Search

Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.

Objective To determine the efficacy of a program to limit the use of the intravenous (IV) push route for opioids on the experience of pain by inpatients and on associated safety events. Design Retrospective cohort study. Setting Two inpatient general medicine floor units at an urban tertiary care academic medical center. Subjects 4,752 inpatient opioid recipients. Methods Patients in one unit were exposed to a multidisciplinary intervention to limit the prescription of opioids via the IV push route, with the other unit used as a control unit. The primary study outcome was the mean numeric pain score per patient during the hospital stay. Secondary measures included the hospital length of stay and postdischarge patient satisfaction. Fidelity measures included the percentage of the patient population exposed to each opioid administration route and the amount of opioid administered per route. Safety measures included patient disposition, transfer to intensive care, and incidence of naloxone administration. Results The intervention was successful in decreasing both the percentage of patients exposed to IV push opioids and the amount of opioid administered via the IV push route, but no associated changes in other study outcomes were identified. Conclusions For the treatment of acute pain in medical inpatients, no evidence of benefit or harm was identified in relation to an increase or decrease in the use of the IV push opioid route.

The digitization of archival collections has become ubiquitous in the modern age. Contrary to the prevalence and popularity of these virtual collections, they are not without their limitations. Archivists have not sufficiently addressed the relationship between digital surrogates and their original objects. This article reviews a project undertaken by the authors who examined forty-two digitized archival collections from seven midwestern states. The study sought to determine whether digital surrogates include sufficient metadata to enable the viewer to understand that the virtual object is a representation of a physical object, that the physical object may be accessed, and that the physical object is part of a larger collection. The article concludes that the metadata fields used to describe digital surrogates vary across repositories, as well as within the institutions; and that very little metadata provides strong connections between the virtual images and the physical materials they represent. The authors conclude by providing recommendations for how archivists might improve the linkages between digital surrogates and their physical counterparts.

Background Teamwork and collaboration are essential to providing high-quality care. Prior research has found discrepancies between nurses’ and physicians’ perceptions in operating rooms, ICUs, and labor and delivery units. Less is known about health care professionals’ perceptions of teamwork and collaboration on general medical services. Methods This cross-sectional study included nurses, nurse assistants, and physicians working on general medical services in four mid-sized hospitals. Researchers assessed teamwork climate using the Safety Attitudes Questionnaire and asked respondents to rate the quality of collaboration experienced with their own and other professional categories. Results Data for 380 participants (80 hospitalists, 13 resident physicians, 193 nurses, and 94 nurse assistants) were analyzed. Hospitalists had the highest median teamwork climate score (83.3, interquartile range [IQR] = 72.3–91.1), and nurses had the lowest (78.6, IQR = 69.6–87.5), but the difference was not statistically significant (p = 0.42). Median teamwork climate scores were significantly different across the four sites (highest = 83.3, IQR = 75.0–91.1; lowest = 76.8, IQR = 66.7–88.4; p = 0.003). Ratings of the quality of collaboration differed significantly based on professional category. Specifically, 63.3% (50/79) of hospitalists rated the quality of collaboration with nurses as high or very high, while 48.7% (94/193) of nurses rated the quality of collaboration with hospitalists as high or very high. Conclusion This study found significant differences in perceptions of teamwork climate across sites and in collaboration across professional categories on general medical services. Given the importance in providing high-quality care, leaders should consider conducting similar assessments to characterize teamwork and collaboration on general medical services within their own hospitals.

BackgroundThe second Multicenter Medication Reconciliation Quality Improvement Study demonstrated a marked reduction in medication discrepancies per patient. The aim of the current analysis was to determine the association of patient exposure to each system-level intervention and receipt of each patient-level intervention on these results.MethodsThis study was conducted at 17 North American Hospitals, the study period was 18 months per site, and sites typically adopted interventions after 2–5 months of preintervention data collection. We conducted an on-treatment analysis (ie, an evaluation of outcomes based on patient exposure) of system-level interventions, both at the category level and at the individual component level, based on monthly surveys of implementation site leads at each site (response rate 65%). We then conducted a similar analysis of patient-level interventions, as determined by study pharmacist review of documented activities in the medical record. We analysed the association of each intervention on the adjusted number of medication discrepancies per patient in admission and discharge orders, based on a random sample of up to 22 patients per month per site, using mixed-effects Poisson regression with hospital site as a random effect. We then used a generalised linear mixed-effects model (GLMM) decision tree to determine which patient-level interventions explained the most variance in discrepancy rates.ResultsAmong 4947 patients, patient exposure to seven of the eight system-level component categories was associated with modest but significant reductions in discrepancy rates (adjusted rate ratios (ARR) 0.75–0.97), as were 15 of the 17 individual system-level intervention components, including hiring, reallocating and training personnel to take a best possible medication history (BPMH) and training personnel to perform discharge medication reconciliation and patient counselling. Receipt of five of seven patient-level interventions was independently associated with large reductions in discrepancy rates, including receipt of a BPMH in the emergency department (ED) by a trained clinician (ARR 0.40, 95% CI 0.37 to 0.43), admission medication reconciliation by a trained clinician (ARR 0.57, 95% CI 0.50 to 0.64) and discharge medication reconciliation by a trained clinician (ARR 0.64, 95% CI 0.57 to 0.73). In GLMM decision tree analyses, patients who received both a BPMH in the ED and discharge medication reconciliation by a trained clinician experienced the lowest discrepancy rates (0.08 per medication per patient).Conclusion and relevancePatient-level interventions most associated with reductions in discrepancies were receipt of a BPMH of admitted patients in the ED and admission and discharge medication reconciliation by a trained clinician. System-level interventions were associated with modest reduction in discrepancies for the average patient but are likely important to support patient-level interventions and may reach more patients. These findings can be used to help hospitals and health systems prioritise interventions to improve medication safety during care transitions.

The traditional approach to injury-severity analyses does not allow in-depth understanding of no-injury crashes, as crash factors found to contribute to the various injury severities may have similar effects on the severity of vehicle damage even if no injury is recorded. Viewing no-injury crashes using the vehicle damage severities as sub-categories and bases for potential injuries can improve understanding of future injury crashes. To better understand the mechanism of no-injury crashes and the crash factors that contribute to the extent of vehicle damage beyond the single categorization of these crashes in injury severity analysis, this study presents a vehicle damage severity analysis for no-injury crashes. To compare the effects of crash contributing factors on crash outcomes, two injury severity models were also estimated. Random parameters multinomial logit models with heterogeneity in means and variances were developed to account for unobserved heterogeneity. Model estimation results revealed that several common factors (e.g., unsafe speed, distracted driving, driving under influence, vehicle age, and run-off-road) are correlated with both injury severity in injury crashes and vehicle damage severity in no-injury crashes. Therefore, the sub-categorization of no-injury crashes by vehicle damage severity can potentially improve estimates of injury severity considered in resource allocation decisions for traffic safety.

Background Hospital-based studies have reported variable associations between outcome after spontaneous intracerebral hemorrhage and peri-hematomal edema volume. Aims In a community-based study, we aimed to investigate the existence, strength, direction, and independence of associations between intracerebral hemorrhage and peri-hematomal edema volumes on diagnostic brain CT and one-year functional outcome and long-term survival. Methods We identified all adults, resident in Lothian, diagnosed with first-ever, symptomatic spontaneous intracerebral hemorrhage between June 2010 and May 2013 in a community-based, prospective inception cohort study. We defined regions of interest manually and used a semi-automated approach to measure intracerebral hemorrhage volume, peri-hematomal edema volume, and the sum of these measurements (total lesion volume) on first diagnostic brain CT performed at ≤3 days after symptom onset. The primary outcome was death or dependence (scores 3–6 on the modified Rankin Scale) at one-year after intracerebral hemorrhage. Results Two hundred ninety-two (85%) of 342 patients (median age 77.5 y, IQR 68–83, 186 (54%) female, median time from onset to CT 6.5 h (IQR 2.9–21.7)) were dead or dependent one year after intracerebral hemorrhage. Peri-hematomal edema and intracerebral hemorrhage volumes were colinear ( R2 = 0.77). In models using both intracerebral hemorrhage and peri-hematomal edema, 10 mL increments in intracerebral hemorrhage (adjusted odds ratio (aOR) 1.72 (95% CI 1.08–2.87); p = 0.029) but not peri-hematomal edema volume (aOR 0.92 (0.63–1.45); p = 0.69) were independently associated with one-year death or dependence. 10 mL increments in total lesion volume were independently associated with one-year death or dependence (aOR 1.24 (1.11–1.42); p = 0.0004). Conclusion Total volume of intracerebral hemorrhage and peri-hematomal edema, and intracerebral hemorrhage volume alone on diagnostic brain CT, undertaken at three days or sooner, are independently associated with death or dependence one-year after intracerebral hemorrhage, but peri-hematomal edema volume is not. Data access statement Anonymized summary data may be requested from the corresponding author.

BackgroundThe first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1.MethodsMARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site’s local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient.DiscussionA mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform.We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.

BACKGROUND Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. OBJECTIVE To compare the effect of 2 hospitalist admission service models (“general” and “admitter-rounder”) on patient disposition and length of stay. DESIGN Retrospective observational cohort study with difference-in-difference analysis. SETTING Large tertiary academic medical center in the United States. PARTICIPANTS Patients (n = 19,270) admitted from the emergency department to hospital medicine and medicine teaching services from July 2010 to June 2013. INTERVENTIONS Admissions to hospital medicine staffed by 2 different service models, compared to teaching service admissions. MEASUREMENTS Incidence of transfer to critical care within the first 24 hours of hospitalization, hospital and emergency department length of stay, and hospital readmission rates ≤30 days postdischarge. RESULTS The change of hospitalist services to an admitter-rounder model was associated with no significant change in transfer to critical care or hospital length of stay compared to the teaching service (difference-in-difference P = 0.32 and P = 0.87, respectively). The admitter-rounder model was associated with decreased readmissions compared to the teaching service on difference-in-difference analysis (odds ratio difference: −0.21, P = 0.01). Adoption of the hospitalist admitter-rounder model was associated with an increased emergency department length of stay compared to the teaching service (difference of +0.49 hours, P < 0.001). CONCLUSIONS Rates of transfer to intensive care and overall hospital length of stay between the hospitalist admission models did not differ significantly. The hospitalist admitter-rounder admission service structure was associated with extended emergency department length of stay and a decrease in readmissions. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine

Background and Purpose— The characteristics of intracerebral hemorrhage (ICH) may vary by ICH location because of differences in the distribution of underlying cerebral small vessel diseases. Therefore, we investigated the incidence, characteristics, and outcome of lobar and nonlobar ICH. Methods— In a population-based, prospective inception cohort study of ICH, we used multiple overlapping sources of case ascertainment and follow-up to identify and validate ICH diagnoses in 2010 to 2011 in an adult population of 695 335. Results— There were 128 participants with first-ever primary ICH. The overall incidence of lobar ICH was similar to nonlobar ICH (9.8 [95% confidence interval, 7.7–12.4] versus 8.6 [95% confidence interval, 6.7–11.1] per 100 000 adults/y). At baseline, adults with lobar ICH were more likely to have preceding dementia (21% versus 5%; P =0.01), lower Glasgow Coma Scale scores (median, 13 versus 14; P =0.03), larger ICHs (median, 38 versus 11 mL; P P P =0.02) than those with nonlobar ICH. One-year case fatality was lower after lobar ICH than after nonlobar ICH (adjusted odds ratio for death at 1 year: lobar versus nonlobar ICH 0.21; 95% confidence interval, 0.07–0.63; P =0.006, after adjustment for known predictors of outcome). There were 4 recurrent ICHs, which occurred exclusively in survivors of lobar ICH (annual risk of recurrent ICH after lobar ICH, 11.8%; 95% confidence interval, 4.6%–28.5% versus 0% after nonlobar ICH; log-rank P =0.04). Conclusions— The baseline characteristics and outcome of lobar ICH differ from other locations.

This study tests the neoclassical concept of interregional migration in post-World War II Japan. The lead-lag relationship between net migration to a core area and regional income inequalities is examined by modeling an ARIMA transfer function. Until 1961 there was a rapid growth in net migration from the periphery to the core area that was accompanied by rapid divergence in regional income inequalities. Since then migration to the core apparently has declined due to a convergence of regional income inequalities. The time series analysis indicates there has been short-run as well as long-run volatility in migration related to cyclical variations in economic performance in the core. (EXCERPT)

Deep packet inspection is playing an increasingly important role in the design of novel network services. Regular expressions are the language of choice for writing signatures, but standard DFA or NFA representations are unsuitable for high-speed environments, requiring too much memory, too much time, or too much per-flow state. DFAs are fast and can be readily combined, but doing so often leads to state-space explosion. NFAs, while small, require large per-flow state and are slow. We propose a solution that simultaneously addresses all these problems. We start with a first-principles characterization of state-space explosion and give conditions that eliminate it when satisfied. We show how auxiliary variables can be used to transform automata so that they satisfy these conditions, which we codify in a formal model that augments DFAs with auxiliary variables and simple instructions for manipulating them. Building on this model, we present techniques, inspired by principles used in compiler optimization, that systematically reduce runtime and per-flow state. In our experiments, signature sets from Snort and Cisco Systems achieve state-space reductions of over four orders of magnitude, per-flow state reductions of up to a factor of six, and runtimes that approach DFAs.

Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process.To compare the effect of 2 hospitalist admission service models ("general" and "admitter-rounder") on patient disposition and length of stay.Retrospective observational cohort study with difference-in-difference analysis.Large tertiary academic medical center in the United States.Patients (n = 19,270) admitted from the emergency department to hospital medicine and medicine teaching services from July 2010 to June 2013.Admissions to hospital medicine staffed by 2 different service models, compared to teaching service admissions.Incidence of transfer to critical care within the first 24 hours of hospitalization, hospital and emergency department length of stay, and hospital readmission rates ≤30 days postdischarge.The change of hospitalist services to an admitter-rounder model was associated with no significant change in transfer to critical care or hospital length of stay compared to the teaching service (difference-in-difference P = 0.32 and P = 0.87, respectively). The admitter-rounder model was associated with decreased readmissions compared to the teaching service on difference-in-difference analysis (odds ratio difference: -0.21, P = 0.01). Adoption of the hospitalist admitter-rounder model was associated with an increased emergency department length of stay compared to the teaching service (difference of +0.49 hours, P0.001).Rates of transfer to intensive care and overall hospital length of stay between the hospitalist admission models did not differ significantly. The hospitalist admitter-rounder admission service structure was associated with extended emergency department length of stay and a decrease in readmissions. Journal of Hospital Medicine 2016;11:669-674. © 2016 Society of Hospital Medicine.

Objective To assess the effect of tablet computers with a mobile patient portal application on hospitalized patients’ knowledge and activation. Methods We developed a mobile patient portal application including pictures, names, and role descriptions of team members, scheduled tests and procedures, and a list of active medications. We evaluated the effect of the application using a controlled trial involving 2 similar units in a large teaching hospital. Patients on the intervention unit were offered use of tablet computers with the portal application during their hospitalization. We assessed patients’ ability to correctly name their nurse, primary service physicians, physician roles, planned tests and procedures, medications started, and medications stopped since admission. We also administered the Short Form of the Patient Activation Measure. Results Overall, 100 intervention- and 102 control-unit patients participated. A higher percentage of intervention-unit patients correctly named ≥1 physician (56% vs 29.4%; P < .001) and ≥1 physician role (47% vs 15.7%; P < .001). Knowledge of nurses’ names, planned tests, planned procedures, and medication changes was generally low and not significantly different between the study units. The Short Form of the Patient Activation Measure mean (SD) score was also not significantly different at 64.1 (13.4) vs 62.7 (12.8); P = .46. Conclusions Additional research is needed to identify optimal methods to engage and inform patients during their hospitalization, which will improve preparation for self- management after discharge.

The unexpected expansion of a 14-bed medical intensive care unit exposed the need for a structured preceptor/orientation program. Staff feedback and a review of quality indicators further substantiated this finding and revealed a decrease in standards of practice and problems in staff development. A restructured preceptor/orientation program yielded improvements in communication and staff satisfaction. Preceptors and orientees now have a better understanding of their roles and expectations, and quality of care is improving in an environment that promotes personal and professional growth.

Electronically available data on the Web is exploding at an ever increasing pace. Much of this data is unstructured, which makes searching hard and traditional database querying impossible. Many Web documents, however, contain an abundance of recognizable constants that together describe the essence of a document's content. For these kinds of data-rich, multiple-record documents (e.g., advertisements, movie reviews, weather reports, travel information, sports summaries, financial statements, obituaries, and many others) we can apply a conceptual-modeling approach to extract and structure data automatically. The approach is based on an ontology – a conceptual model instance – that describes the data of interest, including relationships, lexical appearance, and context keywords. By parsing the ontology, we can automatically produce a database scheme and recognizers for constants and keywords, and then invoke routines to recognize and extract data from unstructured documents and structure it according to the generated database scheme. Experiments show that it is possible to achieve good recall and precision ratios for documents that are rich in recognizable constants and narrow in ontological breadth. Our approach is less labor-intensive than other approaches that manually or semiautomatically generate wrappers, and it is generally insensitive to changes in Web-page format.

Nidificacion En Acantilados De Strix Occidentalis caurina En Oregon El buho Strix occidentalis lucida nidifica ocasionalmente en acantilados o en cuevas, mientras que la subespecie caurina nidifica casi exclusivamente en arboles. Describimos las caracteristicas fisicas y geologicas de cinco nidos en cuevas de S. occidentalis caurina. Los cinco nidos estuvieron en el oeste de Oregon y todos se encontraron en afloramientos de rocas de arenisca o en acantilados. Las caracteristicas fisiograficas de los sitios de los nidos en acantilados fueron similares a aquellas de los sitios de los nidos en arboles. La altura y dimensiones de los nidos de la subespecie caurina fueron similares a la de los nidos de las subespecies lucida y occidentalis. [Traduccion del equipo editorial]

The American system of federalism creates frequent opportunities for clashes between state and federal environmental regulators.State and federal environmental laws overlap but are not easily reconciled. Most federal environmental law provides no clear answer as to how to reconcile differing mandates of state and federal environmental regulators. In this article, they will examine these state-federal conflicts as they played out in 1994 in the cleanup of contaminated sites in the state of Washington. This article describes the way a regional office of the Environmental Protection Agency and the state`s Department of Ecology developed a novel approach to managing the essential tension between overlapping state and federal cleanup laws.

Public Service Company of Colorado (PSCo), in cooperation with the US Department of Energy (DOE) and the Electric Power Research Institute (EPRI), is testing the Integrated Dry NO{sub x}/SO{sub 2} Emissions Control system. This system combines low-NO{sub x} burners, overfire air, selective non-catalytic reduction (SNCR), and dry sorbent injection with humidification to reduce by up to 70% both NO{sub x} and SO{sub 2} emissions from a 100 MW coal-fired utility boiler. The project is being conducted at PSCo`s Arapahoe Unit 4 located in Denver, Colorado as part of the DOE`s Clean Coal Technology Round 3 program. The urea-based SNCR system, supplied by Noell, Inc., was installed in late 1991 and was tested with the unmodified boiler in 1992. At full load, it reduced NO{sub x} emissions by about 35% with an associated ammonia slip limit of 10 ppm. Babcock & Wilcox XLS{reg_sign} burners and a dual-zone overfire air system were retrofit to the top-fired boiler in mid-1992 and demonstrated a NO{sub x} reduction of nearly 70% across the load range. Integrated testing of the combustion modifications and the SNCR system were conducted in 1993 and showed that the SNCR system could reduce NO{sub x} emissions by an additional 45% whilemore » maintaining 10 ppm of ammonia slip limit at full load. Lower than expect4ed flue-gas temperatures caused low-load operation to be less effective than at high loads. NO{sub x} reduction decreased to as low as 11% at 60 MWe at an ammonia slip limit of 10 ppm. An ammonia conversion system was installed to improve performance at low loads. Other improvements to increase NO{sub x} removal at low-loads are planned. The combined system of combustion modifications and SNCR reduced NO{sub x} emissions by over 80% from the original full-load baseline. 11 figs.« less

This paper describes a research effort to use executable slicing as a pre-processing aid to improve the prediction performance of rogue software detection. The prediction technique used here is an information retrieval classifier known as cosine similarity that can be used to detect previously unknown, known or variances of known rogue software by applying the feature extraction technique of randomized projection. This paper provides direction in answering the question of is it possible to only use portions or subsets, known as slices, of an application to make a prediction on whether or not the software contents are rogue. This research extracts sections or slices from potentially rogue applications and uses these slices instead of the entire application to make a prediction. Results show promise when applying randomized projections to cosine similarity for the predictions, with as much as a 4% increase in prediction performance and a five-fold decrease in processing time when compared to using the entire application.

Quantitative trait locus (QTL) analysis is a statistical method to link phenotypes with regions of the genome that affect the phenotypes in a mapping population. R/qtl is a powerful statistical program commonly used for analyzing rodent QTL crosses, but R/qtl is a command line program that can be difficult for novice users to run. J/qtl was developed as an R/qtl graphical user interface that enables even novice users to utilize R/qtl for QTL analyses. In this chapter, we describe the process for analyzing rodent cross data with J/qtl, including data formatting, data quality control, main scan QTL analysis, pair scan QTL analysis, and multiple regression modeling; this information should enable new users to identify QTL affecting phenotypes of interest within their rodent cross datasets.

The concept of Free Space Optical (FSO) communications has been around since the late 1960's.This paper will describe some recent experimental results that demonstrate and validate hybrid FSO/RF communication links as viable components in a tactical high data rate network. In particular, we will describe air-mountain link closure up to ranges of 200 km under heavy atmospheric turbulence. These links were operated at low packet and bit error rates, with occasional link outages. Like the internet, we used retransmission to minimize the effect of these outages on link throughput. For example, when the FSO system is running, ORCA uses the RF system for retransmission to improve link efficiency. In addition, we will discuss potential losses created by the aircraft aero-optics effects. Finally, we will show comparison between model predictions and experimental data that suggest we can predict link performance if the atmospheric turbulence conditions are known.