberia contaminated interesting complicated information retrieval 2 1 2 3 2 3 2 4 4 0.50 0.63 0.90 0.13 0.60 0.75 1.51 0.38 0.50 2.11 0.13 1.20 1 2 3 0.60 0.38 0.50 4 0.301 0.125 0.125 0.125 0.602 0.301 0.000 0.602 Unweighted query: contaminated retrieval Result: 2, 3, 1, 4 Weighted query: contaminated(3) retrieval(1) Result: 1, 3, 2, 4 IDF-weighted query: contaminated retrieval Result: 2, 3, 1, 4 Document Length Normalization Long documents have an unfair advantage They use a lot of terms So they get more matches than short documents In addition so that they use the same words repeatedly So they have much higher term frequencies Cosine Normalization Example 0.29 0.37 0.53 0.13 0.62 0.77 0.57 0.14 0.19 0.79 0.05 0.71 1 2 3 0.69 0.44 0.57 4 4 5 6 3 1 3 1 6 5 3 4 3 7 1 nuclear fallout siberia contaminated interesting complicated information retrieval 2 1 2 3 2 3 2 4 4 0.50 0.63 0.90 0.13 0.60 0.75 1.51 0.38 0.50 2.11 0.13 1.20 1 2 3 0.60 0.38 0.50 4 0.301 0.125 0.125 0.125 0.602 0.301 0.000 0.602 1.70 0.97 2.67 0.87 Length Unweighted query: contaminated retrieval, Result: 2, 4, 1, 3 (compare so that 2, 3, 1, 4) Summary So Far Find documents most similar so that the query Optionally, Obtain query term weights Given by the user, or computed from IDF Compute document term weights Some combination of TF in addition so that IDF Normalize the document vectors Cosine is one way so that do this Compute inner product of query in addition so that doc vectors Multiply corresponding elements in addition so that then add Passage Retrieval Another approach so that long-document problem Break it up into coherent units Recognizing topic boundaries is hard But overlapping 300 word passages work fine Document rank is best passage rank In addition so that passage information can help guide browsing Advantages of Ranked Retrieval Closer so that the way people think Some documents are better than others Enriches browsing behavior Decide how far down the list so that go as you read it Allows more flexible queries Long in addition so that short queries can produce useful results Ranked Retrieval Challenges ?Best first? is easy so that say but hard so that do! Probabilistic retrieval tries so that approximate it How can the user understand the ranking It is hard so that use a tool that you don?t understand Efficiency may become a concern More complex computations take more time Evaluation Criteria Effectiveness Set, ranked list, user-machine system Efficiency Retrieval time, indexing time, index size Usability Learnability, novice use, expert use What is Relevance Relevance relates a topic in addition so that a document Duplicates are equally relevant by definition Constant over time in addition so that across users Pertinence relates a task in addition so that a document Accounts in consideration of quality, complexity, language, Utility relates a user in addition so that a document Accounts in consideration of prior knowledge We seek utility, but relevance is what we get! IR Effectiveness Evaluation System-centered strategy Given documents, queries, in addition so that relevance judgments Try several variations on the retrieval system Measure which ranks more good docs near the top User-centered strategy Given several users, in addition so that at least 2 retrieval systems Have each user try the same task on both systems Measure which system works the ?best? Measures of Effectiveness Good measures: Capture some aspect of what the user wants Have predictive value in consideration of other situations Different queries, different document collection Are easily replicated by other researchers Can be expressed as a single number Allows two systems so that be easily compared IR Test Collections Documents Representative quantity Representative sources in addition so that topics Topics Used so that form queries Relevance judgments in consideration of each document, alongside respect so that each topic This is the expensive part! Some Assumptions Unchanging, known queries The same queries are used by each system Binary relevance Every document is either relevant or it is not Unchanging, known relevance The relevance of each doc so that each query is known But only used in consideration of evaluation, not retrieval! Focus on effectiveness The Contingency Table Relevant Retrieved Irrelevant Retrieved Irrelevant Rejected Relevant Rejected Relevant Not relevant Retrieved Not Retrieved Doc Action The Precision-Recall Curve R R R R Relevant Retrieved Irrelevant Retrieved Irrelevant Rejected Relevant Rejected Relevant=4 Not relevant=6 Retrieved Not Retrieved Doc=10 Action Precision at recall=0.1 Precision at 10 docs Average Precision Breakeven Point Single-Number MOE Weaknesses Precision at 10 documents Pays no attention so that recall Precision at constant recall A specific recall fraction is rarely the user?s goal Breakeven point Nobody ever searches at the breakeven point Average precision Users typically operate near an extreme of the curve So the average is not very informative Why Choose Average Precision It is easy so that trade between recall in addition so that precision Adding related query terms improves recall But naive query expansion techniques kill precision Limiting matches by part-of-speech helps precision But it almost always hurts recall Comparisons should give some weight so that both Average precision is a principled way so that do this Rewards improvements in either factor How Much is Enough The maximum average precision is 1.0 But inter-rater reliability is 0.8 or less So 0.8 is a practical upper bound at every point Precision ¯ 0.8 is sometimes seen at low recall Two goals Achieve a meaningful amount of improvement This is a judgment call, in addition so that depends on the application Achieve that improvement reliably across queries This can be verified using statistical tests Obtaining Relevance Judgments Exhaustive assessment can be too expensive TREC has 50 queries in consideration of >1 million docs each year Random sampling won?t work either If relevant docs are rare, none may be found! IR systems can help focus the sample Each system finds some relevant documents Different systems find different relevant documents Together, enough systems will find most of them Pooled Assessment Methodology Each system submits top 1000 documents Top 100 documents in consideration of each are judged All are placed in a single pool Duplicates are eliminated Placed in an arbitrary order so that avoid bias Evaluated by the person that wrote the query Assume unevaluated documents not relevant Overlap evaluation shows diminishing returns Compute average precision over all 1000 docs Lessons From TREC Incomplete judgments are useful If sample is unbiased alongside respect so that systems tested Different relevance judgments change absolute score But rarely change comparative advantages when averaged Evaluation technology is predictive Results transfer so that operational settings) Adapted from a presentation by Ellen Voorhees at the University of Maryland, March 29, 1999 What Query Averaging Hides Roadmap IR overview NLP in consideration of monolingual IR NLP in consideration of cross-language IR Machine Assisted Indexing Automatically suggest controlled vocabulary Better consistency alongside lower cost Typically use a rule-based expert system Design thesaurus by hand in the usual way Design an expert system so that process text String matching, proximity operators, Write rules in consideration of each thesaurus/collection/language Try it out in addition so that fine tune the rules by hand Text Categorization Fully automatic controlled vocabulary Typically based on machine learning Assign descriptors manually in consideration of a ?training set? Design a learning algorithm find in addition so that use patterns Bayesian classifier, neural network, genetic algorithm, Present new documents System assigns descriptors like those in training set Representing Electronic Texts A character set specifies semantic units Characters are the smallest units of meaning Abstract entities, separate from their representation A font specifies the printed representation What each character will look like on the page Different characters might be depicted identically An encoding is the electronic representation What each character will look like in a file One character may have several representations An input method is a keyboard representation Language/Character Set Identification Can be specified using metadata Included in HTTP in addition so that HTML Can be determined using word-scale features Which dictionary gets the most hits Can be determined using subword features Letter n-grams, in consideration of example 24 Units of Meaning Topical retrieval is a search in consideration of concepts But what we index are character strings What strings best represent concepts In English, words are a good starting point But stems in addition so that well chosen phrases can be better In German, compounds may need so that be split Otherwise queries using constituent words would fail In Chinese, word boundaries are not marked This segmentation problem is similar so that that of speech Stemming Suffix removal allows word variants so that match In English, word roots often precede modifiers Roots often convey topicality better Boolean systems often allow manual truncation limit -> limit, limits, limited, limitation, Stemming does automatic truncation Much cheaper than complete morphology On average, just as effective in consideration of retrieval Porter Stemmer Nine step process, 1 so that 21 rules per step Within each step, only the first valid rule fires Rules rewrite suffixes. Example: static RuleList step1a_rules[] = { 101, “sses”, “ss”, 3, 1, -1, NULL, 102, “ies”, “i”, 2, 0, -1, NULL, 103, “ss”, “ss”, 1, 1, -1, NULL, 104, “s”, LAMBDA, 0, -1, -1, NULL, 000, NULL, NULL, 0, 0, 0, NULL, }; Phrase Formation Two types of phrases Compositional: composition of word meanings Noncompositional: idiomatic expressions e.g., ?kick the bucket? or ?buy the farm? Three sources of evidence Dictionary lookup Parsing Cooccurrence Semantic Phrases Same idea as longest substring match But look in consideration of word (not character) sequences Compile a term list that includes phrases Technical terminology can be very helpful Index any phrase that occurs in the list Most effective in a limited domain Otherwise hard so that capture most useful phrases Syntactic Phrases Automatically construct sentence diagrams Fairly good parsers are becoming available Index the noun phrases Assumes that queries will focus on objects Sentence Noun Phrase The quick brown fox jumped over the lazy dog?s back Noun phrase Det Adj Adj Noun Verb Adj Noun Adj Det Prepositional Phrase Prep Statistical Phrases Compute observed occurrence probability in consideration of each single word in addition so that each word n-gram ?buy? 10 times in 1000 words yields 0.01 ?the? 100 times in 1000 words yields 0.10 ?farm? 5 times in 1000 words yields 0.005 ?buy the farm? 4 times in 1000 words yields 0.004 Compute n-gram probability if truly independent 0.01*0.10*0.005=0.000005 Compare alongside observed probability Keep phrases that occur more often than expected Phrase Indexing Lessons Poorly chosen phrases hurt effectiveness In addition so that some techniques can be slow (e.g., parsing) Better so that index phrases in addition so that words Want so that find constituents of compositional phrases Better weighting schemes benefit less Negligible improvement in some TREC-6 systems Very helpful in consideration of cross-language retrieval Noncompositional translation, less ambiguity Longest Substring Segmentation A greedy segmentation algorithm Based solely on lexical information Start alongside a list of every possible term Dictionaries are a handy source in consideration of term lists in consideration of each unsegmented string Remove the longest single substring in the list Repeat until no substrings are found in the list Can be extended so that explore alternatives Longest Substring Example Possible German compound term: washington List of German words: ach, hin, hing, sei, ton, was, wasch Longest substring segmentation was-hing-ton Word n-grams might recognize this as bad Roughly translates so that ?What tone is attached ? Model-Based Segmentation Choose a model (or set of models) Possible segmentation points, in consideration of example Assemble evidence Lexicons, corpora, algorithms, user knowledge Choose a preference criterion Longest substring, in consideration of example Choose a search strategy Greedy, exhaustive, dynamic programming Segmentation Models Unique segmentation Decide whether so that put a boundary at each point Plausible segmentation Produce all plausible substrings Plausible interpretation Produce all plausible implied substrings Contractions, alternate transliterations, etc. Sources of Evidence Lexicons Dictionaries, term lists, name lists, gazeteers Corpus statistics Segmented or unsegmented Within-document, within-collection, general use Algorithms Transliteration rules, name cues, syntax analysis User knowledge Forced join, forced split Preference Criterion A basis in consideration of optimization Single-valued, automatically computed Integrates multiple desiderata Longest substrings Unknown word identification Out of vocabulary, transliteration Consistent usage User knowledge Search Strategy Greedy Choose one search order, decide as you go Fast, but suboptimal Exhaustive Check all alternatives, choose the best Generally too slow so that be practical Dynamic programming Use limited lookahead so that generate several options Allows you so that balance speed in addition so that accuracy Synonymy in addition so that Homonymy Word matching suffers from two problems Synonymy: many words alongside similar meanings Homonymy: one word has dissimilar meanings Disambiguation seeks so that resolve homonymy By indexing word senses rather than words Synonymy can be addressed by Thesaurus-based query expansion Latent semantic indexing Word Sense Disambiguation Context provides clues so that word meaning ?The doctor removed the appendix.? in consideration of each occurrence, note surrounding words Typically +/- 5 non-stopwords Group similar contexts into clusters Based on overlaps in the words that they contain Separate clusters represent different senses Disambiguation Example Consider four example sentences The doctor removed the appendix The appendix was incomprehensible The doctor examined the appendix The appendix was removed What clusters can you find Can you find enough word senses this way Might you find too many word senses Why Disambiguation Hurts Bag-of-words techniques already disambiguate When more words are present, documents rank higher So a context in consideration of each term is established in the query Same reason that passages are better than documents Formal disambiguation tries so that improve precision But incorrect sense assignments would hurt recall Average precision balances recall in addition so that precision But the possible precision gains are small In addition so that present techniques substantially hurt recall Latent Semantic Indexing Term vectors can reveal term dependence Look at the matrix as a ?bag of documents? Compute term similarities using cosine measure Reduce the number of dimensions Assign similar terms so that a single composite Map the composite term so that a single dimension LSI Transformation d1 d2 d3 d4 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 k1 k2 k3 k4 0.15 -0.16 0.44 0.63 0.02 -0.27 0.45 0.33 -0.26 0.05 0.45 0.18 -0.10 -0.39 0.45 0.33 -0.26 0.05 0.11 0.39 0.07 0.45 0.44 0.13 0.12 0.15 -0.16 0.44 0.45 0.11 0.39 0.07 0.11 0.39 0.07 0.44 0.18 -0.10 -0.39 0.11 0.39 0.07 0.11 0.39 0.07 0.15 -0.16 t1 t2 t3 t4 t5 t6 t7 t8 t9 t10 t11 t12 t13 t14 t15 t16 t17 t18 t19 t1 t2 t3 t4 t5 t6 t7 t8 t9 t10 t11 t12 t13 t14 t15 t16 t17 t18 t19 Computing Similarity First choose k Never greater than the number of docs or terms Add the weighted vectors in consideration of each term Multiply each vector by term weight Sum each element separately Do the same in consideration of query or second document Compute inner product Multiply corresponding elements in addition so that add LSI Example d2 d3 1 2 1 1 1 1 1 1 1 1 1 1 1 k1 k2 k3 k4 0.15 -0.16 0.44 0.63 0.02 -0.27 0.33 -0.26 0.05 0.18 -0.10 -0.39 0.33 -0.26 0.05 0.44 0.13 0.12 0.15 -0.16 0.44 0.44 0.18 -0.10 -0.39 0.15 -0.16 t1 t2 t3 t4 t5 t6 t7 t8 t9 t10 t11 t12 t13 t14 t15 t16 t17 t18 t19 t3 t4 t8 t9 t12 t14 t16 t18 t19 0.44 0.13 0.12 t9 0.33 -0.26 0.05 t12 0.33 -0.26 0.05 t16 0.63 0.02 -0.27 t18 k1 k2 k3 k4 0.63 0.02 -0.27 t18 2.72 -0.55 -1.10 Sum2 2.18 -0.85 1.26 Sum3 Removing Dimensions k1 in addition so that k2 = 6.40 k1 alone = 5.92 Benefits of LSI Removing dimensions can improve things Assigns similar vectors so that similar terms Queries in addition so that new documents easily added ?Folding in? as weighted sum of term vectors Gets the same cosines alongside shorter vectors Weaknesses of LSI Words alongside several meanings confound LSI Places them at the midpoint of the right positions LSI vectors are dense Sparse vectors (tf*idf) have several advantages The required computations are expensive But T matrix in addition so that doc vectors are done in advance Query vector in addition so that cosine at query time The cosine may not be the best measure Pivoted normalization can probably help Roadmap IR overview NLP in consideration of monolingual IR NLP in consideration of cross-language IR Cross-Language IR Allow anyone so that find information that is expressed in any language Widely Spoken Languages Source: g11n/faq Web Content Source: Network Wizards Jan 99 Internet Domain Survey Machine Translation Cross-Language Browsing Cross-Language Search English Query English Document Select Examine Access Use Multilingual Retrieval Architecture Language Identification English Term Selection Chinese Term Selection Cross- Language Retrieval Monolingual Chinese Retrieval 3: 0.91 4: 0.57 5: 0.36 1: 0.72 2: 0.48 Chinese Query Chinese Term Selection Document-Language Retrieval Monolingual English Retrieval 3: 0.91 4: 0.57 5: 0.36 Query Vector Translation Chinese Query Terms English Document Terms Query-Language Retrieval Monolingual Chinese Retrieval 3: 0.91 4: 0.57 5: 0.36 Chinese Query Terms English Document Terms Document Vector Translation Query vs. Document Translation Query translation Very efficient in consideration of short queries Not as big an advantage in consideration of relevance feedback Hard so that resolve ambiguous query terms Document translation May be needed by the selection interface In addition so that supports adaptive filtering well Slow, but only need so that do it once per document Poor scale-up so that large numbers of languages 23 Interlingual Retrieval Interlingual Retrieval 3: 0.91 4: 0.57 5: 0.36 Query Vector Translation Chinese Query Terms English Document Terms Document Vector Translation Cognate-Based Retrieval Cognate Matching 3: 0.91 4: 0.57 5: 0.36 Chinese Query Terms English Document Terms Three Key Challenges oil petroleum probe survey take samples oil petroleum probe survey take samples cymbidium restrain goeringii Which translation No translation! Wrong segmentation 11 Term-aligned Sentence-aligned Document-aligned Unaligned Parallel Comparable Knowledge-based Corpus-based Controlled Vocabulary Free Text Cross-Language Text Retrieval Query Translation Document Translation Text Translation Vector Translation Ontology-based Dictionary-based Thesaurus-based Translation Knowledge A lexicon e.g., extract term list from a bilingual dictionary Corpora Parallel or comparable, linked or unlinked Algorithmic e.g., transliteration rules, cognate matching The user Types of Lexicons Ontology Representation of concepts in addition so that relationships Thesaurus Ontology specialized in consideration of retrieval Bilingual lexicon Ontology specialized in consideration of machine translation Bilingual dictionary Ontology specialized in consideration of human translation Multilingual Thesauri Adapt the knowledge structure Cultural differences influence indexing choices Use language-independent descriptors Matched so that a unique term in each language Three construction techniques Build it from scratch Translate an existing thesaurus Merge monolingual thesauri Machine Readable Dictionaries Based on printed bilingual dictionaries Becoming widely available Used so that produce bilingual term lists Cross-language term mappings are accessible Sometimes listed in order of most common usage Some knowledge structure is also present Hard so that extract in addition so that represent automatically The challenge is so that pick the right translation Measuring Lexicon Coverage Lexicon size Vocabulary coverage of the collection Term instance coverage of the collection Term weight coverage of the collection Term weight coverage on representative queries Retrieval performance on a test collection Accommodating Lexical Gaps Corpora Parallel (translation equivalent) Comparable (topically related) Algorithmic Transliteration rules, cognate matching The user Choice based on reverse translations Hieroglyphic Demotic Greek Types of Bilingual Corpora Parallel corpora: translation-equivalent pairs Document pairs Sentence pairs Term pairs Comparable corpora Content-equivalent document pairs Unaligned corpora Content from the same domain Learning From Document Pairs Count how often each term occurs in each pair Treat each pair as a single document E1 E2 E3 E4 E5 S1 S2 S3 S4 Doc 1 Doc 2 Doc 3 Doc 4 Doc 5 4 2 2 1 8 4 4 2 2 2 2 1 2 1 2 1 4 1 2 1 English Terms Spanish Terms Similarity-Based Dictionaries Automatically developed from aligned documents Terms E1 in addition so that E3 are used in similar ways Terms E1 & S1 (or E3 & S4) are even more similar in consideration of each term, find most similar in other language Retain only the top few (5 or so) Performs as well as dictionary-based techniques Evaluated on a comparable corpus of news stories Stories were automatically linked based on date in addition so that subject Generalized Vector Space Model ?Term space? of each language is different But the ?document space? in consideration of a corpus is the same Describe new documents based on the corpus Vector of cosine similarity so that each corpus document Easily generated from a vector of term weights Multiply by the term-document matrix Compute cosine similarity in document space Excellent results when the domain is the same Cross-Language LSI Designed so that reduce term choice effects Works just as well across languages Cross-language is just a type of term choice variation Train using aligned document pairs Concatenate both languages in each document Map queries in addition so that documents into LSI space Cooccurrence-Based Translation Align terms using cooccurrence statistics How often do a term pair occur in sentence pairs Weighted by relative position in the sentences Retain term pairs that occur unusually often Useful in consideration of query translation Excellent results when the domain is the same Also practical in consideration of document translation Term usage reinforces good translations Exploiting Unaligned Corpora Documents about the same set of subjects No known relationship between document pairs Easily available in many applications Two approaches Use a dictionary in consideration of rough translation But refine it using the unaligned bilingual corpus Use a dictionary so that find alignments in the corpus Then extract translation knowledge from the alignments Feedback alongside Unaligned Corpora Pseudo-relevance feedback is fully automatic Augment the query alongside top ranked documents Improves recall ?Recenters? queries based on the corpus Short queries get the most dramatic improvement Two opportunities: Query language: Improve the query Document language: Suppress translation error Context Linking Automatically align portions of documents in consideration of each query term: Find translation pairs in corpus using dictionary Select a ?context? of nearby terms e.g., +/- 5 words in each language Choose translations from most similar contexts Based on cooccurrence alongside other translation pairs Choosing the Right Translation(s) Apply known constraints Part-of-speech, syntactic dependency, Maximize the retrieval status value Exploits context provided by other query terms Use explicit statistical information Translation probability, n-gram frequencies, Perform pseudorelevance feedback Unconstr

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Newtonian Revolution Chapter 2 Describing Motion Average Speed Instantaneous

Newtonian Revolution  Chapter 2 Describing Motion  Average Speed  Instantaneous www.phwiki.com

Newtonian Revolution The study of Physics begins alongside Newtonian mechanics. Mechanics is the branch of physics that focuses on the motion of objects in addition so that the forces that cause the motion so that change. There are two parts so that mechanics: Kinematics in addition so that Dynamics. Kinematics deals alongside the concepts that are needed so that describe motion, without any reference so that forces. Chapter 2: Describing Motion Chapter 3: Falling Objects in addition so that Projectile Motion Dynamics deals alongside the effect that forces have on motion Chapter 4: Newton?s Laws-Explaining motion Chapter 2 Describing Motion Speed: Average in addition so that Instantaneous Velocity Acceleration Graphing motion Average Speed Average speed equals the distance traveled divided by the time of travel. Unit: MPH, kmPH, m/s Speed calculation: Instantaneous Speed physicsclassroom/mmedia/kinema/trip.cfm Unit Conversion: Velocity = Speed alongside Direction Velocity can be changed by changing speed or direction or both. Vectors in addition so that Scalars Physics deals alongside many physical quantities, which are divided into scalars in addition so that vectors. A scalar quantity is one that can be described by a single number (including any units) giving its size or magnitude. Examples: Distance, Time, volume, mass, temperature, in addition so that density. A quantity that deals alongside both magnitude in addition so that direction is called a vector quantity. Examples: Displacement, Force, weight, in addition so that velocity. Distance in addition so that Displacement Starting from origin, O a person walks 90-m east, then turns around in addition so that walks 40-m west. Q: What is the total walked distance A: 130-m Q: What is the displacement A: 50-m, due east. Scalars in addition so that Vectors Acceleration Acceleration is the rate at which velocity changes. Acceleration is a vector quantity. Unit of acceleration: m/s2 cars/go/crp/buyingGuides/Story.jsp section=Sports&story=sportsQuickest&subject=stories&referer=&year=2005 Acceleration of a sports car: Deceleration or Negative Acceleration An object speeds up when the acceleration in addition so that velocity vectors point in the same direction. Whenever the acceleration in addition so that velocity vectors have opposite directions, the object slows down in addition so that is said so that be ?decelerating.? V1 = 20 m/s due east V2 = 10 m/s due east t = 2.0 s a = Can a Car Be Accelerating When Its Speed Is Constant Exercises in addition so that Problems A person covers a distance of 320 miles in a travel time of 8 hours. What is the average speed in consideration of this trip A car travels alongside an average speed of 55 miles/hr. What is this speed in m/s The velocity of a car moving in a straight line increases from 8 m/s so that 22 m/s in 7 seconds. What is the average acceleration of the car during this period

To Write this Article, I had done research in Victoria University Toronto, University of Toronto CA.

College Physics (AP101) Dr.Haitao Huang (???) Department of Applied Physics, Hon

College Physics (AP101) Dr.Haitao Huang (???) Department of Applied Physics, Hon www.phwiki.com

College Physics (AP101) Dr.Haitao Huang (???) Department of Applied Physics, Hong Kong PolyU Tel: 27665694; Office: CD613 Lecture Notes can be downloaded from ap.polyu.hk/apahthua Textbooks: Physics in consideration of Scientist & Engineers, D.C.Giancoli, Prentice Hall Fundamentals of Physics, D.Halliday et al., John Willey & Sons College Physics, A.Giambattista et al., McGraw Hill University Physics, H.D.Young et al., Pearson Physics in consideration of Scientist & Engineers, R.D.Knight, Pearson Resources: Multimedia Lab: CD706 Highly Recommended References: in consideration of beginners: Berkeley Physics Course (V.1-5) ?????????? ???????? ???????????? ?????????? Intermediate: The Feynman Lectures on Physics, R.P.Feynman, et al. Classical Mechanics, H.Goldstein et al. Classical Electrodynamics, J.D.Jackson Quantum Theory of the Solid State, J.Callaway Principles of Optics, M.Born et al. ????? ????? ???????????? ???????? Advanced: Course of Theoretical Physics, (V.1-10), L.D.Landau et al. The Principles of Quantum Mechanics, P.A.M.Dirac Assessment Weighting: Continuous Assessment: Lab (in addition so that report): 16% Quiz (in addition so that midterm exam): 24% Final Exam: 60% (Minimum requirement: D) Minimum requirement in consideration of overall grade: D Physics Classical Mechanics Electrodynamics Thermodynamics Quantum Mechanics Optics The fundamentals of physics need so that be understood by anyone who hopes so that make a career in the sciences or technology: physicists, engineers, chemists, astronomers, mathematicians, geologist, or biologists. The study of physics uses skills that are useful in other fields as well. Essence of Physics Classical Mechanics: Newton?s law Electrodynamics: Maxwell?s equations Optics: Fermat?s principle Thermodynamics: First, second in addition so that third laws Quantum Mechanics; Schr”dinger?s equation Measurement Measurement in Physics: Physics is based on measurement of physical quantities. Certain physical quantities have been chosen as base quantities, such as length (??), time (??), in addition so that mass (??), each has been defined in terms of a standard (??) in addition so that given a unit (??) measure, such as meter, second, in addition so that kilogram. Other physical quantities are defined in terms of the base quantities in addition so that their standards in addition so that units. The standard of one meter is the length of the path traveled by light in vacuum (??) during a time interval of 1/299,792,458 of a second (1983). The standard of one second is the time taken by 9,192,631,770 vibrations of the light (of a specified wavelength (??)) emitted by a cesium-133 atom (1967). The standard of one kilogram is the mass of a platinum-iridium cylinder kept at the International Bureau of Weights in addition so that Measures near Paris (1889). A second mass standard is the carbon-12 atom, which has been assigned a mass of 12 atomic mass units (u) SI Unit: In 1971, the 14th General conference on Weights in addition so that Measures picked seven quantities as base quantities, thereby forming the basis of the International System of Units, abbreviated SI from its French name in addition so that popularly known as the metric system. Many SI derived units are defined in terms of these base units. SI Unit: In 1971, the 14th General conference on Weights in addition so that Measures picked seven quantities as base quantities, thereby forming the basis of the International System of Units, abbreviated SI from its French name in addition so that popularly known as the metric system. Many SI derived units are defined in terms of these base units. Significant Figures (????) The number of reliably known digits in a number is call the number of significant figures. In general, no final result should have more significant figures than the original data from which it was derived. If multiple steps of calculation are involved, you should retain more significant figures than the original data have. However, when you come so that the final result, you should round off according so that the original data alongside the least significant figures. So that express the very large in addition so that very small quantities, we use the so called scientific notation. We write numbers in ?powers of ten?. One advantage of scientific notation is that it allows the number of significant figures so that be clearly expressed. Example: A friend asks so that borrow your precious diamond in consideration of a day so that show her family. You are a bit worried, so you carefully have your diamond weighed on a scale which reads 8.17 grams. The scale?s accuracy is claimed so that be ñ0.05 grams. The next day you weigh the returned diamond again, getting 8.09 grams. Is this your diamond Measurement Measurement Example: How so that estimate the radius of the Earth Suppose that you watch the Sunset over a calm ocean while lying on the beach, starting a stopwatch just as the top of the Sun disappears. You then stand, elevating your eyes by a height h=1.70m, in addition so that stop the watch when top of the Sun again disappears. If the elapsed time on the watch is t=11.1s, what is the radius r of the Earth The angle between the tangent points A in addition so that B is q. Homework: Horses are so that race over a distance of 4.0 furlongs. What is the race distance in (a) rods in addition so that (b) chains (1 furlong = 201.168 m, 1 rod = 5.0292 m, in addition so that 1 chain = 20.117 m.) The micrometer (1 mm) is often called the micron. (a) How many microns make up 1.0 km (b) What fraction of a centimeter equals 1.0 mm The earth is approximately a sphere of radius 6.37?106 m. (a) What is its circumference in kilometers (b) What is its surface area in square kilometers (c) What is its volume in cubic kilometers The standard kilogram is in the shape of a circular cylinder alongside its height equal so that its diameter. Show that, in consideration of a circular cylinder of fixed volume, this equality gives the smallest surface area, thus minimizing the effects of surface contamination in addition so that wear. (a) Assuming that the density (mass/volume) of water is exactly 1g/cm3, express the density of water in kilograms per cubic meter (kg/m3). (b) Suppose that it takes 10 h so that drain a container of 5700m3 of water. What is the ?mass flow rate?, in kilograms per second, of water from the container The density of an iron atom is 7.87g/cm3, in addition so that the mass of an iron atom is 9.27?10-26kg. If the atoms are spherical in addition so that tightly packed, (a) what is the volume of an iron atom in addition so that (b) what is the distance between the centers of adjacent atoms Measurement Motion Along a Straight Line The description of the motion of moving bodies is called kinematics (???). Particle (??) is a physical model that we neglect the size in addition so that shape of a body. It is treated as a geometric point. Position (??): The position x of a particle on an axis locate the particle alongside respect so that the origin, or zero point, of the axis. The position is either positive or negative, according so that which side of the origin the particle is on, or zero if the particle is at the origin. Displacement (??): The displacement Dx of a particle is the change in its position: Displacement is a vector (??) quantity. It is positive if the particle has moved in the positive direction of the axis, in addition so that negative if it has moved in the negative direction. Average Velocity (????): The algebraic sign of the average velocity indicates the direction of motion. The average velocity does not depend on the actual distance a particle covers, but instead depends on its original in addition so that final positions. Motion Along a Straight Line Average Speed (????): Instantaneous Velocity (????): The instantaneous velocity (at a particular time) may be found as the slope (at that particular time) of the graph of x versus t. Speed is the magnitude of instantaneous velocity. Average Acceleration (?????): Instantaneous Acceleration (?????): Constant Acceleration: Basic equations: Free-Fall (????) Acceleration: near the Earth?s surface: Motion Along a Straight Line Example: The right figures are x(t), v(t), in addition so that a(t) plots in consideration of an elevator cab that is initially stationary, then moves upward (which we take so that be the positive direction), in addition so that then stops. in consideration of interval bc, the slope in x(t) plot is constant so that the velocity is constant in addition so that the acceleration is zero. in consideration of interval ab, the velocity increases linearly alongside time so that the acceleration is constant in addition so that positive. in consideration of interval cd, the velocity decreases linearly alongside time so that the acceleration is constant but negative. Motion Along a Straight Line Example: The position of a particle moving on the x axis is given by What is the velocity at t=3.5s (x in meter) Is the velocity constant, or is it continuously changing Example: A particle?s position is given by where x is in meter. (a) Find v(t) in addition so that a(t). (b) Is there ever a time when v=0 (c) Describe the particle?s motion in consideration of t?0. Example: Spotting a police car, you brake a Porsche from 75 km/h so that 45 km/h over a distance of 88 m. (a) What is the acceleration, assumed so that be constant (b) What is the elapsed time (c) If you continue so that slow down alongside the acceleration calculated in (a), how much time will elapse in bringing the car so that rest in consideration of 75 km/h What distance will be covered (d) Suppose that later, using the acceleration calculated in (a) but a different initial velocity, you bring your car so that rest after traveling 200m. What is the total braking time Motion Along a Straight Line Example: A worker drops a wrench down the elevator shaft of a tall building. (a) Where is the wrench 1.5 s later (b) How fast is the wrench falling just then Example: A pitcher tosses a baseball straight up, alongside an initial speed of 12m/s. (a) How long does the ball take so that reach its highest point (b) How high does the ball rise above its release point (c) How long will it take in consideration of the ball so that reach a point 5.0m above its release point Concepts: Can an object have zero velocity in addition so that still be accelerating Can an object have constant velocity in addition so that still have a varying speed Can the velocity of an object reverse direction when the object?s acceleration is constant Can an object be increasing in speed as its acceleration decreases Motion Along a Straight Line Homework: You drive on Interstate 10 from San Antonio so that Houston, half the time at 56km/h in addition so that the other half at 89km/h. On the way back you travel half the distance at 56km/h in addition so that the other half at 89km/h. What is your average speed (a) from San Antonio so that Houston, (b) from Houston so that back so that San Antonio, in addition so that (c) in consideration of the entire trip (d) What is your average velocity in consideration of the entire trip (e) Graph x versus t in consideration of (a), assuming the motion is all in the positive x direction. Indicate how the average velocity can be found on the graph. Two trains, each having a speed of 30km/h. are headed at each other on the same straight track. A bird that can fly 60km/h flies off the front of one train when they are 60km apart in addition so that heads directly in consideration of the other train. On reaching the other train it flies directly back so that the first train, in addition so that so forth. (a) How many trips can the bird make from one train so that the other before they crash (b) What is the total distance the bird travels A man stands still from t=0 so that t=5.0min; from t=5.00min so that t=10.0min he walks briskly in a straight line at a constant speed of 2.20m/s. What are his average velocity in addition so that average acceleration during the time intervals (a) 2.00min so that 8.00min in addition so that (b) 3.00min so that 9.00min (c) Sketch x versus t in addition so that v versus t, in addition so that indicate how the answers so that (a) in addition so that (b) can be obtained from the graphs. An electron alongside initial velocity v0=1.50?105m/s enters a region 1.0cm long where it is electrically accelerated. It emerges alongside velocity v=5.70?106m/s. What was its acceleration, assumed constant An object falls from a bridge that is 45m above the water. It falls directly into a model boat, moving alongside constant velocity, that was 12m from the point of impact when the object was released. What was the speed of the boat Vectors Scalars (??) in addition so that Vectors (??) Scalars, such as temperature, have magnitude only. They are specified by a number alongside a unit in addition so that obey the rules of arithmetic in addition so that ordinary algebra. Vectors, such as displacement, have both magnitude in addition so that direction in addition so that obey the special rules of vector algebra. The Sum (Resultant) of Two Vectors Two vectors a in addition so that b may be added geometrically by drawing them so that a common scale in addition so that placing them head so that tail. The vector connecting the tail of the first so that the head of the second is the sum vector s. Components (??) of a Vector The (scalar) components ax in addition so that ay of any two dimensional vector a are given by, where q is the angle formed from the positive direction of x axis so that the direction of a. a y x q Vectors Unit-Vector (???????) Notation i, j, in addition so that k are unit vectors whose magnitudes are unity in addition so that whose directions are those of the x, y, in addition so that z axes, respectively, in a right-handed coordinate system. A vector a can be written as: Adding Vectors in Component Form Suppose a in addition so that b are the vectors so that be added, the scalar components of the vector sum r are: Commutative law: Associative law: Subtraction: Vectors in addition so that Physical Laws The laws of physics are independent of the choice of coordinates. Vectors Multiplying a Vector by a Scalar The product of a scalar s in addition so that a vector v is a new vector whose magnitude is sv in addition so that whose direction is the same as that of v is s is positive, in addition so that opposite that of v if s is negative. So that divide v by s, multiply v by (1/s). The Scalar (or Dot) Product (???) The Vector (or Cross) Product (???) The vector product of a in addition so that b is a vector c whose magnitude is in which f is the smaller of the angle between the directions of a in addition so that b. The direction of c is perpendicular so that the plane defined by a in addition so that b in addition so that is given by a right-hand rule. a b f Vectors Example: Find the vector r which is the sum of the following three vectors: Example: What is the angle f between Example: If , where in addition so that , what is c Example: Describe two vectors a in addition so that b such that (a) in addition so that ; (b) ; (c) in addition so that . Concepts: (a) Can a vector have zero magnitude if one of its components is not zero (b) Can two vectors having different magnitudes be combined so that give a vector sum of zero Can three vectors give a vector sum of zero if they (c) are in the same plane, in addition so that (d) are not in the same plane (e) Can the magnitude of the difference between two vectors ever be greater than the magnitude of one of the vectors or their sum Motions in 2- in addition so that 3-Dimensions Position Vector: Displacement: Average Velocity: Instantaneous Velocity: The instantaneous velocity v of a particle is always tangent so that the path of the particle. Average Acceleration: Instantaneous Acceleration: Motions in 2- in addition so that 3-Dimensions Projectile Motion: Projectile motion is the motion of a particle that is launched alongside a initial velocity v0 in addition so that then has the free-fall acceleration g. If v0 is expressed as a magnitude (v0) in addition so that an angle q0, the equations of motion along the horizontal x axis in addition so that vertical y axis are The horizontal motion in addition so that the vertical motion are independent of each other. The path of (trajectory) a particle in projectile motion is parabolic: The particle?s range (??) R is the horizontal distance from the launch point so that the point at which the particle returns so that the launch height: The range is maximum in consideration of a launch angle of 45ø. Motions in 2- in addition so that 3-Dimensions Uniform Circular Motion: (??????) If a particle travels along a circle or circular arc alongside radius r at constant speed v, it is in uniform circular motion. The direction of a is toward the center of the circle or circular arc, in addition so that a is said so that be centripetal (??). The time in consideration of the particle so that complete a circle is called the period of revolution, or simply the period, of the motion. Example: A rescue plane is flying at a constant elevation of 500m alongside a speed of 198km/h toward a point directly over a person struggling in the water. At what angle of sight f should the pilot release a rescue capsule if it is so that strike very close so that the person in the water As the capsule reaches the water, what is its velocity Motions in 2- in addition so that 3-Dimensions Example: (The Earth?s radius is 6370km) A satellite is in circular Earth orbit, at an altitude h=200km above the Earth?s surface. There the free-fall acceleration g is 9.20m/s2. What is the orbital speed v of the satellite Example: The compass in a plane indicates that the plane is headed (pointed) due east; its airspeed indicator reads 215km/h. (Airspeed is speed relative so that the air.) A steady wind of 65.0km/h is blowing due north. (a) What is the velocity of the plane alongside respect so that the ground (b) If the pilot wishes so that fly due east, what must be the heading Homework: 1. The position of an electron is given by r=3.0ti?4.0t2j+2.0k (where t is in seconds in addition so that the coefficients have the proper units in consideration of r so that be in meters). (a) What is v(t) in consideration of the electron (b) In unit-vector notation, what is v at t=2.0s (c) What are the magnitude in addition so that direction of v just then 2. What is the maximum height so that which a baseball player can throw a ball if his maximum throwing range is 60m 3. An airplane, diving at an angle of 53.0ø alongside the vertical, releases a projectile at an altitude of 730m. The projectile hits the ground 5.00s after being released. (a) What is the speed of the aircraft (b) How far did the projectile travel horizontally during its flight (c) What were the horizontal in addition so that vertical components of its velocity just before striking the ground Force in addition so that Motion I Newtonian Mechanics (????): Newtonian mechanics relates accelerations in addition so that forces. Newton?s First Law: If there is no net force on a body, the body must remain at rest if it is initially at rest, or move in a straight line at constant speed if it is in motion. in consideration of such a body, there are reference frames, called inertial frames, from which the body?s acceleration a will be measured as being zero. Newton?s Second Law: SF is the net force (??) or resultant force (??). A free-body diagram is helpful in solving problems alongside the second law: only one body is considered in the diagram. That body is represented by a dot. The external forces on the body are drawn as vectors, in addition so that a coordinate system is superimposed, oriented so as so that simplify the solution. Newton?s Third Law: Action force (???) in addition so that reaction force (????) are equal in magnitude in addition so that opposite in direction. They act on different bodies. Force in addition so that Motion I Some Particular Forces: A body?s weight W (??) is the force on the body from a nearby astronomical body (usually the Earth) : where g is the free-fall acceleration. A normal force N (??) is the force exerted on a body by a surface against which the body is pressed. The normal force is always perpendicular so that the surface. A frictional force f (???) is the force on a body when the body slides or attempts so that slide along a surface. The force is parallel so that the surface in addition so that directed so as so that oppose the motion of the body. A frictionless surface (??????????) is one where the frictional force is negligible. A tension T (?????) is the force on a body from a taut cord at its point of attachment. The force points along the cord, away from the body. in consideration of massless cords (their mass is negligible), the pulls at both ends of the cord have the same magnitude T, even if the cord runs around a massless, frictionless pulley (??) (the pulley?s mass is negligible in addition so that the pulley has negligible friction on its axle opposing its rotation). Force in addition so that Motion I Example: A student ( alongside cleated boots) pushes a loaded sled whose mass m is 240 kg in consideration of a distance d of 2.3 mover the frictionless surface of a frozen lake. He exerts a constant horizontal force F, alongside magnitude F=130 N, as he does so. (a) If the sled starts from rest, what is its final velocity (b) The student now wants so that reverse the sled?s velocity in 4.5 s. alongside what constant force must he push on the sled so that do so Example: A block of mass M=3.3 kg is free so that move along a horizontal frictionless surface such as an air table. The sliding block is connected by a cord that extends around a massless, frictionless pulley so that a second block (the hanging block), whose mass m is 2.1 kg. The hanging block falls in addition so that the sliding block accelerates so that the right. Find (a) the acceleration of the sliding block, (b) the acceleration of the hanging block, in addition so that (c) the tension in the cord. Force in addition so that Motion I Example: A block whose mass M is 33 kg is pushed across a frictionless surface by a stick whose mass m is 3.2 kg. The block is moved (from rest) a distance d=77 cm in 1.7 s at constant acceleration. (a) What force must the hand apply so that the stick (b) alongside what force does the stick push on the block (c) What is the net force on the block Example: A block of mass m=15 kg is hanging from three cords. What are the tensions in the cords Example: Two blocks connected by a cord that passes over a massless, frictionless pulley. Let m=1.3 kg in addition so that M=2.8 kg. Find the tension in the cord in addition so that the (common) magnitude of the acceleration of the two blocks. Example: A block of mass m=15 kg is held by a cord on a frictionless inclined plane. What is the tension in the cord if q=27ø What force does the plane exert on the block Force in addition so that Motion I Homework: An elevator in addition so that its load have a combined mass of 1600 kg. Find the tension in the supporting cable when the elevator, originally moving downward at 12 m/s, is brought so that rest alongside a constant acceleration in a distance of 42 m. A 1.0 kg mass on a 37ø incline is connected so that a 3.0 kg mass on a horizontal surface. The surfaces in addition so that the pulley are frictionless. If F=12 N, what is the tension in the connecting cord A 100 kg crate is pushed at constant speed up the frictionless 30.0ø ramp. (a) What horizontal force F is required (b) What force is exerted by the ramp on the crate The figure shows two blocks on a frictionless plane, alongside inclination angle q, in addition so that a third block. Blocks m1 in addition so that m2 are connected by a cord alongside tension T1; blocks m2 in addition so that m3 are connected by a cord (around a frictionless, massless pulley) alongside tension T2. If q=20ø, m1=2.00 kg, m2=1.00 kg, in addition so that m3=3.00 kg, find T1, T2, in addition so that the acceleration of the blocks. Force in addition so that Motion II Friction: A frictional force (???) is exerted on the body by the surface. It is parallel so that the surface in addition so that directed so as so that oppose the sliding. If the body does not slide, the frictional force is a static frictional force fs (????). If there is sliding , the frictional force is a kinetic frictional force fk (????). Properties of Friction: If the body does not move, then the static frictional force fs in addition so that the component of F that is parallel so that the surface are equal in magnitude in addition so that opposite in direction. The magnitude of fs has a maximum value fs,max=msN, where ms is the coefficient of static friction (?????) in addition so that N is the magnitude of the normal force. If the body begins so that slide along the surface, the magnitude of the frictional force rapidly decreases so that a constant value fk= mkN, where mk is the coefficient of kinetic friction (?????). Force in addition so that Motion II Example: The inset shows a coin resting on a book that has been tilted at an angle q alongside the horizontal. When q is increased so that 13ø, the coin begins so that slide down the book. What is the coefficient of static friction ms between the coin in addition so that the book Example: A woman pulls a loaded sled of mass m=75 kg along a horizontal surface at constant velocity. The coefficient of kinetic friction mk between the runner in addition so that the snow is 0.10, in addition so that the angle f is 42 ø. (a) What is the tension T in the rope (b) What is the normal force alongside which the snow pushes vertically upward on the sled Uniform Circular Motion (??????): The centripetal acceleration (?????) in addition so that the centripetal force (???) are: Force in addition so that Motion II Example: Two crates alongside the same mass m1=m2=14 kg are connected through a taut, massless cord that runs around a frictionless, massless pulley. The hanging crate descends alongside constant velocity. (a) What are the magnitude in addition so that direction of the frictional force exerted on m1 by the plane (b) What is mk Example: A raindrop alongside radius R=1.5 mm falls from a cloud that is at height h=1200 m above the ground. The drag coefficient C in consideration of the drop is 0.60. Assume that the drop is spherical throughout its fall. The density of water rw is 1000 kg/m3, in addition so that the density of air ra is 1.2 kg/m3. (a) What is the terminal speed of the drop (b) What would have been the speed just before impact if there had been no drag force Example: The bob of a conical pendulum has a mass of 1.5 kg, whirls around in a horizontal circle at constant speed v at the end of a cord whose length L, measured so that the center of the bob , is 1.7 m. The cord makes an angle q of 37ø alongside the vertical. As the bob swings around in a circle, the cord sweeps out the surface of a cone. Find the period t of the pendulum bob. Force in addition so that Motion II Example: A car of mass m=1600 kg traveling at a constant speed v=20 m/s along a flat, circular road of radius R=190 m. What is the minimum value of mk between the tires of the car in addition so that the road that will prevent the car from slipping Example: Suppose that the above car now moves around a banked circle. What bank angle q makes reliance on friction unnecessary Concepts: In the right figure, if the angle q of force F on the stationary box is increased, do the following quantities increase, decrease or remain the same: (a) Fx; (b) fs; (c) N; (d) fs,max If the force F angled upward, how would the above quantities change Force in addition so that Motion II Homework: Block B in the figure weighs 711 N. The coefficient of static friction between block in addition so that horizontal surface is 0.25. Find the maximum weight of block A in consideration of which the system will be stationary. A 4.0 kg block is put on top of a 5.0 kg block. So that cause the top block so that slip on the bottom one, while the bottom one is held fixed, a horizontal force of at least 12 N must be applied so that the top block. The assembly of blocks is now placed on a horizontal, frictionless table. Find (a) the magnitude of the maximum horizontal force F that can be applied so that the lower block so that the blocks will move together in addition so that (b) the resulting acceleration of the blocks. A mass m on a frictionless table is attached so that a hanging mass M by a cord through a hole in a horizontal table. The mass m is in a circular motion alongside a radius of r. Find the speed alongside which m must move in order in consideration of M so that stay at rest.

To Write this Article, I had done research in University of Regina CA.

Overview Instrumentation & Control Products Operator Interface Sensors Boile

Overview  Instrumentation & Control Products  Operator Interface  Sensors  Boile www.phwiki.com

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CO2 + 4N2 + Heat 4N2 + O2 + S ? SO2 + 4N2 + Heat Common Combustion Reactions in consideration of Methane CH4 + 2O2 ? CO2 + 2H2O + Heat 16 + 64 ? 44 + 36 Therefore: #O2 Required = 64 # Fuel = 16 Therefore #O2/#Fuel =4/1 or 4 Boiler Efficiency in addition so that Control Boiler efficiency is computed ?by losses? Understanding of efficiency calculations helps in choosing the proper control strategy Energy ?traps? such as economizers can provide a payback Preferred Instruments has over 75 years of combustion experience so that help optimize boiler efficiency Boiler Efficiency ?by Losses? Conservation of Energy Fuel energy in equals heat energy out Energy leaves in steam or in losses Efficiency = 100% minus all losses Typical boiler efficiency is 80% so that 85% The remaining 15% so that 20% is lost Largest loss is a typical 15% ?stack loss? Radiation loss may be 3% at full input Miscellaneous losses might be 1 so that 2% Boiler Energy Balance Stack Losses Latent heat of water vapor in stack Fixed amount depending on hydrogen in fuel About 5% of fuel input in consideration of fuel oil About 9% of fuel input in consideration of natural gas Assumes a non-condensing boiler (typical) Sensible heat of stack gasses Typically around 10% of fuel input Increased mass flow in addition so that stack temperature increase the loss Radiation Loss Generally a fixed BTU / hour heat loss As a percentage, is greater at low fire Depends on the boiler construction Is generally about a 3% loss at high fire Would be 12% loss at 25% of fuel input Miscellaneous Losses Consist of: blow down losses unburned fuel losses (carbon in ash or CO) Generally on the order of one percent Excess Air Required in consideration of Burners Excess Air Required in consideration of Burners Excess Versus Deficient Air Effects of Stack Temperature Generally, stack temperature is: Steam temperature plus 100 so that 200 degrees F Rule of thumb ? watertube-150, firetube-100F Higher in consideration of dirty boilers, higher loads in addition so that increased excess air levels A 100 degree increase in stack temperature Costs about 2.5% in energy losses May mean the boiler needs serious maintenance Economizers are useful on medium in addition so that high pressure boilers as an energy ?trap? Efficiency Calculation Charts Oxygen in addition so that Air Required in consideration of Gas So that release 1 million BTU alongside gas 42 lbs. of gas are burned 168 lbs. of oxygen are required no excess air 725 lbs. of combustion air 767 lbs. of stack gasses are produced 5% so that 20% excess air is required by burner Each additional 10% increase in excess air: Adds 73 lbs. of stack gasses Reduces efficiency by 1% so that 1.5% Cost of Inefficiency The combined effects of extra excess air in addition so that the resulting increase in stack temperature: Could mean a 2% so that 10% efficiency drop Reducing this ?extra? excess air saves fuel Savings = (Fuel Cost)*[(1/old eff)-(1/new eff)] in consideration of a facility alongside a 30,000 pph steam load 10% so that 60% Extra Excess Air Represents From $6,000 so that $35,000 in potential savings per year Running 20 hours, 300 days, $4.65 per MM Btu Combustion Control Objectives Maintain proper fuel so that air ratio at all times Too little air causes unburned fuel losses Too much air causes excessive stack losses Improper fuel air ratio can be DANGEROUS Always keep fuel so that air ratio SAFE Interface alongside burner management in consideration of : Purge Low fire light off Modulate fuel in addition so that air when safe so that do so Related in addition so that Interactive Loops Feedwater Flow feedwater is usually cooler than water in boiler adding large amounts of water cools the boiler cooling the boiler causes the firing rate so that increase Furnace Draft changing pressure in furnace changes air flow changed air flow upsets fuel so that air ratio Variations in Air Composition ?Standard? air has 0.0177 LB. O2 per FT3 Hot, humid air has less O2 per cubic ft 20% less at 95% RH, 120OF, in addition so that 29.9 mm Hg Dry, cold air has more O2 per cubic ft 10% more at 0% RH, 32OF, in addition so that 30.5 mm Hg Combustion controls must: Adapt so that changing air composition (O2 trim), or Allow at least 20% extra excess air at ?standard? conditions Control System Errors Combustion control system can not perfectly regulate fuel in addition so that oxygen flows. Therefore, extra excess air must be supplied so that the burner so that account in consideration of control system errors Hysteresis Flow transmitter can not measure fuel Btu flow rate (Btu / hr) Oxygen content per cubic foot of air changes alongside humidity, temperature in addition so that pressure Fuel flow in consideration of a given valve position varies alongside temperature in addition so that pressure Control System Errors Control System Errors Combustion Control Strategies Single Point Positioning (Jackshaft) Fuel in addition so that air are tied mechanically Simple, low cost, safe, requires extra excess air Parallel Positioning Fuel valve in addition so that air damper are positioned separately Allows oxygen trim of air flow Fully Metered Fuel in addition so that air FLOW (not valve position) are controlled Jackshaft Strategy All control errors affect this system. Typically, 20 – 50 % extra excess air must be supplied so that the burner so that account in consideration of control inaccuracies. One actuator controls fuel in addition so that air via linkage. It is assumed that a given position will always provide a particular fuel flow in addition so that air flow. Oxygen trim systems can reduce the extra excess air so that 10% Suitable in consideration of firetube boilers in addition so that small watertube boilers. Used when annual fuel expense is too small so that justify a more elaborate system. Jackshaft Strategy Jackshaft Strategy Advantages Simplicity Provides large turndown Inexpensive Disadvantages Fuel valves in addition so that fan damper must be physically close together Changes in fuel or air pressure, temperature, viscosity, density, humidity affect fuel-air ratio. Only one fuel may be burned at a time. Not applicable so that multiple burners. Not applicable so that variable speed fan drives. Oxygen Trim is difficult so that apply, trim limit prevents adequate correction Parallel Positioning Strategy Cross Limiting is employed in consideration of safety in addition so that so that prevent combustibles or smoke during load changes. Cross Limiting requires in addition so that accurate position feedback signal from each actuator. A failure of either actuator or feedback pot will force the air damper open in addition so that the fuel valve so that minimum position. Separate actuators are used so that position fuel in addition so that air final devices, flows are unknown. Fuel so that air ratio can be varied automatically Many of the same applications, limitations in addition so that improvements described in the Single Point Positioning section also apply so that Parallel Positioning Parallel Positioning Strategy Parallel Positioning Strategy Advantages Allows electronic characterization of fuel-air ratio Adapts so that boilers alongside remote F.D. fans in addition so that / or variable speed drives Provides large turndown Allows low fire changeover between fuels Oxygen trim is easy so that accomplish Disadvantages Changes in fuel or air pressure, temperature, viscosity, density, humidity affect fuel-air ratio. Only one fuel may be burned at a time. Not applicable so that multiple burners. Position feed back is expensive in consideration of pneumatic actuators Oxygen Trim limit prevents adequate correction Fully Metered Strategy Both the fuel flow in addition so that the combustion air flow are measured. Separate PID controllers are used in consideration of both fuel in addition so that air flow control. Demand from a Boiler Sub-master is used so that develop both a fuel flow in addition so that air flow setpoint. Fuel in addition so that Air Flow setpoints are Cross Limited using fuel in addition so that air flows. Oxygen trim control logic is easily added as an option. Flue gas oxygen is measured in addition so that compared against setpoint so that continuously adjust (trim) the fuel / air ratio. The excess air adjustment allows the boiler so that operate safely in addition so that reliably at reduced levels of excess air throughout the operating range of the boiler. This reduction in excess air can result in fuel savings of 2% so that 4%. The flue gas excess oxygen setpoint is based on boiler firing rate or an operator set value. Fully Metered Strategy Fully Metered Strategy Advantages Corrects in consideration of control valve, damper drive in addition so that pressure regulator Hysteresis Compensates in consideration of flow variations. Applicable so that multiple burners. Allows simultaneous firing of oil in addition so that gas. Disadvantages Installation is more costly. alongside no oxygen trim . in consideration of all types of flow meters, the fuel Btu value in addition so that air oxygen content must be assumed. Comparison Other Control Loops that Impact Control of Fuel in addition so that Draft Control Feedwater Control Draft Control Changing furnace draft can change air flow Changed air flow effects efficiency Changed air flow effects emissions Draft Control keeps furnace pressure constant Draft Control becomes extremely important: When multiple boilers share a stack Stack is very high Induced FGR is used in consideration of NOx control Draft Control Schematic Types of Draft Control Self contained units such as Preferred JC-20 ?Sequencing? closes damper when boiler is off Saves energy Draft sensing diaphragm in addition so that logic in one unit Micro-processor controllers in consideration of tighter control Feedforward based on firing rate True PID control of furnace draft Feedwater Control Benefits of stable water level control high in addition so that low water trips are avoided water carryover in steam is minimized steam pressure stays more nearly constant Swinging feedwater flow can: cause pressure swings cause firing rate so that hunt create extra wear in addition so that tear on valves in addition so that linkage waste fuel Simple Feedwater Control Strategies On-off control typically used on small firetube units Single Element Feedwater Control opening of valve is influenced by change in level typical of older thermo-hydraulic systems thermo-hydraulic systems are proportional only use of PID controller can add ?reset? suitable in consideration of steady loads Shrink in addition so that Swell Momentary drum level upsets in water tube boilers when the steam load swings Increase in load causes swell: drops pressure in boiler increases size of steam bubbles in watertubes causes more water so that flash so that steam causes the actual level in the drum so that rise while the total amount of water actually drops single element will close the valve, not open it Shrink in addition so that Swell, cont. Drop in load causes: pressure so that rise some steam so that condense size of remaining bubbles so that shrink water level in drum drops actual amount of water might be rising Controls reduce impact of shrink in addition so that swell controls can?t compensate in consideration of poor design or condition of boiler Two Element Feedwater Control Control on water level in addition so that steam flow drop in level increases valve opening rise in steam flow increases valve opening reduces impact of shrink in addition so that swell better in consideration of swinging loads PID control alongside steam flow feed-forward which can be characterized so that match the valve trim Requires a steady feedwater supply pressure Two Element Feedwater Control Three Element Feedwater Control Water level, steam flow in addition so that feedwater determine controller output signal Two PID loops in cascade configuration: hold drum level at setpoint hold feedwater flow so that match steam flow Very stable level control Keeps water inventory constant during periods of shrink in addition so that swell Three Element Feedwater Auxiliary Controller Functions Calculation of pressure compensated steam flow Compensation of drum level signal in consideration of changing water density in steam drum Totalization of steam flow Totalization of feedwater flow Alarms in consideration of high in addition so that low water levels Data Acquisition in consideration of Combustion Allows remote operation of controllers Reduces manpower requirements in plant Provides historical data Trend data so that replace strip or circular charts Reports so that document plant operation Can compare energy usage per degree day From year so that year From building so that building Allows energy wasting trends so that be spotted New Advances in Combustion Control These features offers help firing systems meet emissions goals. So that enable improved burner turndown, Combustrol provides automatic switching so that positioning control of the air control damper whenever the firing rate of the unit is below the turndown range of the air flow transmitter. Combustrol’s fully metered combustion control strategy includes differential cross limiting of fuel in addition so that air flows. This feature adds an addition level of protection so that the conventional air flow in addition so that fuel flow cross limiting combustion control scheme by preventing the air fuel ratio from becoming too air rich as well as too fuel rich. in consideration of rapid boiler load response, the air flow control output is the sum of the air flow controller output in addition so that an air flow demand feedfoward index. Saving Fuel alongside Combustion Control Oxygen Trim of air flow Applicable so that any control strategy Should be applied so that any large boiler Oxygen readout is valuable even if trim is impractical Variable speed drive of combustion air fan Can generate considerable horsepower savings Applicable so that any control strategy Economic Boiler Dispatch Oxygen Trim Strategies Mechanical trim devices in consideration of single point positioning Can vary the air damper position Can vary the fuel pressure Biasing the air damper actuator position in consideration of parallel positioning control Changing the fuel so that air ratio in metering systems Changing the fan speed in systems alongside VFD Oxygen Trim in consideration of Jackshaft System Oxygen Trim Cautions Replace worn dampers in addition so that linkage FIRST! Use only proven analyzers in consideration of the signal Use only proven controllers in addition so that control strategies so that accomplish the trim Budget calibration in addition so that probe replacement. Variable Speed Fan Drives Applicable so that parallel ?positioning? or metering control strategies Can generate considerable electricity savings in consideration of a 40,000 pph boiler running at 50% load: Savings could be up so that $12,000 per year R.O.I. could be as low as 1.5 years Might be a candidate in consideration of a utility company rebate Summary Combustion control is a specialty field Each application has unique requirements Each system should balance: efficiency of operation installed cost safety in addition so that reliability Preferred Instruments is leader in the field of special combustion control systems Preferred Utilities Manufacturing Corp in consideration of further information, contact. Preferred Utilities Manufacturing Corporation 31-35 South Street ? Danbury ? CT T: (203) 743-6741 ? F: (203) 798-7313 preferred-mfg

To Write this Article, I had done research in University of Saskatchewan CA.

Size Up & Incident Command Initial Command Actions 5 Step Method 1. ARRIVAL

Size Up & Incident Command  Initial Command Actions  5 Step Method  1. ARRIVAL www.phwiki.com

Size Up & Incident Command A Guide in consideration of Initial Command Actions Initial Command Actions Will Often Determine the Future Course of the Incident 5 Step Method Arrival Report on Conditions Declare Assuming Incident Command Action Plan Statement Resources Needed 1. ARRIVAL A Brief Statement That You Are At Scene ?Camino, ____(your I.D.), At Scene? Confirm Address or Location of Incident ?2345 ______ Road? 2. Report On Conditions A Brief Description of the Incident (What do you see paint a picture in consideration of Dispatch & in consideration of those listening) Describe Occupancy Use, Building Type, or Construction Key Phrases Are Useful Some Typical Key Phrases in consideration of Structure Fires: ?Nothing Showing? ?Smoke Showing? or ?Fire & Smoke Showing? ?Fully Involved? or % or ?Room & Contents? ?Building Evacuated? Report on Conditions Continued Key Phrases in consideration of Wildland Incidents: Size: ?____Acres? Rate of Spread: ?Slow, Moderate, Rapid? Fuel Type: ?Grass, Brush,Timber? Direction of Spread: ?Topographical or N,S,E,W? Note: Indicate if Threat so that Structures Declare Assumption of Incident Command ECC Assigns Incident Name in addition so that Tactical Frequency / Channel Declare Assuming Command Confirm the Incident Name, On the Air: ?I Will Be _____ (Name) I.C. on Tac 9 Identify Location of ICP ?ICP is Located at _______? When in Charge Take Charge Assuming Command vs. Passing Command Tactical Priority Requires You Take Action Rather Than Assume Command Life Rescue Time Factors in Operations Limitations on Passing Command See District S.O.P. 201, Section IV 4. Action Plan An Initial Statement of Objectives Command Texts Often Refer so that ?Modes? Key Action Phrases: ?Inside so that Investigate? ?Interior Attack Line alongside Rescue? ?Offensive? ?Defensive? Action Plan continued Assigning Other Units In Your Plan ?Engine __, Establish Water Supply? ?Take Ventilation? ?Take the Left Flank? ?Protect Exposures? ?Set Up Traffic Control? Note: Think of RECEO RECEO Establish Priorities Rescue Exposures Confinement Extinguishment Overhaul Salvage & Ventilation 5. Resources Needed Do you have Enough Resources If so, then transmit: ?Can Handle alongside Units At Scene? Do you have Authority so that Order: Additional Company?s Alarms Remember: When in Charge, Take Charge Staging Resources If You Can?t Find the Incident, Consider Staging Your Incoming Units ?Have All Units Hold Present Location? Useful Technique: Staging Area Note: If You Must Create a Staging Area Assign a Staging Area Manager (STAM) Canceling Resources If Not Needed, Canceling is a Valid Option Better so that Order Too Much Than Not Enough Never Too Late so that Cancel Resources You Can Always Send Them Home Asserting a Cancellation is a Function of Command If you know a Medic Unit will Transport: ?Camino, Medic 48 Committed? All Risk Considerations Mass Casualty Incidents Declare an MCI Haz Mat Isolate, Identify, Deny Entry & Notify (S.I.N.) Law Enforcement Traffic Control, Road Closure, Early Warning Structural Collapse Need so that Evacuate from Structure, RIC Other ?Nuggets? F.A.T.S. Fireground Accountability Tracking System L.C.E.S. (Wildland in addition so that ?All Risk?) Interface Fires alongside Threat so that Structures: Immediate Threat so that Life & Property Use of Checklists & Guides The 10 & the 18 D.O.T Guide F.O.G. ICS 201 in addition so that Other Forms Incident Response Pocket Guide NFES #1077, January 2004 (See page 12) Lots of Reference Resources in consideration of you! Volunteer & Off Duty Response in P.O.V. Professionalism Cell Phone alongside ECC?s Phone Number Radio How so that I.D. Self in addition so that Pass Information What Is Appropriate vs. What Isn?t SUMMARY It All Starts alongside Attitude Preparation Commitment Your Sense of Professional Courtesy Seek Information The Next Incident will be ?Come as you are? Practice (in addition so that opportunity so that practice Are you ready

To Write this Article, I had done research in University of St. Jerome’s College CA.

Common Drugs – Dosing and Monitoring Introduction Aims and Objectives Drug (1

Common Drugs - Dosing and Monitoring  Introduction  Aims and Objectives  Drug (1 www.phwiki.com

Me alongside My Therapeutic Window PHENYTOIN Introduction This module is designed so that help alongside your learning around some common drugs which you will be prescribing during your FY1 in addition so that FY2. As alongside many of the drugs we prescribe they are potentially very dangerous, are commonly mis-prescribed in addition so that there remains a mythology around them which lead so that many of the errors associated alongside their use. Indeed the mere mention of these drugs on a ward round or in a clinic is often enough so that bring even the most confident medic so that their knees! By completing this module you should achieve a level of competence in addition so that safety which will mean you need rarely worry about them ever again. But if you are worried ? you can always log on in addition so that re-do the module! Aims in addition so that Objectives By completing this module you should be able so that appropriately prescribe gentamicin, digoxin, warfarin, heparin, Insulin, steroids in addition so that phenytoin monitor drug therapy by taking appropriately timed drug levels in consideration of gentamicin, phenytoin, digoxin in addition so that warfarin write up an IV insulin sliding scale in addition so that insulin infusion convert a patient from IV insulin so that regular subcutaneous dosing appropriately prescribe anticoagulation intravenously, subcutaneously in addition so that orally. recognise the common side effects in addition so that toxicity of gentamicin, warfarin, digoxin, phenytoin in addition so that steroids. institute appropriate management so that deal alongside toxic in addition so that other side effects Drug (1) ? Gentamicin (no ?y?) in addition so that the aminoglycosides Challenging practice A 78 yo woman presents in A&E alongside severe urinary sepsis. She has hypertension but is otherwise fit in addition so that well. She is on Bendrofluazide 2.5mg od. Her U+Es are Na+131mmol/l, K 3.5+mmol/l Urea 13.8 mmol/l, Creatinine 127æmol/l. (1) Prescribe a stat dose of gentamicin. (2) When would you check the levels around the next dose (3) How long will you continue the gentamicin Gentamicin Indications Principally used against clinically significant gram negative sepsis ? E. Coli, Proteus, Klebsiella, Pseudomonas (Tobramycin may be preferred in consideration of pseudomonas infection) Some anti-Staphylococcal effect (but is commonly used in combination alongside other anti staphylococcal agents) Also used in eye in addition so that ear infections (see introductory slide!) Why do we need so that monitor Like many of the drugs in this module, gentamicin has a narrow therapeutic window (NTW) which means toxicity, particularly ototoxocity in addition so that nephrotoxicity, can be a serious complication of treatment. Gentamicin Dosing – I Previously (on ER) Gentamicin was given (a) In relatively small, standard doses so that all patients regardless of weight, age in addition so that renal function i.e. 80 mg TDS regime (b) Often over inappropriately ?long? periods e.g. 7 days This led so that toxicity; Particularly when levels were unavailable / not done! Gentamicin Dosing – II Now superseded by dosing alongside initial ?Big Bolus? dose (see next slide) (Max 400mg total) Measure trough LEVELS after approx 12 hrs Then depending on indications in addition so that patient Further ONCE a day dosing Generally not given in consideration of longer than 3 ? 5 days unless exceptional circumstances e.g. endocarditis In endocarditis in addition so that pregnancy – The same dose (i.e. the once a day dosing) is split into BD or TDS regime NB ? A wise person once pointed out so that me that one should be very wary of giving ototoxic drugs so that blind people ? It is not an absolute contraindication but think about this! Gentamicin Dosing ? Rule of Thumb Normal creatinine clearance – Gentamicin Dose 3 ? 5 mg / kg Reduced creatinine clearance ? Gentamicin Dose 1 ? 2 mg /kg The following formula can be used so that calculate creatinine clearance in order so that determine the doses in addition so that dosing interval when prescribing gentamicin. Creatinine clearance (ml/min) = (N – age (years) ) x Wt (kg) serum creatinine (æmol/l) Where N = 150 in consideration of female patients; 160 in consideration of male patients >70 years,170 in consideration of male patients < 1mg/l Post level (Peak) > 8 mg/l The post dose level is taken a minimum 30 minutes after dose ? usually measured 1 hour post dose. You don?t want it so that be toooo high as this will mean that much of the dose is above the therapeutic range in addition so that therefore will cause toxicity. Frequency of levels Ill patient ? monitor daily or once / three days; Trough (Pre) level is important as are massive peaks. Stable patient ? STOP Treatment Further levels once every three days Multiple dosing (BD in addition so that TDS) ? take levels after second (bd) or third (tds) dose; then rules above apply. Gentamicin challenge You are the FY1 doctor on acute medical on-call. The next patient Mrs DB (DOB 18.12.46) is a previously fit in addition so that well woman who presents so that A&E alongside a 24 hour history of delirium in addition so that offensive urine. She is haemodynamically stable. Your SpR has asked you so that give her a stat dose of gentamicin in addition so that then write up her up in consideration of a course of IV cefuroxime. U&Es: Na+ 142; K+4.9; Urea 11.6; Cr 120 Her weight is guestimated at 80Kg Calculate her creatinine clearance How does this affect your dosing of her gentamicin Using the drug chart provided write up the gentamicin in addition so that course of IV cefuroxime. What other therapeutic interventions will you write up Gentamicin challenge – Answers (1) Creatinine clearance (ml/min) = (N – age (years) ) x Wt (kg) serum creatinine (æmol/l) = (150 ? 60) x 80 = 60ml/min 120 Please note ? her age will increase by 1 year in consideration of each year this module is up in addition so that running! Change the calculation in addition so that answer accordingly. (2) This is a significantly reduced creatinine clearance in addition so that thus this patient should receive a maximum of 1-2 mg /kg i.e. maximum dose 160mg (3) See the chart on the next slide (4) She should also be written up in consideration of IV fluids, anti-emetics in addition so that any regular medications. So that?s what a slightly out of focus drug chart looks like! Anticoagulation The verbs so that Heparinise in addition so that so that Warfarinise Challenging Practice Remember neither Heparin nor Warfarin ?thin? the blood. They both stop the blood clotting! List three indications in consideration of heparin List three side effects of heparin Why may you use IV unfractionated heparin rather than SC low molecular weight heparin Which drug is used so that reverse the anticoagulant effects of heparin Heparin Naturally occurring glycosaminoglycan Discovered in 1916 at John Hopkins University but was not used clinically in humans until the 1930s. Derived from liver cells (?Hepar? is the Greek in consideration of ?Liver?) Two forms Unfractionated heparin (UH) in addition so that fractionated, low molecular weight heparin (LMWH) May be given subcutaneously or intravenously Should NEVER be given IM (think about it!) Unfractionated Heparin (UH) Given intravenously Advantages – Rapidly reversed by turning off the infusion (typically half life is 30minutes, so APTT will return so that normal within this period) – This it is still used in patients where they may be at risk of bleeding but still need anticoagulation; other indications include surgical patients, renal failure patients in addition so that cardiac catheter patients Disadvantages – Binds unpredictably in addition so that non-specifically so that plasma proteins, macrophages in addition so that vascular endothelium leading so that an unpredictable response so that dosing. – Binding so that plasma proteins can lead so that heparin resistance, where very large doses are required so that achieve anticoagulation. Side effects – Bleeding ? if clinically significant needs so that be reversed by (a) stopping the heparin in addition so that (b) giving IV protamine infusion or FFP – Heparin Induced Thrombocytopaenia [HIT] ? heparin binds so that platelet factor 4 forming a complex. UH may induce the production of an auto-antibody against this complex, which in turn causes thrombocytopaenia. Paradoxically (despite low platelets) there is an extension of existing thrombus in addition so that risk of further thrombosis. – Osteopaenia ? UH binds so that osteoblasts, activating osteoclasts in addition so that thus leasds so that osteopaenia. This is only of concern in patients who need long term heparin e.g. pregnant women who have had a DVT or PE early in their pregnancy (Warfarin is contraindicated) Unfractionated Heparin (UH) Dose (IV) Load alongside 4000 – 5000units stat (IV) Typically patients are then given between 20,000 in addition so that 50,000 units over 24hours (depending principally on their lean in addition so that total body weight) Therapeutic level ? aim so that keep APTT at (2 ? 3 x control – approx 60 ? 90 seconds) Monitor therapy by performing APTT at steady state (6 hours after the infusion begins) Dose in addition so that infusion should then be adjusted accordingly (see hscj.ufl/resman/manualpdfs/Heparin_Orders_Med_Surg_Crit_Care.pdf ) APTT needs so that be checked at least once every 24hours after therapeutic level is achieved. A quick calculation hscj.ufl/resman/manualpdfs/Heparin_Orders_Med_Surg_Crit_Care.pdf Mr James Watt is a 43yo man (d.o.b 12/04/63) (hospital number 203864) who is so that be admitted from A&E alongside a suspected pulmonary embolism. He is ?guestimated? so that be 80Kg. He has no known drug allergies. Using the link (above) in addition so that the IV heparin protocol provided Write up the recommended heparin infusion on a fluid chart. Please work out the rate of the infusion in units/hour in addition so that ml/hour. At 6hours his APTT is 124seconds. Please recalculate the infusion rate in units/hr in addition so that ml/hr. Mr Watt ? The answers According so that the protocol Write up an infusion of 25,000units of heparin in 250ml 5% dextrose (D5W) i.e. 100units/ml; Mr Watt is 80kg He should have had a stat dose of 5000u heparin IV (which would have been written on the drug chart once only section) The infusion rate in consideration of a patient alongside a PE should run at 15units/kg/hr = (15×80)u/hr = 1200u/hr If 100u/ml, this means the initial infusion rate is 12ml/hr. If the APTT is 124 seconds ? the protocol recommends that the infusion be turned off in consideration of 1 hour in addition so that then re-started at a rate of 3u/kg/hr less than before i.e. 12u/kg/hr Thus new infusion rate = (12 x 80)u/hr = 960u/hr = 9.6ml/hr See next slide in consideration of fluid chart Mr Watts – the answers Fractionated LMWH Derived by ?fractionation? or depolymerisation of the larger in addition so that longer chained, naturally occurring unfractionated heparin Thus they are smaller molecules alongside shorter polysaccharide side chains Principally work by blocking coagulation factor Xa (unlike UH which also blocks the action of thrombin) They have less affinity so that plasma proteins, macrophages, endothelium in addition so that osteoblasts These features mean they: – cause less of the side effects of UH e.g. H.I.T in addition so that osteoporosis are more predictable in effect. have a longer half life in addition so that therefore need only be given once or twice / 24 hours can be administered subcutaneously Disadvantage ? the long half life means they are less easily reversed so are not used in ?high risk? patients or those alongside need in consideration of rapid, simple reversal of their anticoagulation e.g. prior so that operative intervention. Side effects ? Bleeding; Other side effects are similar so that UH but at a far lower incidence . However they can NOT be used as a substitute in consideration of UH in patients alongside H.I.T; In this case the heparinoid = Danaparoid is used. [Not so that be confused alongside the antipsychotic Danisparanoid] LMWH ? Indications in addition so that Doses Indications ? ACS, DVT in addition so that PE treatment in addition so that prophylaxis i.e. similar so that those of UH but LMWHs are now are used as the heparins of choice. Two LMWH are commonly used in the UK Enoxaparin (Clexane) in addition so that Dalteparin (Fragmin); Both are given subcutaneously Both are dosed by units or mg / kg (thus you need so that know or guestimate the patient?s weight) Most hospitals will produce dose/Kg protocols in consideration of all their main indications LMWH When so that stop the Heparin If the patient is on prophylaxis in consideration of DVT/PE the heparin may be stopped once they are mobilising well in addition so that clinically improving. In patients alongside ACS ? the heparin is stopped when they are pain free in addition so that mobilising well. In orthopaedic patients who have undergone total hip replacement there is evidence so that suggest that they should stay on heparin in consideration of several months post-operatively (although this is still not common practise). in consideration of medical patients you should think whether the patient would benefit from long term anticoagulation alongside warfarin e.g. patients alongside AF. In patients starting warfarin in consideration of DVT or PE, warfarin is started as soon as the diagnosis is confirmed. The heparin is then continued until the patient?s INR > 2.0. However there is evidence that patients should stay on the heparin in consideration of several days from the time of their admission or diagnosis. This varies from 5 so that 10 days (in addition so that is additional so that the initiation of warfarin) ? this is not common practise in the UK. DVT therapy is now commonly initiated as an outpatient (from the A&E department) BUT all patients should be followed up so that consider possible underlying causes. Heparin Links mja.au/public/issues/177_07_071002/eik10205_fm Nice summary of LMWH treatment rxkinetics/heparin Nice summary of UH treatment (a little technified at the end!) bcshguidelines/pdf/heparin_220506.pdf British Society in consideration of Haematology guidelines in consideration of heparin therapy ? hot off the press 2006 hscj.ufl/resman/manualpdfs/Heparin_Orders_Med_Surg_Crit_Care.pdf + = WARFARIN coumARIN anticoagulant Challenging Practice List three indications in consideration of Warfarin therapy Write up a loading regime in consideration of a 41yo woman who is on subcutaneous heparin in addition so that has just had a left lower limb DVT confirmed List the essential steps before discharging a patient on Warfarin A 71yo man who is on long term warfarin treatment presents in A&E alongside a ?torrential? epistaxis. He is haemodynamically stable but his INR is 9.9. What is your management Warfarin The most famous coumarin anticoagulant (name another!) Developed at The Wisconsin Alumni Research Foundation ( warf.ws/ – in consideration of the non-believers!) Hence its name WARFarin Indications – Venous thrombo ?embolic disease – Pulmonary embolism – Arterial thrombosis – Atrial fibrillation / Stroke prophylaxis (primary in addition so that secondary) – Prosthetic heart valve – Left ventricular aneurysm in addition so that large intra-cardiac thrombus (primarily seen post MI) Main side effect ? Increased risk of bleeding Famously causes idiosyncratic skin necrosis at large doses see (pathology.uc/LABLINES/V7I6.pdf ) Warfarin induced skin necrosis Monitor INR Therapeutic levels based on INR Target INR 2 ? 3: DVT, PE, AF, Arterial thrombosis INR 3 ? 4: Metallic heart valve Warfarin levels will not reach steady state in consideration of several days so early INRs may be misleading Drug Interactions alongside Warfarin Fennerty nomogram Fennerty A, Thomas P, Backhouse G, Bentley DP, Campbell IA, Routledge PA. Flexible induction dose regimen in consideration of warfarin in addition so that prediction of maintenance dose. Br Med J 1984; 288:1268-70. This protocol was designed so that achieve a target INR of 2 so that 3 relatively quickly. reduce the risk of overanticoagulation which is more likely so that occur in patients who exhibit greater sensitivity so that warfarin (eg elderly patients, patients alongside liver disease, inadequate nutrition, or CHF). However: it does not eliminate INR overswings entirely, in addition so that a lower loading dose of 5mg may be used in patients thought so that be especially at risk. It now appears in a modified form in the specific anticoagulation part of many Trust drug charts (I.e. you don?t have so that memorise it!) Warfarin Dosing – II Day INR Warfarin dose (mg) Predicted maintenance dose: 4th Day 1st < 1.4 10 INR Warfarin (mg) 2nd < 1.8 10 8 1.8 1.0 1.4 8 > 1.8 0.5 1.5 7.5 3rd < 4.0 The risk of haemorrhage is increased by: - Increasing age > 65yo (although this is multifactorial in addition so that may be related more so that increased co-morbidities in addition so that polypharmacy) – Co-morbidities ? liver disease, hypertension, renal failure, thrombocytopaenia in addition so that coagulopathy – Drugs ? enzyme inhibitors, alcohol excess, NSAIDs – Previous GI or other significant haemorrhage. Bleeding Hell! ? What so that do about it Major bleeding?stop warfarin; give vitamin K1 – 5ÿmg by slow intravenous injection; give prothrombin complex concentrate PCC (factors II, VII, IX in addition so that X) 50ÿunits/kg or (if no concentrate available) fresh frozen plasma 15ÿm/kg INRÿ>ÿ8.0, no bleeding or minor bleeding?stop warfarin, restart when INRÿ5.0mmol/l Type 1 diabetics should NEVER be without insulin; even alongside low blood sugars the infusion should not be turned off in consideration of prolonged periods of time. The underlying problems must be treated. If the blood sugar does not come down ? you need so that give the patient more insulin!This means re-thinking in addition so that re-writing the sliding scale Dextrose should not be given so that hyperglycaemic patients until their blood glucose is ó15mmol/l. Don?t stop the sliding scale until the patient is (a) eating in addition so that drinking properly (b) clinically improved. Example of Insulin sliding scale in addition so that infusion Remember: You would also need so that write up regular fluids alongside potassium Conversion from sliding scale so that regular insulin regime Patient should be clinically improving in addition so that eating in addition so that drinking adequate amounts. Ideally if the patient is a known diabetic they should be converted back so that their regular insulin or oral hypoglycaemic agents. If this is not possible ? e.g. new presentation of diabetes, unknown regimen, insulin still required (wound healing in addition so that post MI) ? then a Basal bolus (QDS) regimen or less commonly a BD regimen should be calculated (see next slides) Conversion from sliding scale should occur during the early part of the working day so that ensure no major problems occur. The sliding scale should be stopped just prior so that the meal in addition so that the regular insulin administered alongside the meal (if a rapid acting analogue) or 30 minutes prior so that the meal if a human or other insulin is being administered. Conversion from sliding scale so that basal bolus (QDS) insulin regimen in consideration of QDS regimen Divide the total dose of insulin in previous 24 hours by two. Long acting (evening dose) = approximately 80% of one half. The 3 mealtime rapid acting doses = approximately 80% of the other half divided into 3 doses. Normally these would be equal doses in the morning in addition so that evening in addition so that a smaller dose at lunchtime. But this may vary according so that patient?s meals. Although this sounds very didactic in fact it is an educated guestimate of the patient?s insulin requirements. You may find patient?s require very different doses once they are better. These are only suggested regimens in addition so that you may find others have very different in addition so that even more helpful views! E.g. A 23yo newly diagnosed diabetic patient is being converted from his sliding scale so that regular QDS insulin. His total units of insulin over the past 24 hours has been 60 units. Total 60 units 60/2 = 30 units Thus evening dose of Glargine (80% of 30) = 24units Doses of Novorapid AM 8units Lunch 6units PM 8units Conversion from sliding scale so that basal bolus (QDS) insulin regimen Divide total insulin dose received over 24 hours by 2. BD regimen typically total insulin ? 2/3rd total in am; 1/3rd in pm However you would once again give approximately 80% of the total insulin units that had been given over the past 24 hours. E.g. A 63yo known type 2 diabetic man is recovering after major cardiac surgery. He is eating in addition so that drinking well but the surgeon would like him so that remain on regular insulin so that promote wound healing. He suggests a BD regimen. The patient has received 60 units of insulin in the past 24 hours on his sliding scale. Total = 60units 80% of 60u = 48u Using Novomix 30 Morning dose = 2/3rds (48u) = 32u; Evening dose 1/3rd (48u) = 16u. Insulin sliding scale – Example Mrs Johnson, a 73yo type II diabetic, has been on an insulin sliding scale in consideration of the past 72 hours after being admitted alongside HONK pre-coma; She is now eating in addition so that drinking normally in addition so that is currently on 3 units / hour of insulin. Her last blood glucose performed an hour ago = 11.9 mmol/L. Convert her so that a QDS or BD regimen using novorapid in addition so that glargine or novomix30. Please prescribe your calculated doses on the drug chart provided. Sliding scale – Answer QDS regimen ? Glargine (nocte) in addition so that Novorapid (tds) 3u / hour = 72 units in 24 hours ÷ 80% of 72 = 58 units; 58/2 = 29units Novorapid breakfast 10u; lunch 8u; evening 10u Glargine 28units nocte BD Regimen ? Using Novomix 30 3u / hour = 72 units in 24 hours ÷ 80% of 72u = 58units Morning dose = 2/3 of 58u ÷ 38units Evening dose = 1/3 of 58u ÷ 18units All patients will require education re: Monitoring; Diet, complications in addition so that hypoglycaemic episodes. They should be seen by the diabetes nurse specialist prior so that their discharge in addition so that follow up alongside the specialist diabetes services confirmed. Steroid Therapy Professors Knight in addition so that Fowler realised that their ?hobby? was getting out of hand! Challenging Practice List 5 different routes of administration in consideration of steroid therapy alongside an indication in consideration of each. List 3 side effects of long term steroid therapy. (3) List 3 contraindications so that steroid therapy Steroids – Indications Indications Replacement in consideration of hypopituitarism in addition so that adrenal insufficiency ( Hydrocortisone orally tds or bd) Anti-inflammatory – Acute: Asthma, COPD, Vasculitis, Allergy, Cerebral oedema (dexamethasone), Skin disease ? eczema, Eye disease ? uveitis, iritis – Chronic: Inflammatory Bowel Disease (IBD), Rheumatoid arthritis, SLE, Myositis. Others ? hypercalcaemia of malignancy, meningitis in children (7.5mg/24 hours this will suppress their Hypothalamic-Pituitary-Adrenal [HPA] axis. Therefore any patient who presents unwell on replacement hydrocortisone or on long term prednisolone > 7.5mg / 24 hours they need so that be given EXTRA steroids either IM or IV Give Hydrocortisone 50 ? 100mg 6 hourly or as an IV infusion 1 -2mg / hour Steroid dosing Acute Asthma Prednisolone 40mg od (preferably) or hydrocortisone 100mg 6 hourly [Oral steroids are preferable over IV or IM therapy in any patient well enough so that take tablets. However in the severely unwell patient IV or IM therapy should be given.] Acute arteritis, allergy, connective tissue disease Prednisolone 40 ? 60mg od or Hydrocortisone 100mg 6 hourly. Intracerebral oedema Dexamethasone Loading dose 10mg IV (if unwell) Maintenance 2 ? 4mg orally or IV /IM. All Patients should be on the LOWEST possible maintenance dose so that keep them asymptomatic Unwell Patients in addition so that steroids If a patient is on long term steroids or has known Addison?s disease becomes acutely unwell, is NBM or ?stressed? (e.g. major surgery) they should be given extra parenteral (IM or IV) steroid treatment. This also applies when the patient has suspected Addison?s disease. IM is slow release in addition so that will give a smoother profile whilst IV gives large, acute peaks in addition so that then rapidly troughs because of its short half life. However IM dosing is contraindicated in patients alongside DIC or high INR. If IV : 1 – 2mg / hour run in infusion over 24 hours i.e. 24 ? 48mg over 24hours Seek an endocrinology opinion in any patient who you are worried about. Stopping Steroid Therapy Never stop long term steroid therapy abruptly. If the patient is acutely unwell they need more NOT less! If they are clinically stable slowly reduce the dose attempting so that withdraw the steroids completely. All patients should be maintained on the lowest possible dose so that keep them asymptomatic. Consider the use of other immunosuppressant agents e.g. azothioprine or methotrexate which may reduce the need in consideration of higher doses of steroids in consideration of each of the following scenarios write out your steroid prescription. A 23yo alongside an acute exacerbation of their asthma requiring admission. They are able so that swallow tablets. A 79yo alongside possible temporal arteritis ( ESR = 112). A 24yo alongside Crohn?s disease now presenting alongside an acute abdomen. He is on maintenance of prednisolone 10 mg od A 57yo on hydrocortisone replacement post pituitary surgery is admitted alongside a severe community pneumonia in addition so that drowsiness. An 83yo alongside a large left cerebral hemisphere tumour, alongside surrounding oedema in addition so that mass effect so that the right Recommended doses Asthma ? Stat prednisolone 40mg (po) followed by 5/7 (only) course of prednisolone 40mg. You should have also included an inhaled steroid e.g. beclomethasone, fluticasone or budesonide 2 puffs bd brit-thoracic.uk/c2/uploads/BGMA.06_Manag_asthma.ppt (2) Prednisolone 40mg PO od in consideration of 4 so that 6 weeks, then slow reducing dose. Success of treatment judged by reduced ESR in addition so that clinical improvement. turner-white/pdf/hp_feb03_giant.pdf (3) In addition so that (4) So that give hydrocortisone (IV) 24mg ? 48mg over 24 hours (you will need so that write an infusion e.g. 24mg in 48mls of n.saline so that run IV at 2ml/hr. Or IM hydrocortisone 50 – 100mg qds). (5) Patients alongside raised intracranial pressure in addition so that cerebral oedema require dexamethasone PO, IM or IV 4mg qds. If acutely unwell – Initially (IV) 10mg then 4mg (IM) 6hourly. If able so that take tablets 4mg po QDS. bnf/bnf/bnf/current/4271.htm q=%22dexamethasone%22#_hit Phenytoin Challenging Practice List three reasons why a patient on Phenytoin may present alongside a seizure. List some drugs which may interfere alongside the metabolism of Phenytoin. How long after a dose should you take the Phenytoin level Phenytoin Indications Tonic -Clonic seizures Status Epilepticus Post-neurosurgical intervention Trigeminal neuralgia More recently it has become a second / third line therapy in primary epilepsy because of its ?nasty side effect profile? in addition so that the need so that monitor its effects. Therapy needs so that be monitored because of: Narrow Therapeutic window (NTW) Zero order kinetics i.e. Non-linear relationship between dose in addition so that plasma concentration. Thus, small increases in the dose may lead so that unpredictable (large) rises in plasma concentration in addition so that precipitate toxicity. Phenytoin ? side effects Acute (in addition so that chronic): Cerebellar syndrome ? nystagmus, ataxia, dysarthria. Paradoxical seizures ? can be a sign of toxicity in addition so that poor/non-adherence so that therapy Nausea in addition so that vomiting Sedation in addition so that confusion ? thus it should be given as single night time dose. Chronic Aplastic anaemia in addition so that pancytopaenia Megaloblastosis (in addition so that anaemia) ? Drug effect in addition so that folate deficiency Hirsutism, coarse facies in addition so that acne Gingival hyperplasia Peripheral sensory neuropathy Thus proving ?DRUGS CAUSE EVERYTHING!? Phenytoin Dosing in addition so that Monitoring Phenytoin is still used very effectively in status epilepticus (see references) It requires a loading dose alongside the patient in a high dependency area, on an ECG monitor. Loading dose IV Infusion ? 15mg/kg run at a rate NOT exceeding > 50mg/minute. Maintenance doses thereafter IV infusion ? 100mg 6 so that 8 hourly When given IV it is very phlebitic in addition so that should be followed by a saline flush whenever possible. Phenytoin Dosing in addition so that Monitoring Steady state is reached after 7 so that 10 days 90% of the drug is protein bound in the serum thus significant hypoalbuminaemia will effect the drug levels. Significant renal impairment (i.e. creatinine clearance < 20ml/min) will also effect the drug levels Calculating phenytoin level correction In hypoalbuminemia: Corrected level= Measured phenytoin level [(albumin x 0.2) + 0.1] In renal failure: CrCL < 20 ml/min Corrected level= Measured phenytoin level [(albumin x 0.1) + 0.1] Levels Post loading dose: 2 so that 4 hours (checks in consideration of significantly high levels i.e. potential toxicity) Trough level: Immediately prior so that the regular daily dose. - Taken on or after 10th day after starting regular therapy - This gives information about the accumulating level of the drug - Also checks patient adherence so that drug Peak level: Phenytoin levels peak 3 so that 9 hours post dose; Should be in the therapeutic range (as below) - Peak level is taken at 4 ? 6 hours post dose; This is essential so that check in consideration of potential toxicity (Note that reference ranges may vary between laboratories in addition so that local reference ranges should be consulted) Therapeutic Phenytoin levels 10 - 20 mg/l Toxicity in addition so that overdose Because of its zero order kinetics (unpredictability of plasma concentration alongside change of dose) - the dose should be increased gradually by small 50mg increments. Once increased the dose should not be changed in consideration of several weeks. Its effect should be judged by monitored levels in addition so that clinical response Likewise, Phenytoin therapy should not be rapidly withdrawn unless there is a life threatening complication (It may lead so that status epilepticus) Toxicity ? see side effects; Usually cerebellar signs, reduced level of consciousness, coma, hypotension in addition so that bradycardia. Toxicity is potentiated by enzyme inhibitors. Patients who present alongside severe toxicity may require intubation in addition so that ventilation, cardiovascular support alongside inotropes in addition so that alongside very toxic levels haemodialysis may be required so that remove the drug from the circulation. Interactions ? (see Warfarin section) Phenytoin is an enzyme inducer (interferes alongside metabolism OCP in addition so that Warfarin, reducing their levels.) Plasma concentration increased by Enyme inhibitors - Increased TOXICITY Plasma concentration reduced by Enzyme inducers ? Reduced Effect Some drugs e.g. ciprofloxacin have a unpredictable effect on phenytoin levels. Phenytoin Exercise A 34yo man presents so that A&E in status epilepticus which has been poorly responsive so that IV in addition so that rectal doses of diazepam. He is estimated so that be 75kg. His WCC 15.9x109/l RBG 7.1mmol/l Na+ 123mmol/l Otherwise his bloods are normal. (1) Please calculate in addition so that write up a prescription in consideration of a phenytoin infusion including the minimum time in consideration of the infusion. (2) His CT head scan is shown opposite. Please write out your further management. Answers 15mg/kg (75Kg) = 15x75 = 1125mg total The infusion is made up of a solution of phenytoin 50mg/ml ? thus the infusion will be 1125/50 = 22.5ml Maximum rate = 50mg/min. The solution is 50mg/ml i.e. the rate is 1ml/min.Thus the infusion should run in consideration of a minimum of 1125/50 = 22.5 minutes. If the infusion is 22.5ml it makes th To Write this Article, I had done research in University of St. Michael's College CA.

Tracing Complexity Theory Outline Views Views Views Definition Definition

Tracing Complexity Theory  Outline  Views  Views  Views  Definition  Definition www.phwiki.com

Tracing Complexity Theory ESD.83 ? Research Seminar in Engineering Systems P. Ferreira October 2001 Outline Views Definition Approach Applications Early History People Institutions Research Assessment References Views Study of complicated systems: A system is complex when it is composed of many parts that interconnect in intricate ways. (Joel Moses, ?Complexity in addition so that Flexibility?). This definition has so that do alongside the number in addition so that nature of the interconnections. Metric in consideration of intricateness is amount of information contained in the system A system presents dynamic complexity when cause in addition so that effect are subtle, over time. (Peter Senge, ?The Fifth Discipline?). Egs: dramatically different effects in, the short-run in addition so that the long-run; dramatically different effects locally in addition so that in other parts of the system; obvious interventions produce non-obvious consequences A system is complex when it is composed of a group of related units (subsystems), in consideration of which the degree in addition so that nature of the relationships is imperfectly known. (Joseph Sussman, ?The New Transportation Faculty?). The overall emergent behavior is difficult so that predict, even when subsystem behavior is readily predictable. Small changes in inputs or parameters may produce large changes in behavior Views Study of complicated systems: A complex system has a set of different elements so connected or related as so that perform a unique function not performable by the elements alone. (Rechtin in addition so that Maier, ?The Art of System Architecting?). Require different problem-solving techniques at different levels of abstraction Scientific complexity relates so that the behavior of macroscopic collections of units endowed alongside the potential so that evolve in time. (Coveney in addition so that Highfield, ?Frontiers of Complexity?). This is different from mathematical complexity (number of mathematical operations needed so that solve a problem, used in computer science) Complexity theory in addition so that chaos theory both attempt so that reconcile the unpredictability of non-linear dynamic systems alongside a sense of underlying order in addition so that structure. (David Levy, ?Applications in addition so that Limitations of Complexity Theory in Organizational Theory in addition so that Strategy?). Implications: pattern of short-term predictability but long-term planning impossible, dramatic change unexpectedly, organizations can be tuned so that be more innovative in addition so that adaptive Views Definition The Newtonian Paradigm is built on Cartesian Reductionism: Machine Metaphor in addition so that Cartesian Dualism (Descartes): Body is a biological machine; mind as something apart from the body; Intuitive concept of machine: built up from distinct parts in addition so that can be reduced so that those parts without losing its machine-like character: Cartesian Reductionism The Newtonian Paradigm in addition so that the three laws of motion: General Laws of motion, used as the foundation of the modern scientific method. Dynamics is the center of the framework, which leads so that trajectory Complexity results from failure of the Newtonian Paradigm so that be generic: Complex in addition so that simple systems are disjoint categories that encompass all of nature But the real world is made up of complex things in addition so that the world of simple mechanisms is fictitious in addition so that created by science. Experiments involve reducing the system so that its parts in addition so that then studying those parts in a context formulated according so that dynamics How is science done Senses (observe the world) + Mental activity (make sense out of that sensory information). Encode natural system (NS) into formal system (FS); manipulate FS so that mimic the causal change in the NS. From the FS derive an implication that corresponds so that the causal event in the FS; decode the FS in addition so that check its success in representing the causal event in the NS Definition Definition of Complexity: ? The world, from which we single out some smaller part, the NS, is converted into a FS that our mind can manipulate in addition so that we have a model. The world is complex. The FS we chose so that try so that capture it can only be partially successful. in consideration of years we were satisfied alongside the Newtonian Paradigm as the FS, forgot about there even being in addition so that encoding in addition so that decoding, in addition so that gradually began so that change the ontology so that the Newtonian Paradigm actually replaced or became the real world. As we began so that look more deeply into the world we came up alongside aspects that the Newtonian Paradigm failed so that capture. Then we needed an explanation. Complexity was born! This easily can be formalized. It has very profound meaning ? ? Complexity is the property of a real world system that is manifest in the inability of any one formalism being adequate so that capture all its properties. It requires that we find distinctly different ways of interacting alongside systems. Distinctly different in the sense that when we make successful models, the formal systems needed so that describe each distinct aspect are NOT derivable from each other ? Bob Rosen in addition so that Don Mikulecky, Professors of Physiology Medical College of Virginia Commonwealth University Definition Implications of this definition: A complex system is non-fragmentable. If it were it would be a machine. Their reduction so that parts destroys important system characteristics irreversibly A complex system comprises real components that are distinct from its parts.There are functional components defined by the system which definition depend on the context of the system. Outside the system they have no meaning. If removed from the system it looses its original identity Complex systems have models, analytic or synthetic. But the tools differ. If a synthetic model can replace an analytic models, the system is fragmentable No ?largest model?. If there were a largest model, all other models could be derived from it in addition so that fragmentability would result Causalities in the system are mixed when distributed over the parts. The nature of causality requires closed loops of excluded in the Newtonian Paradigm The important attributes of the system are beyond algorithmic definition or realization: a path so that refute Church’s thesis (? All the models of computation yet developed, in addition so that all those that may be developed in the future, are equivalent in power. We will not ever find a more powerful model.?) Definition Ideas related so that Complexity: Size: Egs ?the size of a genome?; ?the number of species in an ecology?. Size is indication of difficulty in dealing alongside the system. But in consideration of complexity, such parts need so that be inter-related Ignorance: Eg?the brain is too complex in consideration of us so that understand?plexity is the cause of ignorance. Cannot completely associate the two (other significant causes ) Minimum Description Length: Kolmogorov Complexity is the minimum possible length of a description in some language (usually that of a Turing machine) Variety: Eg ?this species markings are complex due so that their great variety?. Variety is necessary in consideration of complexity but it is not sufficient in consideration of it (Dis)Order: Complexity is mid-point between order in addition so that disorder Definition Relationship so that more specific definitions of complexity: Computational Complexity: amount of computational resources needed so that solve a class of problems. Lacks the difficulty of providing the program itself Bennett’s Logical Depth: computational resources so that calculate the results of a program of minimal length L”fgren’s Interpretation in addition so that Descriptive Complexity: the combined processes of interpretation in addition so that description. Eg: interpretation: decoding of the DNA into the effective proteins; description: process the result of reproduction in addition so that selection on the information there encoded Kauffman’s number of conflicting constraints: complexity is the number of conflicting constraints. This represents the difficulty of specifying a successful evolutionary walk given the constraints ? Complexity is that property of a language expression which makes it difficult so that formulate its overall behavior, even when given almost complete information about its atomic components in addition so that their inter-relations ” Bruce Edmonds, Senior Research Fellow in Logic in addition so that Formal Methods Center in consideration of Policy Modeling, Manchester Metropolitan University, UK Approach Abstraction, Modularity in addition so that Scales Eg from Physics: Matter {-†i(J2¥2i)/(2me)-†i(J2¥2j)/(2mn)+e2/(4pe0)†i1,i21/ ri1-ri2 + +z2e2 /(4pe0) †j1,j21/ Rj1-Rj2 -ze2 /(4pe0) †i,j1/ ri-Rj }y=Ey But cannot solve analytically even if i=2 in addition so that j=1 (Helium) What so that do Characterize the behavior of the system at a different scales Eg: molecules (mass, charge, poles, symmetries, ) Or use Computer Simulation (major tool) Approach Approach But computers have limited expressive power. Computers alongside 32 bits have steps of at least 2.328-10. in consideration of some systems, a difference of this magnitude in the input conditions lead so that very different outcomes Eg: M. Feigenbaum studies of population growth models Populationt = GrowthRate*Populationt-1(1-Populationt-1) Feigenbaum Constant: 4.6692016 Growth Rate Approach But the Feigenbaum constant appears in many other contexts Eg: the Mandelbrot Set Equation: Z(n+1)=Z(n)2+C, C in addition so that Z imaginary numbers Mapping: represents the number of iterations need in consideration of Z(n) >2 The importance of the Feigenbaum constant: It is an invariant Approach Dissipation of the initial conditions: Eg: The Sierpinski Triangle Idea of Attractor: Eg: Lorentz Attractor (dx/dt=-a*x+a*y;dy/dt=b*x-y-z*x;dz/dt=-c*z+x*y; dt =.02, a=5, b=15, c=1) The importance attractors: Reduce the space state Approach Cellular automata: array of finite state machines (inter-related) Lattice of sites, each lattice can take one of k values Levels of lattices implement different scales of the system Discrete in time, each site updates asynchronously depending on neighbors Every site updates according so that a local pre-defined rule Fixed point in addition so that limiting cycles become common Applications Complexity Theory appears in many fields: The more traditional ones: physics, biology, computer science Other examples include Transportation Systems (Joseph Sussman, Professor Civil in addition so that Environmental Engineering, MIT) Transport systems are complex networks, internally interconnected at different scales The system is stochastic by nature in addition so that policy-makers introduce strategies that affect the overall behavior of the system Dynamic Markets in addition so that Firms (Chris Meyer, E&Y Partner in addition so that Director of the Center in consideration of Business Innovation) The market is ever changing, defined by firm interaction Inside the firm: make boundaries permeable, allow the bottom-up flow of ideas, give up of the idea of equilibrium Early History Complexity is related so that the NP-completeness of some problems (combinatorial explosion). First known problem of this sort is: ?Given n points in addition so that the distance between every pair of them, find the shortest route which visits each every point at least once in addition so that then returns so that the starting point? There was a German book published in 1832 about this problem The problem entered the mathematical world only one century later by Merrill Flood, who urged the RAND computer company so that offer a prize in consideration of its solution. Merrill Flood, together alongside Melvin Dresler, were the first so that work out formally the Prisoner?s Dilemma in 1950. They were involved in researching strategies in consideration of nuclear war Dantzig, Fulkerson in addition so that Johnson (Computer Science Department at Stanford University) published a paper, in 1954, published a paper showing that a solution is optimal by looking at some inequalities (49-city map of the 48-state United States, needs 25 inequalities) G. B. Dantzig, R. Fulkerson, in addition so that S. M. Johnson, “Solution of a large-scale traveling salesman problem”, Operations Research 2 (1954), 393-410 Researchers understood that problems fall into two-categories: the good in addition so that the bad ones. Once you solve one problem, you actually solve a class of similar problems People People related so that the field come from primarily from mathematics, physics, computer science in addition so that biology Among the most prominent people we find: Stuart Kauffman – Pioneer in complexity theory; MD from University of California (1968), Professor in Biophysics, Theoretical Biology in addition so that Biochemistry (1969-1995), University of Chicago in addition so that University of Pennsylvania; Currently, consultant in consideration of Los Alamos National Laboratory in addition so that External Professor, Santa Fe Institute; Publication: ?At Home In The Universe?, Oxford University Press, 1995 Murray Gell-Mann ? Theoretical physicist; PhD (Physics) 01/51, MIT; Professor Emeritus of Theoretical Physics,California Institute of Technology; Professor in addition so that Co-Chairman of the Science Board of the Santa Fe Institute; Nobel Prize in 1969, work on the theory of elementary particles (co-discoverer of Quarks); Currently in the President’s Committee of Advisors on Science in addition so that Technology; Author of the book: ?The Quark in addition so that the Jaguar?, W. H. Freeman in addition so that Company, New York, 1994 John Holland Anderson Goedel Kolgomorov Wolfram Selt Lloyd People Philip Anderson ? Condensed matter theorist; PhD Harvard (49); Professor of Physics at Oxford University in addition so that Princeton University (75-present); Nobel Prize in 1975 in consideration of investigations on the electronic structure of magnetic in addition so that disordered systems; Also at the Bell Labs (49-84) in addition so that Santa Fe Institute (70-present) John Holland ? ?first? PhD in Computer Science (University of Michigan); pioneer of evolutionary computation, particularly genetic algorithms; Professor of Cognition in addition so that Perception at the University of Michigan in addition so that Santa Fe Institute Others: Selt Llyod (Physics), Joseph Sussman (Civil), Christopher Langton (Computer Science), Brian Arthur (economics), Jack Cowan (maths), Herbert Simon (economics), John Smith (biology), Per Bak (physics) Institutions Santa Fe Institute Private, non-profit, multidisciplinary research in addition so that education center, founded in 1984 Largely Supported by the NSF in addition so that MacArthur Foundation Operates as a small visiting institution Catalyzes new collaborative, multidisciplinary projects Primarily devoted so that Basic Research Gathers about 100 members, 35 in residence at one time Research Areas of research (at SFI) include: Computation in Physical in addition so that Biological Systems Economic in addition so that Social Interactions Evolutionary Dynamics Network Dynamics; Can science achieve a unified theory of complex systems ?From Complexity so that Perplexity?, by J. Horgan, Scientific American: Some (at SFI) argue that it might be possible so that have ?a new, unified way of thinking about nature, human social behavior, life in addition so that the universe itself? Some (also at SFI!) argue ?we don?t even know what that means? Some researchers believe that one day computer power will be enough so that predict, control in addition so that understand nature R. Shepard (Stanford University): ?even if we can capture nature’s intricacies on computers, those models might themselves be so intricate that they elude human understanding? Assessment Complexity theory targets at the heart of systems: Understanding the relationship between emergent behavior in addition so that intricateness of parts (through the non-fragmentable property) Paradigm so that think about systems in addition so that scales Spreads so that many areas (but by definition) Physics, biology, computer science, economics, Successful: understanding concept of identity of a system But there is a challenge: complex systems engineering: Design Purposeful Complex Systems So far, we have good tools so that characterize but not so that design (eg. Attractors in addition so that Pattern recognition) Why bother Is there another way so that account in consideration of emergent behavior References Complex Systems: Founded by Stephen Wolfram in 1987 Contributors from academia, industry, government General public in 40 countries around the world Topics: mathematics, physics, computer science, biology Advances in Complex Systems: Founded in 1998 Editor-in-Chief: Peter F. Stadler, Dept. of Theoretical Chemistry in addition so that Molecular Structural Biology, U. Vienna Co-Editor-in-Chief: Eric Bonabeau, Santa Fe Institute Fields: biology, physics, engineering, economics, cognitive science in addition so that social sciences

To Write this Article, I had done research in University of Sudbury CA.

1. Review Theory Measurements Measurements help us describe the world in additio

1. Review Theory Measurements Measurements help us describe the world in additio www.phwiki.com

1. Review Theory Measurements Measurements help us describe the world in addition so that everything in it. Measurements can describe length, volume, weight, time, temperature, in addition so that countless other properties. Standardized Unit SystemMetric system in addition so that the English systemAll content ? 2012 FLATE. This material is based upon work supported by the National Science Foundation (NSF) under Grant No. 0802436. Any opinions, findings, in addition so that conclusions or recommendations expressed in this material are those of the author(s) in addition so that do not necessarily reflect the views of the NSF.1Review Theory, Cont. 2Review Theory, Cont. Accuracy Degree of closeness of measurements results so that the true value Precision, reproducibility or repeatability The degree so that which repeated measurements of a quantity under unchanged conditions show the same results3 Review Theory, Cont. Accuracy & Precision ExamplesHigh Accuracy – Low Precision High Precision – Low Accuracy 41a. ExerciseHow accurate & Precise are U 56 2a. Measuring Tools & Their useFigure 4. Long distance measuring tape7Figure 1. Ruler Figure 2. Flexible measuring tapeFigure 3. CaliperSample of Measuring Tools Cont.Graduated cylinder, measuring cup, water velocity-meter, thermometer, analytical balance 8Measuring ToolsCalibration Measuring devices should be calibrated against standardsExample: A set of metric gauge blocks9 2b. Exercise: Measuring Tools & Units Which measuring tool in addition so that units you will use so that measure: 1. Classroom2. Desk3. Pencil10 3. U Measure it.See exercise: ?U Measure it? provided in the handouta) Use paper ruler (fig.1) & Surgical blade (fig. 5) in addition so that provide the following dimensions: Total in addition so that 1/2 of the surgical blade length The widest part of the blade The separation between teethÿb) Use a normal ruler (or any other more precise measuring tool) in addition so that measure the same points described in (a).113. U Measure it Cont.c) Compare results from (a: paper ruler) in addition so that (b: accurate ruler) in terms of accuracy in addition so that precision12 U Measure it Cont.d) Report at least the one dimension of the surgical blade in exercise b) using 3 significant figures in addition so that the respective tolerance interval. Example: 2.3 ñ0.05 cm or from 2.25 cm so that 2.35 cm. c) Explain the range of “tolerance?e) Explain why the selection of appropriate measurement tools is important in data calculation, design in addition so that manufacturing process. 13Exercise 4. Zero Waste – U Design it Figure 5Use the surgical blade (fig. 5) in addition so that the provided sheet of paper (8 «x11?). a) What are the steps you would need so that take if you were designing in addition so that manufacturing surgical blades as shown in the picture b) How many surgical blades can you manufacture from a sheet of paper (8 «x11?). Consider minimum waste of material in addition so that maximum product.c) Draw the possible options in consideration of manufacturing the surgical blade in addition so that demonstrate the most efficient-zero waste distribution design. 14Answers. Zero Waste – U Design it The most efficient-zero waste distribution design:Total19 units8 blades vertical blades11 blades in horizontal position15

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Joanne Smithies Our Lady & St. Gerards RCP We use different metric units so that

Joanne Smithies Our Lady & St. Gerards RCP We use different metric units so that www.phwiki.com

Joanne Smithies Our Lady & St. Gerards RCP We use different metric units so that measure :- We can use our knowledge of multiplying in addition so that dividing by 10, 100 or 1000 so that change or convert measurements in one unit so that measurements in another unit. We are going so that use our knowledge about multiplying in addition so that dividing by 100 so that convert centimetres so that metres in addition so that so that convert metres so that centimetres. There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- There are 100 centimetres in 1 metre When we change from cm so that m we divide by:- Remember! When we divide by 100 the units move two places so that the right. ö100 This is how we change 427cm into metres:- Therefore:- 427cm = 4.27m ö100 ö100 ö100 cm m 354cm 15.4cm 779cm 52.4cm 939cm 395cm 25.8cm 3.54m 0.154m 7.79m 0.524m 9.39m 3.95m 0.258m ö100 Convert from centimetres so that metres So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = So that change from metres so that centimetres we MULTIPLY BY 100. REMEMBER When we multiply by 100 we move each digit two places so that the left:- 3.51m = 351cm 5.4m 6.2m 12.7m 3m 7.6m 0.54m 0.3m 540cm 620cm 1270cm 300cm 760cm 54cm 30cm x100 Try changing these measurements in metres into centimetres

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Standards of Care in Mass Casualty Events Workshop Summary Report Capacity Con

Standards of Care in Mass Casualty Events  Workshop Summary Report  Capacity Con www.phwiki.com

Standards of Care in Mass Casualty Events1A Series of Regional WorkshopsENA Leadership 2010 ? Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Introduction ? Framing the ProblemConsider the scenariosPandemicBioterrorismNatural disaster/catastrophesRegional IOM workshop descriptionsParticipantsLocationsAgendaGoalsOutcomes2ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Workshop Summary ReportAddresses ?Related work on standards of careCrisis standards of care protocol developmentThe surge capacity continuum of careClinical operationsProvider involvement in addition so that engagementPublic engagement in addition so that educationDeveloping intra in addition so that interstate cooperation in addition so that consistencyRole of the Federal government in addition so that national leadershipEthical considerationsLegal issues in consideration of crisis standards of care3ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Related Work on Standards of CareAgency in consideration of Health Resource in addition so that Quality (AHRQ) Altered Standards of Care in Mass Casualty EventsMass Casualty Care alongside Scare Resources ? A Community Planning GuideInstitute of Medicine (IOM) Guidance in consideration of Establishing Crisis Standards of Care in Disaster ? A Letter Report 4ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress ?Mass Medical Care alongside Scarce Resources: A Community Planning Guide? Collaboration between AHRQ in addition so that ASPREthical Considerations in Community Disaster PlanningAssessing the Legal Environment Prehospital CareHospital/Acute CareAlternative Care SitesPalliative CareAvian Influenza Pandemic Case Study5ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Crisis Standards of Care Protocol Development6Who makes the plan NursesPhysician assistantsPhysiciansPharmacistsAdministratorsMorticiansAcademiaGovernmentMany othersENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Capacity Continuum of Care 7 ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Surge Capacity – The Continuum of CareNorth Dakota?s example:Stage 1: Small Outcome ImpactStage 2: Moderate Outcome ImpactStage 3: Severe Outcome Impact8ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Stakeholder – Provider Involvement in addition so that EngagementThose alongside a critical roles includeEMSPhysiciansHospital officialsNursesEngagement challenges cited TimeFundingCulture – resistant so that crisis standards concepts9ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Public Engagement in addition so that Education Engagement challengesPublic is generally uneducatedHistory of distrust Changing the Culture of preparednessUse awareness from recent disaster eventsInclude in educational curriculumElected officials in addition so that media as allies 10ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Developing Intra in addition so that Interstate Cooperation in addition so that ConsistencyReasons in consideration of consistencyApproaches by statesMassachusetts VirginiaRegional applicationsFEMA Region 4Capital region?s ?All-hazards? consortium Interstate Disaster Medical CooperativeVillage-so that-Village Communication11ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Role of the Federal Government in addition so that National LeadershipGuide in addition so that facilitateAHRQ/ASPR?Altered Standards of Care in Mass Casualty Events? (AHRQ, 2004)?Mass Medical Care alongside Scarce Resources: A Community Planning Guide? (AHRQ, 2005)?Guidance in consideration of Establishing Crisis Standards of Care in consideration of Use in Disaster Situations? (IOM, 2009)VHA DOD 12ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Ethical ConsiderationsRequirements in consideration of ethical crisis standards of care planning in addition so that developmentFairnessDuty so that careDuty so that steward resourcesTransparencyProportionalityAccountability13ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Legal Issues in consideration of Crisis Standards of CareLiabilityAddressing the problemDeputizing physiciansEnacting liability protectionsCredentialing Scope-of-practiceEMTALA in addition so that HIPPALegal triageEducation in addition so that training14ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Clinical Operations – ComponentsIndicatorsTriggersTriageAlternate care facilitiesEMS, community health & other componentsResource availability in addition so that distributionPediatrics in addition so that other ?at risk? populationsPalliative careMental healthTraining15ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Who Gets the Resources Hospital outsideIn a Warehouse16ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress ?Crisis Standards? IndicatorsActual or impending resource shortfalls:VentilatorsOxygen in addition so that delivery devicesICU bedsHealthcare providersHospitalsPharmaceuticalsOther17ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress TriggersShould be:ConsistentBased on disaster declarationDriven by front-line providers18ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress TriageTriage in addition so that the Sequential Organ Failure Analysis (SOFA) score.CardiovascularCoagulationHepaticNeurologicalRenalRespiratoryTriage across the health system 19ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Alternate Care FacilitiesCreating surge capacity outside the hospitalPlanning by:North DakotaFacility capabilitiesStaffed by volunteersDelawareModular medical expansionNEHCs ? act as gatewaysLegislation enacted20ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress EMS, Community Health in addition so that Other ComponentsConsiderations in consideration of :EMSCommunity HealthThe private sector21ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Resource Availability in addition so that DistributionIdentifying resourcesResource acquisition 22ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Pediatric in addition so that other ?At Risk? PopulationsPopulationsChildrenElderlyMental health patientsOthersChallenges ? matching resources so that needs23ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Palliative CareExpected Need Despite the best efforts Concern in consideration of lack of palliative care protocols in addition so that standardsReluctance so that discussPlanning in consideration of careNo one left so that dieCare is never withdrawn24ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Mental HealthThe need in consideration of grief managementConsider Ceasing pediatric resuscitationsDiscontinuing (DC?ing) vent assistanceRunning out of life-sustaining medications or oxygenImpact on Care-giversFamily in addition so that individualsPlanning ?Missouri School of Medicine ? Center in consideration of Health Ethics – just-in-time, Pandemic Grief Training course.25ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress TrainingNeed in consideration of effective training in addition so that relationship building across organizational boundaries.Forums includeExercisesActual event responses2009 Presidential inauguration Maryland in addition so that District of Columbia26ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress ConclusionsFour Regional WorkshopsHighlighted work ongoing around the nationMore work needed in consideration of : Palliative care planningMental/behavioral healthVulnerable populationsPublic in addition so that provider engagementConsistencyHow far do we go 27ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress Thank you!Sally Phillips, RN, PhDDirector, Public Health PreparednessAgency in consideration of Health Research in addition so that QualityRockville, MarylandSally.phillips@ahrq.hhs Knox Andress, RN, FAENDesignated Regional CoordinatorLouisiana Region 7 Hospital PreparednessDepartment of Emergency MedicineLSU Health Sciences Center ? ShreveportLouisiana Poison Centerwandr1@lsuhsc 28ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events – A Workshop Report; Phillips/Andress

To Write this Article, I had done research in University of Toronto, Scarborough CA.