Dartmouth Institute for Health Policy and Clinical Practice
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Accidents
Get PDFReports of rescues and accidents in the White Mountains of New Hampshire from the warm months of 2024 opens with thoughts on the dangers of selfies. A 38-year-old hiker encounters trouble attempting a Presidential Range traverse in early May. A man breaks his leg and with the help of a passing Appalachian Trail thru-hiker crawls 0.3 miles to a trail junction for a helicopter pickup. An 84-year-old glider operator crashes into trees on a ridge west of Mount Moosilauke. A hiker struggles to cross the swollen Wild River after a period of storms. Trail runners suddenly must call for help after getting injured on rough terrain. A hiker bushwhacking down the treacherous Lincoln Slide slips and is injured. After riding the Cog Railway to the summit of Washington, a man makes a fatal decision to try hiking down in bad weather. Speedy help by passing hikers saves an unconscious man near Lakes of the Clouds Hut. Finally, a meditation on how to pay close attention out there
Open Access Office Hours
No full textHave a burning question related to Open Access? Maybe you\u27re wondering how the new NIH Public Access policy affects you—or where you should deposit your dataset to make it openly available. Drop by to speak with our experts in Research Facilitation
Averting Death by PowerPoint
No full textThis lesson empowers students to design presentation slides that effectively communicate their ideas to unfamiliar audiences. The lesson emphasizes the key guiding principle for slide design, one message per slide, along with four steps to implement it. Students will develop the vocabulary to assess the quality of others\u27 presentation slides and apply these four steps in creating their own. The lesson seeks to cultivate a dynamic, collaborative, and creative learning environment by design
Confronting Indecision
No full textThis course aims to increase students\u27 understanding of indecision and how to confront it. The class provides insight into how the fear of the unknown holds people back from making decisions and about understanding one\u27s values as a means to combat indecision. Students and teachers alike explore instances of indecision and evaluate their own impulses & thought processes by reflecting on the deeper reasons for their choices. Students will increase their comfort level of asking themselves and their peers questions about the values that guide them and, in doing so, strengthen their relationships with themselves and others
Design of Experiments for Improving Mortar Strength through Metal Fiber Additives
No full textThis research project investigates the improvement of mortar strength by incorporating metal fiber additives, to develop a high-performance mortar for construction applications where traditional concrete with coarse aggregates is not viable. Sponsored by Creare LLC who have received a Small Business Innovation Research (SBIR) grant from the U.S. Department of Defense, the upper limits of metal fiber loading in mortar are explored to achieve compressive and flexural strengths that are similar to traditional concrete. The study uses a design of experiments: varying fiber type and concentration to determine the impact on mechanical properties, including compressive and flexural strength while maintaining workability and limiting metal fiber clumping. Following ASTM standards, compression, and flexural tests are carried out on samples with Helix 5-25 micro rebar metal fibers and with Euclid PSI Crimped Steel Fibers. The results demonstrated statistically significant improvements in both flexural strength (\u3e400 psi) and compressive strength (\u3e2500 psi) compared to 0% fiber controls. Chi-squared spatial randomness analyses show the challenge of fiber clumping at higher concentrations, but mortar flow tests demonstrate workability even at high metal fiber concentrations. This research confirms the potential of metal fiber additives to elevate mortar strength and also lays the groundwork for further innovations in the development of lighter, high-strength materials suitable for electromagnetic interference (EMI) / electromagnetic pulse (EMP) and blast protection, contributing to defense infrastructure resilience
Novel End-Tidal Carbon Dioxide Monitoring Device
No full textEnd tidal Carbon Dioxide (EtCO2) monitoring is the gold standard to verify correct placement of advanced airway devices (endotracheal and supraglottic) and to guide patient ventilation (respiratory rate and tidal volume). Colorimetric EtCO2 is utilized in medical settings where detailed continuous, quantitative EtCO2 is unavailable (e.g., out of the operating room and ICU hospital environments, austere environments). This tool, however, is often binary (showing CO2 as present or absent) and is not utilized continuously, falling short to indicate whether the patient is hyperventilated or hypoventilated or the airway device has dislodged. This project created a “good enough technology” with a 4-level colorimetric EtCO2 monitor that is integrated into an airway device to prove correct positioning of the airway and, as opposed to current colorimetric EtCO2 detectors, help guide ventilation by showing EtCO2 levels below 5mmHg, between 5-35mmHg, between 35-45mmHg, and above 45mmHg. This technology does not require electricity, is durable, and is less expensive in order to expand access for use (e.g. high volume military use in austere settings, resource-limited countries that cannot afford more technologically advanced monitors). Critical technical elements of this project include analytical chemistry that underpins the color change reactions, and fluidics that ensures optimal interactions between airflow and the device
2025 Solar Decathlon Net Zero Design Challenge: Sharon Elementary School
No full textOur team participated in the 2025 US Department of Energy Solar Decathlon Design Challenge, an international collegiate competition where teams are tasked with designing sustainable, net-zero buildings to support innovation and communities. We partnered with Sharon Elementary School in Sharon, VT. This small K-6 school was looking to propose an upgrade and expansion to accommodate their growing class. They struggled to find a cost-friendly construction plan to address necessary maintenance, over-occupancy, security concerns, and poor energy efficiency. By collaborating with the administration, teachers, and students, along with the firm behind the previous expansion proposal (Banwell Architects), our team created a design solution that not only provides 7000 additional square feet of classrooms and community space, but also uses innovative straw bale panels and recycled low-carbon cellulose to improve insulation in the roof and walls from R-20 and R-3 to R-65 and R-38, respectively. We designed a greenhouse on the south side of the school to capture solar energy and provide a green educational space for students. With our envelope improvements and efficient air-water heat pumps, site EUI was reduced by 61%, before photovoltaics. Furthermore, by considering various financial grants and expanding roof solar to achieve net-zero, we bring 4M bond while minimizing annual energy bills. Lastly, by visiting Sharon and speaking with students about our design as well as sustainability and STEM education in general, we hope our work has a lasting, positive impact on Sharon Elementary and the community at large
Simulated Respiration Model for 1-3 Month Old Infants
No full textTracheal intubation in 4 - 12 week old infants is a highly risky procedure due to their immature, narrow and weak physiology that makes them less resilient to stress and more susceptible to complications. Currently, there is a lack of clinical models that adequately mimic an infant’s respiratory response. Hence, we developed a respiratory simulation model specifically trained for infants in this age range as an educational tool. DartLung, is a simulation model that represents the changes in alveolar pressure, lung volume, airflow rate, and muscle pressure during spontaneous breathing. Our work builds upon existing respiratory models and ventilation studies, introducing an approach tailored specifically for the 4 - 12 week infant population. Using a system of differential equations and physiological parameters, we simulate spontaneous respiratory mechanics. We created a user interface that allows users to input patient parameters and receive predictive output. This is the first iteration of DartLung, and while it provides a foundational framework for understanding infant respiratory mechanics, it does not yet offer real-time clinical guidance or fully validated predictions for intubation outcomes. Further refinements are needed, including integration of more comprehensive physiological data, validation against clinical cases, and expansion to model critical respiratory events such as oxygen desaturation. The project is conducted in collaboration with Dartmouth-Hitchcock Medical Center (DHMC) with the goal of benefiting anesthesiologists, pediatricians, and researchers. As researchers expand upon DartLung, the simulation model has the potential to positively impact patient care for a vulnerable population
Visualized shared mental modeling: an adapted practical framework for interdisciplinary teams solving complex problems in healthcare
No full textHealthcare systems and the scientific community are increasingly recognizing the need for multidisciplinary, inter-organizational perspectives and skill sets to tackle the most pressing challenges of our time to improve human health. However, as our approach to scientific inquiry is evolving, our methods of working across teams remain largely unchanged. Using a case example of a human-centered design project focused on improving care transitions during reentry to the community from incarceration, this paper details the importance and function of visualized shared mental models for multidisciplinary teams addressing complex multisystem problems. This paper contributes a practical framework for developing a stakeholder-validated, visualized shared mental model (vSMM). This framework provides a pragmatic process that enables multidisciplinary teams to develop shared understanding, navigate complexity, and coordinate effectively across systems. By describing both process and application, this paper provides a tool to enhance collaboration in health-oriented research, quality improvement, innovation, and implementation processes
Magicicada and Mathematics: What the Parochiality of Our Explanations Means for the Indispensability Argument
No full textThis thesis examines whether the indispensability argument justifies belief in the existence of mathematical entities. I adopt ontological naturalism, arguing that we should believe in entities that feature in our best scientific theories, which are determined through inference to the best explanation. The indispensability argument contends that because mathematical entities are explanatorily indispensable to our best scientific theories – as demonstrated by examples like the prime number explanation of cicada life cycles – we should believe they exist just as we believe in electrons and stars.
However, I identify a challenge: our scientific explanations are inherently parochial, shaped by human cognitive interests, abilities, and limitations. Using Bradford Skow\u27s distinction between first-level and higher-level reasons why, I explore whether mathematical explanations could be segregated as merely accommodating human limitations. I argue that this approach fails because first-level and higher-level reasons are fundamentally entangled – we cannot identify causes without appealing to broader theoretical frameworks that include mathematical patterns.
This entanglement reveals that explanation is unavoidably parochial, meaning our ontology will necessarily reflect pragmatic considerations. Rather than undermining the indispensability argument, I contend this shows we should accept a pragmatic approach to ontology. I defend this position by comparing it with Rudolf Carnap\u27s linguistic frameworks approach, arguing that the indispensability argument\u27s use of a single total theory provides a more unified and valuable method for determining what exists. The thesis concludes that while our belief in mathematical entities has an ineliminable pragmatic dimension, the indispensability argument remains a compelling justification for mathematical anti-nominalism