Friesgaard, Kristian Dahl; Nikolajsen, Lone; Giebner, Matthias
BACKGROUND: Management of pain in the pre-hospital setting is often inadequate. In 2011, ambulance personnel were authorized to administer intravenous fentanyl in the Central Denmark Region. The aim of this study was to evaluate the efficacy and safety of intravenous fentanyl administered...... by ambulance personnel. METHODS: Pre-hospital medical charts from 2348 adults treated with intravenous fentanyl by ambulance personnel during a 6-month period were reviewed. The primary outcome was the change in pain intensity on a numeric rating scale (NRS) from before fentanyl treatment to hospital arrival....... Secondary outcomes included the number of patients with reduction in pain intensity during transport (NRS ≥ 2), the number of patients with NRS > 3 at hospital arrival, and potential fentanyl-related side effects. RESULTS: Fentanyl reduced pain from before treatment (8, IQR 7-9) to hospital arrival (4, IQR...
Ambulance personnel were required to view a PowerPoint. (Microsoft, USA) presentation of the vignettes (Table 1) and then mention whether stroke was present or absent and motivate how they reached the diagnosis. Three vignettes were positive for stroke diagnosis according to the LAPSS and CPSS, while four vignettes.
Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen
Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island....
Raaber, Nikolaj; Bøtker, Morten T; Riddervold, Ingunn S
. In the intervention period, the EMCC was manned 24/7 with physicians experienced in emergency care. Eligible participants included all patients with nonurgent conditions receiving an ambulance after a medical emergency call. Ambulance personnel assessed patients and subsequently performed a telephone consultation...
Hansen, Claus D.; Nielsen, Kent J
alone. Aim This presentation investigates whether failure to use AT is linked to male ambulance workers’ gender identity? Is lifting patients alone a way of performing masculinity for AP’s? Method Data is taken from MARS, a panel study of AP workers in Denmark (n = 1606). Information from questionnaires...... measuring traditional male role norms (MRNI), safety attitudes and safety behavior will be linked to company register information on work injuries categorized as lifting accidents. Logistic regression is used to analyse associations between masculinity, lifting behavior, and lifting accidents. Results...... alone. For those 5% scoring lowest on MRNI the probability of reporting lifting alone was 6% while this figure was 17% for those scoring above the 95th percentile. Conclusion This study suggests that male ambulance workers performance of masculinity might pose a threat to their safety. AP...
A total of 40 basic life support (BLS) and intermediate life support (ILS) personnel from different sites diagnosed 280 vignettes. BLS personnel were able to diagnose stroke with a sensitivity of 85.3% and a specificity of 89.9% (positive predictive value (PPV) 86.7%, negative predictive value (NPV) 88.8%), while ILS achieved ...
Brinkrolf, Peter; Lukas, Roman; Harding, Ulf; Thies, Sebastian; Gerss, Joachim; Van Aken, Hugo; Lemke, Hans; Schniedermeier, Udo; Bohn, Andreas
High-quality chest compressions during cardiopulmonary resuscitation (CPR) play a significant role in surviving cardiac arrest. Chest-compression quality can be measured and corrected by real-time CPR feedback devices, which are not yet commonly used. This article looks at the acceptance of such systems in comparison of equipped and unequipped personnel. Two groups of emergency medical services' (EMS) personnel were interviewed using standardized questionnaires. The survey was conducted in the German cities Dortmund and Münster. Overall, 205 persons participated in the survey: 103 paramedics and emergency physicians from the Dortmund fire service and 102 personnel from the Münster service. The staff of the Dortmund service were not equipped with real-time feedback systems. The test group of equipped personnel of the ambulance service of Münster Fire brigade uses real-time feedback systems since 2007. What is the acceptance level of real-time feedback systems? Are there differences between equipped and unequipped personnel? The total sample is receptive towards real-time feedback systems. More than 80% deem the system useful. However, this study revealed concerns and prejudices by unequipped personnel. Negative ratings are significantly lower at the Münster site that is experienced with the use of the real-time feedback system in contrast to the Dortmund site where no such experience exists-the system's use in daily routine results in better evaluation than the expectations of unequipped personnel. Real-time feedback systems receive overall positive ratings. Prejudices and concerns seem to decrease with continued use of the system.
Utku, Semih; Özcanhan, Mehmet Hilal; Unluturk, Mehmet Suleyman
Patient delivery time is no longer considered as the only critical factor, in ambulatory services. Presently, five clinical performance indicators are used to decide patient satisfaction. Unfortunately, the emergency ambulance services in rapidly growing metropolitan areas do not meet current satisfaction expectations; because of human errors in the management of the objects onboard the ambulances. But, human involvement in the information management of emergency interventions can be reduced by electronic tracking of personnel, assets, consumables and drugs (PACD) carried in the ambulances. Electronic tracking needs the support of automation software, which should be integrated to the overall hospital information system. Our work presents a complete solution based on a centralized database supported by radio frequency identification (RFID) and bluetooth low energy (BLE) identification and tracking technologies. Each object in an ambulance is identified and tracked by the best suited technology. The automated identification and tracking reduces manual paper documentation and frees the personnel to better focus on medical activities. The presence and amounts of the PACD are automatically monitored, warning about their depletion, non-presence or maintenance dates. The computerized two way hospital-ambulance communication link provides information sharing and instantaneous feedback for better and faster diagnosis decisions. A fully implemented system is presented, with detailed hardware and software descriptions. The benefits and the clinical outcomes of the proposed system are discussed, which lead to improved personnel efficiency and more effective interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Fournier, Marc; Chenaitia, Hichem; Masson, Catherine; Michelet, Pierre; Behr, Michel; Auffray, Jean-Pierre
Ambulance drivers often travel under stressful conditions at high speed while using vehicles with poor high-speed maneuverability. The occupant safety of ambulance vehicles has not yet been addressed by the automotive safety paradigm; particularly for the rear patient compartment. This study had two objectives: (1) to assess by survey the French Emergency Medical Services (EMS) to determine the layout of the vehicle most often used and the EMS personnel's behavior during transport; and (2) to conduct a crash test to analyze the injuries which may affect EMS personnel and patients in the rear patient compartment. Firstly, a survey was distributed to the 50 largest metropolitan French EMS programs. Secondly, a crash test was performed with a Mobile Intensive Care Unit (MICU) in conditions closest to reality. Forty-nine of the 50 biggest metropolitan French EMS programs responded to the survey. This represents 108 French MICUs. During the last three years, 12 of 49 EMS programs (24%) identified at least one accident with an MICU, and six of these 12 (50%) suffered at least one death in those accidents. A crash test using a typical French EMS MICU showed that after impact of a collision, the ambulance was moved more than five meters with major consequences for all passengers. A study-approved human cadaver placed in the position of a potential patient was partially thrown from the stretcher with a head impact. The accelerometric reaction of the anthropomorphic manikin head was measured at 48G. The crash test demonstrated a lack of safety for EMS personnel and patients in the rear compartment. It would be preferable if each piece of medical equipment were provided with a quick release system resistant to three-dimensional 10G forces. The kinetic changes undergone by the "patient" substitute on the stretcher would probably have an effect of causing injury pathology. This study highlights the need for more research and development in this area.
Cuijpers, N.; Brown, P.R.
Violence towards public sector employees is perceived as a growing problem in a number of societies, attracting the attention of mass media, politicians and social scientists alike. In this article we discuss how national newspapers have reported aggression towards ambulance workers in the
Little is known about the impact of Critical Incidents (CIs) on the lives of ambulance personnel. One-to-one interviews were conducted with 27 participants who had experienced CIs during the previous 12 months in order to: assess the nature and impact of CIs on health and well-being; examine attitudes toward support services; and explore barriers to service use. The results showed that incidents involving children, suicides, and grotesque mutilation were the most distressing. Participants reported a wide range of physical and mental health problems including sleep difficulties, angry outbursts, irrationality and feelings of alienation. Key themes included: low support service uptake due to fears relating to confidentiality and machismo; a perceived lack of concern and support from management; and a need for professional counselling and stress awareness training. Emergency Medical Controllers (EMCs) also reported a number of difficulties unique to their role. The findings suggest that exposure to CIs has a significant impact on health and well-being; this has important implications for recognizing and appropriately addressing the health and training needs of ambulance personnel, including the effective management of Critical Incident Stress.
Plat, M J; Frings-Dresen, M H W; Sluiter, J K
Some occupations have tasks and activities that require monitoring safety and health aspects of the job; examples of such occupations are emergency services personnel and military personnel. The two objectives of this systematic review were to describe (1) the existing job-specific workers' health surveillance (WHS) activities and (2) the effectiveness of job-specific WHS interventions with respect to work functioning, for selected jobs. The search strategy systematically searched the PubMed, PsycINFO and OSH-update databases. The search strategy consisted of several synonyms of the job titles of interest, combined with synonyms for workers' health surveillance. The methodological quality was checked. At least one study was found for each of the following occupations fire fighters, ambulance personnel, police personnel and military personnel. For the first objective, 24 studies described several job-specific WHS activities aimed at aspects of psychological, 'physical' (energetic, biomechanical and balance), sense-related, environmental exposure or cardiovascular requirements. The seven studies found for the second objective measured different outcomes related to work functioning. The methodological quality of the interventions varied, but with the exception of one study, all scored over 55% of the maximum score. Six studies showed effectiveness on at least some of the defined outcomes. The studies described several job-specific interventions: a trauma resilience training, healthy lifestyle promotion, physical readiness training, respiratory muscle training, endurance and resistance training, a physical exercise programme and comparing vaccines. Several examples of job-specific WHS activities were found for the four occupations. Compared to studies focusing on physical tasks, a few studies were found that focus on psychological tasks. Effectiveness studies for job-specific WHS interventions were scarce, although their results were promising. We recommend studying
Hansen, Claus D; Rasmussen, Kurt; Kyed, Morten
Background Reviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance......,691) and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality. Results Ambulance personnel have half the prevalence of poor self...... with higher levels of poor mental health and poor sleep quality. To improve work environment, attention should be paid to musculoskeletal problems and the presence of positive organizational support mechanisms that can prevent negative effects from the high levels of emotional demands....
Plat, M. J.; Frings-Dresen, M. H. W.; Sluiter, J. K.
Some occupations have tasks and activities that require monitoring safety and health aspects of the job; examples of such occupations are emergency services personnel and military personnel. The two objectives of this systematic review were to describe (1) the existing job-specific workers' health
Strong gamme or X-ray sources are utilized for non-destructive testing of i.e. bridges. The activities involve certain risks of accident that might lead to serious injuries caused by radiation. The National Institute of Radiation Protection has during the laste decade greatly yhe inspection rate in this area. It has today made controls of most enterprieses running ambulating radiography. (O.S.)
Sep 15, 1990 ... recent months some medical practitioners were of the opinion that ambulance personnel were being trained to do more than they should. Unfortunately many doctors still seem to view the ambulance service as mainly a patient transport service and not as the emergency medical service it has become.
ion 15 14% Nasogastric Tube 12 11% Foley 10 9% Tracheostomy Care 10 9% Immobilization 8 7% Incubator 3 2% Other 11 10% Total Patients Needing Special...Results indicated that trauma patients travelling to larger medical centers were the primary patient category. Generally, Registered Nurses accompanied...minimal knowledge level of each inflight attendant, and instructor qualifications are not indicated . Further, volunteer air ambulance services are
It would be in the interest of the patient if a sound working relationship between pre-hospital, hospital and private medical practitioners could be established and that each group becomes familiar with the capabilities of the other. It is equally important that ambulance personnel be welcomed into the health profession of ...
Brown, Lawrence H; Chaiechi, Taha; Buettner, Petra G; Canyon, Deon V; Crawford, J Mac; Judd, Jenni
To evaluate the impact of changing energy prices on Australian ambulance systems. Generalised estimating equations were used to analyse contemporaneous and lagged relationships between changes in energy prices and ambulance system performance measures in all Australian State/Territory ambulance systems for the years 2000-2010. Measures included: expenditures per response; labour-to-total expenditure ratio; full-time equivalent employees (FTE) per 10,000 responses; average salary; median and 90th percentile response time; and injury compensation claims. Energy price data included State average diesel price, State average electricity price, and world crude oil price. Changes in diesel prices were inversely associated with changes in salaries, and positively associated with changes in ambulance response times; changes in oil prices were also inversely associated with changes in salaries, as well with staffing levels and expenditures per ambulance response. Changes in electricity prices were positively associated with changes in expenditures per response and changes in salaries; they were also positively associated with changes in injury compensation claims per 100 FTE. Changes in energy prices are associated with changes in Australian ambulance systems' resource, performance and safety characteristics in ways that could affect both patients and personnel. Further research is needed to explore the mechanisms of, and strategies for mitigating, these impacts. The impacts of energy prices on other aspects of the health system should also be investigated. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.
RONOJOY GHOSH; VIVEK SHAH; HITESH AGARWAL; ASHUTOSH BHUSHAN; PRASUN KANTI GHOSH
With the increase in traffic road density, several causalities occur due to delay in taking a patient to the hospital in an ambulance. In this paper, we have developed an algorithm to find the shortest path to reach the required destination. As required the software will identify the present location of the vehicle and ask the user for the destination. Then it will show all the available paths, highlighting the shortest one or in several cases the most optimum one. Further we made the traffic...
O'Hara, Niamh B; Reed, Harry J; Afshinnekoo, Ebrahim; Harvin, Donell; Caplan, Nora; Rosen, Gail; Frye, Brook; Woloszynek, Stephen; Ounit, Rachid; Levy, Shawn; Butler, Erin; Mason, Christopher E
Microbial communities in our built environments have great influence on human health and disease. A variety of built environments have been characterized using a metagenomics-based approach, including some healthcare settings. However, there has been no study to date that has used this approach in pre-hospital settings, such as ambulances, an important first point-of-contact between patients and hospitals. We sequenced 398 samples from 137 ambulances across the USA using shotgun sequencing. We analyzed these data to explore the microbial ecology of ambulances including characterizing microbial community composition, nosocomial pathogens, patterns of diversity, presence of functional pathways and antimicrobial resistance, and potential spatial and environmental factors that may contribute to community composition. We found that the top 10 most abundant species are either common built environment microbes, microbes associated with the human microbiome (e.g., skin), or are species associated with nosocomial infections. We also found widespread evidence of antimicrobial resistance markers (hits ~ 90% samples). We identified six factors that may influence the microbial ecology of ambulances including ambulance surfaces, geographical-related factors (including region, longitude, and latitude), and weather-related factors (including temperature and precipitation). While the vast majority of microbial species classified were beneficial, we also found widespread evidence of species associated with nosocomial infections and antimicrobial resistance markers. This study indicates that metagenomics may be useful to characterize the microbial ecology of pre-hospital ambulance settings and that more rigorous testing and cleaning of ambulances may be warranted.
Yamamoto, Y. [Toyota Motor Co. Ltd., Aichi (Japan)
Ambulances are playing an important role in the supporting of the activities of fire fighters belonging to the fire stations in the whole of the country, or saving the irreplaceable lives. In accordance with an increase in recent years in the percentage of the aged in the population of the nation and the number of accidents and disasters, it has become urgently necessary that pre-hospital care (first-aid treatment of a sick or injured person before rushed to a hospital) be set up, and the characteristics which the ambulances are required to possess have greatly changed. This paper describes the main points of and future requirements for the development of ambulances mainly of the second generation of Toyota ambulance `Himedic` of specifications of high standards developed in accordance with the start of the first-aid and life-saving qualifier system in 1991. The characteristics which ambulances are required to have, and which are referred to in this paper, are improved mobility, provision of a sufficient space in the ambulance for internal activity, capability of reducing the patient`s burden and improved safety. The future requirements referred to in the paper include he unification of specifications, reduction of dimensions and weight of medical equipment and adoption of a hybrid system and ITS (Intelligent Transport System). 3 refs., 5 figs., 2 tabs.
Due to developments of the health market, economic aspects of the health system are more relevant. In this upcoming market the patient is regarded as customer and the doctor as provider of medical services. Studies on customer orientation in the ambulant medicine lag behind this dynamic. An aim of the study is to comprehend the attitudes of the doctors referring to the customer orientation. In a second step the findings are discussed according to statements of health-care paticipants. Developments in role comprehension of doctor and patient are focused to gain results in scientific and practical applications. Guideline-supported, partly narrative interviews with n=9 gynaecologists and n=11 general practitioners in Freiburg/Germany are recorded, transcribed and reviewed in a qualitative analysis. The statements of the doctors show patient satisfaction has an incremental meaning sspecially regarding the sequence of patient relationship and economic management of the doctor's workplace. The doctor's role comprehension meets with a refusal of the role of salesman and the patient as customer. The method of interviews is suitable to gather empirical impressions of the doctors. The control sample is adequate, however a bias due to inhomogeneous thematic affinitiy and local social-demographics might be possible. The customer orientation has become an important factor in doctor-patient relationtships. The relevance of the doctor-patient conversation and the risk of misuse of the patient confidence are mentioned by the doctors. The doctor as paternalistic care provider gives way to the customer-focused service provider. The doctor's necessity of autonomyssss and dependency on patient satisfaction have potential for conflict. Intensive mention of customer orientation in medicine in the media emphasises its importance. Rational handling with the possibilities of individual health markets is a prospective challange. Further research could be established in all aspects of
The ambulance is to replace another based on the off-road vehicle design which was originally acquired for the civil engineering phase of LEP construction. Just one figure, in 1999, the CERN ambulance was called out 195 times.
Ferriero, Giorgio; Kristensen, Morten T; Invernizzi, Marco
. EVIDENCE ACQUISITION: A literature search was conducted on research articles published between 2006 and June 2016 in journals indexed by MEDLINE and Scopus databases using as search item: "Cumulated Ambulation Score"[All Fields], and selecting studies that presented a psychometric analysis of the scale...
Küpper, Thomas E; Zimmer, Bernd; Conrad, Gerson; Jansing, Paul; Hardt, Aline
Although ambulance flights are routine work and thousands of employees work in repatriation organizations, there is no data on noise exposure which may be used for preventive advice. We investigated the noise exposure of crews working in ambulance flight organizations for international patient repatriation to get the data for specific guidelines concerning noise protection. Noise levels inside Learjet 35A, the aircraft type which is most often used for repatriation operations, were collected from locations where flight crews typically spend their time. A sound level meter class 1 meeting the DIN IEC 651 requirements was used for noise measurements, but several factors during the real flight situations caused a measurement error of ~3%. Therefore, the results fulfill the specifications for class 2. The data was collected during several real repatriation operations and was combined with the flight data (hours per day) regarding the personnel to evaluate the occupationally encountered equivalent noise level according to DIN 45645-2. The measured noise levels were safely just below the 85 dB(A) threshold and should not induce permanent threshold shifts, provided that additional high noise exposure by non-occupational or private activities was avoided. As the levels of the noise produced by the engines outside the cabin are significantly above the 85 dB(A) threshold, the doors of the aircraft must be kept closed while the engines are running, and any activity performed outside the aircraft - or with the doors opened while the engines are running - must be done with adequate noise protection. The new EU noise directive (2003/10/EG) states that protective equipment must be made available to the aircrew to protect their hearing, though its use is not mandatory.
Takegawa, Ryosuke; Ohnishi, Mitsuo; Hirose, Tomoya; Hatano, Yayoi; Imada, Yuko; Endo, Yoko; Shimazu, Takeshi
In cases of transport by rescue helicopter or ambulance of patients having ingested hazardous substances, medical personnel may be at a certain risk of inhaling the substances. However, few reports have addressed such risk of causing secondary casualties. This simulation study aimed to assess the risk of inhalation of hydrogen sulfide and chlo-opicrin in the cabin of a helicopter or an ambulance transporting a patient who has ingested calcium polysulfide or chloropicrin, which were previously reported to cause secondary casualties. Concentrations of hydrogen sulfide and chloropicrin were assessed on the following as-umptions :The patient ingested 100 mL of the causative or original chemical. All chemical substances reacted with the gastric juice or were thoroughly vomited and evaporated uniformly within the cabin space of the helicopter or ambulance. Environmental conditions were 20 *degrees at 1 atmosphere of pres-ure in a 5 m3 cabin volume in the helicopter and a 13.5 m3 cabin volume in the ambulance. In the case of calcium polysulfide ingestion which produced hydrogen sulfide, its concen-ration reached 774 ppm in the helicopter and 287 ppm in the ambulance. For chloropicrin ingestion, the concentrations were 4,824 ppm and 1,787 ppm, respectively. The simulated concentration of hydrogen sulfide was more than 500 ppm in the heli-opter, which may lead to respiratory paralysis and death. The simulated concentration of chloropicrin was more than 300 ppm, which has a risk of death within 10 minutes. Currently, as far as Japanese laws are concerned, there are no restrictions requiring pretransport assessment or setting criteria for transporting patients who might have ingested hazardous substances that could cause secondary casu-lties when vomited. When patients who might have ingested hazardous chemicals are transported, it is important to recognize the risk of causing secondary casualties by vomiting the chemicals.
Yun, Jong Geun; Jeung, Kyung Woon; Lee, Byung Kook; Ryu, Hyun Ho; Lee, Hyoung Youn; Kim, Mu Jin; Heo, Tag; Min, Yong Il; You, Yeonho
The available data suggest that automated external defibrillators (AED) can be safely used in vibration-like moving conditions such as rigid inflatable boats and aircraft environments. However, little literature exists examining their performance in a moving ambulance. The present study was undertaken to determine whether an AED is able to analyse the heart rhythm correctly during ambulance transport. An ambulance was driven on paved (20-100 km/h) and unpaved (10 km/h) roads. The performance of two AED devices (CU ER 2, CU Medical Systems Inc., Korea, and Heartstart MRx, Phillips, USA) was determined in a moving ambulance using manikins. Vibration intensity was measured simultaneously with a digital vibrometer. AED performance was then evaluated again on manikins and on a swine model under simulated vibration intensities (0.5-5m/s(2)) measured by the vibrometer in the previous phase of the investigation. The vibration intensity increased with increasing speeds on paved roads (1.98+/-0.44 m/s(2) at 100 km/h). While driving on unpaved roads, it increased to 6.40+/-1.06 m/s(2). Both AED algorithms analysed the heart rhythm correctly under resting state. When tested on pigs, both algorithms showed substantially degraded performances, even at low vibration intensities of 0.5-1m/s(2), which corresponded to vibration intensities while driving on paved roads at 20-60 km/h. This study also showed that electrocardiograms generated on manikins were more resistant to motion artifacts than were the pig electrocardiograms. Ambulance personnel should consider the possibility of misinterpretation by an AED when this device is used while transporting a patient. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
Luna-Reyes, O B; Reyes, T M; So, F Y; Matti, B M; Lardizabal, A A
The energy expenditures (Ee) for locomotion by nondisabled and disabled Filipino children aged 7 to 13 were determined and compared using indirect calorimetry. Forty-one controls (20 boys and 21 girls) ambulated at a comfortable pace; 16 children (eight boys and eight girls) with lower extremity poliomyelitis of varying severity ambulated by (1) wheelchair propulsion, (2) bilateral axillary crutches, (3) unilateral lower extremity ankle-foot orthoses or knee-ankle-foot orthoses, and (4) unassisted. Disabled children, regardless of their mode of ambulation, had to expend significantly more energy to ambulate than normal children (p less than 0.05). Wheelchair propulsion cost 16% more energy than the normal gait; crutch ambulation cost 41% more than the control. Children using unilateral braces sacrificed speed to attain near-normal Ee. When they ambulated without orthoses, their Ee increased by 109% over the control. In ascending order, the least energy was expanded by normal ambulation followed by disabled ambulation with unilateral brace, disabled propelling a wheelchair, disabled ambulation with bilateral axillary crutches, and disabled ambulation without brace. Efficiency of locomotion was reflected in the values obtained for Ee in terms of kcal x 10(-3)/kg/m, as demonstrated by the lower Ee but slower ambulation of children with braces, as compared to the nondisabled children.
Cardiac arrests claim millions of lives each year. The condition can often be treated with a de ﬁbrillator,buttimeisaverycriticalfactor. Asaconsequence,survivalratesarelow. Recent developments in drone technology have made civilian drones both cheap, easy to operate, and reliable. This paper looks into opportunities to use drones to deliver deﬁbrilla tors to cardiac arrest victims faster than an ambulance, and focuses on unifying the needs of emergencyresponsewiththerulesandreg...
Doherty-King, Barbara; Bowers, Barbara J
Functional decline has been identified as a leading negative outcome of hospitalization for older person. Functional decline is defined as a loss in ability to perform activities of daily living including a loss of independent ambulation. In the hospital literature, a patient's loss in ability to independently ambulate during the hospital stay varies between 15 and 59%. Lack of ambulation and deconditioning effects of bed rest are one of the most predictable causes of loss of independent ambulation in hospitalized older persons. Nurses have been identified as the professional most capable of promoting walking independence in the hospital setting. However, nurses do not routinely walk patients. The purpose of this study was to explore the relationship between nurses' attributions of responsibility for ambulating hospitalized patients and their decisions about whether to ambulate. A descriptive, secondary analysis of data gathered for a parent study was conducted. Grounded dimensional analysis was used to analyze the data. Participants consisted of 25 registered nurses employed on medical or surgical units from two urban hospitals in the United States. Nurses fell into two groups: those who claimed ambulation of patients within their responsibility of practice and those who attributed the responsibility to another discipline. Nurses who claimed responsibility for ambulation focused on patient independence and psychosocial well-being. This resulted in actions related to collaborating with physical therapy, determining the appropriateness of activity orders, diminishing the risk and adjusting to resource availability. Nurses who attributed the responsibility deferred decisions about initiating ambulation to either physical therapy or medicine. This resulted in actions related to waiting, which involved, waiting for physical therapy clearance, physician orders, risks to decrease, and resources to improve before ambulating. Nurses who claimed responsibility for
Full Text Available Background. Spasticity of the legs is common in multiple sclerosis (MS, but there has been limited research examining its association with ambulatory outcomes. Objective. This study examined spasticity of the legs and its association with multiple measures of ambulation in persons with MS. Methods. The sample included 84 patients with MS. Spasticity of the legs was measured using a 5-point rating scale ranging between 0 (normal and 4 (contracted. Patients completed the 6-minute walk (6 MW, timed 25 foot walk (T25FW, and timed up-and-go (TUG, and O2 cost of walking was measured during the 6 MW. The patients undertook two walking trials on a GAITRite (CIR systems, Inc. for measuring spatial and temporal parameters of gait. The patients completed the Multiple Sclerosis Walking Scale-12 (MSWS-12 and wore an accelerometer over a seven-day period. Results. 52% (n=44 of the sample presented with spasticity of the legs. Those with leg spasticity had significantly worse ambulation as measured by 6 MW (P=0.0001, d=-0.86, T25FW (P=0.003,d=0.72, TUG (P=0.001, d=0.84, MSWS-12 (P=0.0001,d=1.09, O2 cost of walking (P=0.001, d=0.75, average steps/day (P<0.05, d=-0.45, and walking velocity (P<0.05, d=-0.53 and cadence (P<0.05, d=-0.46. Conclusion. Leg spasticity was associated with impairments in ambulation, including alterations in spatiotemporal parameters and free-living walking.
Larsson, Ricard; Engström, Åsa
Effective pre-hospital treatment of a person suffering cardiac arrest is a challenging task for the ambulance nurses. The aim of this study was to describe ambulance nurses' experiences of nursing patients suffering cardiac arrest. Qualitative personal interviews were conducted during 2011 in Sweden with seven ambulance nurses with experience of nursing patients suffering cardiac arrests. The interview texts were analyzed using qualitative thematic content analysis, which resulted in the formulation of one theme with six categories. Mutual preparation, regular training and education were important factors in the nursing of patients suffering cardiac arrest. Ambulance nurses are placed in ethically demanding situations regarding if and for how long they should continue cardio-pulmonary resuscitation (CPR) to accord with pre-hospital cardiac guidelines and patients' wishes. When a cardiac arrest patient is nursed their relatives also need the attention of ambulance nurses. Reflection is one way for ambulance nurses to learn from, and talk about, their experiences. This study provides knowledge of ambulance nurses' experiences in the care of people with cardiac arrest. Better feedback about the care given by the ambulance nurses, and about the diagnosis and nursing care the patients received after they were admitted to the hospital are suggested as improvements that would allow ambulance nurses to learn more from their experience. Further development and research concerning the technical equipment might improve the situation for both the ambulance nurses and the patients. Ambulance nurses need regularly training and education to be prepared for saving people's lives and also to be able to make the right decisions. © 2013 Wiley Publishing Asia Pty Ltd.
Iorga, Magdalena; Dascalu, Neonila; Soponaru, Camelia; Ioan, Beatrice
Healthcare professionals are frequently confronted with urgent situations and a high-risk human intervention. They are usually exposed to what is called burnout syndrome. To identify the effects of burnout syndrome on the professional conduct and attitudes of doctors and nurses who work in the Romanian public ambulance service. Secondary, the causal relationships between burnout and various socio-demographic variables were analyzed. The 20-item Toronto Alexithymia Scale (TAS- 20), Maslach Burnout Inventory and Job Satisfaction Questionnaire were administered to 122 ambulance doctors, nurses and drivers (62 females and 60 males). The degree of job satisfaction is the most important indicator of burnout syndrome. Significant differences were found between low and high alexithymic subjects. Women are more susceptible to experience higher levels of burnout than men. The level of burnout is influenced by the combined effect of job satisfaction and alexithymia. Burnout syndrome is a common problem among people working in the emergency medical system. The causes of job-related burnout have to be identified in order to apply an appropriate level of burnout intervention program and to increase the efficiency of coping strategies.
Ambulance vehicles are required to respond rapidly to medical emergencies. A number of factors may affect response times, most importantly the location of emergency services stations, the number of ambulance vehicles available at each station, road conditions and traffic volumes. To support spatial planning and provide ...
..., which are defined in § 414.605 of this chapter: (1) Basic life support (BLS) (emergency and nonemergency). (2) Advanced life support, level 1 (ALS1) (emergency and nonemergency). (3) Advanced life support... Coverage of ambulance services. (a). Basic rules. Medicare Part B covers ambulance services if the...
Hinton, C A; Cullen, K E
Thirteen normal male college students were studied during unassisted ambulation and nonweight-bearing ambulation with Ortho crutches and axillary crutches to determine energy expenditure. Subjects walked at self-selected velocities. Energy expenditure was determined by analyzing expired air collected by a calorimeter. Heart rate was monitored by telemetry. During the first 2.5 minutes of walking, heart rate and energy expenditure were significantly greater for ambulation with axillary crutches than with Ortho crutches. After 11.5 minutes of walking, no difference in energy cost was found between crutch types; however, heart rate increased significantly (p less than .01) during ambulation with axillary crutches. Differences in energy cost and heart rate were attributed to increased upper extremity work performed when using axillary crutches. We concluded that during nonweight-bearing ambulation for short periods of time or over a short distance, the Ortho crutch is less taxing in terms of energy cost and heart rate demands.
Sollid, Stephen J M; Rehn, Marius
The care administered on air ambulances has become increasing complex. This has led to a discussion among experts as to whether air ambulance travel should be manned by physicians. This review provides evidence in support of anaesthesiologists being the physician-leaders in air ambulance medicine, because of their training in advanced airway management, critical care, and resuscitation. Successful prehospital care requires the ability to perform a complex set of advanced diagnostics and interventions. These include airway management, haemorrhage control, pain management, point-of-care diagnostics, complex interfacility transport, and advanced interventions. This skill set closely mirrors the training and expertise of anaesthesiologists. There are few studies investigating the specific benefit of anaesthesiologists in air ambulance medicine. However, current evidence indicates that their presence does improve patient care and safety. Future studies on this topic should use evidence-based quality indicators and standardized data sets to seek answers to optimal staffing of air ambulance teams.
Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul
The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance.
Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul
Objective The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. Methods This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Results Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). Conclusions In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance. PMID:26115183
Full Text Available [i][/i][b]Introduction and objectives. [/b]The system of emergency medical services (EMS in Poland was established in 2006. The risk of occupational injuries to EMS personnel is very high, irrespective of the country where they operate, as they face many hazards in their everyday work. The aim of this study is to describe the type, incidence and consequences of occupational accidents among the personnel of the National Emergency Medical Services in Poland (NEMS – land and air ambulance crews in 2008–2012. [b]Material and methods:[/b] The study reviewed all occupational accidents among the EMS personnel reported to the National Labour Inspectorate in 2008–2012. [b]Results[/b]: In the period reported, the number of accidents decreased from 32 in 2008 to just 6 in 2012. Traffic accidents predominated and most of the victims were male paramedics under 30 years of age. The most common injuries included multiple organ injuries and injuries of the cervical spine, chest and trunk. [b]Conclusions:[/b] The growing professional experience of the EMS personnel has a beneficial effect on occupational injury rates as they tend to decrease with longer employment. Occupational accidents are definitely more common among ambulance crews than in the personnel of other organizational units of the National Emergency Medical Services.
Mahmood, M. A.; Thornes, J. E.; Bloss, W.; Pope, F.
Ambulances are an integral part of a country's infrastructure ensuring its citizens and visitors are kept healthy. The impact of weather, climate and climate change on ambulance services around the world has received increasing attention in recent years but most studies have been area specific and there is a need to establish basic relationships between ambulance data (both response and illness data) and meteorological parameters. In this presentation, the effects of temperature and relative humidity on ambulance call out rates for different medical categories will be investigated. We use call out data obtained from the London Ambulance Service (LAS) and meteorological data from a central London meteorological station. A time-series analysis was utilized to understand the relation between temperature, relative humidity, air pollutants and different call out categories. There are statistically significant relationships between mean temperature and ambulance callout rate for most of the categories investigated. Most categories show a negative dependence on temperature, i.e. call outs increase with decreasing temperature but some categories showed a positive dependence such as alcohol related call outs. Relative humidity is significant for some categories but in general is much less important than temperature. Significant time lag effects were observed for most of the categories related to infectious illnesses, which are transferrable through human contact. These findings support the opinion that ambulance attendance callouts records are an effective and well-timed source of data and can be used for health early warning systems. Furthermore the presented results can much improve our understanding of the relationships between meteorological conditions and human health thereby allowing for better prediction of ambulance use through the application of long and short-term weather forecasts.
Tsegaye, Ademe; Somigliana, Edgardo; Alemayehu, Tadesse; Calia, Federico; Maroli, Massimo; Barban, Paola; Manenti, Fabio; Putoto, Giovanni; Accorsi, Sandro
To evaluate the functionality of an ambulance service dedicated to emergency obstetric care (EmOC) that referred pregnant women to health centers for delivery assistance or to a hospital for the management of obstetric complications. A retrospective study investigated an ambulance referral system for EmOC in a rural area of Ethiopia between July 1 and December 31, 2013. The service was available 24h a day and was free of charge. Women requesting referral were transported to nearby health centers. Assistance was provided locally for uncomplicated deliveries. Women with obstetric complications were referred from health centers to a hospital. A total of 528 ambulance referrals were recorded. The majority of patients (314 [59.5%]) were transported from villages to health centers. The remaining individuals were brought to a hospital, having been referred from health centers (179 [33.9%]) or were referred directly from villages owing to hospital proximity (35 [6.6%]). Of the 179 patients referred to the hospital from health centers, 84 (46.9%) were diagnosed with major direct obstetric complications. No maternal deaths were recorded among patients using the ambulance service. The cost of the ambulance service was US$ 18.47 per referred patient. An ambulance service dedicated to EmOC that interconnected health centers and a hospital facilitated referrals and better utilized local resources. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Hansen, Claus D.
of this presentation is to examine the associations between objectively measured work load taken from the company register, health and long-term sickness absence (LTSA) in 1-year follow up period. Methods: Data is taken from the first round of MARS – Men, accidents, risk and safety, a two wave panel study of AP......-reported sickness absence and LTSA even when adjusting for baseline health. 7 % of the participants were sick-listed for at least 4 consecutive weeks in the follow up period. AP’s with mean number of work tasks higher than median had more than two-fold risk of being sick-listed (HR: 2.17 (95% CI: 1.......35-3.51)). Conclusions: This study is one of the first to study the association between objectively measured work load among AP and their association with health, (self-reported) work environment and sickness absence. The results show that increasing work load is associated with adverse health and work environment...
Full Text Available Abstract Background Undergraduate paramedic students undertake clinical placements in a variety of locations. These placements are considered an essential element for paramedic pre-employment education. However, anecdotal evidence suggests some students have not had positive experiences on their emergency ambulance placements. The objective of this study was to identify the type of experiences had by students during ambulance clinical placements and to provide feedback to the ambulance services. Methods In this pilot study we employed a cross-sectional study methodology, using a convenience sample of undergraduate paramedic students available in semester one of 2007 to ascertain the students' views on their reception by on-road paramedics and their overall experience on emergency ambulance clinical placements. Ethics approval was granted. Results There were 77 students who participated in the survey, 64% were females, with 92% of students Conclusion This study demonstrates that for a small group of students, emergency ambulance clinical placements were not a positive experience clinically or educationally. Some qualified paramedics doubt if a number of female students can perform the physical role of a paramedic.
The arrival of a new vehicle is always an important moment in the life of a fire station. So when a new ambulance was delivered to the CERN Fire Brigade on Wednesday 16 September 2000, it was given a warm welcome, attended by staff of the different divisions involved in its purchase. It took a year from the first administrative moves to the day of acquisition. On the one hand there were the calls for tender needed for such a purchase and on the other the development of this custom-designed ambulance with its unique features. Three visits to the manufacturer had to be made, including two to the head office of the Miesen factory at Bonn to study and incorporate in the ambulance the special requirements called for by its future users. These requirements, born from the past experience of CERNs ambulance crews, concerned not only interior arrangements but also included a new side panel, opening up a stowage compartment where everything will be put that gets dirty during ambulance operations. This will minimize ...
Poetter-Lang, S.; Herold, C.J. [Medizinische Universitaet Wien, Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Wien (Austria)
The diagnosis of community-acquired pneumonia (CAP) is often not possible based only on the clinical symptoms and biochemical parameters. For every patient with the suspicion of CAP, a chest radiograph in two planes should be carried out. Additionally, a risk stratification for the decision between outpatient therapy or hospitalization is recommended. Based on the evaluation of the different radiological patterns as well as their extent and distribution, a rough allocation to so-called pathogen groups as well as a differentiation between viral and bacterial infections are possible; however, because different pathogens cause different patterns an accurate correlation is not feasible by relying purely on imaging. The radiological findings serve as proof or exclusion of pneumonia and can also be used to evaluate the extent of the disease (e.g. monolobular, multilobular, unilateral or bilateral). In cases of prolonged disease, suspicion of complications (e.g. pleural effusion or empyema, necrotizing pneumonia or abscess) or comorbid conditions (e.g. underlying pulmonary or mediastinal diseases) computed tomography is an important diagnostic tool in addition to chest radiography. Ultrasound is often used to diagnose pleural processes (e.g. parapneumonic effusion or pleural empyema). (orig.) [German] Anhand der klinischen Symptome und laborchemischen Befundkonstellation alleine ist es oft nicht moeglich, die Diagnose einer ambulant erworbenen Pneumonie (''community-acquired pneumonia'', CAP) zu stellen. Bei jedem Patienten mit Verdacht auf CAP sollte eine Roentgenthoraxaufnahme in 2 Ebenen angefertigt werden. Weiter muss eine Risikostratifizierung im Sinne der Entscheidung ambulante Therapie vs. Hospitalisierung erfolgen. Anhand der Analyse radiologischer Muster sowie deren Verteilung und Ausdehnung koennen eine grobe Zuordnung zu sogenannten Erregergruppen sowie eine Differenzierung zwischen viralen und bakteriellen Infektionen gelingen. Da
Al-Harbi, Nada; El-Masri, Samir; Saddik, Basema
In this paper we propose an Emergency Department Information System that will be integrated with the ambulance system to improve the communication, enhance the quality of provided emergency services and facilitate information sharing. The proposed system utilizes new advanced technologies such as mobile web services that overcome the problems of interoperability between different systems, HL7 and GPS. The system is unique in that it allows ambulance officers to locate the nearest specialized hospital and allows access to the patient's electronic health record as well as providing the hospital with required information to prepare for the incoming patient.
Clutterbuck, Georgina; Auld, Megan; Johnston, Leanne
Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP). A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters. Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II-IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n = 3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n = 2, all Evidence Level II) and Physical Fitness Training (n = 4, Evidence Level II-V). Weak positive evidence was available for Modified Sport (n = 3, Evidence Level IV-V) and Non-Immersive Virtual Reality (n = 12, Evidence Level II-V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n = 4, all Evidence Level II). Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP. Implications for rehabilitation Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy. Gross Motor Activity Training is the most common and effective intervention. Practice variability is essential to improve gross motor function. Participation was rarely measured and requires further
... 29 Labor 3 2010-07-01 2010-07-01 false Ambulance and rescue service employees. 553.215 Section 553.215 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS APPLICATION OF THE FAIR LABOR STANDARDS ACT TO EMPLOYEES OF STATE AND LOCAL GOVERNMENTS Fire Protection and Law Enforcement Employees of...
Wastell, D.; Newman, M.
The development of information systems (IS) is a problematic process that all too often ends in failure. This paper reports a comparative analysis of two projects involving the computerisation of ambulance control-room operations in London and Manchester. The outcomes were strikingly different. In
Bohström, Dan; Carlström, Eric; Sjöström, Nils
Ambulance nurses display stress symptoms, resulting from their work with patients in an emergency service. Certain individuals seem, however, to handle longstanding stress better than others and remain in exposed occupations such as ambulance services for many years. This paper examines stress inducing and stress defusing factors among ambulance nurses. A qualitative descriptive design using critical incident technique was used. A total of 123 critical incidents were identified, and a total of 61 strategies dealing with stress were confirmed. In all, 13 sub-categories (seven stress factors and five stress reducing factors) were merged into four categories (two stress categories and two stress reducing categories). The study shows that ambulance nurses in general experience emergency calls as being stressful. Unclear circumstances increase the stress level, with cases involving children and childbirth being especially stressful. Accurate information and assistance from the dispatch centre reduced the stress. Having discussions with colleagues directly after the assignment were particularly stress reducing. Advanced team collaboration with teammates was viewed as effective means to decrease stress, in addition to simple rituals to defuse stress such as taking short breaks during the workday. The study confirmed earlier studies that suggest the benefits of defusing immediately after stress reactions. Copyright © 2016 Elsevier Ltd. All rights reserved.
The current state-of-the-art in neutron personnel dosimetry is reviewed. Topics covered include dosimetry needs and alternatives, current dosimetry approaches, personnel monitoring devices, calibration strategies, and future developments
Taylor, Alexander; Boyle, Adrian; Sutherland, Alex; Giacomantonio, Chris
Previous work has demonstrated that much violence requiring medical help is not recorded by the police. Sharing emergency department data on victims of violence is associated with reductions in community violence and is well established throughout the UK. We undertook a critical literature review to determine whether sharing ambulance data was useful to identify violence hotspots and offered unique information for violence prevention. A search of the major medical and criminological databases was undertaken using search terms related to the ambulance service, violence and assault, as well as data collection. The search was conducted within the NICE Evidence, Cochrane Library, Google Scholar, Criminal Justice Abstracts, Scopus and National Criminal Justice Reference Service databases, along with the websites of various relevant institutions. Overall, 36 papers were identified by abstract scanning and bibliography search, of which 10 were considered relevant. A further nine papers were detected in the grey literature, and two were considered to be useful in providing evidence for use of ambulance data in violence surveillance. Two of the identified papers were interventional studies, and the other 10 were observational studies. Although the standard of evidence was generally low, most studies demonstrated that ambulance services detected a substantial proportion of assaults that were not recorded by the police or the emergency departments. We identified only two interventional studies, but they were of low quality. Although the interventional evidence base is currently weak, ambulance data provide a unique source of information about the epidemiology of community violence and have the potential to improve current violent crime surveillance methods.
The activities and purposes of the Personnel Monitoring Dept. of the Institute of Radioprotection and Dosimetry of the Brazilian CNEN are presented. A summary of the personnel monitoring service is given, such as dosemeters supply, laboratorial inspections, and so on. The programs of working, publishing, courses and personnel interchange are also presented. (J.A.M.M.)
Krause, James S.
The author compares current employment status after spinal cord injury between participants who were independent in ambulation (required no assistance from others) and those who were dependent in ambulation (required assistance from at least one other person to ambulate). Those who were independent of assistance from others in ambulation were…
Nielsen, Kamilla; Johansson, Pär I; Dahl, Benny
BACKGROUND: Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision...... surgery. METHODS: The trial was registered at Clinicaltrials.gov ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation...... received RBC. CONCLUSIONS: A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing....
Chin, Su Na; Cheah, Phee Kheng; Arifin, Muhamad Yaakub; Wong, Boh Leng; Omar, Zaturrawiah; Yassin, Fouziah Md; Gabda, Darmesah
Ambulance response time (ART) is one of the standard key performance indicators (KPI) in measuring the emergency medical services (EMS) delivery performances. When the mean time of ART of EMS system reaches the KPI target, it shows that the EMS system performs well. This paper considers the determinants of ART, using data sampled from 967 ambulance runs in a government hospital in Sabah. Multiple regression analysis with backward elimination was proposed for the identification of significant factors. Amongst the underlying factors, travel distance, age of patients, type of treatment and peak hours were identified to be significantly affecting ART. Identifying factors that influence ART helps the development of strategic improvement planning for reducing the ART.
The practice-as-research project Homing Place proposes a transferable percipient-led methodology of performance and research activated by ambulant and conversive mechanisms as the culmination of this research. The thesis is comprised of a range of activity that represents a moment and way of writing practice. Three artworks that comprise part of the practical component of this thesis--- way from home, Take me to a place and Yodel Rodeo-- each involved participation and contribu...
Hignett, Sue; Griffiths, Paula; Murdey, Ian D; Lee, Sandra L
Musculoskeletal disorders (MSDs) are the most common occupational illness in Great Britain affecting 1.1 million people a year. Paramedics, in particular, are known to have a high incidence of MSDs resulting, for many, in early retirement. To explore the management of MSDs at two ambulance services with respect to the implementation of policies and experience of staff. The data were collected at two ambulance services using document retrieval and semi-structured interviews. The first service used a functional-centred occupational health (OH) approach with patient participation. The second service used a more traditional medical model with the patient in a more passive role. The first service reported their MSD management policies and procedures concurred with 28 of the 32 Faculty of Occupational Medicine guidelines (88%) in contrast to the second service, where only 17 (53%) concurred. For both services, the expected recovery pathways (management policies and procedures) had points of variance with the experienced recovery pathways. Both services had haphazard referral to OH resulting in limited referral for treatment in the first 4 weeks post-injury and no difference in median recovery times. These variances resulted in a convergence in the timing and type of treatment received by staff at both services. Both ambulance services were found to have variance in the experienced recovery pathway in comparison to the expected pathway. It was concluded that without systematic monitoring and regular audit, there was likely to be a lack of compliance with the policy and procedures.
Gustavsson, Pär; Nilsson, Peter M
The fact that Sweden has been spared from war on its soil for almost 200 years, has not stopped Swedish citizens from participating in conflicts worldwide during this period. This has been described, especially from the soldiers perspective. The contribution of Swedish physicians has not been written about to the same extent. When Mussolini's Italy in October 1935 invaded the poor and underdeveloped country of Ethiopia (former Abyssinia) an ambulance was immediately organized by the Swedish Red Cross. To lead such an expedition, a great knowledge of Ethiopian culture och maybe most importantly, of the weather and geographical conditions, was undoubtedly demanded. Therefore, the Swedish Red Cross turned to two Ethiopian veterans. Doctor Fride Hylander, a missionary-son who had been working on a hospital project in the Ethiopian province of Harrar and his friend since school years, doctor Gunnar Agge, were assigned the leadership of the ambulance. Dr Agge had also participated in improving the Ethiopian health care both in Harrar and later as civilian and military doctor in the province of Ogaden, where he was medically responsible for the more than 9 000 men strong army that the Ethiopian emperor had stationed there after Italian provocations. Most of the other members of the ambulance were handpicked by these two leaders and many of them had, just like themselves, a stong religious belief. A money-raise was immediately initiated and in less than six weeks 700 000 Swedish crowns had been collected, more then twice the sum the ambulance was calculated to cost. In early november 1935 the ambulance was clear to go. Their primary objective was to travel through British Somaliland and establish a field-hospital in the province of Harrar. However, the Ethiopian emperor had other things in mind. He wanted to reorganize the ambulance and divide it in two and place it closer to the front line. The ambulance decided to go along with his wish. Both groups started eventually
Barclay, Ruth E; Stevenson, Ted J; Poluha, William; Ripat, Jacquie; Nett, Cristabel; Srikesavan, Cynthia S
Community ambulation refers to the ability of a person to walk in their own community, outside of their home and also indoors in private or public locations. Some people choose to walk for exercise or leisure and may walk with others as an important aspect of social functioning. Community ambulation is therefore an important skill for stroke survivors living in the community whose walking ability has been affected. To determine: (1) whether interventions improve community ambulation for stroke survivors, and (2) if any specific intervention method improves community ambulation more than other interventions. We searched the Cochrane Stroke Group Trials Register (September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (November 2013), PubMed (1946 to November 2013), EMBASE (1980 to November 2013), CINAHL (1982 to November 2013), PsycINFO (1887 to November 2013), Scopus (1960 to November 2013), Web of Science (1900 to November 2013), SPORTDiscus (1975 to November 2013), and PEDro, CIRRIE and REHABDATA (November 2013). We also searched ongoing trials registers (November 2013) and reference lists, and performed a cited reference search. Selection criteria included parallel-group randomised controlled trials (RCTs) and cross-over RCTs, studies in which participants are adult (aged 18 years or more) stroke survivors, and interventions that were aimed at improving community ambulation. We defined the primary outcome as participation; secondary outcomes included activity level outcomes related to gait and self-efficacy. One review author independently screened titles. Two review authors screened abstracts and full text articles, with a third review author was available to resolve any disagreements. Two review authors extracted data and assessed risk of bias. All outcomes were continuous. The analysis for the primary outcome used the generic inverse variance methods for meta-analysis, using the standardised mean difference (SMD) and standard error (SE
Tokuda, Yasuharu; Abe, Toshikazu; Ishimatsu, Shinichi; Hinohara, Shigeaki
Background Few studies have investigated ambulance utilization in people aged 85 years or older, ie, the oldest old. Methods We conducted a 1-year population-based observational study of patients transported by ambulance to emergency departments in Tokyo, Japan, which has a population of about 12 million. Demographic data, symptoms/events associated with ambulance transport, and the proportion of hospital admissions were recorded. Transport rates by age and sex were calculated using data for the background population and ambulance transports, and the 10 most frequent symptoms/events requiring transport were compared between the oldest old and those aged 65 to 84 years. Results Of the 642 764 patients who were transported to hospitals by ambulances, 59 570 (9%) were aged ≥85 years; 64% were women. The annual ambulance transport rate for this population was 250 per 1000/year and was significantly greater than the rate (90 per 1000/year) for those aged 65 to 84 years. The highest rate was for men aged 85 to 99 years (292 per 1000/year). Among the oldest old, the most frequent reason for ambulance transport was fall (38.5 per 1000/year), and the symptom most likely to result in hospital admission was dyspnea. Conclusions The ambulance transport rate for the oldest old was high, particularly among men aged ≥95 years. To reduce the need for ambulance transport among the oldest old, preventive care is needed to reduce falls and acute exacerbations of cardiac and respiratory disorders. PMID:20814165
Bingley, Paul; Westergård-Nielsen, Niels Chr.
There is a growing awareness of large differences in worker turnover and pay between firms. However, there is little knowledge about the effects of this on firm performance. This paper describes how personnel policies with respect to pay, tenure and worker flows are related to economic performance...... personnel structure variation. It is found that personnel policy is strongly related to economic performance. At the margin, more hires are associated with lower profit, and more separations with higher profit. For the average firm, one new job, all else equal, is associated with ?2680 (2000 prices) lower...
A personnel monitoring program must include a well integrated combination of dose determination methods, and should not depend on a single dosimetry system. Many of the necessary techniques have become well developed and dependable, such as the personnel gamma dosimeters in use today. However, other monitoring methods are still not adequate. The two most important personnel monitoring problems remaining are development of personnel neutron dosimeter and in-vivo measurement of plutonium at sublung burden levels. Although there are a few techniques under development to attack these problems, satisfactory long-term solutions will require much more work. As the developments in nuclear power and medicine continue, the need for solutions to these problems will intensify
This revision; (1) Contains changes required by the establishment of a consolidated and realigned management structure for civilian personnel, manpower, and related functions in the Office of the Assistant Secretary of the Army...
This edited transcript of a presentation on personnel neutron discusses the accuracy of present dosimetry practices, requirements, calibration, dosemeter types, quality factors, operational problems, and dosimetry for a criticality accident. 32 figs
The book contains the 21 technical papers presented at the Technical Committee Meeting to Elaborate Procedures and Data for the Intercomparison of Personnel Dosimeters organizaed by the IAEA on 22-26 April 1985. A separate abstract was prepared for each of these papers. A list of areas in which additional research and development work is needed and recommendations for an IAEA-sponsored intercomparison program on personnel dosimetry is also included
Orseck, Michael J; Smith, Christopher Robert; Kirby, Sean; Trujillo, Manuel
Successful outcomes after microsurgical reconstruction of the lower extremity include timely return to ambulation. Some combination of physical examination, ViOptix tissue oxygen saturation monitoring, and the implantable venous Doppler have shown promise in increasing sensitivity of current flap monitoring. We have incorporated this system into our postoperative monitoring protocol in an effort to initiate earlier dependency protocols. A prospective analysis of 36 anterolateral thigh free flap and radial forearm flaps for lower extremity reconstruction was performed. Indications for reconstruction were acute and chronic wounds, as well as oncologic resection. Twenty-three patients were able to ambulate and 3 were able to dangle their leg on the first postoperative day. One flap showed early mottling that improved immediately after elevation. After reelevation and return to baseline, the dependency protocol was successfully implemented on postoperative day 3. All flaps went on to successful healing. Physical examination, implantable venous Doppler, and ViOptix can be used reliably as an adjunct to increase the sensitivity of detecting poorly performing flaps during the postoperative progression of dependency.
Sep 15, 1990 ... basic fIrst aid was administered to the patient. Mter World. War H the value of the ambulance service as a formal health service was realised and Britain. systematically established ambulance services as health services independent from fIre departments. The colonies, however, maintained combined.
Pope, Francis; Chapman, Lee; Fisher, Paul; Mahmood, Marliyyah; Sangkharat, Kamolrat; Thomas, Neil; Thornes, John
Ambulances are an integral part of a country's infrastructure ensuring its citizens and visitors are kept healthy. The impact of weather, climate and climate change on ambulance services around the world has received increasing attention in recent years but most studies have been area specific and there is a need to establish basic relationships between ambulance data (both response and illness data) and meteorological parameters. In this presentation, the effects of temperature, other meteorological and air pollution variables on ambulance call out rates for different medical categories will be investigated. We use ambulance call out obtained from various ambulance services worldwide which have significantly different meteorologies, climatologies and pollution conditions. A time-series analysis is utilized to understand the relation between meteorological conditions, air pollutants and different call out categories. We will present findings that support the opinion that ambulance attendance call outs records are an effective and well-timed source of data and can be used for health early warning systems. Furthermore the presented results can much improve our understanding of the relationships between meteorology, climate, air pollution and human health thereby allowing for better prediction of ambulance use through the application of long and short-term weather, climate and pollution forecasts.
Full Text Available This paper proposes a novel approach to analyze potential accessibility to ambulance services by combining the demand-covered-ratio and potential serviceability with the ambulance-covering-ratio. A Geographic Information System (GIS-based spatial analysis will assist ambulance service planners and designers to assess and provide rational service coverage based on simulated random incidents. The proposed analytical model is compared to the gravity-based two-step floating catchment area method. The study found that the proposed model could efficiently identify under-covered and overlapped ambulance service coverage to improve service quality, timeliness, and efficiency. The spatial accessibility and serviceability identified with geospatial random events show that the model is able to plan rational ambulance service coverage in consideration of households and travel time. The model can be applied to both regional and statewide coverage plans to aid the interpretation of those plans.
Keeratisiroj, Orawan; Thawinchai, Nuanlaor; Siritaratiwat, Wantana; Buntragulpoontawee, Montana
The objectives of this study were to determine prognostic predictors for ambulation among Thai children with cerebral palsy and identify their ambulatory status. A retrospective cohort study was performed at 6 special schools or hospitals for children with physical disabilities. The prognostic predictors for ambulation were analyzed by multivariable ordinal continuation ratio logistic regression. The 533 participants aged 2 to 18 years were divided into 3 groups: 186 with independent ambulation (Gross Motor Function Classification System [GMFCS I-II]), 71 with assisted ambulation (Gross Motor Function Classification System III), and 276 with nonambulation (Gross Motor Function Classification System IV-V). The significant positive predictors for ambulation were type of cerebral palsy (spastic diplegia, spastic hemiplegia, dyskinesia, ataxia, hypotonia, and mixed type), sitting independently at age 2 years, and eating independently. These predictors were used to develop clinical scoring for predicting the future ability to walk among Thai children with cerebral palsy. © The Author(s) 2015.
Muhammad Yasir Khan
Full Text Available Philip Larkin is known as a movement poet, because there are many poems which were published in the book of poetic movement, New Lines. This movement was started in 1950, against the unreasonable, inflated and extortionate romanticism of 1930's and 1940's. The common features of movement poetry are; the use of irony and wit, an element of satire, the loneliness of modern man, pessimistic outlook on life, realism, use of ordinary diction, use of symbols, and loss of religious faith. Robert Conquest is known as the representative poet of this movement. The poets of this movement believed that the language of poetry should be simple, lucid and intelligible. The poem Ambulance deals with the important features of movement poetry. Through the stylistics study of this poem the researchers will show the loneliness and concept of death in modern man.
This lecture precises the method and means developed by EDF to ensure the training of maintenance personnel according to their initial educational background and their experience. The following points are treated: General organization of the training for maintenance personnel in PWR and GCR nuclear power stations and in Creys Malville fast breeder reactor; Basic nuclear training and pedagogical aids developed for this purpose; Specific training and training provided by contractors; complementary training taking into account the operation experience and feedback; Improvement of velocity, competence and safety during shut-down operations by adapted training. (orig.)
Kataoka, Hiroaki; Mochimasu, Kazumi Dokai; Katayama, Akihiko; Kanda, Kanae Oda; Sakano, Noriko; Tanaka, Keiko; Miyatake, Nobuyuki
The aim of this study was to investigate the linkage among climate parameters, total ambulance transports and the number of deaths in Asahikawa City in northern Japan. Monthly data on total ambulance transports and the number of deaths from January 2004 to December 2011 were obtained from Asahikawa City Fire Department and the Asahikawa City official website. Climate parameters for the required period were also obtained from the Japan Meteorological Agency, Japan. To adjust for the population, we also used monthly population data on Asahikawa City. The linkage among climate parameters, total ambulance transports and the number of deaths was evaluated by ecological analysis. The mean air temperature in the Asahikawa area was 7.3 ± 10.1 °C. Total ambulance transports (/a hundred thousand people/day) and the number of deaths (/a hundred thousand people/day) were 10.0 ± 0.6 and 2.6 ± 0.3, respectively. Using quadratic curves, total ambulance transports and the number of deaths were weakly correlated with some climate parameters. The number of deaths was weakly and positively correlated with total ambulance transports. A weak linkage among climate parameters, total ambulance transports and the number of deaths was noted in Asahikawa City, Japan. However, these associations were not as high as expected.
Rubin, Richard, Ed.
Twelve articles discuss personnel management in libraries. Topics covered include building job commitment among employers, collective bargaining, entry-level recruitment, employee turnover, performance evaluation, managing resistance to change, training problems, productivity, employee stress, compensation systems, and the Allerton Park Institute.…
Ohio Board of Regents, Columbus. Management Improvement Program.
This manual is one of 10 completed in the Ohio Management Improvement Program (MIP) during the 1971-73 biennium. In this project, Ohio's 34 public universities and colleges, in an effort directed and staffed by the Ohio Board of Regents, have developed manuals of management practices, in this case, concerning personnel management. Emphasis in this…
Nuclear Regulatory Authority of the Slovak Republic (NRA SR) activities in the area of NPPs staff qualification followed requirements of the Act No. 28/1984 of Collection on the state supervision over nuclear safety of nuclear installations and Decree of CSKAE No. 191/1989 of Collection. Based on these documents, staff having direct influence on nuclear safety by their working activity are subject to an examination of special vocational capability, i.e. verification of a set of their vocational knowledge and skills. Selected staff is examined by the State Examining Committee established by NRA's chairman. Based on successfully passed exams before the State Examining Commission, the NRA issues licences for selected personnel working at the WWER type of a nuclear installation. The positions are as follows: shift supervisor, unit supervisor, primary circuit operator, secondary circuit operator, and reactor physicist.Such licenses are valid for two years from the date of issue.In the event of passing an exam with grade with grade e xcellent , licences for a 4-year period can be granted to select personnel of the NPP V-2. For the past year of 1997, the number of licences issued to NPPs V-1 and V-2 selected personnel is reviewed. During the year, the technical equipment testing on the NPP Mochovce simulator was done. Granted licences on the ground of the NPP Mochovce for selected personnel as professional qualifications of simulation training instructors. Working negotiations at international level were held during the year to secure funds to improve the NPP V-2 simulator (US AID); also testing of technical equipment of the full-scope simulator of NPP-Mochovce, professional eligibility and overall preparation of simulator training including simulator software. Funded by the PHARE programme, an in co-operation with the IAEA, personnel qualification upgrade courses continued
Lapostolle, Frédéric; Couvreur, James; Koch, François Xavier; Savary, Dominique; Alhéritière, Armelle; Galinski, Michel; Sebbah, Jean-Luc; Tazarourte, Karim; Adnet, Frédéric
Hypothermia is common in trauma victims and is associated with increased mortality, however its causes are little known. The objective of this study was to identify the risk factors associated with hypothermia in prehospital management of trauma victims. This was an ancillary analysis of data recorded in the HypoTraum study, a prospective multicenter study conducted by the emergency medical services (EMS) of 8 hospitals in France. Inclusion criteria were: trauma victim, age over 18 years, and victim receiving prehospital care from an EMS team and transported to hospital by the EMS team in a medically equipped mobile intensive care unit. The following data were recorded: victim demographics, circumstances of the trauma, environmental factors, patient presentation, clinical data and time from accident to EMS arrival. Independent risk factors for hypothermia were analyzed in a multivariate logistic regression model. A total of 461 trauma patients were included in the study. Road traffic accidents (N = 261; 57%) and falls (N = 65; 14%) were the main causes of trauma. Hypothermia (present in 136/461 cases (29%). Independent factors significantly associated with the presence of hypothermia were: a low GCS (Odds Ratio (OR) = 0,87 ([0,81-0,92]; p measurement and immediate thermal protection should be routine, and special attention should be given to patients who are wet. Prospective, multicenter, open, observational study; Level IV.
Haferburg, M.; Rehn, H.
Personnel training in German nuclear power plants adheres to high standards complying with government regulations. The development of PC technology allows the introduction of new training methods, e.g. computer based training (CBT), as well as their integration into existing systems. In Germany, the operators of nuclear power plants have developed their own computer based standards with a screen design, a hardware platform and an assessment standard. 25% of the theoretical training of the shift personnel is covered by CBT. The CBT-Programmes offer multimedia features: videos, photographs, sound, graphs and switching diagrams of existing systems, practice oriented simulations and 3-D animations. Interaction is the most important attribute of an efficient self-learning-programme. A typical example of such an appropriate theme is the CBT-Lesson ''Pressure Surges in Pipes and Components of Power Plants''. (author)
US Agency for International Development — The eOPF is a digital recreation of paper personnel folder that stores electronic personnel data spanning an individual's Federal career. eOPF allows employees to...
Lattin, Kenneth R.
United Nuclear Industries, Inc. (UNI) has developed an automatic personnel contamination monitor (APCM), which uniquely combines the design features of both portal and hand and shoe monitors. In addition, this prototype system also has a number of new features, including: micro computer control and readout, nineteen large area gas flow detectors, real-time background compensation, self-checking for system failures, and card reader identification and control. UNI's experience in operating the Hanford N Reactor, located in Richland, Washington, has shown the necessity of automatically monitoring plant personnel for contamination after they have passed through the procedurally controlled radiation zones. This final check ensures that each radiation zone worker has been properly checked before leaving company controlled boundaries. Investigation of the commercially available portal and hand and shoe monitors indicated that they did not have the sensitivity or sophistication required for UNI's application, therefore, a development program was initiated, resulting in the subject monitor. Field testing shows good sensitivity to personnel contamination with the majority of alarms showing contaminants on clothing, face and head areas. In general, the APCM has sensitivity comparable to portal survey instrumentation. The inherit stand-in, walk-on feature of the APCM not only makes it easy to use, but makes it difficult to bypass. (author)
On 19 April the Fire Brigade unveiled its latest acquisition: a brand-new ambulance specially designed for CERN. One of the Fire Brigade's two ambulances has just been replaced by a state-of-the-art vehicle tailor-made to meet CERN's unique requirements. At 4.6 metres long it's much more spacious than its predecessors, providing plenty of room for patient, doctor and paramedic. The ambulance's design and manufacture are the result of a successful collaboration between the Fire Brigade and the technicians from Profile Vehicles, the Finnish company that won the contract following a call for tenders launched in June 2011. "It took us six months to finalise the specification for our new ambulance," explains Patrick Berlinghi, who is responsible for the Fire Brigade's logistics. "We wanted it to be spacious enough for us to be able to work comfortably and to have the latest safety and patient care equipment. We also reques...
Acharya, Rija; Badhu, Angur; Shah, Tara; Shrestha, Sharmila
An effective ambulance is a vital requirement for providing an emergency medical service. Well-equipped ambulances with trained paramedics can save many lives during the golden hours of trauma care. The objective was to document the availability and utilization of basic life support equipment in the ambulances and to assess knowledge on first aid among the drivers. Descriptive design was used. Total of 109 ambulances linked to B.P. Koirala Institute of Health Sciences were enrolled using purposive sampling method. Self- constructed observation checklist and semi structured interview schedule was used for data collection. More than half of the respondents had less than five years of experience and were not trained in first aid. About two-third of the respondents had adequate knowledge on first aid. About 90% of the ambulance had oxygen cylinder and adult oxygen mask which was 'usually' used equipment. More than half of ambulance had equipment less than 23% as compared to that of national guidelines. There was significant association of knowledge with the experience (p = 0.004) and training (p = 0.001). Availability of equipment was associated with training received (p = 0.007),organization (p= 0.032)and district (p = 0.023) in which the ambulance is registered. The study concludes that maximum ambulance linked to BPKIHS, Nepal did not have even one fourth of the equipment for basic life support. Equipment usually used was oxygen cylinder and oxygen mask. Majority of driver had adequate knowledge on first aid and it was associated with training and experience.
Discussion: This multicentre randomised study will be the first to test whether a home-based multi-component physiotherapy intervention targeting specific precursors of community ambulation (PUSH is more likely to lead to community ambulation than a home-based non-specific multi-component physiotherapy intervention (PULSE in older adults after hip fracture. The study will also estimate the potential economic value of the interventions.
Dr. Shantanu K. Dixit; Miss. Ashwini A. Joshi
Proposed paper presents design of such a monitoring system for emergency patient transportation employing ARM 7 processor module. The system will be useful for monitoring ambulance location using Google map. It also include biomedical sensors to monitor heart bit rate and temperature of patient through SMS. The front end application at the monitoring system is developed using visual basic software in Personal Computers. It can display location of ambulance and status of heart ...
Valenzuela Espinoza, Alexis; Devos, Stefanie; van Hooff, Robbert-Jan; Fobelets, Maaike; Dupont, Alain; Moens, Maarten; Hubloue, Ives; Lauwaert, Door; Cornu, Pieter; Brouns, Raf; Putman, Koen
Background Stroke is a very time-sensitive pathology, and many new solutions target the optimization of prehospital stroke care to improve the stroke management process. In-ambulance telemedicine, defined by live bidirectional audio-video between a patient and a neurologist in a moving ambulance and the automated transfer of vital parameters, is a promising new approach to speed up and improve the quality of acute stroke care. Currently, no evidence exists on the cost effectiveness of in-ambu...
Competence of personnel is one of the important problems for safety operation of nuclear power plant. This paper gives a description of some aspects, such as the administration of NPP, posts, competence of personnel, training, assessing the competence and personnel management
Wong, Ho-Ting; Lai, Poh-Chin
The daily ambulance demand for Hong Kong is rising, and it has been shown that weather factors (temperature and humidity) play a role in the demand for ambulance services. This study aimed at developing short-term forecasting models of daily ambulance calls using the 7-day weather forecast data as predictors. We employed the autoregressive integrated moving average (ARIMA) method to analyze over 1.3 million cases of emergency attendance in May 2006 through April 2009 and the 7-day weather forecast data for the same period. Our results showed that the ARIMA model could offer reasonably accurate forecasts of daily ambulance calls at 1-7 days ahead of time and with improved accuracy by including weather factors. Specifically, the inclusion of average temperature alone in our ARIMA model improved the predictability of the 1-day forecast when compared to that of a simple ARIMA model (8.8% decrease in the root mean square error, RMSE=53 vs 58). The improvement in the 7-day forecast with average temperature as a predictor was more pronounced, with a 10% drop in prediction error (RMSE=62 vs 69). These findings suggested that weather forecast data can improve the 1- to 7-day forecasts of daily ambulance demand. As weather forecast data are readily accessible from Hong Kong Observatory's official website, there is virtually no cost to including them in the ARIMA models, which yield better prediction for forward planning and deployment of ambulance manpower.
Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Alberti, Gloria; Perilli, Viviana; Oliva, Doretta; Buono, Serafino
Three microswitch-aided programs were assessed in three single-case studies to enhance physical exercise or ambulation in participants with multiple disabilities. Study I was aimed at helping a woman who tended to have the head bending forward and the arms down to exercise a combination of appropriate head and arms movements. Study II was aimed at promoting ambulation continuity with a man who tended to have ambulation breaks. Study III was aimed at promoting ambulation with appropriate foot position in a girl who usually showed toe walking. The experimental designs of the studies consisted of a multiple probe across responses (Study I), an ABAB sequence (Study II), and an ABABB(1) sequence (Study III). The last phase of each study was followed by a post-intervention check. The microswitches monitored the target responses selected for the participants and triggered a computer system to provide preferred stimuli contingent on those responses during the intervention phases of the studies. Data showed that the programs were effective with each of the participants who learned to exercise head and arms movements, increased ambulation continuity, and acquired high levels of appropriate foot position during ambulation, respectively. The positive performance levels were retained during the post-intervention checks. The discussion focused on (a) the potential of technology-aided programs for persons with multiple disabilities and (b) the need of replication studies to extend the evidence available in the area. Copyright © 2014 Elsevier Ltd. All rights reserved.
In the field of personnel policy and management two main points must be considered and fitted together: the aspects of the applicant and the aspects of the utility. The applicant wishes a position which suits to his abilities, education, training, experience and self-evaluation. The enterprise has beside these qualification criteria to look to some additional points: reliability - not only in the profession of the applicant but also in his daily life. In this examination licensing authorities are involved too; responsibility in a very broad sense and the ability to make correct decisions sometimes under stress situations. (orig.)
With the increasing use of nuclear power and radiation sources, the selection of optimum systems for personnel monitoring is becoming a matter of worldwide concern. The present status of personnel dosimetry, sometimes characterized by unstable and inaccurate detectors and oversimplified interpretation of the results, leaves much to be desired. In particular, photographic film, although having certain advantages with regard to economics and information content, undergoes rapid changes in warm and humid climates. Careful sealing reduces, but does not prevent, these problems. The replacement of film by solid-state dosimeters, primarily thermoluminescence dosimeters, is in progress or being considered by an increasing number of institutions and requires a number of decisions concerning the choice of the optimum detector(s), badge design, and evaluation system; organizational matters, such as the desirability of automation and computerized bookkeeping; etc. The change also implies the potential use of such advanced concepts as different detectors and monitoring periods for the large number of low-risk persons and the small number of high-risk radiation workers. (auth)
Selected staffs (in the area of NPPs) are examined by the State Examining Committee established by Nuclear Regulatory Authority of the Slovak Republic (NRA SR's) chairman. The committee consists of representatives of NRA SR , Bohunice NPPs, Mochovce NPP, Research Institute of Nuclear Energy and experts from the Faculty of Electrical Engineering and Information Technology of the Slovak Technical University. The review of selected personnel of NPP V-1, V-2 and Mochovce NPP which passed exams in 1996 is given. NRA SR paid attention to the upgrading training process of individual categories of staff for V-1, V-2 and Mochovce NPPs, simulator training and training with computerized simulation system according to the United criteria of nuclear installation personnel training that started in 1992. During the year, an inspection was performed focused on examination of technical equipment of the simulator of Mochovce NPP, professional eligibility and overall preparation of simulator training including simulator software. Throughout the year launching works continued at the simulator with the deadline of commissioning to trial use operation in the first half of 1997
Full Text Available Objectives: To assess walking ability of spinal cord injury (SCI patients and observe its correlation with functional and neurological outcomes. Patients and Methods: The present prospective, observational study was conducted in a tertiary research hospital in India with 66 patients (46 males between January 2012 and December 2013. Mean age was 32.62 ± 11.85 years (range 16-65 years, mean duration of injury was 85.3 ± 97.6 days (range 14-365 days and mean length of stay in the rehabilitation unit was 38.08 ± 21.66 days (range 14-97 days in the study. Walking Index for spinal cord injury (WISCI II was used to assess ambulation of the SCI patients. Functional recovery was assessed using Barthel Index (BI and Spinal Cord Independence Measures (SCIM. Neurological recovery was assessed using ASIA impairment scale (AIS. We tried to correlate ambulatory ability of the patients with functional and neurological recovery. Results: Ambulatory ability of the patients improved significantly using WISCI II (P < 0.001 when admission and discharge scores were compared (1.4 ± 3.5 vs 7.6 ± 6.03. Similarly, functional (BI: 31.7 ± 20.5 vs 58.4 ± 23.7 and SCIM: 29.9 ± 15.1 vs 56.2 ± 20.6 and neurological recovery were found to be very significant (P < 0.001 when admission vs discharge scores were compared. Improvement in WISCI II scores was significantly correlated with improvement in neurological (using AIS scores and functional status (using BI and SCIM scores (P < 0.001. Conclusions: Significant improvement was seen in WISCI II, BI, and SCIM scores after in-patient rehabilitation. Improvement in WISCI II scores also significantly correlated with functional and neurological recovery.
Branas, C C; MacKenzie, E J; ReVelle, C S
To develop a mathematical model for the location of trauma care resources. Severely injured patients queried from Maryland hospital discharge and vital statistics data. A spatial injury profile was created by parsing these patients into ZIP codes. The Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) was formulated using integer and heuristic programming. To maximize coverage of severely injured patients, trauma centers and aeromedical depots were simultaneously sited using TRAMAH. A severe injury was considered covered if at least one trauma center was sited within a time standard by ground, or if an aeromedical depot-trauma center pair was sited in such a way that the sum of the flying time from the aeromedical depot to the scene of injury plus the flying time from the scene of injury to the trauma center was within the same time standard. From 1992 to 1994, 26,774 severe injuries were considered for coverage. Across Maryland, 94.8 percent of severely injured residents had access to trauma system resources within 30 minutes and 70.3 percent had access within 15 minutes. For the same number of resources as the existing Maryland Trauma System, TRAMAH achieved a coverage objective of 99.97 percent within 30 minutes. This translated into an additional 461 severely injured people covered each year. Holding in place the trauma centers of the existing system, approximately the same percentage of coverage as that of the existing system was achieved within 15 minutes by optimally locating six fewer aeromedical depots. TRAMAH will allow trauma systems planners to better locate their resources with respect to spatial needs and response times.
Full Text Available BACKGROUND Abdominal hysterectomy is one of the most frequently performed surgical procedures in women. The non-ambulatory postoperative period is a high risk period for the development of various complications like wound infection, venous stasis, lower respiratory infection, secondary haemorrhage, deep vein thrombosis, pulmonary embolism, paralytic ileus etc. Prolonged surgery, delayed ambulation and not feeding the patient within 48 hours of surgery are often associated with post-operative morbidity and mortality. This study aims to assess the effectiveness of Scheduled Ambulation on early post-operative outcome among patients undergone abdominal hysterectomy by introduction of Scheduled Ambulation from second day of surgery. MATERIALS AND METHODS Method used is quantitative and quasi experimental post-test control method. Scheduled ambulation technique and pattern were taught pre operatively to 35 patients consecutively selected from general and post-operative ward who formed the experimental group. They were given scheduled ambulation from second to fifth post-operative days and results analysed. Another 35 patients taken as control were given the routine post-operative care. Data Analysis- was performed using SPSS version 17.0. Between group comparisons, quantitative variables analysed by Chisquare test p value >0, 05 considered significant. RESULTS The indication of hysterectomy was fibroid uterus in 80% of the control group and 88, 6% of the experimental group. 51.4% of the hysterectomies were encountered in the age group 40-49 years. There was a statistically significant reduction in the severity of pain, fatigue, postural hypotension and risk for developing Deep vein thrombosis in the experimental group on practicing Scheduled Ambulation from second to fifth post-operative days. CONCLUSION Scheduled ambulation helped the abdominal hysterectomy patients to recover from fatigue, pain, postural hypotension and risk for Deep vein thrombosis
Li Wang; Xilin Hou; Lili Zhang
The existing personnel selection decisions in practice are based on the evaluation of job seeker's human capital, and it may be difficult to make personnel-job matching and make each party satisfy. Therefore, this paper puts forward a new personnel selection method by consideration of bilateral matching. Starting from the employment thoughts of ¡°satisfy¡±, the satisfaction evaluation indicator system of each party are constructed. The multi-objective optimization model is given according to ...
Chari, Satyan R; McRae, Prue; Stewart, Matthew J; Webster, Joan; Fenn, Mary; Haines, Terry P
Objective The aim of the present study was to establish the point prevalence of 'suboptimal' features in footwear reported to have been used by older hospital patients when ambulating, and to explore underpinning factors for their choice of footwear. Method A cross-sectional investigation was undertaken on 95 of 149 eligible in-patients across 22 high fall-risk wards in a large metropolitan hospital in Brisbane, Australia. Results Over 70% of participants experienced an unplanned admission. Although most participants had access to some form of footwear in hospital (92%), nearly all reported ambulating in footwear with 'suboptimal' features (99%). Examples included slippers (27%), backless slippers (16%) or bare feet (27%). For patients who ambulated in bare feet, only one-third reported 'lack of access to footwear' as the primary cause, with others citing foot wounds, pain, oedema and personal choice as the main reason for bare foot ambulation. Conclusions Admitted patients frequently use footwear with 'suboptimal' features for ambulation in hospital. While some footwear options (for example well-fitting slippers) could be suited for limited in-hospital ambulation, others are clearly hazardous and might cause falls. Since footwear choices are influenced by multiple factors in this population, footwear education strategies alone may be insufficient to address the problem of hazardous footwear in at-risk patients. Footwear requirements may be more effectively addressed within a multidisciplinary team approach encompassing foot health, mobility and safety. What is known about the topic? Accidental falls while ambulating are an important health and safety concern for older people. Because certain footwear characteristics have been negatively linked to posture and balance, and specific footwear types linked to falls among seniors, the use of footwear with fewer suboptimal characteristics is generally recommended as a means of reducing the risk of falling. While footwear
Erbay, Hasan; Alan, Sultan; Kadıoğlu, Selim
This paper will examine a sample case encountered by ambulance staff in the context of the basic principles of medical ethics. An accident takes place on an intercity highway. Ambulance staff pick up the injured driver and medical intervention is initiated. The driver suffers from a severe stomach ache, which is also affecting his back. Evaluating the patient, the ambulance doctor suspects that he might be experiencing internal bleeding. For this reason, venous access, in the doctor's opinion, should be achieved and the patient should be quickly started on an intravenous serum. The patient, however, who has so far kept his silence, objects to the administration of the serum. The day this is taking place is within the month of Ramadan and the patient is fasting. The patient states that he is fasting and that his fast will be broken and his religious practice disrupted in the event that the serum is administered. The ambulance doctor informs him that his condition is life-threatening and that the serum must be administered immediately. The patient now takes a more vehement stand. 'If I am to die, I want to die while I am fasting. Today is Friday and I have always wanted to die on such a holy day,' he says. The ambulance physician has little time to decide. How should the patient be treated? Which type of behaviour will create the least erosion of his values?
Asci, Ozlem; Hazar, Guleser; Sercan, Isa
The objective of this study is to determine the states of health care personnel, working at 112 emergency stations in the province of Artvin, to encounter with regarding forensic cases and determine their practices aimed at recognizing, protecting, and reporting the evidences that may affect the forensic process. This descriptive study was conducted with nurses and emergency medicine technicians working at 112 emergency stations in Artvin between January 2013 and February 2014. Of 141 health personnel that constituted sample of the study, 48.9% were nurses, 9.9% emergency medicine technicians, and 41.1% ambulance and emergency care technicians. The rate of feeling sufficient in coping with forensic cases and incidents was 20.6%. There was a lower rate of receiving education about the approach towards forensic cases (15.6%). In the study, the frequency of encountering with at least one forensic case was 88.7%. Traffic accidents (72.5%), suicides (41.5%) and assaults (41.5%) were among the most frequent reasons of forensic cases. The practices of nurses were more successful in woundings by firearms compared to other health personnel (p forensic cases. The personnel with higher educational level and nurses have more successful practices in forensic cases. Health personnel have approaches that may negatively affect the solution of forensic cases.
Deakin, Charles D; England, Simon; Diffey, Debbie; Maconochie, Ian
Most out-of-hospital paediatric cardiac arrests (CA) are not identified until a call is made to the emergency medical services. Accurate identification increases overall survival by enabling immediate ambulance dispatch and delivery of bystander CPR. European ambulance services use a variety of didactic telephone scripts to interrogate the caller and rapidly identify paediatric CA. The performance of these scripts has not been reported. This study aims to evaluate the diagnostic accuracy of the NHS Pathways as a telephone triage tool to identify patients less than 16 years age in cardiac arrest. All emergency calls to South Central Ambulance Service (SCAS) over a 12-month period screened by 'NHS Pathways' v9.04 were identified. All actual or presumed paediatric CAs (telephone triage system for identifying CA. Further work is required to refine telephone triage pathways for paediatric cardiac arrest. Copyright © 2017 Elsevier B.V. All rights reserved.
Heightman, A J
You can see and hear more about my journey throughout Germany and England in a special, archived, free Webcast on jems.com. And in future articles, videos and Web presentations, you'll see and learn about the different EMS delivery models I saw, the men and women whom I met and rode with on calls, and, most importantly, their impressive attitude about patient care, customer service and safety. Progressive American and Canadian ambulance manufacturers now agree with safety experts and forward-thinking ambulance operators that the squad bench is dead. These manufacturers now offer innovative seats that are much safer and functional than those coffin-like obstructions that gobbled up so much space in our rigs for the past three decades. Design your next ambulance around the needs and safety of your crews and their patients, and spec a patient compartment that is laid out logiclaly and efficient.
Sehnaz Akın Paker
Full Text Available Objectives: In our study we aimed to investigate the quality and quantity of medical management inside ambulances for 14 and over 14 years old patients transported to a level three emergency department (ED. Material and methods: Our study was conducted prospectively at a level three ED. 14 and over 14 years old patients who were transported to the ED by ambulance were included in the study consecutively. “Lack of vital rate” was described as missing of one or more of five vital rates during ambulance transportation. Both of two attending emergency physicians evaluated the medical procedures and management of patients at the ambulance simultaneously and this was recorded on the study forms. Results: Four hundred and fifty six patients were included in the study. Missing vital signs were identified for 90.1% (n = 322 of the patients that were transported by physicians and 92.4% (n = 73 of the patients that were transported by paramedics. For five patients with cardiac arrest two (33.3% had cardiopulmonary resuscitation (CPR, one (20% was intubated, one (20% received adrenaline. Out of 120 patients, needed spinal immobilization, 69 (57.5% had spinal board. Cervical collar usage was 65.1% (n = 69 We have revealed that 316 (69.3% patients did not receive at least one of the necessary medical intervention or treatment. Conclusion: During ambulance transportation, life-saving procedures like cardiopulmonary resuscitation, vital sign measurement, crucial treatment administration, endotracheal intubation, defibrillation, fracture immobilization were not performed adequately. Increasing the training on the deficient interventions and performing administrative inspections may improve quality of patient care. Keywords: Emergency department, Ambulance, Prehospital emergency care
Discusses the backgrounds and qualifications appropriate for a library personnel administrator, including (1) a master's degree in library science; (2) library work experience; (3) additional training in administration, personnel management, organizational development, and psychology; and (4) personal attributes such as good communication skills,…
As required by 10 CFR Part 73, this training manual provides guidance to assist licensees in the development of security personnel training and qualifications programs. The information contained in the manual typifies the level and scope of training for personnel assigned to perform security related tasks and job duties associated with the protection of nuclear fuel cycle facilities and nuclear power reactors
An automated Personnel Low-Level Radiation Portal Monitor has been developed by UNC Nuclear Industries, Inc. It is micro-computer controlled and uses nineteen large gas flow radiation detectors. By employing a micro-computer, sophisticated mathematical analysis is used on the detector informational data base to determine the statistical probability of contamination. This system provides for: (1) Increased sensitivity to point source contamination; (2) Real time background level compensation before and during Portal occupancy; (3) Variable counting periods as necessary to provide a significant statistical probability of contamination; (4) Continuous self-testing of system components, detector operability and sensitivity; and (5) Multiple modes of operation allowing the operator/owner control from continuous walk-through (for SNM detection at gates) to complete whole body counts (at step-off points from radiation zones). Sr-90 sources of .005 uCi can be detected from the hands and feet with a 90% confidence level, less than .1% false alarm rate with background levels up to 0.1 mR/hr. For the occupants periphery adjacent to the detectors, a sensitivity of .01 uCi is readily attainable. Alpha particle detection is legitimately available on hands, due to close proximity detection and thin Mylar detector cover techniques
An automated Personnel Low-Level Radiation Portal Monitor has been developed by UNC Nuclear Industries, Inc. It is micro-computer controlled and uses nineteen large gas flow radiation detectors. By employing a micro-computer, sophisticated mathematical analysis is used on the detector informational data base to determine the statistical probability of contamination. This system provides for: (1) Increased sensitivity to point source contamination; (2) Real time background level compensation before and during Portal occupancy; (3) Variable counting periods as necessary to provide a significant statistical probability of contamination; (4) Continuous self-testing of system components, detector operability and sensitivity; and (5) Multiple modes of operation allowing the operator/owner control from continuous walk-through (for SNM detection at gates) to complete whole body counts (at step-off points from radiation zones). Sr-90 sources of .005 uCi can be detected from the hands and feet with a 90% confidence level, less than .1% false alarm rate with background levels up to 0.1 mR/hr. For the occupants periphery adjacent to the detectors, a sensitivity of .01 uCi is readily attainable. Alpha particle detection is legitimately available on hands, due to close proximity detection and thin Mylar detector cover techniques.
The first step of on-the-job training is practical observation phase in an operating Nuclear Plant, where the participants are assigned to shift work. The simulator training for operating personnel, for key personnel and, to some extent, also for maintenance personnel and specialists give the practical feeling for Nuclear Power Plant behaviour during normal and abnormal conditions. During the commissioning phase of the own Nuclear Power Plant, which is the most important practical training, the participants are integrated into the commissioning staff and assisted during their process of practical learning by special instructors. The preparation for the licensing exams is vitally important for shift personnel and special courses are provided after the first non-nuclear trial operation of the plant. Personnel training also includes performance of programmes and material for retraining, training of instructors and assistance in building up special training programmes and material as well as training centers. (orig./RW)
Itshayek, Eyal; Candanedo, Carlos; Fraifeld, Shifra; Hasharoni, Amir; Kaplan, Leon; Schroeder, Josh E; Cohen, José E
Metastatic epidural spinal cord compression (MESCC) is a disabling consequence of disease progression. Surgery can restore/preserve physical function, improving access to treatments that increase duration of survival; however, advanced patient age may deter oncologists and surgeons from considering surgical management. Evaluate the duration of ambulation and survival in elderly patients following surgical decompression of MESCC. Retrospective file review of a prospective database, under IRB waiver of informed consent, of consecutive patients treated in an academic tertiary care medical center from 8/2008-3/2015. Patients ≥65 years presenting neurological and/or radiological signs of cord compression due to metastatic disease, who underwent surgical decompression. Duration of ambulation and survival. Patients underwent urgent multidisciplinary evaluation and surgery. Ambulation and survival were compared with age, pre- and postoperative neurological (American Spinal Injury Association [ASIA] Impairment Scale [AIS]) and performance status (Karnofsky Performance Status [KPS], and Tokuhashi Score using Kruskal-Wallis and Wilcoxon signed-rank tests, Pearson correlation coefficient, Cox regression model, log rank analysis, and Kaplan Meir analysis. 40 patients were included (21 male, 54%; mean age 74 years, range 65-87). Surgery was performed a mean 3.8 days after onset of motor symptoms. Mean duration of ambulation and survival were 474 (range 0-1662) and 525 days (range 11-1662), respectively; 53% of patients (21/40) survived and 43% (17/40) retained ambulation for ≥1 year. There was no significant relationship between survival and ambulation for patients aged 65-69, 70-79, or 80-89, although Kaplan Meier analysis suggested stratification. There was a significant relationship between duration of ambulation and pre- and postoperative AIS (p=0.0342, p=0.0358, respectively) and postoperative KPS (p=0.0221). Tokuhashi score was not significantly related to duration of
Raun, L H; Ensor, K B; Campos, L A; Persse, D
Asthma is a serious, sometimes fatal condition, in which attacks vary in severity, potentially requiring emergency medical services (EMS) ambulance treatment. A portion of asthma attacks requiring EMS ambulance treatment may be prevented with improved education and access to care. The aim of this study was to identify areas of the city with high rates of utilization of EMS ambulance for treatment, and the demographics, socio-economic status, and time of day associated with these rates, to better target future interventions to prevent emergencies and reduce cost. A cross-sectional study was conducted on individuals in Houston, TX (USA) requiring ambulance treatment for asthma attacks from 2004 to 2011. 12,155 EMS ambulance-treated asthma attack cases were linked to census tracts. High rate treatment areas were identified with geospatial mapping. Census tract demographic characteristics of these high rate areas were compared with the remainder of the city using logistic regression. The association between case level demographics and the time of day of asthma attack within the high rate area was also assessed with logistic regression. EMS ambulance-treated high rate areas were identified and found to have a utilization incidence rate over six times higher per 100,000 people than the remainder of the city. There is an increased risk of location in this high rate area with a census tract level increase of percent of population: earning less than $10,000 yearly income (RR 1.21, 1.16-1.26), which is black (RR 1.08, 1.07-1.10), which is female (RR 1.34, 1.20-1.49) and have obtained less than a high school degree (RR 1.02, 1.01-1.03). Within the high rate area, case level data indicates an increased risk of requiring an ambulance after normal doctor office hours for men compared with women (RR 1.13, 1.03-1.22), for black compared with Hispanic ethnicity (RR 1.31, 1.08-1.59), or for adults (less than 41 and greater than 60) compared with children. Interventions to prevent
These principles have been applied to our air ambulance system based from Lanseria International Airport. By combining preventative and control measures, there has been no breach in our infection control strategies, as evidenced by no growth noted on specific and random swabs even when more and more ”super bugs” are being identified in hospital. As an air ambulance service flying patients from various African countries, we have the responsibility to conduct our own ”Border Security” to keep our hospitals, patients, aircraft and crews clean and safe. In this presentation we will share our ”Border Security” principles and experiences with the audience.
Dieperink, Willem; Weelink, E. E. M.; van der Horst, I. C. C.; de Vos, R.; Jaarsma, T.; Aarts, L. P. H. J.; Zijlstra, F.; Nijsten, M. W. N.
Background: Early initiation of continuous positive airway pressure (CPAP) applied by face mask benefits patients with acute cardiogenic pulmonary oedema (ACPE). The simple disposable Boussignac CPAP (BCPAP) has been used in ambulances by physicians. In the Netherlands, ambulances are manned by
Wihlborg, Jonas; Edgren, Gudrun; Johansson, Anders; Sivberg, Bengt
The Swedish ambulance health care services are changing and developing, with the ambulance nurse playing a central role in the development of practice. The competence required by ambulance nurses in the profession remains undefined and provides a challenge. The need for a clear and updated description of ambulance nurses' competence, including the perspective of professional experiences, seems to be essential. The aim of this study was to elucidate ambulance nurses' professional experiences and to describe aspects affecting their competence. For data collection, the study used the Critical Incident Technique, interviewing 32 ambulance nurses. A qualitative content analysis was applied. This study elucidates essential parts of the development, usage and perceptions of the competence of ambulance nurses and how, in various ways, this is affected by professional experiences. The development of competence is strongly affected by the ability and possibility to reflect on practice on a professional and personal level, particularly in cooperation with colleagues. Experiences and communication skills are regarded as decisive in challenging clinical situations. The way ambulance nurses perceive their own competence is closely linked to patient outcome. The results of this study can be used in professional and curriculum development. Copyright © 2016 Elsevier Ltd. All rights reserved.
Nabeyama, Bobby; Sturmey, Peter
The study analyzed the effects of self-recording and behavioral skills training on guarding responses of 3 staff members while they assisted 3 students with multiple disabilities to ambulate. The intervention increased the percentage of correct posture and guarding responses and the distance that students ambulated. These effects generalized when staff taught new students.
Nabeyama, Bobby; Sturmey, Peter
The study analyzed the effects of self-recording and behavioral skills training on guarding responses of 3 staff members while they assisted 3 students with multiple disabilities to ambulate. The intervention increased the percentage of correct posture and guarding responses and the distance that students ambulated. These effects generalized when…
Jacobs, Bart; Men, Cheanrithy; Sam, Oeun Sam; Postma, Sjoerd
Emergency referral care is considered an essential component of the district health system. Nevertheless, the establishment of effective and durable transport arrangements of such referral care by use of an ambulance is considered controversial in low-income countries. We aim to assess the extent to which an ambulance service as part of the district health system is feasible in rural Cambodia. In a rural health district, we assessed the population's perception of the ambulance service, its recurrent costs requirements, government financial contribution to its operations, profile and medical conditions of ambulance (non)users, reasons for (non)use of the ambulance and contextual factors required for the ambulance services to operate. This observation was obtained through nine key informant interviews, five focus group discussions, structured interviews with 225 caretakers of admitted patients, a 1-month census of admitted emergency cases and assessment of annual recurrent costs for the ambulance services. The ambulance services were well received by the population and authorities and appeared to reinforce an appreciation of the hospital. Ambulance services were mainly used by the poor and by women, especially for emergency obstetric care. Less than half the number of transported patients, 44%, was considered a medical emergency. The direct cost to the hospital per collected emergency case was $34.4. When certain conditions are met, effective ambulance services can be an integral part of the district health system and positively contribute to the population's appreciation of the hospital services and respective district health system. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
Bergmueller, A; Zavgorodnii, I; Zavgorodnia, N; Kapustnik, W; Boeckelmann, I
The work in Emergency Medical Ambulance Service is one of the professions, which is accompanied by high psychological and emotional stress. The aim was to determine the risk of professional burnout syndrome of Emergency Medical Ambulance Service staff and the relationship between burnout syndrome and personality. Ninety-seven doctors (57 women and 40 men, aged 37.0±12.21) of Emergency Medical Ambulance Service were interviewed using the MBI-GS questionnaire and the Freiburg personality questionnaire (FPI). Correlation and regression analysis were used. Nine (11.5%) of respondents had a risk of burnout syndrome and 28 (35.9%) had some symptoms. In the group, aged 45 years and older, the risk of burnout syndrome was not identified. The staff of Emergency Medical Ambulance Service is characterized by stable personality features. It is necessary to identify the prevalence of burnout syndrome and also to identity the causes for its prevention and development of measures on the increase of personal stress resilience.
Schoenmakers, MAGC; Gulmans, VAM; Gooskens, RHJM; Pruijs, JEH; Helders, PJM
The aim of this study was to determine the influence of spinal fusion on ambulation and functional abilities in children with spina bifida for whom early mobilization was stimulated. Ten children (three males and seven females) with myelomeningocele were prospectively followed. Their mean age at
Simpson, Paul M; Bendall, Jason C; Patterson, Jillian; Tiedemann, Anne; Middleton, Paul M; Close, Jacqueline Ct
To quantify the size and scope of the operational burden for a large ambulance service arising from older people who have fallen and to describe this population. Retrospective analysis of ambulance records from New South Wales, Australia for emergency calls classified as 'falls' in the period 1 July 2008 to 30 June 2009. There were 42 331 responses to people aged 65 years or older, constituting 5.1% of total emergency workload. The median age of patients was 83 (interquartile range 76-87) and 62% were women. The transport rate was 76%. Transport to hospital was more likely during the day (odds ratio (OR) 1.8, 95% confidence interval (CI) 1.7-1.9) and on weekends (OR 1.06, 95%CI 1.0-1.1). Falls by older people constitute approximately 5% of all emergency responses, of which one quarter are not transported to emergency department (ED) after paramedic assessment. Increasing the sophistication of ambulance dispatch processes to older people who have fallen, and continuing with the development of new models of care aimed at decreasing unnecessary transports to the EDs, should be a priority when planning ambulance service delivery for older people who have fallen. © 2012 The Authors. Australasian Journal on Ageing © 2012 ACOTA.
Schull, Michael J.; Morrison, Laurie J.; Vermeulen, Marian; Redelmeier, Donald A.
Objective Emergency department overcrowding sometimes results in diversion of ambulances to other locations. We sought to determine the resulting prehospital delays for cardiac patients. Methods Data on consecutive patients with chest pain who were transported to Toronto hospitals by ambulance were obtained for a 4-month period in 1997 and a 4-month period in 1999, which represented periods of low and high emergency department overcrowding respectively. Multivariate analyses were used to model 90th percentile system response (initiation of 9-1-1 call to arrival on scene), on-scene (arrival on scene to departure from scene) and transport (departure from scene to arrival at hospital) intervals. Predictor variables were study period (1997 or 1999), day of the week, time of day, geographic location of the patient, dispatch priority, case severity, return priority and number of other patients with chest pain transported within 2 hours of the index transport. Results A total of 3609 patients (mean age 66.3 years, 50.3% female) who met the study criteria were transported by ambulance during the 2 study periods. There were no significant differences in patient characteristics between the 2 periods, despite the fact that more patients were transported during the second period (p overcrowding in emergency departments was associated with a substantial increase in the system response interval and the ambulance transport interval for patients with chest pain. PMID:12566332
Nilsson, Tomas; Lindström, Veronica
Several previous studies have explored nursing students' perceptions of clinical learning at hospitals and in other health care facilities, but there are few studies exploring nursing students' perceptions of the clinical learning in the ambulance service. Therefore, the aim of this study was to explore nursing students' perceptions of learning nursing skills in the ambulance service. An inductive qualitative study design with two focus group interviews and content analysis was used. Two themes were identified. The first theme, professional skills, included: Assessment, Prioritizing and initiating care, and Medical treatment and evaluation of interventions. The second theme, a holistic approach to the care included: Cultural, social, and ethical aspects of caring, Decision-making in collaboration with patients, and Care provided in the patients' home. The ambulance service provides a learning environment where the students face a multifaceted picture of health and illness. This learning environment helps nursing students to learn independently how to use professional nursing skills and how to care by employing a holistic approach. However, further research is needed to explore if and how this knowledge about nursing and caring in the ambulance service is useful when working as a Registered Nurse in other health care settings. Copyright © 2017 Elsevier Ltd. All rights reserved.
Ambulance Services of Lagos State, Nigeria: A Six-Year (2001–2006) Audit. ... The developed world has recognized the importance of organized emergency medical services and has well established systems. The Lagos State Government ... Analysis of the data was done using the Microsoft Excel software. RESULTS: A ...
Wang, Po T.; King, Christine E.; Chui, Luis A.; Do, An H.; Nenadic, Zoran
Objective. Spinal cord injury (SCI) often leaves affected individuals unable to ambulate. Electroencephalogram (EEG) based brain-computer interface (BCI) controlled lower extremity prostheses may restore intuitive and able-body-like ambulation after SCI. To test its feasibility, the authors developed and tested a novel EEG-based, data-driven BCI system for intuitive and self-paced control of the ambulation of an avatar within a virtual reality environment (VRE). Approach. Eight able-bodied subjects and one with SCI underwent the following 10-min training session: subjects alternated between idling and walking kinaesthetic motor imageries (KMI) while their EEG were recorded and analysed to generate subject-specific decoding models. Subjects then performed a goal-oriented online task, repeated over five sessions, in which they utilized the KMI to control the linear ambulation of an avatar and make ten sequential stops at designated points within the VRE. Main results. The average offline training performance across subjects was 77.2±11.0%, ranging from 64.3% (p = 0.001 76) to 94.5% (p = 6.26×10-23), with chance performance being 50%. The average online performance was 8.5±1.1 (out of 10) successful stops and 303±53 s completion time (perfect = 211 s). All subjects achieved performances significantly different than those of random walk (p prosthesis systems may be feasible.
Ten Duis, K.; Bosmans, J. C.; Voesten, H. G. J.; Geertzen, J. H. B.; Dijkstra, P. U.
The aim of this study was to analyze survival, wound healing and ambulation after knee disarticulation (KD). A historic cohort study using medical records and nursing home records was performed. Data included demographics, reason for amputation, concomitant diseases, survival, wound healing,
Ackermann, Ole [Wedau-Kliniken Duisburg (Germany). Klinik fuer Unfallchirurgie; Ruchholtz, Steffen [Universitaetsklinikum Giessen und Marburg GmbH, Marburg (Germany). Klinik fuer Unfall-, Hand- und Wiederherstellungschirurgie; Siemann, Holger [LVR Klinikum Essen (Germany); Barkhausen, Joerg [Universitaetsklinikum Schleswig-Holstein, Luebeck (Germany). Klinik fuer Radiologie und Nuklearmedizin
The radiology trainer for surgical ambulance includes informative X-ray imaging examples for the following issues: zygoma, nasal bone, spinal cord, clavicle, shoulder, upper arms, elbow, forearms, wrist, hand, phalanx, thorax, sternum, pelvis, abdomen, hips, femur, knee, lower leg, ankle, feet.
Nijmeijer, Rachelle; Voesten, Henricus G. J. M.; Geertzen, Joannes H. B.; Dijkstra, Pieter U.
OBJECTIVE: This study analyzed survival of the amputee patients, wound healing, and ambulation after knee disarticulation (KD). METHODS: Between July 1989 and October 2015, 153 KDs in 138 patients were performed at Nij Smellinghe Hospital, Drachten. Data were retrieved from hospital medical records.
Dhar, Shabir Ahmed; Dar, Tahir Ahmed; Wani, Sharief Ahmed; Hussain, Shahid; Dar, Reyaz Ahmed; Wani, Zaid Ahmed; Aazad, Shah; Yaqoob, Suhail; Mansoor, Imtiyaz; Ali, Murtaza Fazal; Ahmed, Muzaffar; Mumtaz, Imran; Azhar, Idrees
The purpose of this study was to identify the problems faced by ambulance drivers working in a conflict zone. This study was conducted on ambulance drivers working for the four major hospitals in Kashmir, India. The drivers were interviewed and asked a series of 30 work-related questions. The individual interviews were conducted over a three-month period in the valley of Kashmir that was affected by continuous violence, strict curfew, and strikes. A total of 35 ambulance drivers were interviewed. Drivers worked an average of 60 h/wk, and they drove an average of 160 km/d. Twenty-nine (83%) of the drivers experienced >1 threat of physical harm; 18 (54%) experienced physical assaults; and 31 (89%) reported evidence of psychological morbidity associated with their jobs. The atmosphere of conflict on the streets of Kashmir impacted the ambulance drivers adversely, both physically as well as mentally. The stress faced by these professionals in conflict zones during their duty hours should be recognized, and corrective measures must be put in place.
Abdollahi, Ali Akbar; Mehranfard, Shahzad; Behnampour, Nasser; Kordnejad, Abdol Mohamad
After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization. In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol), early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS) of pain and Kristin Swain's check list was applied to evaluate the severity of bleeding and hematoma. None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference. Based on the findings of this study, changing patients' position can be safe and they can be ambulated early after angiography.
Ali Akbar Abdollahi
Full Text Available Introduction: After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization. Methods: In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol, early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS of pain and Kristin Swain’s check list was applied to evaluate the severity of bleeding and hematoma. Results: None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference.Conclusion: Based on the findings of this study, changing patients’ position can be safe and they can be ambulated early after angiography.
Full Text Available conditions and traffic volumes. To support spatial planning and provide input to the Integrated Development Plan of the City of Tshwane, a GIS based analysis of ambulance response time was undertaken. The purpose was to make recommendations aimed...
Gardner, Andrew W.; Parker, Donald E.; Krishnan, Sowmya; Chalmers, Laura J.
Purposes To compare daily ambulatory measures in children, adolescents, and young adults with and without metabolic syndrome, and to assess which metabolic syndrome components, demographic measures, and body composition measures are associated with daily ambulatory measures. Methods Two-hundred fifty subjects between the ages of 10 and 30 years were assessed on metabolic syndrome components, demographic and clinical measures, body fat percentage, and daily ambulatory strides, durations, and cadences during seven consecutive days. Forty-five of the 250 subjects had metabolic syndrome, as defined by the International Diabetes Federation. Results Subjects with metabolic syndrome ambulated at a slower daily average cadence than those without metabolic syndrome (13.6 ± 2.2 strides/min vs. 14.9 ± 3.2 strides/min; p=0.012), and they had slower cadences for continuous durations of 60 minutes (p=0.006), 30 minutes (p=0.005), 20 minutes (p=0.003), 5 minutes (p=0.002), and 1 minute (p=0.001). However, the total amount of time spent ambulating each day was not different (p=0.077). After adjustment for metabolic syndrome status, average cadence is linearly associated with body fat percentage (pmetabolic syndrome ambulate more slowly and take fewer strides throughout the day than those without metabolic syndrome, even though the total amount of time spent ambulating is not different. Furthermore, the detrimental influence of metabolic syndrome on ambulatory cadence is primarily a function of body fatness. PMID:22811038
van de Port, Ingrid G.; Kwakkel, Gert; Lindeman, Eline
Objective: To explore the strength of the association between gait speed and community ambulation and whether this association is significantly distorted by other variables. Design: Cross-sectional study conducted 3 years after stroke. Subjects: A total of 102 patients after first-ever stroke
van de Port, I.; Kwakkel, G.; Lindeman, E.
Objective: To explore the strength of the association between gait speed and community ambulation and whether this association is significantly distorted by other variables. Design: Cross-sectional study conducted 3 years after stroke. Subjects: A total of 102 patients after first-ever stroke
Mulder, L. J. M.; Dijksterhuis, C.; Stuiver, A.; de Waard, D.
Adaptive support has the potential to keep the operator optimally motivated, involved, and able to perform a task. in order to use such support, the operator's state has to be determined from physiological parameters and task performance measures. In an environment where the task of an ambulance
van Halteren, Aart; Konstantas, D.; Bults, Richard G.A.; Wac, K.E.; Dokovski, N.T.; Koprinkov, G.T.; Jones, Valerie M.; Widya, I.A.; Demiris, G.
The wide availability of high bandwidth public wireless networks as well as the miniaturisation of medical sensors and network access hardware allows the development of advanced ambulant patient monitoring systems. The MobiHealth project developed a complete system and service that allows the
To describe motor development toward ambulation in children with myelomeningocele. Forty-three children were followed prospectively from 6 months to 6 years of age. Walking function had been achieved at the 1-year follow-up in 2 of 38 children, at the 1.5-year follow-up in 7 of 39, at the 2-year follow-up in 14 of 36, at the 3-year follow-up in 21 of 28, at the 4-year follow-up in 28 of 36, and at the 6-year follow-up in 30 of 38. At the 6-year follow-up, spasticity was present in 22 of 38 children, 42 of 43 used orthoses, and 9 children had not achieved ambulation expected with respect to muscle function. In children with myelomeningocele, walking starts in some during the first year of life and is seen increasingly more frequently until 6 years of age. Motor development before ambulation varies among children with similar muscle function. An increased incidence of spasticity is found among those not having achieved ambulation with respect to muscle function.
Results: The median total, indirect and direct annual costs to rural ambulating HIV/AIDS patients on HAART were estimated to be $US71.18 (115.16 Ghana cedis), $US2.740 (3.92 Ghana cedis) and $US53.04 (75.00 Ghana cedis) respectively. Conclusion: Although the cost of antiretroviral drugs has been subsidized by ...
Office of Personnel Management — Security file-related information for the U.S. Office of Personnel Management (OPM)'s employee and contractor personnel. The data is OPM-specific, not government-wide.
Williams, Teresa A; Finn, Judith; Celenza, Antonio; Teng, Tiew-Hwa; Jacobs, Ian G
Acute pulmonary edema (APE) is a common cause of acute dyspnea. In the prehospital setting, it is often difficult to differentiate APE from other causes of shortness of breath (SOB). Radiography and echocardiography aid in the identification of APE but are often not available. There is little information on how accurately ambulance paramedics identify patients with APE. Objectives. This study aimed to 1) describe the prehospital clinical presentation and management of patients with a clinical diagnosis of APE and 2) compare the accuracy of coding of APE by paramedics against the emergency department (ED) medical discharge diagnosis. This study included a retrospective cohort of all patients who had episodes identified as APE by ambulance paramedics and were transported to a metropolitan hospital ED in 2011. Two databases were used: an ambulance database and the Emergency Department Information System. The ED medical discharge diagnosis (using International Statistical Classification of Diseases and Related Problems, 10th Revision, Australian Modification [ICD-10-AM] codes) was used as the comparator with paramedic-assigned problem codes for APE. The outcomes for the study were the positive predictive value, i.e., the proportion of patients identified as having APE in the ambulance database who also had an ED discharge diagnosis of APE, and the sensitivity of paramedic identification of APE, i.e., the proportion of patients with an ED discharge diagnosis of APE that were correctly identified as APE by the ambulance paramedics. Four hundred ninety-five patients were transported to an ED with APE identified by the paramedics as the primary problem code. Shortness of breath, crepitations, high systolic blood pressure, and chest pain were the most common presenting signs and symptoms. Pink frothy sputum was rare (3% of patient episodes of APE). One hundred eighty-six patients received an ED discharge diagnosis of APE, i.e., a positive predictive value of 41%. Of 631 ED
Casey, Megan L; Nguyen, Duong T; Idriss, Barrie; Bennett, Sarah; Dunn, Angela; Martin, Stephen
Prehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control. An ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance. A convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed. Many vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a
Ssebunya, Rogers; Matovu, Joseph K B
Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda. This was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool. Of the 391 women, 189 (48.3%) reported that they had ever utilized motorcycle ambulances. Of these, 94.7% were currently married or living together with a partner while 50.8% earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95% CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95% CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95% CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95% CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances
Objective of this manual is to train security personnel to protect special nuclear materials and nuclear facilities against theft and sabotage as required by 10 CFR Part 73. This volume contains the introduction and rationale
... INFORMATION CONTACT: Barbara Goldberg, Human Resources Specialist, Office of Personnel Management, Office of.... E-mail: firstname.lastname@example.org . Telephone: (202) 606-4054. Facsimile: (202) 606-1719...
Tharion, William J; Lieberman, Harris R; Montain, Scott J; Young, Andrew J; Baker-Fulco, Carol J
...) have been measured while training under various conditions. Group mean total energy expenditures for 424 male military personnel from various units engaged in diverse missions ranged from 13.0 to 29.8 MJ per day...
Social Security Administration — The purpose of this agreement is for SSA to verify SSN information for the Office of Personnel Management. OPM will use the SSN verifications in its investigative...
The status and trend of personnel external dose monitoring system are introduced briefly. Their characteristics, functions and TLD bedges of some commercially available automatic TLD system, including UD-710A (Matsushita, Japan), Harshaw-2271, 2276 (Harshaw, USA), Harshaw-8000 (Harshaw/Filtrol), Studsvik-1313 (Sweden) and Pitman-800 (UK) were depicted in detail. Finally, personnel dose management and record keeping system were presented and two examples were given
Thornes, John Edward; Fisher, Paul Anthony; Rayment-Bishop, Tracy; Smith, Christopher
Although there has been some research on the impact of extreme weather on the number of ambulance call-out incidents, especially heat waves, there has been very little research on the impact of cold weather on ambulance call-outs and response times. In the UK, there is a target response rate of 75% of life threatening incidents (Category A) that must be responded to within 8 min. This paper compares daily air temperature data with ambulance call-out data for Birmingham over a 5-year period (2007-2011). A significant relationship between extreme weather and increased ambulance call-out and response times can clearly be shown. Both hot and cold weather have a negative impact on response times. During the heat wave of August 2003, the number of ambulance call-outs increased by up to a third. In December 2010 (the coldest December for more than 100 years), the response rate fell below 50% for 3 days in a row (18 December-20 December 2010) with a mean response time of 15 min. For every reduction of air temperature by 1°C there was a reduction of 1.3% in performance. Improved weather forecasting and the take up of adaptation measures, such as the use of winter tyres, are suggested for consideration as management tools to improve ambulance response resilience during extreme weather. Also it is suggested that ambulance response times could be used as part of the syndromic surveillance system at the Health Protection Agency.
Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick
U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.
Rerucha, F.; Odehnal, J.
Basic scheme of the training system for NPP personnel of CEZ-EDU personnel training system is described in detail. This includes: specific training both basic and periodic, and professional training meaning specialized and continuous training. The following schemes are shown: licence acquisition and authorisation for PWR-440 Control Room Personnel; upgrade training for job positions of Control Room personnel; maintaining and refresh training; module training for certificate acquisition of servicing shift and operating personnel
Assessing mobility through readily available and affordable protocols may help advance public health by providing early detection and implementing intervention therapies aimed at mitigating the progression from physiological vitality to disability at older ages. Until now, little attention has been given to how self-reported mobility (SRM) and gait speed can be combined in a categorization scheme. The specific aim of this report is to introduce the Ambulation Speed-Endurance (ASE) Typology to the literature-a classification system that intersects SRM and gait speed to create a multi-dimensional measure of ambulation. Cross-sectional. Community-dwelling older adults in the United States. Evidence is provided from the National Health and Aging Trends Study (NHATS) that community-dwelling older adults (n=5,403) may be found in each of the ASE Typologies. The discussion is complimented by investigating the cross-sectional predictors of a "Discrepancy Score" (measure of gap between speed and endurance) amongst those with gait speeds speed-endurance discrepancy is higher amongst: non-Latino-Blacks (β=0.48); Latinos (β=0.42); older ages; and lower educated. Models also show that severity in speed-endurance discrepancy is lower amongst: females (β=-0.38); those with higher body mass index; with more chronic health conditions; and poorer self-rated health. Research should continue to investigate how to optimize SRM.
van Bergen, Leo
The paper looks at two First World War ambulance teams which distinctly differed from each other, both in the way they perceived the war and the places at the front where they worked. The first was working on the Serbian side and the second on the Austrian-Hungarian. The questions raised are: how was medical neutrality defined (was it defined at all)? Was neutrality maintained, and if so how? The writings of several protagonists are closely examined, and placed in context, to show that total neutrality was not adhered to by the physicians and nurses of these ambulances. Apparently neutrality in wartime is difficult, even for men and women coming from a neutral country with an occupation seen as essentially neutral.
Ischaemic stroke clinical outcomes are improved by earlier treatment with intravenous thrombolysis. An existing pathway at the Mater University Hospital for assessment of suspected acute stroke in the Emergency Department was updated, aiming to shorten ‘door to needle time’. This study examines the final clinical diagnosis of Dublin Fire Brigade Ambulance Paramedic identified Face Arm Speech Test (FAST) positive patients presenting to the Emergency Department over a 7 month period. A retrospective analysis was carried out of 177 consecutive FAST positive patients presenting between March and November 2014. The final clinical diagnosis was acute stroke in 57.1% (n=101) of patients. Of these, 76 were ischaemic strokes of whom 56.5% (n=43) were thrombolysed. In the pre-hospital setting Ambulance Paramedics can identify, with reasonable accuracy, acute stroke using the FAST test. Over half of the ischaemic stroke patients presenting via this pathway can be treated with intravenous thrombolysis
Kuisma, Markku; Väyrynen, Taneli; Hiltunen, Tuomas; Porthan, Kari; Aaltonen, Janne
We examined the effect of the change from paper records to the electronic patient records (EPRs) on ambulance call duration. We retrieved call duration times 6 months before (group 1) and 6 months after (group 2) the introduction of EPR. Subgroup analysis of group 2 was fulfilled depending whether the calls were made during the first or last 3 months after EPR introduction. We analyzed 37 599 ambulance calls (17 950 were in group 1 and 19 649 were in group 2). The median call duration in group 1 was 48 minutes and in group 2 was 49 minutes (P = .008). In group 2, call duration was longer during the first 3 months after EPR introduction. In multiple linear regression analysis, urgency category (P introduction was noticed, reflecting adaptation process to a new way of working.
Jenstrup, M T; Jæger, P; Lund, J
Total knee arthroplasty (TKA) is associated with intense post-operative pain. Besides providing optimal analgesia, reduction in side effects and enhanced mobilization are important in this elderly population. The adductor-canal-blockade is theoretically an almost pure sensory blockade. We...... hypothesized that the adductor-canal-blockade may reduce morphine consumption (primary endpoint), improve pain relief, enhance early ambulation ability, and reduce side effects (secondary endpoints) after TKA compared with placebo....
Our attention has focused on the choice of a relevant work. It concerns an implemented and conceived service of medical Teleassistance for monitoring risky persons brought by ambulance service. Thus, a medical bulletin is automatically filled on mobile terminal, immediately transmitted to the service of the emergency (on doctors mobile terminal, data base of clinic). This paper recalls a complete architecture of an economic wireless transmission system with the implementation of an effective ...
Mort, Alasdair J.; Fitzpatrick, David; Wilson, Philip M. J.; Mellish, Chris; Schneider, Anne
The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (SpO2). The second was the RESpeck respiratory rate (RR) sensor, which was wireless-enabled with a Bluetooth? Low Energy protocol. Sensor data were ...
Gjersing, Linn; Bretteville-Jensen, Anne Line
To assess whether people who inject drugs (PWID) and who are treated for overdose by ambulance services have a greater mortality risk compared with other PWID, and to compare mortality risk within potentially critical time-periods (1 week, 1 month, 3 months, 6 months, 1 year, 5 years) after an overdose attendance with the mortality risk within potentially non-critical time-periods (time before and/or after critical periods). A prospective cohort study. Oslo, Norway. A total of 172 PWID street-recruited in 1997 and followed-up until the end of 2004. Interview data linked to data from ambulance records, Norwegian Correctional Services, Opioid Substitution Treatment records and National Cause of Death Registry. Separate Cox regression models (one for each critical time-period) were estimated. Ambulance services treated 54% of the participants for an overdose during follow-up. The mortality rate was 2.8 per 100 person-years for those with an overdose and 3.3 for those without; the adjusted hazard ratio (HR) was 1.3 (95% CI = 0.6, 2.6, P = 0.482). Mortality risk was greater in all but the shortest critical time-period following ambulance attendance than in the non-critical periods. The mortality risk remained significantly elevated during critical periods, even when adjusted for total time spent in prison and substitution treatment. The HR ranged from 9.4 (95% CI = 3.5, 25.4) in the month after an overdose to 13.9 (95% CI = 6.4, 30.2) in the 5-year period. Mortality risk among people who inject drugs is significantly greater in time-periods after an overdose attendance than outside these time-periods. © 2015 Society for the Study of Addiction.
Rosell Ortiz, Fernando; García Del Águila, Javier; Fernández Del Valle, Patricia; J Mellado-Vergel, Francisco; Vergara-Pérez, Santiago; R Ruiz-Montero, María; Martínez-Lara, Manuela; J Gómez-Jiménez, Francisco; Gonzáez-Lobato, Ismael; García-Escudero, Guillermo; Ruiz-Bailén, Manuel; Caballero-García, Auxiliadora; Vivar-Díaz, Itziar; Olavarría-Govantes, Luis
To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome. Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.
Full Text Available The importance of early access to prehospital care has been demonstrated in many medical emergencies. This work aims to describe the potential time benefit of implementing a student Community First Responder scheme to support ambulance services in an inner-city setting in the United Kingdom. Twenty final and penultimate year medical students in the UK were trained in the “First Person on Scene” Business and Technology Education Council (BTEC qualification. Over 12 months, they attended 89 emergency calls in an inner-city setting as Community First Responders (CFRs, alongside the West Midlands Ambulance Service, UK. At the end of this period, a qualitative survey investigated the perceived educational value of the scheme. The mean CFR response time across all calls was an average of 3 minutes and 8 seconds less than ambulance crew response times. The largest difference was to calls relating to falls (12 min. The difference varied throughout the day, peaking between 16:00 and 18:00. All questionnaire respondents stated that they felt more prepared in assessing and treating acutely unwell patients. In this paper, the authors present a symbiotic solution which has both reduced time to first on scene and provided training and experience in medical emergencies for senior medical students.
Managers of ambulance stations face many communicative challenges in their interaction with employees working in prehospital first-line services. The article presents an exploratory study of how paramedics experience these challenges in communication with station leaders. On the basis of a dialogue perspective in qualitative method, 24 paramedics were interviewed in one-to-one and focus group settings. Naturalistic and phenomenological approaches were used to analyze the interviews. All the paramedics said that they wished to be more involved in decision processes and that station managers should provide better explanations of information "from above." The paramedics understood that it was difficult for the managers to find time for extensive dialogue, but many thought that the managers should give more priority to communication. The paramedics' views correspond to theoretical assumptions in human resource management. According to this model, employees should be involved in decision processes on management levels, as long as it is realistically possible to do so. Furthermore, expressing emotional support and positive attitudes does not take much time, and the study suggests that many ambulance managers should focus more on interpersonal relations to employees. It has been extensively documented that management communication affects organizational performance. The study indicates that managers of ambulance stations should be more aware of how their leadership style affects professional commitment and motivation in the first-line services.
Holmberg, Mats; Fagerberg, Ingegerd; Wahlberg, Anna Carin
The aim of the study was to identify the types of knowledge that Swedish Emergency Medical Service (EMS) managers considered desirable in their Ambulance Clinicians. Emergency medical service managers are responsible for organisational tasking and in this are dependent on the knowledge possessed by their ambulance clinicians. It would therefore be of value to explore EMS managers' approach to this knowledge. A modified Delphi method in three rounds. In total thirty-six EMS managers participated, and twenty-four finished all three rounds. They were encouraged to rate each sub-category, and the ten with the highest mean were interdependently ranked in the final round. Five categories and twenty-six sub-categories emerged in the first round, covering knowledge related to; contextual aspects, medical and holistic assessments, formal education and organisational issues. Eventually, the sub-category 'Knowledge to assess the patient's situation from a holistic perspective' was the highest ranked, followed by 'Medical knowledge to assess and care for different diseases' and 'Knowledge to be able to care for critically ill patients'. Taken together the knowledge areas address essentially medical care, contextual aspects and nursing. The boundaries between these can sometimes be seen as elusive, calling for ambulance clinicians to balance these areas of knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.
Halpern, Janice; Maunder, Robert G; Schwartz, Brian; Gurevich, Maria
Ambulance workers are exposed to critical incidents that may evoke intense distress and can result in long-term impairment. Individuals who can regulate distress may experience briefer post-incident distress and fewer long-term emotional difficulties. Attachment research has contributed to our understanding of individual differences in stress regulation, suggesting that secure attachment is associated with effective support-seeking and coping strategies, and fewer long-term difficulties. We tested the effect of attachment insecurity on emotional distress in ambulance workers, hypothesizing that (1) insecure attachment is associated with symptoms of current distress and (2) prolonged recovery from acute post-critical incident distress, coping strategies and supportive contact mediate this relationship. We measured (1) attachment insecurity, (2) acute distress, coping and social contact following an index critical incident and (3) current symptoms of post-traumatic stress, depression, somatization and burnout and tested the hypothesized associations. Fearful-avoidant insecure attachment was associated with all current symptoms, most strongly with depression (R=0.38, pinsecurity was also associated with maladaptive coping, reduced social support and slower recovery from social withdrawal and physical arousal following the critical incident, but these processes did not mediate the relationship between attachment insecurity and current symptoms. These findings are relevant for optimizing post-incident support for ambulance workers. Copyright © 2011 John Wiley & Sons, Ltd.
Irving, Andy; Turner, Janette; Marsh, Maggie; Broadway-Parkinson, Andrea; Fall, Dan; Coster, Joanne; Siriwardena, A Niroshan
Patient and public involvement (PPI) is recognized as an important component of high-quality health services research. PPI is integral to the Pre-hospital Outcomes for Evidence Based Evaluation (PhOEBE) programme. The PPI event described in detail in this article focusses on the process of involving patients and public representatives in identifying, prioritizing and refining a set of outcome measures that can be used to support ambulance service performance measurement. To obtain public feedback on little known, complex aspects of ambulance service performance measurement. The event was codesigned and coproduced with the PhOEBE PPI reference group and PhOEBE research team. The event consisted of brief researcher-led presentations, group discussions facilitated by the PPI reference group members and electronic voting. Data were collected from eighteen patient and public representatives who attended an event venue in Yorkshire. The results of the PPI event showed that this interactive format and mode of delivery was an effective method to obtain public feedback and produced a clear indication of which ambulance performance measures were most highly favoured by event participants. The event highlighted valuable contributions the PPI reference group made to the design process, supporting participant recruitment and facilitation of group discussions. In addition, the positive team working experience of the event proved a catalyst for further improvements in PPI within the PhOEBE project. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
van Silfhout, L; Peters, A E J; Graco, M; Schembri, R; Nunn, A K; Berlowitz, D J
Retrospective study. To determine the accuracy of a previously described Dutch clinical prediction rule for ambulation outcome in routine clinical practice. Adult (⩾18 years) patients who were admitted to the Austin Hospital with a traumatic spinal cord injury between January 2006 and August 2014. Data from medical records were extracted to determine the score of the Dutch clinical ambulation prediction rule proposed by van Middendorp et al. in 2011. A receiver-operating characteristics (ROC) curve was generated to investigate the performance of the prediction rule. Univariate analyses were performed to investigate which factors significantly influence ambulation after a traumatic spinal cord injury. The area under the ROC curve (AUC) obtained during the current study (0.939, 95% confidence interval (CI) (0.892, 0.986)) was not significantly different from the AUC from the original Dutch clinical prediction model (0.956, 95% CI (0.936, 0.976)). Factors that were found to have a significant influence on ambulation outcome were time spent in the ICU, number of days hospitalised and injury severity. Age at injury initially showed a significant influence on ambulation however, this effect was not apparent after inclusion of the 24 patients who died due to the trauma (and therefore did not walk after their injuries). The Dutch ambulation prediction rule performed similarly in routine clinical practice as in the original, controlled study environment in which it was developed. The potential effect of survival bias in the original model requires further investigation.
Guerra, Aline B.; Lorenzini, Fabiane; Carlos, Janaina; Bernasiuk, Maria E.B.; Rizzatti, Mara R.; Fuentefria, Jose L.B.
Surveillance of several health institutions who use ionizing radiation sources, as well as data from the state of Rio Grande do Sul (Brazil) are studied concerning the use of personnel dosimeters. The results show that several institutions do not provide them and those which provide do not know how to use them
Full Text Available An important factor for the success management of IT projects is the human resource. People involved in the project management process have to be evaluated. In order to do that, same criteria has to be specified. This paper describes some aspects regarding the personnel evaluation.
Barker, Gale; And Others
This module on rights and responsibilities is intended to introduce the hospitality manager or supervisor to sound personnel management practices that comply with the law. The material is presented in a self-instructional format in seven sections. At the beginning of each section is a statement of the objectives that will be achieved as a result…
Bielawska-Drózd, Agata; Cieślik, Piotr; Wlizło-Skowronek, Bożena; Winnicka, Izabela; Kubiak, Leszek; Jaroszuk-Ściseł, Jolanta; Depczyńska, Daria; Bohacz, Justyna; Korniłłowicz-Kowalska, Teresa; Skopińska-Różewska, Ewa; Kocik, Janusz
Assessment of microbial air quality and surface contamination in ambulances and administration offices as a control place without occupational exposure to biological agents; based on quantitative and qualitative analysis of bacteria, yeasts and filamentous fungi found in collected samples. The sampling was done by wet cyclone technology using the Coriolis recon apparatus, imprint and swab methods, respectively. In total, 280 samples from 28 ambulances and 10 offices in Warszawa were tested. Data was analyzed using Shapiro-Wilk normality test, Kruskal-Wallis test with α = 0.05. P value ≤ 0.05 was considered as significant. The levels of air contamination were from 0 to 2.3×101 colony-forming unit (CFU)/m3 for bacteria and for yeast and filamentous fungi were from 0 to 1.8×101 CFU/m3. The assessment of office space air samples has shown the following numbers of microorganisms: bacteria from 3.0×101 to 4.2×101 CFU/m3 and yeast and filamentous fungi from 0 to 1.9×101 CFU/m3. For surface contamination the mean bacterial count in ambulances has been between 1.0×101 and 1.3×102 CFU/25 cm2 and in offices - between 1.1×101 and 8.5×101 CFU/25 cm2. Mean fungal count has reached the level from 2.8×100 to 4.2×101 CFU/25 cm2 in ambulances and 1.3×101 to 5.8×101 CFU/25 cm2 in offices. The qualitative analysis has revealed the presence of Acinetobacter spp. (surfaces), coagulase - negative Staphylococci (air and surfaces), Aspergillus and Penicillium genera (air and surfaces). The study has revealed a satisfactory microbiological quantity of analyzed air and surface samples in both study and control environments. However, the presence of potentially pathogenic microorganisms in the air and on surfaces in ambulances may endanger the medical emergency staff and patients with infection. Disinfection and cleaning techniques therefore should be constantly developed and implemented. Int J Occup Med Environ Health 2017;30(4):617-627. This work is available in Open Access
Kotani, Kazuya; Ueda, Kayo; Seposo, Xerxes; Yasukochi, Shusuke; Matsumoto, Hiroko; Ono, Masaji; Honda, Akiko; Takano, Hirohisa
The elderly population has been the primary target of intervention to prevent heat-related illnesses. According to the literature, the highest risks have been observed among the elderly in the temperature-mortality relationship. However, findings regarding the temperature-morbidity relationship are inconsistent. This study aimed to examine the association of temperature with ambulance dispatches due to acute illnesses, stratified by age group. Specifically, we explored the optimum temperature, at which the relative health risks were found to be the lowest, and quantified the health risk associated with higher temperatures among different age groups. We used the data for ambulance dispatches in Fukuoka, Japan, during May and September from 2005 to 2012. The data were grouped according to age in 20-year increments. We explored the pattern of the association of ambulance dispatches with temperature using a smoothing spline curve to identify the optimum temperature for each age group. Then, we applied a distributed lag nonlinear model to estimate the risks of the 85th-95th percentile temperature relative to the overall optimum temperature, for each age group. The relative risk of ambulance dispatches at the 85th and 95th percentile temperature for all ages was 1.08 [95% confidence interval (CI): 1.05, 1.12] and 1.12 (95% CI: 1.08, 1.16), respectively. In comparison, among age groups, the optimum temperature was observed as 25.0°C, 23.2°C, and 25.3°C for those aged 0-19, 60-79, and ≥80, respectively. The optimum temperature could not be determined for those aged 20-39 and 40-59. The relative risks of high temperature tended to be higher for those aged 20-39 and 40-59 than those for other age groups. We did not find any definite difference in the effect of high temperature on ambulance dispatches for different age groups. However, more measures should be taken for younger and middle-aged people to avoid heat-related illnesses.
Full Text Available Objectives: Assessment of microbial air quality and surface contamination in ambulances and administration offices as a control place without occupational exposure to biological agents; based on quantitative and qualitative analysis of bacteria, yeasts and filamentous fungi found in collected samples. Material and Methods: The sampling was done by wet cyclone technology using the Coriolis recon apparatus, imprint and swab methods, respectively. In total, 280 samples from 28 ambulances and 10 offices in Warszawa were tested. Data was analyzed using Shapiro-Wilk normality test, Kruskal-Wallis test with α = 0.05. P value ≤ 0.05 was considered as significant. Results: The levels of air contamination were from 0 to 2.3×101 colony-forming unit (CFU/m3 for bacteria and for yeast and filamentous fungi were from 0 to 1.8×101 CFU/m3. The assessment of office space air samples has shown the following numbers of microorganisms: bacteria from 3.0×101 to 4.2×101 CFU/m3 and yeast and filamentous fungi from 0 to 1.9×101 CFU/m3. For surface contamination the mean bacterial count in ambulances has been between 1.0×101 and 1.3×102 CFU/25 cm2 and in offices – between 1.1×101 and 8.5×101 CFU/25 cm2. Mean fungal count has reached the level from 2.8×100 to 4.2×101 CFU/25 cm2 in ambulances and 1.3×101 to 5.8×101 CFU/25 cm2 in offices. The qualitative analysis has revealed the presence of Acinetobacter spp. (surfaces, coagulase – negative Staphylococci (air and surfaces, Aspergillus and Penicillium genera (air and surfaces. Conclusions: The study has revealed a satisfactory microbiological quantity of analyzed air and surface samples in both study and control environments. However, the presence of potentially pathogenic microorganisms in the air and on surfaces in ambulances may endanger the medical emergency staff and patients with infection. Disinfection and cleaning techniques therefore should be constantly developed and implemented. Int J Occup
Full Text Available Bed rest has been considered as the cornerstone of management of deep vein thrombosis (DVT for a long time, though it is not evidence-base, and there is growing evidence favoring early ambulation.Electronic databases including Medline, PubMed, Cochrane Library and three Chinese databases were searched with key words of "deep vein thrombosis", "pulmonary embolism", "venous thrombosis", "bed rest", "immobilization", "mobilization" and "ambulation". We considered randomized controlled trials, prospective or retrospective cohort studies that compared the outcomes of acute DVT patients managed with early ambulation versus bed rest, in addition to standard anticoagulation. Meta-analysis pertaining to the incidence of new pulmonary embolism (PE, progression of DVT, and DVT related deaths were conducted, as well as the extent of remission of pain and edema.13 studies were included with a total of 3269 patients. Compared to bed rest, early ambulation was not associated with a higher incidence of new PE, progression of DVT, or DVT related deaths (RD -0.03, 95% CI -0.05∼ -0.02; Z = 1.24, p = 0.22; random effect model, Tau2 = 0.01. Moreover, if the patients suffered moderate or severe pain initially, early ambulation was related to a better outcome, with respect to remission of acute pain in the affected limb (SMD 0.42, 95%CI 0.09∼0.74; Z = 2.52, p = 0.01; random effect model, Tau2 = 0.04. Meta-analysis of alleviation of edema cannot elicit a solid conclusion because of significant heterogeneity among the few studies.Compared to bed rest, early ambulation of acute DVT patients with anticoagulation was not associated with a higher incidence of new PE, progression of DVT, and DVT related deaths. Furthermore, for the patients suffered moderate or severe pain initially, a better outcome can be seen in early ambulation group, regarding to the remission of acute pain in the affected limb.
Sergei N. Drachev
Full Text Available Objectives. To assess daily variations in ambulance calls for cardiovascular diseases (CVDs, mental and behavioral disorders, and external causes in Arkhangelsk, Northwest Russia, in 2000–2008. Study design. A population-based study. Methods. Data about all ambulance calls during the years 2000–2008 were obtained from the Arkhangelsk ambulance station. Information about patient's gender, age, doctor's diagnosis according to International Classification of Diseases, 10th revision, and the date of call were recorded. Pearson's Chi-squared tests were used for comparing proportions of ambulance calls across the week for CVDs (I00-99, mental and behavioral disorders (F00-F99, and external causes (S00-T98, V01-Y98. The ratio of incidence of ambulance calls on Saturday, Sunday, and Monday versus the rest of week was also calculated. Results. There is a significant daily variation (p < 0.001 in calls for CVDs in men and women aged 18–59 and women aged 60 years and older, with increased numbers of calls on weekends and Mondays varying between 2 and 3% excess calls. For mental and behavioral disorders, a similar pattern was found in the age group of 18–59 year-olds. Ratios for the number of calls during weekends and Mondays vs. the rest of the week were 1.05 (95% CI: 1.02–1.08 among women and 1.02 (95% CI: 1.00–1.05 among men. For external causes, a significant variation and an increase in ambulance calls during Saturdays, Sundays, and Mondays from 4 to 17% excess calls was observed for both age and gender groups. Conclusions. The observed daily variations in ambulance calls with an increased number of calls on weekends and Mondays for CVDs, mental and behavioral disorders, and external causes may be associated with excessive alcohol consumption on the weekends. Further research using data on individual levels of alcohol consumption are warranted.
Kraus, W.; Herrmann, D.; Kiesewetter, W.
The physical properties of radiation detectors for personnel dosimetry are described and compared. The suitability of different types of dosimeters for operational and central monitoring of normal occupational exposure, for accident and catastrophe dosimetry and for background and space-flight dosimetry is discussed. The difficulties in interpreting the dosimeter reading with respect to the dose in individual body organs are discussed briefly. 430 literature citations (up to Spring 1966) are given
In this paper are presented essential themes in the subject of personnel economics. In the first part analysis has been conducted on the impact of peer pressure on workplace behaviour. Then again models for compensation structures within firms, and their influence on the utility of work by employees. In the final section of the paper the productivity spillover effect has been analyzed, and the causes of existence of spillovers and their impact on workers’ productivity
This paper explains how selected personnel can now obtain a Bachelor of Science degree in Physics with a Nuclear Power Operations option. The program went into effect the Fall of 1984. Another program was worked out in 1982 whereby students attending the Nuclear Operators Training Program could obtain an Associates of Science degree in Mechanical Engineering Technology at the end of two years of study. This paper presents tables and charts which describe these programs and outline the career path for operators
Tasca, A. J.
Recently, personnel executives and their staffs are being asked to help management solve an increasing number of human resource and business problems. Personnel management must undergo some changes if it is to achieve its full potential. (Author/AJ)
US Agency for International Development — The NFC system is an USDA system used for processing transactions for payroll/personnel systems. Personnel processing is done through EPIC/HCUP, which is web-based....
Carol B. Furtwengler
Full Text Available This article is an analysis four major policy issues associated with state actions for personnel evaluation from 1983 to 1992 and provides descriptive information about state policy actions taken during those years. Twenty states enacted their first requirements for performance evaluation, and states assumed new roles for program development, implementation, and staff development. Twenty-nine states passed legislation for performance pay programs, but only five programs remained viable by 1992. States generally avoided the issue of teacher tenure when enacting legislation for teacher evaluation. Thirty-eight states enacted 67 changes in legislation prescribing specific requirements for personnel evaluation. During the early part of the reform movement, state actions focused on accountability; toward the end of the reform movement states actions relinquished control and returned responsibility for evaluation to local school districts. Legislation varied across the states in the purpose for evaluation: improvement, continuing employment, and performance pay. The study found a positive relationship (0.48 between state control over personnel evaluation and state funding of education.
Abebe, Yonas; Dida, Tolesa; Yisma, Engida; Silvestri, David M
Africa accounts for one sixth of global road traffic deaths-most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined. This is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months. Emergency Department triage records were used to abstract clinical and arrival characteristics, including acuity. The outcome of interest was ambulance arrival. Secondary outcomes of interest were inter-facility referral and referral communication. Descriptive and multivariable statistics were computed to identify factors independently associated with outcomes. Over half of patients arrived with either high (13.1%) or moderate (42.2%) acuity. Over half (59.0%) arrived by ambulance, and nearly two thirds (65.9%) were referred. Among referred patients, inter-facility communication was poor (57.7%). Patients with high acuity were most likely to be referred (aOR 2.20, 95%CI 1.16-4.17), but were not more likely to receive ambulance transport (aOR 1.56, 95%CI 0.86-2.84) or inter-facility referral communication (aOR 0.98, 95%CI 0.49-1.94) than those with low acuity. Nearly half (40.2%) of all patients were referred by ambulance despite having low acuity. Despite ambulance expansion in Addis Ababa, ambulance use among RTC patients remains heavily concentrated among those with low-acuity. Inter-facility referral appears a primary contributor to low-acuity ambulance use. In other contexts, similar routine ambulance monitoring may help identify low-value utilization. Regional guidelines may help direct ambulance use where most valuable, and warrant further evaluation.
numt>er) performance assessment, biomagnetism , testing potential, magnetoencephalography, evoked potential, personnel...here. EF recordings were obtained using a DC SQUID Biomagnetic Detection System (B.T.I., Inc. model 600B, second derivative gradiometer). The single... Biomagnetism : Possible new predictor of personnel performance. (NPRDC Tech. Rep. 84-43). San Diego: Navy Personnel Research and Development Center
... 49 Transportation 3 2010-10-01 2010-10-01 false Personnel health. 193.2711 Section 193.2711 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY...: FEDERAL SAFETY STANDARDS Personnel Qualifications and Training § 193.2711 Personnel health. Each operator...
Basic methodic principles related to the NPP personnel selection are considered. Suggestions on the selection organization are given as well as some psycho-physiological methods of the personnel professional fitness estimating. The personnel distribution over the working places with respect to psycho-phisiological abilities has been shown to represent a way to improvement of NPP radiation safety [ru
Anderson, Eileen R.
Although personnel management in the public sector has become increasingly difficult because of recent social changes, more worker and middle management involvement in decision-making processes can improve all levels of personnel management. The social changes affecting personnel management have assumed three forms: (1) the entrance into the work…
Seyfarth, John T.
Myriad issues face those who manage school personnel. Explicating the wide range of activities covered by the term "personnel management" is the object of this text. It is geared for prospective and current school administrators whose responsibilities include any aspect of personnel management. The text is organized around the premise that student…
... 10 Energy 1 2010-01-01 2010-01-01 false Personnel monitoring. 34.47 Section 34.47 Energy NUCLEAR... not to exceed three months. (4) After replacement, each personnel dosimeter must be processed as soon... immediately until a replacement personnel dosimeter meeting the requirements in paragraph (a) is provided and...
Full Text Available Background: Stroke subjects face reduced tolerance to activity and sedentary lifestyle due to various impairments, such as muscle weakness, pain, spasticity, and poor balance. Thus, loss of independent ambulation especially outdoors is generally observed in them. Methods: Chronic stroke patients (> 6 months with Functional Ambulation Category score > 2 and able to walk at least 10 meters of distance with and without assistance from a tertiary healthcare centre were selected and treated. Subjects were randomly divided into 2 groups control group (n=14 and experimental group (n=13. Each group received Motor Relearning Programme for 60 minutes, 6 times a week for 4 weeks. The experimental group received an additional shoe-raise of 1 cm on the unaffected side along with while ambulating during therapy as well as at home. Pre and post treatment the patients were assessed for spatio-temporal parameters using foot print analysis method and Rivermead Visual Gait Assessment (RVGA Score using RVGA scale. Results: There was significant improvement seen in almost all the spatio-temporal gait parameters and RVGA score in within group analysis. Whereas on between group the results from between group comparison suggests that subjects in MRP with shoe-raise group showed better results in spatio-temporal parameters of gait than subjects receiving MRPalone. But there was no additional benefit of shoe-raise seen on RGVA score and angle of toe-out parameter. Conclusion: Additional use of shoe-raise helps to improve spatio-temporal gait parameters. However, there was no additional change seen in RVGA score.
Simon, Ann M.; Ingraham, Kimberly A.; Fey, Nicholas P.; Finucane, Suzanne B.; Lipschutz, Robert D.; Young, Aaron J.; Hargrove, Levi J.
Lower limb prostheses that can generate net positive mechanical work may restore more ambulation modes to amputees. However, configuration of these devices imposes an additional burden on clinicians relative to conventional prostheses; devices for transfemoral amputees that require configuration of both a knee and an ankle joint are especially challenging. In this paper, we present an approach to configuring such powered devices. We developed modified intrinsic control strategies—which mimic the behavior of biological joints, depend on instantaneous loads within the prosthesis, or set impedance based on values from previous states, as well as a set of starting configuration parameters. We developed tables that include a list of desired clinical gait kinematics and the parameter modifications necessary to alter them. Our approach was implemented for a powered knee and ankle prosthesis in five ambulation modes (level-ground walking, ramp ascent/descent, and stair ascent/descent). The strategies and set of starting configuration parameters were developed using data from three individuals with unilateral transfemoral amputations who had previous experience using the device; this approach was then tested on three novice unilateral transfemoral amputees. Only 17% of the total number of parameters (i.e., 24 of the 140) had to be independently adjusted for each novice user to achieve all five ambulation modes and the initial accommodation period (i.e., time to configure the device for all modes) was reduced by 56%, to 5 hours or less. This approach and subsequent reduction in configuration time may help translate powered prostheses into a viable clinical option where amputees can more quickly appreciate the benefits such devices can provide. PMID:24914674
Asselin, Pierre K.; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M.
Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment. PMID:27340808
Mort, Alasdair J; Fitzpatrick, David; Wilson, Philip M J; Mellish, Chris; Schneider, Anne
The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (SpO2). The second was the RESpeck respiratory rate (RR) sensor, which was wireless-enabled with a Bluetooth(®) Low Energy protocol. Sensor data were recorded from 16 pre-hospital patients, who were monitored for 21.2 ± 9.8 min, on average. Some form of error was identified on almost every HR and SpO2 trace. However, the mean proportion of each trace exhibiting error was <10 % (range <1-50 % for individual patients). There appeared to be no overt impact of the gross motion associated with road ambulance transit on the incidence of HR or SpO2 error. The RESpeck RR sensor delivered an average of 4.2 (±2.2) validated breaths per minute, but did not produce any validated breaths during the gross motion of ambulance transit as its pre-defined motion threshold was exceeded. However, this was many more data points than could be achieved using traditional manual assessment of RR. Error was identified on a majority of pre-hospital physiologic signals, which emphasised the need to ensure consistent sensor attachment in this unstable and unpredictable environment, and in developing intelligent methods of screening out such error.
Full Text Available MR Beseler,1 C Rubio,1 E Duarte,1 D Hervás,2 MC Guevara,1 M Giner-Pascual,1 E Viosca1 1Physical Medicine and Rehabilitation, La Fe Hospital, Valencia, Spain; 2Statistical Unit, La Fe Hospital, Valencia, Spain Background: Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients. Methods: A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old. Manual muscle test was used for checking strength of hip flexor muscles, hip abductor muscles and knee extensor muscles. Grip strength was assessed by hydraulic dynamometer. Walking ability was assessed by functional ambulation categories and Functional Classification of Sagunto Hospital Ambulation. Existence of cognitive impairment (Short Portable Mental Status of Pfeiffer and comorbidity (abbreviated Charlson index were considered to be confounding variables. Statistical analysis: Simple comparisons and mixed models of multiple ordinal regression. Results: The sample presented generalized weakness in scapular (mean 4.22 and pelvic (mean 3.82 muscle. Mean hand grip values were similar: 11.98 kg right hand; 11.70 kg left hand. The patients had lost walking ability. After treatment, there was a statistically significant for scapular waist strength (P=0.001, pelvic waist strength (P=0.005 and walking ability (P=0.001. A statistically significant relationship in the regression analysis was found between the grip (right and left hands and walking ability post-treatment (P=0.009; odds ratio 1.14 and P=0.0014 odds ratio 1.113 for each walking scale. The confounding variables showed no statistical significance in the results.Conclusion: Grip strength is associated with walking ability in hospitalized frail elderly. Grip strength assessment by hydraulic dynamometry is useful in patients with poor collaboration. Walking ability training in frail elderly inpatients is useful. Keywords: gait
Zorab, Ollie; Robinson, Maria; Endacott, Ruth
A shift from a predominantly emergency service, towards one where a wide range of conditions are managed and treated on scene presents numerous challenges for ambulance services and clinicians. The effective management of a broad range of patients and conditions in the ambulance setting will have an impact on other parts of the health service including emergency departments and primary care. A two part online survey was distributed to operational staff working for a regional UK ambulance service. Clinicians were asked to report their experiences of accessing patient information and making decisions about patient management based on four hypothetical patient scenarios. A survey of clinical staff (n = 302) revealed that (i) the vast majority experienced difficulties in accessing patients' health information, (ii) this was particularly true in the out of hours period and (iii) They felt that better access would likely lead to more appropriate selection of care pathways. Decisions regarding the most appropriate care for patients presenting to the ambulance service are best informed by access to accurate and complete health information and records. An understanding of patients' pre-existing medical conditions, recent treatments and health information is needed for the selection of the most appropriate care; this information is often difficult to obtain in the ambulance service setting.
Ojha, Heidi A; Kern, Rebecca W; Lin, Chien-Ho Janice; Winstein, Carolee J
Approximately 75% of all injury-producing falls on steps for people of all ages occur in people 65 years of age and older. Diminished attentional capacity contributes to fall risk in older adults, particularly when task demands are high. The purpose of this study was to compare the attentional demands of ascending and descending a set of stairs (stair ambulation) in older adults and younger adults. This was a nonblinded, prospective, single-site, observational cohort study. Ten older (>65 years of age) and 10 younger (21-33 years of age) adults without disabilities were recruited. A dual-task approach was used for 2 task conditions: the first task was standing and responding verbally to an unanticipated auditory tone as quickly as possible (probe task), and the second task was ascending or descending a set of stairs with the same probe task. A 2-factor (group x task) analysis of variance with repeated measures on task (standing and stair ambulation) was performed for voice response time (VRT). Significance for the analysis was set at Ptask interaction was significant for VRT. Post hoc analyses indicated that during stair ambulation, the VRT for older adults was significantly longer than that for younger adults. For the standing task, the VRTs (X+/-SD) were similar for younger (322+/-65 milliseconds) and older (306+/-22 milliseconds) participants. For stair ascent and descent, the average VRTs were more than 100 milliseconds longer for older participants (493+/-113 and 470+/-127 milliseconds, respectively) than for younger participants (365+/-56 and 356+/-67 milliseconds, respectively). Because of the small sample size and generally fit older group, generalization of findings to older people at risk for falls is not recommended until further research is done. The results demonstrated that although both older and younger adults required similar attentional resources for the standing task, older adults required significantly more resources during stair ambulation. The
Beseler, MR; Rubio, C; Duarte, E; Hervás, D; Guevara, MC; Giner-Pascual, M; Viosca, E
MR Beseler,1 C Rubio,1 E Duarte,1 D Hervás,2 MC Guevara,1 M Giner-Pascual,1 E Viosca1 1Physical Medicine and Rehabilitation, La Fe Hospital, Valencia, Spain; 2Statistical Unit, La Fe Hospital, Valencia, Spain Background: Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients. Methods: A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old). Manual muscle ...
Yang, Yea-Ru; Tsai, Meng-Pin; Chuang, Tien-Yow; Sung, Wen-Hsu; Wang, Ray-Yau
This is a single blind randomized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke. Twenty subjects with stroke were assigned randomly to either the control group (n=9) or the experimental group (n=11). Subjects in the control group received the treadmill training. Subjects in the experimental group underwent the virtual reality-based treadmill training. Walking speed, community walking time, walking ability questionnaire (WAQ), and activities-specific balance confidence (ABC) scale were evaluated. Subjects in the experimental group improved significantly in walking speed, community walking time, and WAQ score at posttraining and 1-month follow-up periods. Their ABC score also significantly increased at posttraining but did not maintain at follow-up period. Regarding the between-group comparisons, the experimental group improved significantly more than control group in walking speed (P=0.03) and community walking time (P=0.04) at posttraining period and in WAQ score (P=0.03) at follow-up period. Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke.
Wijsman, Carolien A; van Heemst, Diana; Hoogeveen, Evelien S; Slagboom, P Eline; Maier, Andrea B; de Craen, Anton J M; van der Ouderaa, Frans; Pijl, Hanno; Westendorp, Rudi G J; Mooijaart, Simon P
Glucose metabolism marks health and disease and is causally inferred in the aging process. Ambulant continuous glucose monitoring provides 24-h glucose rhythms under daily life conditions. We aimed to describe ambulant 24-h glucose rhythms measured under daily life condition in relation to calendar and biological age in apparently healthy individuals. In the general population and families with propensity for longevity, we studied parameters from 24-h glucose rhythms; glucose levels; and its variability, obtained by continuous glucose monitoring. Participants were 21 young (aged 22-37 years), 37 middle-aged (aged 44-72 years) individuals from the general population, and 26 middle-aged (aged 52-74 years) individuals with propensity for longevity. All were free of diabetes. Compared with young individuals, middle-aged individuals from the general population had higher mean glucose levels (5.3 vs. 4.7 mmol L(-1) , P rhythms depending on calendar and biological age. © 2012 The Authors Aging Cell © 2012 Blackwell Publishing Ltd/Anatomical Society of Great Britain and Ireland.
Brand, T; Slob, A K
The validity of the hypothesis put forward earlier, that testicular secretions during puberty have an organizing effect on open field ambulation was examined. Male rats were castrated or sham-operated at days 21, 43 or 70. At the age of 17 weeks the males were tested in an automated, octagonal open field (3 consecutive days, 3 min/day) for locomotor activity. Male rats castrated at day 21 or day 43 ambulated more than sham-castrated controls. Males castrated at day 70 did not differ from sham-castrated controls. It thus appears that pubertal testicular secretion(s) organize adult open field locomotor activity in male rats. From 18 weeks of age partner preference behavior was tested in the same open field apparatus with one adjacent cage containing an ovariectomized female and an opposite one containing an ovariectomized female brought into heat. The females in the adjacent cages were separated from the experimental males in the octagonal cage by wire mesh. Peripubertally castrated males did not show a clear-cut partner preference, whereas the intact males preferred the vicinity of the estrous female. There were no differences among the males castrated either before, during or after puberty. Testosterone treatment (crystalline T in silastic capsules) caused peripubertally castrated males to prefer the estrous female. Thus, adult partner preference behavior does not seem to be organized by peripubertal testicular androgens.
Full Text Available Aim: The purpose of this study was to determine the reasons for referral to the hospital and 112 emergency ambulance service uses patterns of the inmates and convicts in an E type prison. Material and Method: In this descriptive study, it was evaluated the prison records associated with referral to the hospital and 112 emergency ambulance service uses for one year in 2010- 2011. Of the statistical analysis, descriptive statistics, chi-square test and Fisher%u2019s Exact Test were used. Results: All inmates and convicts were man, the median of age was 30,0 (min 18- max 68 years and substance use was 34,5%. The number of prisoners were referred to the hospital 815, total referrals were 1491; (referrals ranged from one to six and most common in January; and according to frequency, reasons of the referral were eyes problems, musculoskeletal disorders and psychological problems. Emergency medical service was used for in medical causes (78,3%, accident, trauma and injuries (16,4%, suicide (5,3%. Discussion: Findings from the study show that prisoners are more likely to have suffered physical and mental health problems that compared to the rest of society and have significantly high substance use rates.
Somers, John M.; Halliday, Katharine E.; Chapman, Stephen
Humeral fracture in a non-ambulant infant younger than 1 year is suspicious for a non-accidental injury unless there is a credible accidental explanation. A previously unrecognised accidental mechanism was described in 1996 whereby a 5-month-old infant was rolled by a 3-year-old sibling from a prone to a supine position. To investigate the widely accepted view that an infant with limited mobility cannot sustain a fracture of the humerus by his or her own actions in the absence of the intervention of an external party. We present seven cases of non-ambulant infants between 4 and 7 months of age in whom an isolated humeral fracture was the only injury present. In each case the caregiver described the fracture occurring when the child rolled over, trapping the dependent arm, without the intervention of another party. There is no proof for this mechanism in the form of an independent witness or video recording. However, we propose that this mechanism is worthy of further consideration as a rare and unusual cause for the injury. Further study is required. (orig.)
Severinsen, Kaare; Jakobsen, Johannes K; Pedersen, Asger R; Overgaard, Kristian; Andersen, Henning
The aim of this study was to directly compare the effects of aerobic training (AT) with progressive resistance training (RT) after stroke to determine whether AT-induced fitness gains or RT-induced strength gains translate into improved ambulation across a 12-wk intervention and whether gains are retained 1 yr after cessation of formal training. This study is a randomized controlled 12-wk intervention trial with a 1-yr follow-up. Forty-three community-dwelling independent walkers with a chronic ischemic hemiparetic stroke were allocated to AT using a cycle ergometer (n = 13), RT using training machines (n = 14), or low-intensity sham training of the arms (n = 16). The main outcome measures were 6-min walk distance and fast 10-m walking speed. Comparisons between AT, RT, and sham training revealed no clinically relevant effects on walking velocity or walking distance. Muscle strength improved after RT (P muscle strength or aerobic capacity using non-task-specific training methods does not result in improved ambulation in patients with chronic stroke. Muscle strength gains were maintained at follow-up, whereas all improvements of aerobic capacity were lost, indicating a long-lasting effect of intensive RT even without maintenance training.
Somers, John M.; Halliday, Katharine E. [Nottingham University Hospitals, Radiology Department, Nottingham (United Kingdom); Chapman, Stephen [Birmingham Children' s Hospital, Birmingham (United Kingdom)
Humeral fracture in a non-ambulant infant younger than 1 year is suspicious for a non-accidental injury unless there is a credible accidental explanation. A previously unrecognised accidental mechanism was described in 1996 whereby a 5-month-old infant was rolled by a 3-year-old sibling from a prone to a supine position. To investigate the widely accepted view that an infant with limited mobility cannot sustain a fracture of the humerus by his or her own actions in the absence of the intervention of an external party. We present seven cases of non-ambulant infants between 4 and 7 months of age in whom an isolated humeral fracture was the only injury present. In each case the caregiver described the fracture occurring when the child rolled over, trapping the dependent arm, without the intervention of another party. There is no proof for this mechanism in the form of an independent witness or video recording. However, we propose that this mechanism is worthy of further consideration as a rare and unusual cause for the injury. Further study is required. (orig.)
N. F. Plavunov
Full Text Available Over the last years the incidence of cardiovascular diseases had increased in Russian Federation. In a period of 2010-2014 y. the number of patients diagnosed hypertension increased by 16,8% (139,5 thousand patients. High prevalence of hypertension leads to different cardiac complications that could be responsible for death. Hypertension is a major risk factor for ischemic heart disease and stroke, increases the risk in 3-4 times, and therefore one of the most important causes of morality. The major cause that required emergency hospitalization in adult population was estimated to be cardiovascular diseases (23,9%, including ischemic heart disease (10,7%, cerebrovascular diseases (6%, and diseases attributable to high blood pressure (3,3%. We studied 1 605 374 (9,6% emergency ambulance calls to patients with high blood pressure during the period of 6 month (2015 y. . In 16,1% cases emergency service calls were related to hypertensive crisis and 1,45% of patients needed emergency evacuation. We determined that in 7,2% cases patients with high blood pressure called for emergency service again during 24 hours period. Among this group of patients the percent of hypertensive crisis and evacuation was higher — 19,4% and 4,1% respectively. Also we identified that in 59,5% cases the diagnosis was hypertensive disease. We determined that majority of frequent ambulance callers were elderly persons.
Dwyer, R; Gabbe, B; Tran, T D; Smith, K; Lowthian, J A
to examine demand for emergency ambulances by older people. retrospective cohort study using secondary analysis of routinely collected clinical and administrative data from Ambulance Victoria, and population data from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. Victoria, Australia. people aged 65 years and over, living in Residential Aged Care Facilities (RACF) and the community, attended by emergency ambulance paramedics, 2009-13. rates of emergency ambulance attendance. older people living in RACF experienced high rates of emergency ambulance attendance, up to four times those for age- and sex-matched people living in the community. Rates remained constant during the study period equating to a consistent, 1.45% average annual increase in absolute demand. Rates peak among the 80-84-year group where the number of attendances equates to greater than one for every RACF-dwelling person each year. Increased demand was associated with winter months, increasing age and being male. these data provide strong evidence of high rates of emergency ambulance use by people aged 65 years and over living in RACF. These results demonstrate a clear relationship between increased rate of ambulance use among this vulnerable group of older Australians and residence, sex, age and season. Overall, absolute demand continues to increase each year adding to strain on health resources. Additional research is needed to elucidate individual characteristics, illness and health system contributors to ambulance use to inform strategies to appropriately reduce demand.
Kressler, Jochen; Wymer, Tracie; Domingo, Antoinette
To investigate the effects of overground bionic ambulation with variable assistance on cardiorespiratory and metabolic responses in persons with motor-incomplete spinal cord injury. Case series. Four participants with chronic, motor-incomplete spinal cord injury. Subjects completed a maximal graded exercise test on an arm-ergometer and 3 6-min bouts of overground bionic ambulation using different modes of assistance, i.e. Maximal, Adaptive, Fixed. Cardiorespiratory (oxygen consumption) and metabolic (caloric expenditure and substrate utilization) measures were taken using a mobile metabolic cart at each overground bionic ambulation assistance. Cardiorespiratory responses ranged from low (24% VO2peak) for the least impaired and fittest individual to supramaximal (124% VO2peak) for the participant with the largest impairments and the lowest level of fitness. Different overground bionic ambulation assistive modes elicited small (3-8% VO2peak) differences in cardiorespiratory responses for 3 participants. One participant had a large (28% VO2peak) difference in cardiorespiratory responses to different modes of overground bionic ambulation. Metabolic responses mostly tracked closely with cardiorespiratory responses. Total energy expenditure ranged from 1.39 to 7.17 kcal/min. Fat oxidation ranged from 0.00 to 0.17 g/min across participants and different overground bionic ambulation modes. Overground bionic ambulation with variable assistance can substantially increase cardiorespiratory and metabolic responses; however, these responses vary widely across participants and overground bionic ambulation modes.
Full Text Available Objective: To investigate the effects of overground bionic ambulation with variable assistance on cardiorespiratory and metabolic responses in persons with motor-incomplete spinal cord injury. Design: Case series. Subjects: Four participants with chronic, motor-incomplete spinal cord injury. Methods: Subjects completed a maximal graded exercise test on an arm-ergometer and 3 6-min bouts of overground bionic ambulation using different modes of assistance, i.e. Maximal, Adaptive, Fixed. Cardiorespiratory (oxygen consumption and metabolic (caloric expenditure and substrate utilization measures were taken using a mobile metabolic cart at each overground bionic ambulation assistance. Results: Cardiorespiratory responses ranged from low (24% VO2peak for the least impaired and fittest individual to supramaximal (124% VO2peak for the participant with the largest impairments and the lowest level of fitness. Different overground bionic ambulation assistive modes elicited small (3–8% VO2peak differences in cardiorespiratory responses for 3 participants. One participant had a large (28% VO2peak difference in cardiorespiratory responses to different modes of overground bionic ambulation. Metabolic responses mostly tracked closely with cardiorespiratory responses. Total energy expenditure ranged from 1.39 to 7.17 kcal/min. Fat oxidation ranged from 0.00 to 0.17 g/min across participants and different overground bionic ambulation modes. Conclusion: Overground bionic ambulation with variable assistance can substantially increase cardiorespiratory and metabolic responses; however, these responses vary widely across participants and overground bionic ambulation modes.
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Office of Personnel Management responsibilities. 250.202 Section 250.202 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT IN AGENCIES Strategic Human Capital Management § 250.202 Office of Personnel...
Sjölin, Helena; Lindström, Veronica; Hult, Håkan; Ringsted, Charlotte; Kurland, Lisa
In Sweden, ambulances must be staffed by at least one registered nurse. Twelve universities offer education in ambulance nursing. There is no national curriculum for detailed course content and there is a lack of knowledge about the educational content that deals with the ambulance nurse practical professional work. The aim of this study was to describe the content in course curricula for ambulance nurses. A descriptive qualitative research design with summative content analysis was used. Data were generated from 49 courses in nursing and medical science. The result shows that the course content can be described as medical, nursing and contextual knowledge with a certain imbalance with largest focus on medical knowledge. There is least focus on nursing, the registered nurses' main profession. This study clarifies how the content in the education for ambulance nurses in Sweden looks today but there are reasons to discuss the content distribution. Copyright © 2014 Elsevier Ltd. All rights reserved.
Dear Colleagues, Many important discussions are scheduled for the upcoming Council Week (13-17 June) on topics including the Medium-Term Plan, the Pension Fund and other matters of great relevance to us. I would therefore like to share the main outcome of the week with you and I invite you to join me and the Directors in the Main Auditorium at 10 a.m. on Thursday 23 June. The meeting will last about one hour and a webcast will also be available. Best regards, Fabiola Gianotti DG presentation to personnel Thursday 23 June at 10 am Main Auditorium Retransmission in Council Chamber, IT Auditorium, Kjell Jonhsen Auditorium, Prevessin 864-1-C02 Webcast on cern.ch/webcast More information on the event page.
Poole, D.E.; Ring, T.
The personnel safety system designed for the SRS at Daresbury is a unified system covering the three accelerators of the source itself, the beamlines and the experimental stations. The system has also been applied to the experimental areas of the Nuclear Structure Facility, and is therefore established as a site standard. A dual guardline interlock module forms a building block for a relay based interlock system completely independent of the machine control system, although comprehensive monitoring of the system status via the control system computer is a feature. An outline of the design criteria adopted for the system is presented together with a more detailed description of the philosophy of the guardline logic and the way this is implemented in a standard modular form. The emphasis is on the design features of a modern microprocessor based variant of the original SRS system. Experience with the original system during build-up and operation of the SRS facility is described. 2 refs., 4 figs
Roberson, P.L.; Fox, R.A.; Hadley, R.T.; Holbrook, K.L.; Hooker, C.D.; McDonald, J.C.
A base of technical information has been acquire and used to evaluate the calibration, design, and performance of selected personnel systems in use at Department of Energy (DOE) facilites. A technical document was prepared to guide DOE and DOE contractors in selecting and evaluating personnel dosimetry systems and calibration. A parallel effort was initiated to intercompare the adiological calibrations standards used to calibrate DOE personnel dosimeters
Raaber, Nikolaj; Duvald, Iben; Riddervold, Ingunn; Christensen, Erika F; Kirkegaard, Hans
Emergency departments (ED) recognize crowding and handover from prehospital to in-hospital settings to be major challenges. Prehospital Geographical Information Systems (GIS) may be a promising tool to address such issues. In this study, the use of prehospital GIS data was implemented in an ED in order to investigate its effect on 1) wait time and unprepared activations of Trauma Teams (TT) and Medical Emergency Teams (MET) and 2) nurses' perceptions regarding patient reception, workflow and resource utilization. From May 1st 2014 to October 31th 2014, GIS data was displayed in the ED. Data included real-time estimated time of arrival, distance to ED, dispatch criteria, patient data and ambulance contact information. Data was used by coordinating nurses for time activation of TT and MET involved in the initial treatment of severely-injured or critically-ill patients. In addition, it was used as a logistics tool for handling all other patients transported by ambulance to the ED. The study followed a mixed-methods design, consisting of a quantitative study (before and after intervention) and a qualitative study (survey and interviews). Participants included all patients received by TT or MET and coordinating nurses in the ED. 1.) Quantitative: 599 patients were included. The median wait time for TT and MET was 5 min both before and after the GIS intervention, showing no difference (p = 0.18). A significant reduction in the subgroup of waits >10 min was found (p GIS data as a tool to optimize resource utilization and quality of all patients' reception, critically or non-critically ill. No substantial disadvantages were reported. The contradiction of measured median wait time and nurses perceived improved timing of team activation may result from having both RT- ETA and supplemental patient information not only for seriously-injured or critically-ill patients received by the TT and MET, but for all patients transported by ambulance. The reduction in waits > 10
Jyoti V. Dube
Full Text Available Background: Caesarean section has been a part of human culture since ancient times. It has been used effectively throughout the 20th century and among the major abdominal surgeries, it is the most common, oldest worldwide surgery performed in obstetrics. Despite the life saving advantages, there are several adverse consequences of caesarean delivery for a woman and to her household. The rate and risk of these complications increases due to the increasing incidence mainly in countries like India. The role of nurse midwife is to act in the best interest of patient and newborn and make the patient independent in carrying out the activities of daily living as soon as possible. This can lead to a faster recovery and shorter hospital stay. Also it can indirectly help in reducing the complications associated with prolonged bed rest and can improve the maternal newborn bonding. Aim and Objectives: The present study was done to evaluate the effect of planned early ambulation on selected biophysiological health parameters of post caesarean patients. Material and Methods: The study included total 500 study subjects, 250 in experimental and 250 in control group. Quasi experimental approach with multiple time series design was adopted for the study. The experimental group was given an early planned recommended ambulation technique starting from the day of surgery. This consisted of deep breathing exercise, cough exercise, leg exercise and early mobilization. Over and above, the routine general health care was given by the doctors and nurses. The control group received only by routine general care by doctors and nurses and mobilization on third post operative day as per strategy adopted by the hospital. The deep breathing exercises, coughing exercises and leg exercises were not given routinely and hence were not given to the control group. Post caesarean biophysiological parameters chart was used to assess the selected parameters for first five post operative
Social Security Administration — SSA provides the Office of Personnel Management (OPM) with tax returns, Social Security benefits, and military retirement information for the purpose of correctly...
.... It implements policy, establishes uniform DoD-wide procedures, provides guidelines and model programs, delegates authority, and assigns responsibilities regarding civilian personnel management within...
Sapronov, V.G.; Issupov, V.I.
Khmelnitsky nuclear power plant personnel training system improvement is described, including creation of Training center, development of training courses based on SAT methodology, development of training hardware
Included are comments and statistics on current employment levels, projected requirements for future stations, sources of personnel for current and projected stations, and methods of employee selection
Kristensen, Morten Tange; Andersen, Lene; Bech-Jensen, Rie
OBJECTIVE: To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture. DESIGN: An intertester reliability study...
Sommers, Juultje; Wieferink, Denise C.; Dongelmans, Dave A.; Nollet, Frans; Engelbert, Raoul H. H.; van der Schaaf, Marike
Purpose: Early mobilisation is advocated to improve recovery of intensive care unit (ICU) survivors. However, severe weakness in combination with tubes, lines and machinery are practical barriers for the implementation of ambulation with critically ill patients. The aim of this study was to explore
Jorge Luis Alvarado‐Socarras
Conclusions: Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation to obtain good clinical outcomes according type of ambulance.
Knorth, Erik J; Knot-Dickscheit, Jana; Tausendfreund, Tim; Schulze, Gisela C; Strijker, Johan
The enhancement of community-based, ambulant care for children with serious behavioural problems (in German: "Ambulantisierung") implies supporting them as long as possible in their own family environment. One tries to avoid an out-of-home placement. This policy, strongly underlined during the last
Foss, Nicolai B; Kristensen, Morten Tange; Jensen, Pia Søe
BACKGROUND: Perioperative anemia leads to increased morbidity and mortality and potentially inhibits rehabilitation after hip fracture surgery. As such, the optimum transfusion threshold after hip fracture surgery is unknown. PATIENTS AND METHODS: A total of 120 elderly, cognitively intact hip...... fracture patients admitted from their own home were randomly assigned to receive transfusion at a hemoglobin threshold of 10.0 g per dL (liberal) versus 8.0 g per dL (restrictive) in the entire perioperative period. Patients were treated according to a well-defined multimodal rehabilitation program....... Primary outcome was postoperative functional mobility measured with the cumulated ambulation score (CAS). RESULTS: Patients in the liberal group received transfusions more frequently than those in the restrictive group (44 patients vs. 22 patients; p transfusions during...
Gait analysis systems are widely used for the assessment of gait disabilities and provide more accurate and detailed information than clinical tests. Scores and indexes have been proposed to summarize the large volume of data produced, each emphasizing different aspects of gait. Based on specific spatiotemporal parameters, the Functional Ambulation Performance Score (FAPS) quantifies gait at a self-selected speed. Integrated within electronic walkways, the FAPS is commonly used for clinical evaluations and has been used in an increasing number of publications over the past few years. However, its use is sometimes distorted by misunderstandings of its composition and calculation, practical and/or conceptual limits, and even the meaning of the score. This technical report reviews the use of the FAPS for the evaluation of gait based on peer-reviewed articles and clinical experience and addresses important issues that must be considered for an optimal unbiased understanding and analysis of the score.
Encheff, Jenna L; Armstrong, Charles; Masterson, Michelle; Fox, Christine; Gribble, Phillip
This study investigated the effects of a 10-week hippotherapy program on trunk, pelvis, and hip joint positioning during the stance phase of gait. Eleven children (6 boys and 5 girls; 7.9 ± 2.7 years) with neurological disorders and impaired ambulation participated. Joint range of motion data were collected via 3-dimensional computerized gait analysis before and after the program. Paired t tests were performed on kinematic data for each joint. Significant improvements (P ≤ .008) and large effect sizes (ESs) for sagittal plane hip positions at initial contact and toe-off were found. No differences in pelvic or trunk positioning were determined, although sagittal plane pelvic positioning displayed a trend toward improvement with large ESs. Several trunk variables displayed moderate ESs with a trend toward more upright positioning. Improvements in pelvic and hip joint positioning and more normalized vertical trunk position may indicate increased postural control during gait after 10 sessions of hippotherapy.
James Robert Langabeer
Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.
Full Text Available We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009–2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs, in which the conditions for the emergency calls were made coded I.10–I.15. The Kaunas Weather Station provided daily records of air temperature (T, wind speed (WS, relative humidity, and barometric pressure (BP. We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS > 600 km/s increased the daily number of elevated arterial blood pressure (EABP by 12% (RR = 1.12; 95% confidence interval (CI 1.04–1.21; and WS ≥ 3.5 knots during days of T < 1.5 °C and T ≥ 12.5 °C by 8% (RR = 1.08; CI 1.04–1.12. An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T ≥ 17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population’s sensitivity to different weather conditions.
Lin, Chih-Hao; Kao, Chung-Yao; Huang, Chong-Ye
Ambulance diversion (AD) is considered one of the possible solutions to relieve emergency department (ED) overcrowding. Study of the effectiveness of various AD strategies is prerequisite for policy-making. Our aim is to develop a tool that quantitatively evaluates the effectiveness of various AD strategies. A simulation model and a computer simulation program were developed. Three sets of simulations were executed to evaluate AD initiating criteria, patient-blocking rules, and AD intervals, respectively. The crowdedness index, the patient waiting time for service, and the percentage of adverse patients were assessed to determine the effect of various AD policies. Simulation results suggest that, in a certain setting, the best timing for implementing AD is when the crowdedness index reaches the critical value, 1.0 - an indicator that ED is operating at its maximal capacity. The strategy to divert all patients transported by ambulance is more effective than to divert either high-acuity patients only or low-acuity patients only. Given a total allowable AD duration, implementing AD multiple times with short intervals generally has better effect than having a single AD with maximal allowable duration. An input-throughput-output simulation model is proposed for simulating ED operation. Effectiveness of several AD strategies on relieving ED overcrowding was assessed via computer simulations based on this model. By appropriate parameter settings, the model can represent medical resource providers of different scales. It is also feasible to expand the simulations to evaluate the effect of AD strategies on a community basis. The results may offer insights for making effective AD policies. Copyright © 2012. Published by Elsevier B.V.
Røislien, Jo; van den Berg, Pieter L; Lindner, Thomas; Zakariassen, Erik; Aardal, Karen; van Essen, J Theresia
Helicopter emergency medical services are an important part of many healthcare systems. Norway has a nationwide physician staffed air ambulance service with 12 bases servicing a country with large geographical variations in population density. The aim of the study was to estimate optimal air ambulance base locations. We used high resolution population data for Norway from 2015, dividing Norway into >300 000 1 km×1 km cells. Inhabited cells had a median (5-95 percentile) of 13 (1-391) inhabitants. Optimal helicopter base locations were estimated using the maximal covering location problem facility location optimisation model, exploring the number of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, both in green field scenarios and conditioning on the current base structure. We reanalysed on municipality level data to explore the potential information loss using coarser population data. For a 45 min threshold, 90% of the population could be covered using four bases, and 100% using nine bases. Given the existing bases, the calculations imply the need for two more bases to achieve full coverage. Decreasing the threshold to 30 min approximately doubles the number of bases needed. Results using municipality level data were remarkably similar to those using fine grid information. The whole population could be reached in 45 min or less using nine optimally placed bases. The current base structure could be improved by moving or adding one or two select bases. Municipality level data appears sufficient for proper analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Goemans, Nathalie; Lowes, Linda P.; Alfano, Lindsay N.; Berry, Katherine; Shao, James; Kaye, Edward M.; Mercuri, Eugenio; Hamid, Hoda Abdel; Byrne, Barry J.; Connolly, Anne M.; Dracker, Robert A.; Matthew Frank, L.; Heydemann, Peter T.; O'Brien, Kevin C.; Sparks, Susan E.; Specht, Linda A.; Rodino‐Klapac, Louise; Sahenk, Zarife; Al‐Zaidy, Samiah; Cripe, Linda H.; Lewis, Sarah; M, Pane; E, Mazzone; S, Messina; GL, Vita; Bertini, D Amico A; Casimiro, Berardinelli A; Y, Torrente; F, Magri; GP, Comi; G, Baranello; T, Mongini; A, Pini; R, Battini; E, Pegoraro; C, Bruno; L, Politano; S, Previtali
Objective To continue evaluation of the long‐term efficacy and safety of eteplirsen, a phosphorodiamidate morpholino oligomer designed to skip DMD exon 51 in patients with Duchenne muscular dystrophy (DMD). Three‐year progression of eteplirsen‐treated patients was compared to matched historical controls (HC). Methods Ambulatory DMD patients who were ≥7 years old and amenable to exon 51 skipping were randomized to eteplirsen (30/50mg/kg) or placebo for 24 weeks. Thereafter, all received eteplirsen on an open‐label basis. The primary functional assessment in this study was the 6‐Minute Walk Test (6MWT). Respiratory muscle function was assessed by pulmonary function testing (PFT). Longitudinal natural history data were used for comparative analysis of 6MWT performance at baseline and months 12, 24, and 36. Patients were matched to the eteplirsen group based on age, corticosteroid use, and genotype. Results At 36 months, eteplirsen‐treated patients (n = 12) demonstrated a statistically significant advantage of 151m (p < 0.01) on 6MWT and experienced a lower incidence of loss of ambulation in comparison to matched HC (n = 13) amenable to exon 51 skipping. PFT results remained relatively stable in eteplirsen‐treated patients. Eteplirsen was well tolerated. Analysis of HC confirmed the previously observed change in disease trajectory at age 7 years, and more severe progression was observed in patients with mutations amenable to exon skipping than in those not amenable. The subset of patients amenable to exon 51 skipping showed a more severe disease course than those amenable to any exon skipping. Interpretation Over 3 years of follow‐up, eteplirsen‐treated patients showed a slower rate of decline in ambulation assessed by 6MWT compared to untreated matched HC. Ann Neurol 2016;79:257–271 PMID:26573217
Full Text Available Objective: Emergency departments are the first places to which patients present with unexpected or unforeseen health problems. The purpose of this study was to assess the urgency of cases brought by ambulance to the Hospital on the basis of a three-level triage system. Methods: This study was performed between 01.06.2013 and 31.09.2013 at the Diyarbakır Education and Research Hospital. Our emergency service unit is a third degree service for all adult patient groups and all child trauma types. Triage of patients brought to the emergency department by ambulance was performed by emergency medicine specialists. Patients’ vital findings, identity data and triage categories were assessed. Results: 712 patients were included, 382 (53.7% male and 330 (46.3% female, with a mean age of 45. In this study, 619 (86.9% patients were transferred from the scene and 93 (13.1 between hospitals, 483 (67.8% patients were brought by emergency medicine technician (EMT teams, 107 (15% by physician-led teams, 107 (15 by paramedic teams and 15 (2.1% by other teams, 442 (62.1% patients were assessed as yellow, 141 (19.8% as green and 129 (19.1% as red zone. Five hundred eighty (81.5% patients were discharged and 115 (15.9% were hospitalized. Conclusion: Emergency health services are clearly developing rapidly in Turkey. In order for pre-hospital emergency health services not to be abused, we think that these services should be up to the standards of those in developed countries and that public awareness needs to be increased, particularly with regard to triage. J Clin Exp Invest 2015; 6 (2: 126-129
Polanco-González, Carlos; Castañón-González, Jorge Alberto; Villanueva-Martínez, Sebastián; Samaniego-Mendoza, José Lino; Buhse, Thomas
In most places all over the world–including our country–services in emergency rooms are oversaturated. This situation frequently forces the continuously arriving ambulances to be redirected to other medical units, delaying the admission of patients moved and thus adversely affecting their physical condition. To introduce an improvement to the Índicede Saturación Modificado computational system, which monitors the degree of saturation of a network of emergency medical services, to include a network of ambulances, enabling in the system: (i) the effective allocation of ambulances to the site of the accident, or severe clinical event, and (ii) the remote booking of beds in the nearest and least saturated emergency room available. The evaluation and connectivity of the computational improvement to the Índicede Saturación Modificado system was carried out with a computational test verifying these two aspects, using only differences in postal codes, for time measuring. The verification of its sustainability online showed the new Índice de Saturación Modificado y Ambulancias system (ISMA) has a robust structure capable of being adapted to mobile phones, laptops or tablets, and can efficiently administrate: (i) the quantification of excessive demand in the emergency room services of a hospital network, (ii) the allocation of ambulances attending the site of the event or contingency, and (iii) the allocation of ambulances and patients, in the best distance-time conditions, from the site of the accident or clinical event to the nearest and least saturated emergency room service. This administrative management tool is efficient and simple to use, and it optimally relates independent service networks.
Abrams, Darryl C; Brenner, Keith; Burkart, Kristin M; Agerstrand, Cara L; Thomashow, Byron M; Bacchetta, Matthew; Brodie, Daniel
Acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring invasive mechanical ventilation (IMV) are associated with significant morbidity and mortality. Extracorporeal carbon dioxide removal (ECCO₂R) may facilitate extubation and ambulation in these patients and potentially improve outcomes. We assessed the feasibility of achieving early extubation and ambulation in subjects requiring IMV for exacerbations of COPD using single-site ECCO₂R. Five subjects with exacerbations of COPD with uncompensated hypercapnia requiring IMV were enrolled in this single-center, prospective, feasibility trial using a protocol of ECCO₂R, extubation, and physical rehabilitation. The primary endpoint was extubation within 72 hours of starting ECCO₂R. Mean preintubation pH and PaCO₂ were 7.23 ± 0.05 and 81.6 ± 15.9 mm Hg, respectively. All subjects met the primary endpoint (median duration, 4 h; range, 1.5-21.5 h). Mean duration of extracorporeal support was 193.0 ± 76.5 hours. Mean time to ambulation after extracorporeal initiation was 29.4 ± 12.6 hours. Mean maximal ambulation on extracorporeal support was 302 feet (range, 70-600). Four subjects were discharged home, and one underwent planned lung transplantation. Two minor bleeding complications occurred. There were no complications from mobilization on extracorporeal support. ECCO₂R facilitates early extubation and ambulation in exacerbations of COPD requiring IMV and has the potential to serve as a new paradigm for the management of a select group of patients. Rigorous clinical trials are needed to corroborate these results and to investigate the effect on long-term outcomes and cost effectiveness over conventional management.
The principal contributions to the radiation doses of the Swedish power reactor personnel are identified. The possi bilities to reduce these doses are examined. The radiation doses are analyzed according to different personnel categories, specific maintenance operations or inspections and to different radiation activities. Suggestions are given for reducing the radiation doses. (L.E.)
... Department of the Army 32 CFR Part 513 Indebtedness of Military Personnel AGENCY: Department of the Army, DoD. ACTION: Final rule; removal. SUMMARY: This action removes regulations concerning indebtedness of military... CFR Part 112, ``Indebtedness of Military Personnel,'' and DoD Financial Management Review (FMR...
Lievens, F.; van Dam, K.; Anderson, N.
The aim of this article is to identify recent developments in personnel selection and to review existing research with regard to these recent developments. To this end, 26 human resource representatives were asked to list current or future trends in personnel selection. In addition, existing
MacLean, Douglas G.
The personnel function of top management is examined by first studying the environment in which top management functions. The basic skills required to perform the function are discussed. Against this background, six elements of personnel management in colleges and universities are considered: goals and objectives, organization for personnel…
Civil Service Commission, Denver, CO. Regional Training Center.
This manual for the introductory Federal personnel management course covers: major personnel laws and sources of information; position classification (standards and task analysis); staffing and placement (competitive appointments, temporary appointments/promotions, recruitment, and noncompetitive actions); merit promotion; qualification standards;…
... 34 Education 2 2010-07-01 2010-07-01 false Personnel development. 300.207 Section 300.207 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION... CHILDREN WITH DISABILITIES Local Educational Agency Eligibility § 300.207 Personnel development. The LEA...
Full Text Available This article deals with transition way of economic of the Russian Federation on an innovative way of development. The special attention is given the internal social and economic environment of the organizations which, as a rule, counteracts development of innovative activity of the personnel. Ways of increase of innovative activity of the personnel are offered.
... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Personnel training. 154.840... Personnel training. (a) A person in charge of a transfer operation utilizing a vapor control system must have completed a training program covering the particular system installed at the facility. Training...
Plat, Marie-Christine J.; Westerveld, Gre J.; Hutter, Renée C.; Olff, Miranda; Frings-Dresen, Monique H. W.; Sluiter, Judith K.
This study i) describes the number of police personnel with PTSD who are working and those who are on sick leave before and after an out-patient-clinic treatment program and ii) examines which factors are related to return to work. Police personnel treated for PTSD (n=121). In this retrospective
... 10 Energy 1 2010-01-01 2010-01-01 false Personnel monitoring. 39.65 Section 39.65 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety... dosimeters replaced at least quarterly. After replacement, each personnel dosimeter must be promptly...
Binger, Cathy; Ball, Laura; Dietz, Aimee; Kent-Walsh, Jennifer; Lasker, Joanne; Lund, Shelley; McKelvey, Miechelle; Quach, Wendy
Completing an augmentative and alternative communication (AAC) assessment is a complex process that involves many stakeholders and professionals. To help clarify professional roles and provide assessment guidelines, an AAC Assessment Personnel Framework was developed. This framework was adapted from the work of Beukelman, Ball, and Fager in 2008, which focused on general AAC needs (not just assessment) and concentrated specifically on adults. In contrast, the present model examines the assessment process for all individuals who require AAC. The following AAC assessment personnel are discussed: AAC finders, general practice SLPs, AAC clinical specialists, facilitators and communication partners, collaborating professionals, AAC research and policy specialists, manufacturers and vendors, funding agencies and personnel, and AAC/assistive technology agencies and personnel. Current barriers for successful assessment outcomes are discussed, and suggestions for addressing personnel-related barriers are explored.
Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio
The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between -20 and 4 (mean -4.4). The mean changes were -3.79 in the glucocorticoid group, -5.52 in those who stopped at loss of ambulation and -4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Office of Personnel Management adjudication. 300.706 Section 300.706 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT (GENERAL) Statutory Bar to Appointment of Persons Who Fail To Register Under Selective Service Law § 300.706 Office of Personnel...
Booker, Matthew J; Purdy, Sarah; Shaw, Alison R G
To understand the reasons behind, and experience of, seeking and receiving emergency ambulance treatment for a 'primary care sensitive' condition. A comprehensive, qualitative systematic review. Medline, Embase, PsychInfo, Cumulative Index of Nursing and Allied Health, Health Management Information Systems, Healthcare Management Information Consortium, OpenSigle, EThOS and Digital Archive of Research Theses databases were systematically searched for studies exploring patient, carer or healthcare professional interactions with ambulance services for 'primary care sensitive' problems. Studies using wholly qualitative approaches or mixed-methods studies with substantial use of qualitative techniques in both the methods and analysis sections were included. An analytical thematic synthesis was undertaken, using a line-by-line qualitative coding method and a hierarchical inductive approach. Of 1458 initial results, 33 studies met the first level (relevance) inclusion criteria, and six studies met the second level (methodology and quality) criteria. The analysis suggests that patients define situations worthy of 'emergency' ambulance use according to complex socioemotional factors, as well as experienced physical symptoms. There can be a mismatch between how patients and professionals define 'emergency' situations. Deciding to call an ambulance is a process shaped by practical considerations and a strong emotional component, which can be influenced by the views of caregivers. Sometimes the value of a contact with the ambulance service is principally in managing this emotional component. Patients often wish to hand over responsibility for decisions when experiencing a perceived emergency. Feeling empowered to take control of a situation is a highly valued aspect of ambulance care. When responding to a request for 'emergency' help for a low-acuity condition, urgent-care services need to be sensitive to how the patient's emotional and practical perception of the situation
Organization of monitoring of overalls and personnel skin contamination wastes is considered. The devices used for this purpose are enumerated. In sanitary sluices through which the personnel leaving the repair zone it is recommended to particularly thoroughly control hand skin contamination and most contaminated parts of overalls (sleeves, breeches lower parts, pockets, stomack region). In sanitary check points during personnel leaving the operator zone monitoring of overalls and skin contamination is performed. The overalls and other individual protective clothing are subjected to control in a special loundry before and after washing (decontamination) [ru
Muehleisen, R. [Alfred Kaercher Gmbh and Co., Winnenden (Germany)
Nuclear decontamination of personnel and material has to be carried out immediately after any contaminating incident. A safe decontamination will only be successful when a suitable decontamination system and effective decontamination agent are used. The aim hereby is, that personnel will not suffer from any acute somatic or late somatic effect and that material can be re-used again without any protective devices. Test results have shown, that personnel decontamination is more effective today due to new technologies. Also material decontamination, nowadays carried out with hot foam and high pressure units improves the deradiation result.
Villarreal, Manuel; Leach, Jonathan; Ngianga-Bakwin, Kandala; Dale, Jeremy
Emergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department(ED) . The service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria. GPs supported the assessment of such patients either at scene or by telephone. Routine data were collected from October 2012 to November 2013, from the ambulance service computer-aided dispatch system. Logistic regression models were used to determine the likelihood for patients being transported to ED. Of 23 395 emergency contacts during the evaluation period, 1903 (8.1 %) patients were triaged to GP supported assessment. Mean age (SD) was 61.8 (27.9) years; 42.9 % were aged 75 years and over. 1221 (64.2%) had face-to-face GP assessment and 682 (35.8%) via telephone. 1500 (78%) of those who received GP support were not transported to hospital. After controlling for confounders, those aged greater than 75 years (OR 0.67; 95% CI 0.52 to 0.86), and females (OR 0.64; 95% CI 0.51 to 0.82) were less likely to be transported, while those who received GP telephone input rather than face-to-face assessment were more likely to be transferred to an ED (OR 2.14; 95% CI 1.69 to 2.72). Support of the paramedic service by GPs enabled patients to avoid transfer to an ED, potentially avoiding subsequent hospital admission, reducing costs and improving quality of care for patients that are not in need of hospital services. However, use of services in the days following the call was not assessed, and hence the overall impact and safety requires further evaluation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is
Office of Personnel Management — Precursor to the Enterprise Human Resources Integration-Statistical Data Mart (EHRI-SDM). It contains data about the employee and their position, along with various...
Social Security Administration — Each year the Office of Personnel Management (OPM) sends SSA a file to be verified and matched against the Master Earnings File (MEF) and Employer Information File...
McKinley, Richard L; Bjorn, Valerie S; Hall, John A
.... Normally, the source of the noise cannot be quieted without loss in performance. Therefore hearing protection is the primary tool to mitigate aviation personnel noise exposures during operations of aircraft...
Hurst, James C.; Ivey, Allen E.
This article is an attempt to diagnose basic issues of concern to students and to suggest new alternative programs for the future of student personnel based on the needs suggested by this diagnosis. (Author)
Domingues, Patricia M.
Examines literature to determine impact of foreign students on American campuses, reviews essentials necessary for providing effective services for them, speculates on future of advising them within realm of student personnel work. (Author)
US Agency for International Development — WebPass Explorer (WebPASS Framework): USAID is partnering with DoS in the implementation of their WebPass Post Personnel (PS) Module. WebPassPS does not replace...
Roberson, P.L.; Holbrook, K.L.
This guide describes minimum acceptable performance levels for personnel dosimetry systems used at Department of Energy (DOE) facilities. The goal is to improve both the quality of radiological calibrations and the methods of comparing reported occupational doses between DOE facilities. Reference calibration techniques are defined. A standard for evaluation of personnel dosimetry systems and recommended design parameters for personnel dosimeters are also included. Approximate intervals for the radiation energies for which these guidelines are appropriate are 15 keV to 2 MeV for photons; above 0.3 MeV for beta particles; and 1 keV to 2 MeV for neutrons. An analysis of ANSI N13.11 was completed using performance evaluations of selected personnel dosimetry systems in use at DOE facilities. The results of this analysis are incorporated in the guidelines
Hammond, Edward H.
Discusses sex discrimination and how it relates to student personnel work. Deals specifically with co-curricular activities that are a part of higher educational institutions, and examines pertinent court decisions. (HMV)
The ISO Standard 1757 ''Personnel Photographic Film Dosemeters'', issued in June 1980, is briefly described. UVVVR's own dosemeter developed for use in the national film dosimetry service in Czechoslovakia is evaluated in relation to this ISO Standard. (author)
Brueckel, S.; Schwarz, W.
The present personnel situation in large West Germany research establishments, reasons for and direction of mobility, a so-called status-quo-projection, and the influenceability of the situation are discussed. (HK/AK) [de
Alemdaroğlu, Ipek; Karaduman, Ayşe; Yilmaz, Öznur Tunca; Topaloğlu, Haluk
We investigated and compared the effects of 2 different types of upper extremity exercise training on upper extremity function, strength, endurance, and ambulation in patients with early-stage Duchenne muscular dystrophy (DMD). The study group (n = 12) exercised with an arm ergometer under the supervision of a physiotherapist, whereas the control group (n = 12) underwent a strengthening range-of-motion (ROM) exercise program under the supervision of their families at home for 8 weeks. Upper extremity functional performance, strength, endurance, and ambulatory status were assessed before and after the training. Ambulation scores, endurance, and arm functions, as well as proximal muscle strength, were improved after the training in the study group (P exercises alone. © 2014 Wiley Periodicals, Inc.
Simon, Ann M; Ingraham, Kimberly A; Spanias, John A; Young, Aaron J; Finucane, Suzanne B; Halsne, Elizabeth G; Hargrove, Levi J
Powered lower limb prostheses can assist users in a variety of ambulation modes by providing knee and/or ankle joint power. This study's goal was to develop a flexible control system to allow users to perform a variety of tasks in a natural, accurate, and reliable way. Six transfemoral amputees used a powered knee-ankle prosthesis to ascend/descend a ramp, climb a 3- and 4-step staircase, perform walking and standing transitions to and from the staircase, and ambulate at various speeds. A mode-specific classification architecture was developed to allow seamless transitions at four discrete gait events. Prosthesis mode transitions (i.e., the prosthesis' mechanical response) were delayed by 90 ms. Overall, users were not affected by this small delay. Offline classification results demonstrate significantly reduced error rates with the delayed system compared to the non-delayed system (p knee-ankle prosthesis.
Adesesan B. Adeyemo; Oluwafemi Oriola
This paper applies forensic data mining to determine the true status of employees and thereafter provide useful evidences for proper administration of administrative rules in a Typical Nigerian Teaching Service. The conventional technique of personnel audit was studied and a new technique for personnel audit was modeled using Artificial Neural Networks and Decision Tree algorithms. Atwo-layer classifier architecture was modeled. The outcome of the experiment proved that Radial Basis Function ...
Bachelor thesis discusses the importance of employees and employee care in tourism, particularly in the hotel industry. The aim of this thesis is to analyze the issue of personnel management and attitude to human resources in an organization which is typical for the tourism industry. The theoretical part deals with human resources management and the position of personnel activities in a company, specifies the importance of employees in the service sector and focuses on hotel management and it...
The growing demand for greater safety, environmental friendliness and economies for power stations is altering requirements from operating personnel. In-depth technological understanding, the combination of theory and practice, mental capability, systematic utilization of equipment and operational aids, safety and environment consciousness are expressions which characterise the capabilities of operating personnel. Education and further education in the joint central training establishments of the power station owners have proved effective. (orig.) [de
The basics of personnel dosimetry technics, used by the Radiologic Protetion and Assessorie Service (SAPRA) are presented, consisting on use of thermoluminescent and CaSO 4 :Dy monitors in aggregated pellets by Teflon. The characteristics of this dosemeters, relating to the sensitivity, energetic dependence, spike temperature, characteristic emission curve, decay and light effect are shown. The thermoluminescent dosemeter measure system and the personnel monitoring system are also described. (C.G.C.) [pt
Full Text Available Resalta la experiencia de comunicación que plantea Le Cinéma Numérique Ambulant CNA (África cuyo objetivo es difundir filmes de ficción, acompañados de documentos audiovisuales destinados a sensibilizar a los espectadores sobre los problemas de desarrollo de salud, o de convivencia en sociedad, en las regiones donde no existe el cine.
Azimi, S.; Delavar, M. R.; Rajabifard, A.
In response to natural disasters, efficient planning for optimum allocation of the medical assistance to wounded as fast as possible and wayfinding of first responders immediately to minimize the risk of natural disasters are of prime importance. This paper aims to propose a multi-agent based modeling for optimum allocation of space to emergency centers according to the population, street network and number of ambulances in emergency centers by constraint network Voronoi diagrams, wayfinding of ambulances from emergency centers to the wounded locations and return based on the minimum ambulances travel time and path length implemented by NSGA and the use of smart city facilities to accelerate the rescue operation. Simulated annealing algorithm has been used for minimizing the difference between demands and supplies of the constrained network Voronoi diagrams. In the proposed multi-agent system, after delivering the location of the wounded and their symptoms, the constraint network Voronoi diagram for each emergency center is determined. This process was performed simultaneously for the multi-injuries in different Voronoi diagrams. In the proposed multi-agent system, the priority of the injuries for receiving medical assistance and facilities of the smart city for reporting the blocked streets was considered. Tehran Municipality District 5 was considered as the study area and during 3 minutes intervals, the volunteers reported the blocked street. The difference between the supply and the demand divided to the supply in each Voronoi diagram decreased to 0.1601. In the proposed multi-agent system, the response time of the ambulances is decreased about 36.7%.
Full Text Available Abstract Background Research undertaken in developing countries has assessed discrepancies in police reporting of Road Traffic Injury (RTI for urban settings only. The objective of this study was to assess differences in RTI reporting across police, ambulance, and hospital Emergency Department (ED datasets on an interurban road section in Pakistan. Methods The study setting was the 196-km long Karachi-Hala road section. RTIs reported to the police, Edhi Ambulance Service (EAS, and five hospital EDs in Karachi during 2008 (Jan to Dec were compared in terms of road user involved (pedestrians, motorcyclists, four-wheeled vehicle occupants and outcome (died or injured. Further, records from these data were matched to assess ascertainment of traffic injuries and deaths by the three datasets. Results A total of 143 RTIs were reported to the police, 531 to EAS, and 661 to hospital EDs. Fatality per hundred traffic injuries was twice as high in police records (19 per 100 RTIs than in ambulance (10 per 100 RTIs and hospital ED records (9 per 100 RTIs. Pedestrian and motorcyclist involvement per hundred traffic injuries was lower in police records (8 per 100 RTIs than in ambulance (17 per 100 RTIs and hospital ED records (43 per 100 RTIs. Of the 119 deaths independently identified after matching, police recorded 22.6%, EAS 46.2%, and hospital ED 50.4%. Similarly, police data accounted for 10.6%, EAS 43.5%, and hospital ED 54.9% of the 1 095 independently identified injured patients. Conclusions Police reporting, particularly of non-fatal RTIs and those involving vulnerable road users, should be improved in Pakistan.
Lund, Cathrine; Bjornaas, Mari A; Sandvik, Leiv; Ekeberg, Oivind; Jacobsen, Dag; Hovda, Knut E
The long-term mortality after prehospital treatment for acute poisoning has not been studied previously. Thus, we aimed to estimate the five-year mortality and examine the causes of death and predictors of death for all acutely poisoned patients treated in ambulances, the emergency outpatient clinic, and hospitals in Oslo during 2003-2004. A prospective cohort study included all adults (≥16 years; n=2045, median age=35 years, male=58%) who were discharged after treatment for acute poisoning in ambulances, the emergency outpatient clinic, and the four hospitals in Oslo during one year. The patients were observed until the end of 2008. Standardized mortality rates (SMRs) were calculated and multivariate Cox regression analysis was applied. The study comprised 2045 patients; 686 treated in ambulances, 646 treated in the outpatient clinic, and 713 treated in hospitals. After five years, 285 (14%) patients had died (four within one week). The SMRs after ambulance, outpatient, and hospital treatment were 12 (CI 9-14), 10 (CI 8-12), and 6 (CI 5-7), respectively. The overall SMR was 9 (CI 8-10), while the SMR after opioid poisoning was 27 (CI 21-32). The most frequent cause of death was accidents (38%). In the regression analysis, opioids as the main toxic agents (HR 2.3, CI 1.6-3.0), older age (HR 1.6, CI 1.5-1.7), and male sex (HR 1.4, CI 1.1-1.9) predicted death, whereas the treatment level did not predict death. The patients had high mortality compared with the general population. Those treated in hospital had the lowest mortality. Opioids were the major predictor of death.
Full Text Available Background: In general, many patients with acute proximal deep vein thrombosis (DVT are treated with heparin and oral anticoagulant. Many physicians have been taught to admit these patients to absolute bed rest for the first 24-48 hours due to the fear of dislodging clots that may lead to fatal pulmonary embolism (PE. Objective: The aim of this study is to compare the differences among the changing circumference of affected limb, the severity of pain, and the incidence of symptomatic PE in 3 groups of acute proximal DVT, including absolute bed rest with compression bandages (group 1, ambulation with compression bandages (group 2, and ambulation without compression bandages (group 3. Methods: Between January 2006 and March 2011, 60 patients were enrolled in this study. In this analysis, the clinical characteristics, the changes of affected limb circumference and pain score during the first week of admis- sion and the incidence of symptomatic PE among 3 groups of this study were analyzed. Results: There were no statistical differences in the characteristics among 3 groups of patients. The most gender was female and the mean age for 3 groups ranged from 55.1 to 63.7 years. Comparing among 3 groups, it showed a significant difference of calf circumferences between group 1 and group 3. None of pain score differences were statistically significant among 3 groups. In addition, there was no incidence of symptomatic PE in the three groups of the present study. Conclusion: Our findings confirm that acute proximal DVT treatment with ambulation does not increase the incidence of symptomatic PE, compared with absolute bed rest. Although there is no statistical decrease of the severity of pain between those 3 groups, the group of absolute bed rest and compression can promote the resolution of calf swelling, compared with the group of ambulation without compression bandages.
Full Text Available In response to natural disasters, efficient planning for optimum allocation of the medical assistance to wounded as fast as possible and wayfinding of first responders immediately to minimize the risk of natural disasters are of prime importance. This paper aims to propose a multi-agent based modeling for optimum allocation of space to emergency centers according to the population, street network and number of ambulances in emergency centers by constraint network Voronoi diagrams, wayfinding of ambulances from emergency centers to the wounded locations and return based on the minimum ambulances travel time and path length implemented by NSGA and the use of smart city facilities to accelerate the rescue operation. Simulated annealing algorithm has been used for minimizing the difference between demands and supplies of the constrained network Voronoi diagrams. In the proposed multi-agent system, after delivering the location of the wounded and their symptoms, the constraint network Voronoi diagram for each emergency center is determined. This process was performed simultaneously for the multi-injuries in different Voronoi diagrams. In the proposed multi-agent system, the priority of the injuries for receiving medical assistance and facilities of the smart city for reporting the blocked streets was considered. Tehran Municipality District 5 was considered as the study area and during 3 minutes intervals, the volunteers reported the blocked street. The difference between the supply and the demand divided to the supply in each Voronoi diagram decreased to 0.1601. In the proposed multi-agent system, the response time of the ambulances is decreased about 36.7%.
Serene S Paul; Lara Harvey; Therese Carroll; Qiang Li; Soufiane Boufous; Annabel Priddis; Anne Tiedemann; Lindy Clemson; Stephen R Lord; Sandy Muecke; Jacqueline CT Close; Serigne Lo; Catherine Sherrington
Objective and importance of study: To describe characteristics and temporal trends of fall-related ambulance service use and hospital admission in older adults in New South Wales (NSW), Australia. Such information will facilitate a more targeted approach to planning and delivery of health services to prevent falls and their adverse sequelae in different groups of older adults. Study type: Retrospective population-based descriptive study. Methods: Fall-related ambulance use and hospita...
Berntsson, Tommy; Hildingh, Cathrine
The development of the Swedish ambulance service has resulted in three different competence levels in Swedish ambulance teams: specialist ambulance nurses, registered nurses and emergency medical technicians. A nursing scientific model developed by Peplau (Peplau, H., 1991. Interpersonal Relations in Nursing. Springer Publishing Company, New York.) breaks down the nurse-patient relationship into a number of phases: an orientation, an identification, an exploitation and a resolution phase. This model has then been adapted to the pre-hospital emergency care by Suserud (Dahlberg, K., Segesten, K., Nyström, M., Suserud, B.-O., Fagerberg, I., 2003. Att förstå vårdvetenskap [To Understand Caring Science]. Studentlitteratur, Lund.). The purpose of this study was to explore, by direct content analysis, how the phases of the pre-hospital nurse-patient relationship described by Suserud (Dahlberg et al., 2003), emerge in 17 specialist ambulance nursing students descriptions of ambulance missions. The results show that the four phases of the pre-hospital nurse-patient relationship could be identified and each phase includes several different parts. Furthermore, the results show that the parts of each phase can vary depending on the patient's condition and the environmental circumstances of the ambulance mission. This improved understanding of the four phases of the pre-hospital nurse-patient relationship, and their parts, could be used by ambulance team members as a support during the pre-hospital caring process in ambulance missions. This new knowledge could also be used in education. Copyright © 2012 Elsevier Ltd. All rights reserved.
Full Text Available Background: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care. Methods: A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30 was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30 no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS, subjective comments on cold experiences, and finger, ear and air temperatures. Results: Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001 but decreased in the control group (p=0.014. A significant higher proportion (57% of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001. At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions: The use of active heat from underneath increases the patients’ thermal comfort and may prevent the negative consequences of cold stress.
Full Text Available Abstract Background From January 30-February 6, 2011, New South Wales was affected by an exceptional heat wave, which broke numerous records. Near real-time Emergency Department (ED and ambulance surveillance allowed rapid detection of an increase in the number of heat-related ED visits and ambulance calls during this period. The purpose of this study was to quantify the excess heat-related and all-cause ED visits and ambulance calls, and excess all-cause mortality, associated with the heat wave. Methods ED and ambulance data were obtained from surveillance and administrative databases, while mortality data were obtained from the state death registry. The observed counts were compared with the average counts from the same period from 2006/07 through 2009/10, and a Poisson regression model was constructed to calculate the number of excess ED visits, ambulance and deaths after adjusting for calendar and lag effects. Results During the heat wave there were 104 and 236 ED visits for heat effects and dehydration respectively, and 116 ambulance calls for heat exposure. From the regression model, all-cause ED visits increased by 2% (95% CI 1.01-1.03, all-cause ambulance calls increased by 14% (95% CI 1.11-1.16, and all-cause mortality increased by 13% (95% CI 1.06-1.22. Those aged 75 years and older had the highest excess rates of all outcomes. Conclusions The 2011 heat wave resulted in an increase in the number of ED visits and ambulance calls, especially in older persons, as well as an increase in all-cause mortality. Rapid surveillance systems provide markers of heat wave impacts that have fatal outcomes.
Jochen Kressler; Tracie Wymer; Antoinette Domingo
Objective: To investigate the effects of overground bionic ambulation with variable assistance on cardiorespiratory and metabolic responses in persons with motor-incomplete spinal cord injury. Design: Case series. Subjects: Four participants with chronic, motor-incomplete spinal cord injury. Methods: Subjects completed a maximal graded exercise test on an arm-ergometer and 3 6-min bouts of overground bionic ambulation using different modes of assis...
Gonzalez Anez, Francisco; Agueero Agueero, Jorge
The continuous evolution and improvement of safety-related processes has included the analysis, design and development of training plans for the qualification of maintenance nuclear power plant personnel. In this respect, the international references in this area recommend the establishment of systematic qualification programmes for personnel performing functions or carrying out safety related tasks. Maintenance personnel qualification processes have improved significantly, and training plans have been designed and developed based on Systematic Approach to Training methodology to each job position. These improvements have been clearly reflected in recent training programmes with new training material and training facilities focused not only on developing technical knowledge and skills but also on improving attitudes and safety culture. The objectives of maintenance training facilities such as laboratories, mock-ups real an virtual, hydraulic loops, field simulators and other training material to be used in the maintenance training centre are to cover training necessities for initial and continuous qualification. Evidently, all these improvements made in the qualification of plant personnel should be extended to include supplemental personnel (external or contracted) performing safety-related tasks. The supplemental personnel constitute a very spread group, covering the performance of multiple activities entailing different levels of responsibility. Some of these activities are performed permanently at the plant, while others are occasional or sporadic. In order to establish qualification requirements for these supplemental workers, it is recommended to establish a rigorous analysis of job positions and tasks. The objective will be to identify the qualification requirements to assure competence and safety. (authors)
Full Text Available Background: Occupational stress and associated physical and mental health related issues are not addressed in Indian police personnel with adequate importance. Methods: Cross-sectional survey was conducted among police personnel (both male and female in Calicut urban police district, Kerala state, India. Police personnel from all designations (ranks, except from the all India services (Indian Police Service were included in the study. Data were collected using a specifically designed datasheet covering socio-demographic profile, physical and mental health related details which was prepared by researchers. Occupational stress was measured using Operational Police Stress Questionnaire (PSQ-OP and Organisational Police Stress Questionnaire (PSQ-ORG. Result: The study found that both operational and organisational stress was significant among the police officers. Organisational stress was experienced in moderate level by 68% and in high level by 14%. Operational stress scores were in the moderate range in 67% and in high range in 16.5%. The younger age group (21-35 years and lower level rank police personnel had higher stress. Stress was higher among female police personnel compared to males. While 23% of them had been diagnosed with physical illnesses, a significant four per cent of them with mental illness, and 29% of them reported substance abuse. Conclusion: The results point to the high level of stress among Indian police personnel and the need for urgent interventions from the government to address the occupational stress.
.... It includes projects in the following areas: personnel information systems, personnel actions processing, classification, staffing, pay, employee and labor relations, performance management, security, training, retirement and benefits...
Mudumbai, Seshadri C; Kim, T Edward; Howard, Steven K; Workman, J Justin; Giori, Nicholas; Woolson, Steven; Ganaway, Toni; King, Robert; Mariano, Edward R
Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established. We determined whether, after TKA, patients with adductor canal CPNB versus patients with femoral CPNB demonstrated (1) greater total ambulation distance on Postoperative Day (POD) 1 and 2 and (2) decreased daily opioid consumption, pain scores, and hospital length of stay. Between October 2011 and October 2012, 180 patients underwent primary TKA at our practice site, of whom 93% (n = 168) had CPNBs. In this sequential series, the first 102 patients had femoral CPNBs, and the next 66 had adductor canal CPNBs. The change resulted from a modification to our clinical pathway, which involved only a change to the block. An evaluator not involved in the patients' care reviewed their medical records to record the parameters noted above. Ambulation distances were higher in the adductor canal group than in the femoral group on POD 1 (median [10(th)-90(th) percentiles]: 37 m [0-90 m] versus 6 m [0-51 m]; p randomized studies are needed to validate our major findings. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Havel, Christof; Schreiber, Wolfgang; Trimmel, Helmut; Malzer, Reinhard; Haugk, Moritz; Richling, Nina; Riedmüller, Eva; Sterz, Fritz; Herkner, Harald
Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation. To assess the effect of real time automated feedback on the quality of resuscitation in an emergency transportation setting. Randomised cross-over trial. Medical University of Vienna, Vienna Municipal Ambulance Service and Helicopter Emergency Medical Service Unit (Christophorus Flugrettungsverein) in September 2007. European Resuscitation Council (ERC) certified health care professionals performing CPR in a flying helicopter and in a moving ambulance vehicle on a manikin with human-like chest properties. CPR sessions, with real time automated feedback as the intervention and standard CPR without feedback as control. Quality of chest compression during resuscitation. Feedback resulted in less deviation from ideal compression rate 100 min(-1) (9+/-9 min(-1), pautomated feedback improves certain aspects of CPR quality in flying helicopters and moving ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
Pearn, J; Wales, M
Surgeon John Thomson (1847-1909), a Scot who made his life's work in Queensland, was a pioneer surgeon, radiologist and bacteriologist, and one of the founders of the St John Ambulance movement in Australia and the Railway Ambulance Corps. He was variously President of the British Medical Association (Queensland Branch), the Medical Board of Queensland, the Medico-Ethical Association, and the Intercolonial Medical Congress, which was held in Brisbane in 1899. A pioneer military surgeon in this country, he was the foundation Principal Medical Officer (as Surgeon-Major) of the Queensland Ambulance Corps within the Queensland Defence Force. His advocacy for a university north of Sydney was one of the factors which led to the foundation of the University of Queensland, a body which honoured him by the establishment of the John Thomson Lectureship, which for half a century was its most prestigious public oration. The life and times of this singular doctor exemplify one small class of pre-Federation medical pioneers whose professional outreach established a number of voluntary organisations which have blossomed in Australian society to the present day.
Simon, Ann M; Fey, Nicholas P; Finucane, Suzanne B; Lipschutz, Robert D; Hargrove, Levi J
Recently developed powered lower limb prostheses allow users to more closely mimic the kinematics and kinetics of non-amputee gait. However, configuring such a device, in particular a combined powered knee and ankle, for individuals with a transfemoral amputation is challenging. Previous attempts have relied on empirical tuning of all control parameters. This paper describes modified stance phase control strategies - which mimic the behavior of biological joints or depend on the instantaneous loads within the prosthesis - developed to reduce the number of control parameters that require individual tuning. Three individuals with unilateral transfemoral amputations walked with a powered knee and ankle prosthesis across five ambulation modes (level ground walking, ramp ascent/descent, and stair ascent/descent). Starting with a nominal set of impedance parameters, the modified control strategies were applied and the devices were individually tuned such that all subjects achieved comfortable and safe ambulation. The control strategies drastically reduced the number of independent parameters that needed to be tuned for each subject (i.e., to 21 parameters instead of a possible 140 or approximately 4 parameters per mode) while relative amplitudes and timing of kinematic and kinetic data remained similar to those previously reported and to those of non-amputee subjects. Reducing the time necessary to configure a powered device across multiple ambulation modes may allow users to more quickly realize the benefits such powered devices can provide.
Tashman, S; Zajac, F E; Perkash, I
We developed a three dimensional, four segment, eight-degree-of-freedom model for the analysis of paraplegic ambulation in a reciprocating gait orthosis (RGO). Model development was guided by experimental analysis of a spinal cord injured individual walking in an RGO with the additional assistance of arm crutches. Body forces and torques required to produce a dynamic simulation of the RGO gait swing phase were found by solving an optimal control problem to track the recorded kinematics and ground reaction forces. We found that high upper body forces are required, not only during swing but probably also during double support to compensate for the deceleration of the body during swing, which is due to the pelvic thrust necessary to swing the leg forward. Other stimulations showed that upper body forces and body deceleration during swing can be reduced substantially by producing a ballistic swing. Functional neuromuscular stimulation of the hip musculature during double support would then be required, however, to establish the initial conditions needed in a ballistic swing.
Lloyd, Gemma; Dean, Catherine M; Ada, Louise
Recruitment to clinical trials is often slow and difficult, with a growing body of research examining this issue. However there is very little work related to stroke. The aim of this study was to examine the success and efficiency of recruitment of community-dwelling stroke survivors over the first two years of a clinical trial aiming to improve community ambulation. Recruitment strategies fell into 2 broad categories: (i) advertisement (such as newspaper advertising and media releases), and (ii) referral (via hospital and community physiotherapists, a stroke liaison officer and other researchers). Records were kept of the number of people who were screened, were eligible and were recruited for each strategy. The recruitment target of 60 in the first two years was not met. 111 stroke survivors were screened and 57 were recruited (i.e., a recruitment rate of 51%). The most successful strategy was referral via hospital-based physiotherapists (47% of recruited participants) and the least successful were media release and local newspaper advertising. The referral strategies were all more efficient than any of the advertisement strategies. In general, recruitment was inefficient and costly in terms of human resources. Given that stroke research is underfunded, it is important to find efficient ways of recruiting stroke survivors to clinical trials. An Australian national database similar to other disease-specific data bases (such as the National Cancer Database) is under development. In the interim, recruiting for several clinical trials at once may increase efficiency.
Oster, Jörg; Moser, Anna Sophie; Danner-Weinberger, Alexandra; von Wietersheim, Jörn
The aim of this study was to analyze the experiences of patients suffering from mostly chronic psychosomatic disorders in an ambulant art therapy in the group. Especially, the focus was on the experienced changes, helpful factors and specifics of the therapy as well as on the experienced benefit. For this, 30 patients were interviewed in a semi-standardized way. Additionally, the symptom-based strain was psychometrically recorded in a part of the patients (21) at the beginning of the therapy and after at least 6 months of participation. The evaluation of those interviews with the qualitative analysis of the therapy subjects surrendered an improvement of the health state in most of the participants. Especially group factors, art as a mean of communication, becoming aware of feelings but also diversion and fun were proved to be beneficial. The art therapy also serves for structuring the week as well as a contact point and a resource in the interpersonal communication of everyday life. Nearly all of the patients referred to some important turning point pictures. Mostly, the benefit was valued as being high. But, in contrast, the psychometric measure did not show any significant change. The results emphasize the stabilizing function of art therapy in the examined patients, whereat the classification of the psychometric result is complicated by the absence of a control group. © Georg Thieme Verlag KG Stuttgart · New York.
Bello, Luca; Morgenroth, Lauren P; Gordish-Dressman, Heather; Hoffman, Eric P; McDonald, Craig M; Cirak, Sebahattin
To correlate time to loss of ambulation (LoA) and different truncating DMD gene mutations in a large, prospective natural history study of Duchenne muscular dystrophy (DMD), with particular attention to mutations amenable to emerging molecular treatments. We analyzed data from the Cooperative International Neuromuscular Research Group Duchenne Natural History Study for participants with DMD single- or multi-exon deletions or duplications with defined exon boundaries (n = 186), or small mutations identified by sequencing (n = 26, including 16 nonsense point mutations). We performed a time-to-event analysis of LoA, a strong indicator of overall disease severity, adjusting for glucocorticoid treatment and genetic modifiers. Participants with deletions amenable to skipping of exon 44 had later LoA (median 14.8 years, hazard ratio 0.31, 95% confidence interval 0.14-0.69, p = 0.004). Age at LoA did not differ significantly in participants with deletions amenable to exon 45, 51, and 53 skipping, duplications, and small rearrangements. Nonsense mutation DMD also showed a typical median age at LoA (11.1 years), with a few outliers (ambulatory around or after 16 years of age) carrying stop codons within in-frame exons, more often situated in the rod domain. As exon 44 skipping-amenable DMD has a later LoA, mutation-specific randomization and selection of placebo groups are essential for the success of clinical trials. © 2016 American Academy of Neurology.
Full Text Available Reconstructive surgery following an internal hemipelvectomy for a malignant pelvic tumor is difficult due to the structural complexity of the pelvis and the massive extension of the tumor. While high complication rates have been encountered in various types of reconstructive surgery, resection without reconstruction reportedly involved fewer complications. However, this method often results in limb shortening with resultant instability during walking. We reported herein leg lengthening performed to correct lower limb shortening after an internal hemipelvectomy, which improved ambulatory stability and overall QOL. An 18-year-old male patient came to our hospital to correct a lower limb discrepancy resulting from a left internal hemipelvectomy. His left pelvis and proximal femur had been resected, and the femur remained without an acetabular roof. His left lower limb was about 8 centimeters shorter. The left tibia was lengthened 8 centimeters with an external fixator. After the lengthening, the patient was able to walk without support and his gait remarkably improved. Additionally he no longer required placing a wallet in his back pocket as a pad as a means of raising the left side of his torso while sitting. Leg lengthening was a useful method of improving ambulation after an internal hemipelvectomy.
Russell Esposito, Elizabeth; Lipe, Delbert H; Rábago, Christopher A
Walking in high heels presents biomechanical challenges, yet they remain part of many women's attire. However, women with a lower limb amputation are limited in available footwear options. Case description and methods: This case study is in response to one patient's assertion that she walked better and more symmetrically in heels than flat shoes with her below-knee prosthesis. She underwent gait analysis in athletic shoes and 10-cm stiletto high heels worn with a pediatric running foot to determine if these claims could be substantiated through biomechanical measures. Global gait asymmetry indices were calculated. Findings and outcomes: Asymmetry indices were nearly identical between athletic shoes and heels but joint-level findings differed substantially. Ankle mechanics were more symmetrical in heels but hip mechanics were less. The maintenance of symmetry in stiletto high heels does not imply maintenance of gait quality, as high heels are known to adversely affect some components walking mechanics. Clinical relevance Returning to high-heel wear is achievable for prosthesis users. Accommodations can be made using creativity in prosthetic foot selection to enable successful ambulation; however, attention to gait mechanics may be important for patient safety.
Beil, Tracy L; Street, Glenn M; Covey, Steven J
Interface pressures were measured during ambulation with a normal total-surface weight-bearing suction socket and a vacuum-assisted socket. The vacuum-assisted socket has been shown to eliminate daily volume loss. Urethane liners were instrumented with five force-sensing resistors to measure positive pressures and one air pressure sensor at the distal end of the liner to document negative pressures. Nine unilateral transtibial amputees participated in the study. The vacuum-assisted socket created significantly lower positive-pressure impulse (42.8, 39.6 kPa x s) and peak pressures (83.5, 80.0 kPa) during the stance phase. The pressure impulse (-10.5, -13.3 kPa x s), average (-21.2, -26.5 kPa), and peak (-28.5, -36.3 kPa) negative pressures during swing phase were significantly greater in magnitude with the vacuum-assisted socket. We believe that lower positive pressures seen during stance using the vacuum-assisted socket reduces the fluid forced out and greater negative pressures seen during swing increases the amount of fluid drawn into the limb, thereby preventing volume loss.
Halter, Mary; Vernon, Susan; Snooks, Helen; Porter, Alison; Close, Jacqueline; Moore, Fionna; Porsz, Simon
Older people who fall commonly present to the emergency ambulance service, and approximately 40% are not conveyed to the emergency department (ED), despite an historic lack of formal training for such decisions. This study aimed to understand the decision-making processes of emergency ambulance staff with older people who have fallen. During 2005 ambulance staff in London tested a clinical assessment tool for use with the older person who had fallen. Documented use of the tool was low. Following the trial, 12 staff participated in semistructured interviews. Interviews were recorded and transcribed. Thematic analysis was carried out. The interviews revealed a similar assessment and decision-making process among participants: Prearrival: forming an early opinion from information from the emergency call. Initial contact: assessing the need for any immediate action and establishing a rapport. Continuing assessment: gathering and assimilating medical and social information. Making a conveyance decision: negotiation, referral and professional defence, using professional experience and instinct. An assessment process was described that highlights the complexity of making decisions about whether or not to convey older people who fall and present to the emergency ambulance service, and a predominance of informal decision-making processes. The need for support for ambulance staff in this area was highlighted, generating a significant challenge to those with education roles in the ambulance service. Further research is needed to look at how new care pathways, which offer an alternative to the ED may influence decision making around non-conveyance.
Ponomarenko, V N; Gorenkov, V M
The article summarizes the archive data concerning the results of the bombing attacks and machine-gun fire of fascist aviation against hospital trains and sanitary trains (HT & ST). During the war period 349 HT & ST have suffered air attacks (including 95 organic HT, 111 temporary HT, and 143 ST). In the result of these attacks the losses among the medical personnel of HT & ST were 1682 wounded and 833 killed. As for sick and wounded who were being evacuated by these HT & ST 3040 of them were repeatedly wounded, 2017 were killed or burned by fire in railway medical carriages. These data testifies the flagrant transgression by fascists of international agreements on the neutrality of sanitary transport and its personnel.
The Guidebook will prove especially useful for, and is addressed primarily to: nuclear power operating organizations establishing or upgrading their NPP personnel training systems; regulatory personnel responsible for setting requirements and/or evaluating NPP personnel training; and organizations (within or outside the operating organization) responsible for the development, implementation and evaluation of training programmes for NPP personnel. Figs, tabs
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Personnel actions during employee's absence. 353.106 Section 353.106 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE... to use sick or annual leave. (c) Agency promotion plans must provide a mechanism by which employees...
Lijovic, M; Bernard, S; Nehme, Z; Walker, T; Smith, K
To assess the impact of automated external defibrillator (AED) use by bystanders in Victoria, Australia on survival of adults suffering an out-of-hospital cardiac arrest (OHCA) in a public place compared to those first defibrillated by emergency medical services (EMS). We analysed data from the Victorian Ambulance Cardiac Arrest Registry for individuals aged >15 years who were defibrillated in a public place between 1 July 2002 and 30 June 2013, excluding events due to trauma or witnessed by EMS. Of 2270 OHCA cases who arrested in a public place, 2117 (93.4%) were first defibrillated by EMS and 153 (6.7%) were first defibrillated by a bystander using a public AED. Use of public AEDs increased almost 11-fold between 2002/2003 and 2012/2013, from 1.7% to 18.5%, respectively (p defibrillation occurred sooner in bystander defibrillation (5.2 versus 10.0 min, p defibrillated patients was significantly higher than for those first defibrillated by EMS (45% versus 31%, p defibrillation by a bystander using an AED was associated with a 62% increase in the odds of survival to hospital discharge (adjusted odds ratio 1.62, 95% CI: 1.12–2.34, p = 0.010) compared to first defibrillation by EMS. Survival to hospital discharge is improved in patients first defibrillated using a public AED prior to EMS arrival in Victoria, Australia. Encouragingly, bystander AED use in Victoria has increased over time. More widespread availability of AEDs may further improve outcomes of OHCA in public places.
Sugihara, M.; Ikeda, K.; Shinomiya, Y.; Hada, M.
Nuclear power generation in Japan reached 24.7% of its electric power supply with its capacity and time availability factors of 76.2% and 77.1%, respectively (in the calendar year 1986 - as of December 31, 1986). One of the reasons for such high performance is attributable to high quality of operating and maintenance personnel in the nuclear power plants. Ministry of International Trade and Industry of the Japanese Government has an overall responsibility with relation to the safety regulations and supervises all scope of training, while the Thermal and Nuclear Power Engineering Society is authorized to conduct licensing activities to qualify the chief shift supervisor of nuclear power plant operation and individual utility companies are required to train their plant operating and maintenance personnel. General status of training for plant personnel is briefly described in this paper, touching the practical education and training systems of utility companies and operation and maintenance training facilities
For the past decade, the demand for health physics personnel, at both the professional and technical levels, has been increasing, and indeed has become quite acute in recent years. The need for health physics personnel is demonstrated by a summary of projected requirements and potential candidates by the year 1991. Suggestions made for ensuring the availability of qualified health physics personnel includes: 1) a characterization study of health physicists should be conducted, with emphasis on industry, to determine qualifications, job satisfaction factors, and other data pertinent to entry and retention in the field; 2) the curricula currently offered by post-secondary schools should be evaluated for quality and relevance; and 3) an industry standard or protocol for qualification and training of health physics should be developed and implemented
Clauss, D.B.; Parks, M.B.; Julien, J.T.; Peters, S.W.
Sandia National Laboratories (Sandia) is investigating the leakage potential of mechanical penetrations as part of a research program on containment integrity under severe accident loads for the U.S. Nuclear Regulatory Commission (NRC). Barnes et al. (1984) and Shackelford et al. (1985) identified leakage from personnel airlocks as an important failure mode of containments subject to severe accident loads. However, these studies were based on relatively simple analysis methods. The complex structural interaction between the door, gasket, and bulkhead in personnel airlocks makes analytical evaluation of leakage difficult. In order to provide data to validate methods for evaluating the leakage potential, a full-size personnel airlock was subject to simulated severe accident loads consisting of pressure and temperature up to 300 psig and 800 degrees F. The test was conducted at Chicago Bridge and Iron under contract to Sandia. The authors provide a detailed report on the test program
Michel, Per-Olof; Lundin, Tom; Larsson, Gerry
Increased suicide rates for military personnel suffering from post-traumatic stress disorders have been reported in various countries. Although it is known that some peacekeepers are exposed to potentially traumatic events and are thus at risk of suffering from post-traumatic stress reactions, only a few studies have examined suicide rates in this group. Therefore, the aim of this study was to investigate the suicide rate among former Swedish peacekeeping personnel. We compared 39,768 former Swedish peacekeepers to the general population in the National General Population Registry and the Cause-of-Death Registry. A lower number of suicides was found among former Swedish peacekeepers than in the general population. In conclusion, Swedish personnel serving in international peace-keeping operations do not show a higher suicide rate than the general population. Unique problems associated with this research area are discussed.
The management principles in this publication were developed by a committee of senior utility officials with assistance by the staff of the Institute of Nuclear Power Operations (INPO) and with input from virtually all U.S. nuclear utilities. The principles are aimed at creating an environment within a nuclear power plant that promotes a healthy respect for the unique technology that nuclear electric power represents and, thus, to promote great care and conservative, thoughtful decision-making by the nuclear plant staff. The scope of the principles includes all nuclear personnel and gives guidance in the selection and development of management and supervisory personnel and other key individuals in the areas of operations, maintenance, technical support and engineering. Utility managers are encouraged to make in-depth comparisons between these principles and their day-to-day policies and practices, and to use such efforts as opportunities to communicate their organization's management philosophy to all nuclear personnel
Griffith, R.V.; Fisher, J.C.; Hankins, D.E.; Miller, D.E.
Approximately 40 employees at LLL work in areas where personnel neutron monitoring is necessary. The dose rate in these areas is low, rarely exceeding 0.5 rem per year. However, the wide variety of neutron environments (dt neutron generators; a 3 MW pool type reactor; a 100 MeV electron Linac; and a number of vaults and glove boxes where alpha, n and spontaneous fission sources are stored) makes the neutron monitoring task difficult. As a result, we have been studying potential developments in personnel dosimetry and neutron field monitoring, particularly as they relate to proposed changes in the neutron quality factor and the implied reduction in allowable dose limits
Current performance estimates for personnel access control systems use estimates of Type I and Type II verification errors. A system performance equation which addresses normal operation, the insider, and outside adversary attack is developed. Examination of this equation reveals the inadequacy of classical Type I and II error evaluations which require detailed knowledge of the adversary threat scenario for each specific installation. Consequently, new performance measures which are consistent with the performance equation and independent of the threat are developed as an aid in selecting personnel access control systems
With the ultimate aim of reducing the possibility of human error in nuclear power plant operations, the Guidebook discusses the organizational aspects, the staffing requirements, the educational systems and qualifications, the competence requirements, the ways to establish, preserve and verify competence, the specific aspects of personnel management and training for nuclear power plant operations, and finally the particular situations and difficulties to be overcome by utilities starting their first nuclear power plant. An important aspect presented in the Guidebook is the experience in training and qualification of nuclear power plant personnel in various countries: Argentina, Belgium, Canada, Czechoslovakia, France, Federal Republic of Germany, Spain, Sweden, United Kingdom and United States of America
The personnel dosimetry monitoring program at the Portsmouth uranium enrichment facility has been improved by using thermoluminescent dosimetry to monitor for ionizing radiation exposure, and by automating most of the operations and all of the associated information handling. A thermoluminescent dosimeter (TLD) card, worn by personnel inside security badges, stores the energy of ionizing radiation. The dosimeters are changed-out periodically and are loaded 150 cards at a time into an automated reader-processor. The resulting data is recorded and filed into a useful form by computer programming developed for this purpose
Full Text Available Pilates, a popular form of exercise, greatly emphasizes on the strengthening of the core muscles; however, the efficacy of exercise program can be impaired in patients with cognitive impairments. To bridge this gap, mental practice of a desired task can help to mentally simulate a given action and retain many properties of the corresponding real action. This study tries to gain preliminary understanding on the effectiveness of the combination of mental practice and core-strengthening Pilates exercises. To explore the effectiveness of mental practice and Pilates-based training on core strength, balance and mobility in multiple sclerosis (MS patients. This study highlights a single center case series describing the outcomes in ambulant patients with MS treated with mental practice and Pilates. Five volunteer ambulant individuals with stable relapsing-remitting MS participated in 20 individualized sessions, spread over 10-week duration. Pilates with mental practice session was delivered by a physiotherapist. Each session comprised 20 min of mental practice followed by 40 min of core-strengthening Pilates exercises. All the included patients were screened with Movement Imagery Questionnaire-Revised Second Version to determine if they are were able to effectively engage in imagery practice. A range of outcomes were measured: Timed up and go, chair stand test, curl-ups, the abdominal angle through leg raises, and the Activities-specific Balance Confidence Scale before and after the intervention. Group data analysis indicated significant improvement between baseline and post-intervention phases for all the tested parameters. This study provides preliminary insight into this novel combination technique to improve balance and mobility in ambulant people with MS. Mental practice played an important role in keeping the patient's compliance, which was analyzed through structured interviews. Variations in response to the intervention are evident.
Full Text Available So far, Brain-Machine Interfaces (BMIs have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals. To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training and one movement-free condition (BMI motor imagery task are compared to perform this study.Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions.
Costa, Álvaro; Salazar-Varas, Rocio; Úbeda, Andrés; Azorín, José M.
So far, Brain-Machine Interfaces (BMIs) have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals). To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training) and one movement-free condition (BMI motor imagery task) are compared to perform this study. Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD) of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions. PMID:26941601
Czerniecki, Joseph M; Morgenroth, David C
Amputation results in reduced mobility and contributes to reduced quality of life. The increased metabolic cost of ambulation has been suggested as an important contributor to reduced mobility in this population. Current research on the metabolic energy expenditure of ambulation will be critically reviewed from the perspectives of ecological validity of the research methods and the relative contribution to functional improvement in amputees. Recommendations will be made regarding possible future directions for research and their potential clinical utility. Narrative review. The methods used to quantify metabolic energy expenditure of amputee ambulation do not emulate typical mobility conditions that amputees experience. Amputee mobility is characterized by short bouts of activity with starting, stopping and changes of direction. This is opposed to the typical metabolic testing protocol that requires at least 5 min of steady state linear walking on a treadmill. These studies, therefore, have limitations in ecological validity and therefore limitations in the extent to which they accurately reflect the effect of amputation level, amputation etiology and prosthetic components on energy consumption during walking. Further, the broader perspective on outcomes after dysvascular amputation and sports participation limitations, raises questions about the relative importance of improving metabolic costs and its potential effect on improving mobility in amputees. The greatest potential clinical impact of future research requires methods with improved ecological validity, and the ability to translate metabolic energy expenditure outcomes into functional terms that are meaningful to both clinicians and patients. Implications for Rehabilitation The search for objective measurements to define the effects of amputation on outcome and the consequences of prosthetic components on mobility has focused in part on the use of study designs incorporating metabolic measurement. However
... assurance that the drug product has the safety, identity, strength, quality, and purity that it purports or... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Personnel qualifications. 211.25 Section 211.25 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS...
... regarding the safety of his flight operations or his competence in dispensing agricultural materials or... Operating Rules § 137.41 Personnel. (a) Information. The holder of an agricultural aircraft operator certificate shall insure that each person used in the holder's agricultural aircraft operation is informed of...
... 49 Transportation 3 2010-10-01 2010-10-01 false Personnel safety. 193.2511 Section 193.2511 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY LIQUEFIED NATURAL GAS FACILITIES...
Procopio, Michael J.
We present the Sandia Advanced Personnel Locator Engine (SAPLE) web application, a directory search application for use by Sandia National Laboratories personnel. SAPLE's purpose is to return Sandia personnel 'results' as a function of user search queries, with its mission to make it easier and faster to find people at Sandia. To accomplish this, SAPLE breaks from more traditional directory application approaches by aiming to return the correct set of results while placing minimal constraints on the user's query. Two key features form the core of SAPLE: advanced search query interpretation and inexact string matching. SAPLE's query interpretation permits the user to perform compound queries when typing into a single search field; where able, SAPLE infers the type of field that the user intends to search on based on the value of the search term. SAPLE's inexact string matching feature yields a high-quality ranking of personnel search results even when there are no exact matches to the user's query. This paper explores these two key features, describing in detail the architecture and operation of SAPLE. Finally, an extensive analysis on logged search query data taken from an 11-week sample period is presented.
Wangler, Lawrence A.
Discusses personnel profession's increased responsibilities which are due to (1) consolidation of the Equal Employment Opportunity Commission, (2) labor law reform, (3) privacy legislation, (4) social security legislation, (5) open retirement, (6) medical plan costs, (7) codetermination, (8) labor scarcity, (9) top management compensation, and…
... Physical Therapy and Speech-Language Pathology Services § 485.705 Personnel qualifications. (a) General... involved in the furnishing of outpatient physical therapy, occupational therapy, and speech-language...) of the Act and the requirements in part 484 of this chapter. (2) For a speech-language pathologist...
The purpose was to provide applied and research dosimetrists with sufficient information to evaluate the status and direction of their programs relative to the latest guidelines and techniques. A technical program was presented concerning experience, requirements, and advances in gamma, beta, and neutron personnel dosimetry
nutbers of available youth. John haisbitt, author of Megatrends, predicts that labor short.ges are beginning to occur and will continue throughout the...available resources (e.g., personnel and material). 81. Your work group’s performance in compariscn to similar work groups is very high. ORGANIZATION CLIMA "E
KOROTKOVA M.V.; RYBKINA M.V.; NIKITINA S.O.; SCHERNYKH A.V.
The article analyzes the strategic human resource management in an educational institution. Analyzes the basic normative-legal documents regulating educational activities, including the part of management. Particular importance is given to the types of educational institutions (budgetary, state, and autonomous). The stages of strategic management of staff in educational institutions and development model of strategic management personnel are shown.
... 10 Energy 2 2010-01-01 2010-01-01 false Protective personnel. 95.31 Section 95.31 Energy NUCLEAR..., or other person possesses Secret Restricted Data related to nuclear weapons design, manufacturing and vulnerability information; and certain particularly sensitive Naval Nuclear Propulsion Program information (e.g...
Meriläinen, Matti; Sinkkonen, Hanna-Maija; Puhakka, Helena; Käyhkö, Katinka
This study focuses on the degree, nature and consequences of bullying or inappropriate behaviour among faculty personnel (n = 303) in a Finnish university. A total of 114 (38%) faculty members answered the email questionnaire. According to the results, 15% of the respondents had experienced bullying; in addition, 45% had experienced inappropriate…
It is argued that the penalty for most mistakes made by security is the payment of money by the utility. The security personnel has only to act reasonably and not in a negligent manner. Preventing of sabotage is more important than obtaining a conviction, so it is better to search and not get a conviction than it is not to search
At the first annual Office Automation Conference, the consensus was that personnel involvement in the development of office automation is vital if the new technology is to be successfully deployed. This report explores the problems inherent in office automation and provides a broad overview of the subject. (CT)
Leinbach, Philip E.; And Others
Fourteen articles address issues related to library personnel administration in an automated environment, such as education for automation, salaries, impact of technology, expert systems, core competencies, administrative issues, technology services, job satisfaction, and performance appraisal. A selected annotated bibliography is included. (MES)
... clinical laboratory toxicology; or (ii) A PhD in one of the natural sciences with an adequate undergraduate... 10 Energy 1 2010-01-01 2010-01-01 false Laboratory personnel. 26.155 Section 26.155 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Laboratories Certified by the Department of Health and Human...
... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Personnel. 110.10 Section 110.10 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN... food, chewing gum, drinking beverages, or using tobacco. (9) Taking any other necessary precautions to...
... AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.32 Personnel qualifications. (a) It shall be... least the following areas: (1) Humane methods of animal maintenance and experimentation, including: (i...) Aseptic surgical methods and procedures; (2) The concept, availability, and use of research or testing...
It is argued that the penalty for most mistakes made by security is the payment of money by the utility. The security personnel has only to act reasonably and not in a negligent manner. Preventing of sabotage is more important than obtaining a conviction, so it is better to search and not get a conviction than it is not to search. (DLC)
Dinh, Michael M; Muecke, Sandy; Berendsen Russell, Saartje; Chalkley, Dane; Bein, Kendall J; Muscatello, David; Nagaraj, Guruprasad; Paoloni, Richard; Ivers, Rebecca
The study aimed to analyze ambulance transportations to Emergency Departments (EDs) in New South Wales (NSW) and to identify temporal changes in demographics, acuity, and clinical diagnoses. This was a retrospective analysis of a population based registry of ED presentations in New South Wales. The NSW Emergency Department data collection (EDCC) collects patient level data on presentations to designated EDs across NSW. Patients that presented to EDs by ambulance between January 2010 and December 2014 were included. Patients dead on arrival, transferred from another hospital, or planned ED presentations were excluded. A total of 10.8 million ED attendances were identified of which 2.6 million (23%) were transported to ED by ambulance. The crude rate of ambulance transportations to EDs across all ages increased by 3.0% per annum over the five years with the highest rate observed in those 85 years and over (620.5 presentations per 1,000 population). There was an increase in the proportion of category 1 and 2 (life-threatening or potentially life-threatening) cases from 18.1% to 24.0%. Demand for ambulance services appears to be driven by older patients presenting with higher acuity problems. Alternative models of acute care for elderly patients need to be planned and implemented to address these changes.
In 1996, the IAEA published Technical Reports Series No. 380, Nuclear Power Plant Personnel Training and its Evaluation: A Guidebook. This publication provides guidance for the development, implementation and evaluation of training programmes for all nuclear power plant personnel using the systematic approach to training (SAT) methodology. The SAT methodology has since been adopted and used for the development and implementation of training programmes for all types of nuclear facility and activities in the nuclear industry. The IAEA Technical Working Group on Training and Qualification of Nuclear Power Plant Personnel recommended that an additional publication be prepared to provide further guidance concerning competency assessments used for measuring the knowledge, skills and attitudes of personnel as the result of training. This publication has been prepared in response to that recommendation. A critical component of SAT (as part of the implementation phase) is the assessment of whether personnel have achieved the standards identified in the training objectives. The nuclear industry spends a significant amount of resources conducting competency assessments. Competency assessments are used for employee selection, trainee assessment, qualification, requalification and authorization (in some Member States the terminology may be 'certification' or 'licensing'), and job advancement and promotion. Ineffective testing methods and procedures, or inappropriate interpretation of test results, can have significant effects on both human performance and nuclear safety. Test development requires unique skills and, as with any skill, training and experience are needed to develop and improve them. Test item and examination development, use, interpretation of results and examination refinement, like all other aspects of SAT, should be part of an ongoing, systematic process. This publication is primarily intended for use by personnel responsible for developing and administering
Otimização da localização das bases de ambulâncias e do dimensionamento das suas regiões de cobertura em rodovias Optimizing the location of ambulance bases and the districting of their covering regions on highways
Ana Paula Iannoni
Full Text Available Neste artigo combinamos extensões do modelo hipercubo de filas com algoritmos genéticos para otimizar a configuração e operação de sistemas médicos emergenciais em rodovias. Inicialmente apresentamos um método para localizar as bases de ambulâncias ao longo da rodovia, de forma a otimizar as principais medidas de desempenho do sistema. Em seguida estendemos a abordagem para apoiar duas decisões combinadas: a localização das bases de ambulâncias e o dimensionamento das regiões de cobertura de cada base na rodovia. Por exemplo, a abordagem permite determinar os locais para posicionar as bases de ambulâncias e dimensionar os tamanhos das suas áreas de atuação, tais que minimizem o tempo médio de resposta aos usuários e/ou o desbalanceamento das cargas de trabalho das ambulâncias do sistema. Para ilustrar a aplicação dos métodos propostos, analisamos os resultados de dois estudos de caso em rodovias brasileiras.In this paper we combine extensions of the hypercube queueing model with genetic algorithms to optimize the configuration and operation of emergency medical systems on highways. Initially we present a method to locate the ambulance bases along the highway so that the main system performance measures are optimized. Then we extend the approach to support combined decisions: the location of ambulance bases and the districting of the covering regions of each base on the highway. For instance, the approach can search for locals to place the ambulance bases and determine the sizes of their operation areas, such that the mean user response time and/or the ambulance workload imbalance are minimized. To illustrate the application of the proposed methods, we analyze the results of two case studies of Brazilian highways.
Briso, Hugo A.
The accelerated process of globalization affecting mankind doesn't exclude safety matters. Indeed, some trans national corporations are increasingly offering specialized engineering services such as industrial radiography or well lodging. As well, a growing scientific exchange involves the mobility of nuclear researchers in different areas, for instance radiochemistry, nuclear medicine and radiotherapy. Such a breakdown in the technological frontiers must necessarily be reflected by the regulatory solutions. Particularly, diverse levels of theoretical-practical training for radiation exposed personnel coexist in the Latin-American Region, being an especially sensitive problem for radiation protection matters. The spectrum goes from post-graduate courses required for radiation protection officers in some countries, while in others only basic recommendations are required for the operating personnel. Another scheme consists of medium level course for the operating personnel, while radiation protection officers don't have special requirements. Many educational private institutions teach non standardized courses which only give broad concepts of radiation protection. On the other hand, usually nothing is said about the operational training, or else its certification is entrusted to the employer itself. In some countries multiple Regulatory Authorities apply dissimilar criteria to assess safety matters, including the evaluation of workers applications. The necessary regional integration makes indispensable to establish common standards for granting authorizations. Having similar or homogeneous requirements for the universe of radiation exposed personnel, i.e. source operators, radiation protection officers, qualified experts and technical support people would be easier for the Regulatory Authorities to have common methodologies of evaluation for the applicants. An IAEA supported technical cooperation project related to this paper seeks to establish standardized
Oberscheider, Marco; Hirsch, Patrick
Efficient transport of non-emergency patients is crucial for ambulance service providers to cope with increased demand resulting from aging Western societies. This paper deals with the optimization of the patient transport operations of the Red Cross of Lower Austria, which is the main provider in this state. Different quality levels of the provided service - expressed by time windows, feasible maximum ride times and exclusive transports - are tested and analyzed on real-life instances to show daily impacts on the provider's resources. Comparisons of the developed solution approach to the recorded manual schedule prove its advantages. In contrast to previous work in this field, non-static service times that depend on the combination of patients, their transport mode, the vehicle type as well as the pickup or delivery locations are used. These service times are based on statistical analyses that have been performed on an anonymized dataset with more than 600,000 requests. To solve the given problem, a matheuristic solution approach was developed that deals with the exact optimization of combinations of requests as a first stage. Subsequently, the identified combinations are used as an input into a Tabu Search strategy, where the vehicle routing is optimized. Three representative days of the year 2012 were chosen for the four regions of Lower Austria to test five different service levels and the quality of the solution method. For the standard scenario, the operation time of the manual schedule is reduced in the range from 14.1 % to 19.8 % for all tested instances. Even in the best service scenario, the matheuristic computes better results than the manual schedule. The service level has a high impact on the operation time of providers. The relative savings that are achieved by the algorithm are significantly lowered by introducing higher quality standards. The main reason is that less feasible combinations of patients can be generated. This leads to diminished
Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Alberti, Gloria; Campodonico, Francesca
Motor impairments such as lack of standing and/or independent ambulation are common among persons with multiple disabilities. These two studies assessed technology-aided programs for persons with those impairments. Specifically, Study I assessed a program to teach two non-ambulatory adults to hand reach a stimulation-linked object by standing up. Study II assessed a program to teach a child and a man to ambulate while holding a rail or following a corridor wall. Standing increased from below 15% to about or over 80% of the session duration in Study I. The participants of Study II managed to complete brief ambulation trials independent of guidance. These performance achievements were discussed in relation to the technology-aided programs employed in the studies and the programs' applicability in daily contexts. © The Author(s) 2016.
Jaldell, Henrik; Lebnak, Prachaksvich; Amornpetchsathaporn, Anurak
To calculate the monetary value of the time factor per minute and per year for emergency services. The monetary values for ambulance emergency services were calculated for two different time factors, response time, which is the time from when a call is received by the emergency medical service call-taking center until the response team arrives at the emergency scene, and operational time, which includes the time to the hospital. The study was performed in two steps. First, marginal effects of reduced fatalities and injuries for a 1-minute change in the time factors were calculated. Second, the marginal effects and the monetary values were put together to find a value per minute. The values were found to be 5.5 million Thai bath/min for fatality and 326,000 baht/min for severe injury. The total monetary value for a 1-minute improvement for each dispatch, summarized over 1 year, was 1.6 billion Thai baht using response time. The calculated values could be used in a cost-benefit analysis of an investment reducing the response time. The results from similar studies could for example be compared to the cost of moving an ambulance station or investing in a new alarm system. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Joseph H. Schwab
Full Text Available Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity. Purpose. The purpose of our study was to evaluate whether minimally invasive posterior spinal instrumentation provided significant pain relief and improved function. Study Design. We compared pre- and postoperative pain scores as well as ambulatory status in a population of patients suffering from oncologic conditions in the spine. Patient Sample. A consecutive series of patients with spine tumors treated minimally invasively with stabilization were reviewed. Outcome Measures. Visual analog pain scale as well as pre- and postoperative ambulatory status were used as outcome measures. Methods. Twenty-four patients who underwent minimally invasive posterior spinal instrumentation for metastasis were retrospectively reviewed. Results. Seven (29% patients were unable to ambulate secondary to pain and instability prior to surgery. All patients were ambulating within 2 to 3 days after having surgery (=0.01. The mean visual analog scale value for the preoperative patients was 2.8, and the mean postoperative value was 1.0 (=0.001. Conclusion. Minimally invasive posterior spinal instrumentation significantly improved pain and ambulatory status in this series.
Sommers, Juultje; Wieferink, Denise C; Dongelmans, Dave A; Nollet, Frans; Engelbert, Raoul H H; van der Schaaf, Marike
Early mobilisation is advocated to improve recovery of intensive care unit (ICU) survivors. However, severe weakness in combination with tubes, lines and machinery are practical barriers for the implementation of ambulation with critically ill patients. The aim of this study was to explore the feasibility of Body Weight-Supported Treadmill Training (BWSTT) in critically ill patients in the ICU. A custom build bedside Body Weight-Supported Treadmill was used and evaluated in medical and surgical patients in the ICU. Feasibility was evaluated according to eligibility, successful number of BWSTT, number of staff needed, adverse events, number of patients that could not have walked without BWSTT, patient satisfaction and anxiety. Twenty participants, underwent 54 sessions BWSTT. Two staff members executed the BWSTT and no adverse events occurred. Medical equipment did not have to be disconnected during all treatment sessions. In 74% of the sessions, the participants would not have been able to walk without the BWSTT. Patient satisfaction with BWSTT was high and anxiety low. This proof of concept study demonstrated that BWSTT is safe, reduces staff resource, and facilitates the first time to ambulation in critically ill patients with severe muscle weakness in the ICU. Copyright © 2017 Elsevier Inc. All rights reserved.
Chan, Herbert; Brasher, Penelope; Erdelyi, Shannon; Desapriya, Edi; Asbridge, Mark; Purssell, Roy; Macdonald, Scott; Schuurman, Nadine; Pike, Ian
Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. PMID:25121822
Estrada, A X; Weiss, D J
The purpose of this study was to assess attitudes of enlisted military personnel with regard to homosexuality. Seventy-two male members of the Marine Corps Reserve responded to a questionnaire exploring attitudes toward lesbians and gay men and attitudes toward homosexuals in the military. Results showed that attitudes with respect to these topics were mildly unfavorable. In addition, several predictor variables employed in similar studies with civilians were examined. Correlational evidence showed that participants expressing more negative attitudes tended to have more conservative political ideology, reported more religious attendance, and were more likely to have had no contact with a gay or lesbian person than those expressing less negative attitudes. These findings suggest that the attitudes held by enlisted personnel are similar to those of their civilian counterparts.
The basic training of nuclear power reactor personnel should be given very close attention since it constitutes the foundation of their knowledge of nuclear technology. Emphasis should be given on the thorough understanding of basic nuclear concepts in order to have reasonable assurance of successful assimilation by those personnel of more specialized and advanced concepts to which they will be later exposed. Basic training will also provide a means for screening to ensure that those will be sent for further spezialized training will perform well. Finally, it is during the basic training phase when nuclear reactor operators will start to acquire and develop attitudes regarding reactor operation and it is important that these be properly founded. (orig.)
Katagiri, Hisako; Yamagata, Junko
We introduce our efforts to utilize education, training, competence assessment, and quality control of personnel engaged in urinary sediment and blood cell morphology examinations in our laboratory. There are no standard samples for these morphological examinations, and standardization has not been completed for all types of blood cells or urinary sediment components. We had been carrying out simultaneous microscopic examination involving trainee staff and senior laboratory technologists as a means of education and evaluation, but acceptance criteria were unclear. Moreover, we had continued our operation without assessment of the level of achievement of routine works or the competence of individual staff members. Taking the opportunity of receiving ISO 15189 certification, we have been able to establish clear standards for evaluating personnel education and training in morphological examinations. We will continuously make efforts to maintain and manage this system.
Simulator training and retraining of operations personnel is essential for their acquiring the necessary knowledge, skills and qualification for operating a nuclear power plant, and for effective feedback of experience including human based operating errors. Simulator training is the most effective way by far of training operations personnel in co-operation and communication in a team, which also involves instilling attitudes and approaches for achieving excellence and individual responsibility and alertness. This technical document provides guidance to Member States on the procurement, setting up and utilization of a simulator training centre; it will also be useful for organizations with previous experience in the use of simulators for training. The document is the result of a series of advisory and consultants meetings held in the framework of the International Working Group on Nuclear Power Plant Control and Instrumentation in 1989-1992. 17 refs, 2 tabs
Bush, W.J.; Bengston, S.J.; Kalbeitzer, F.L.; Cusimano, J.P.; Gupta, V.P.
Thermoluminescent analyzer (TLA) calibration procedures were used to estimate personnel radiation exposure levels at the Idaho National Engineering Laboratory (INEL). A statistical analysis is presented herein based on data collected over a six-month period in 1979 on four TLA's located in the Department of Energy Radiological and Environmental Sciences Laboratory at the INEL. Both gamma and beta radiation models are developed. Observed TLA readings of thermoluminescent dosimeters are correlated with known radiation levels. This correlation is then used to predict unknown radiation doses from future analyzer readings of personnel thermoluminescent dosimeters. The statistical techniques applied in this analysis include weighted linear regression, estimation of systematic and random error variances, prediction interval estimation using Scheffe's theory of calibration, the estimation of the ratio of the means of two normal bivariate distributed random variables and their corresponding confidence limits according to Kendall and Stuart, tests of normality, experimental design, a comparison between instruments, and quality control
of one day of basic pay for each unit training assembly ( UTA ) they attend. A UTA is generally a four-hour period of instruction, and there are usually...training assembly ( UTA ), one point for each day of annual training (AT), and one point for each day of active duty. Points can also be earned for completing... on the vitality of the reserve components, such as funding, equipment, and personnel policy. This report is designed to provide an overview of key
Procedure for education and training of all the personnel employed at Bohunice Nuclear power plant is presented in detail describing the training system structure, kinds of training, staff members qualification development, short term and long term tasks needed to assure attaining the training objectives. The proposed Staff Members Lifetime education implementation project contains basic starting points, measures to be implemented by 1998. It was prepared on the basis of a primary analysis which confirmed the existing need for implementing the lifetime education system
This report examined specific functional components of the routine external personnel dosimeter program at Hanford. Components studied included: dosimeter readout; dosimeter calibration; dosimeter field response; dose calibration algorithm; dosimeter design; and TLD chip acceptance procedures. Additional information is also presented regarding the dosimeter response to light- and medium-filtered x-rays, high energy photons and neutrons. This study was conducted to clarify certain data obtained during the FY-1980 studies.
The purpose of this report is to present the evaluated data from external exposures of 1268 radiation workers in Guatemala carried out in the period of 1997-2000. The collective dose in medicine, industry and other applications shown a tendency to increase in the period of study, radiology is the practice that shown a trend to decrease, that could be explained as a result of inspections and personnel training carried out in this practice
The global market and global communications mark the beginning of a new story, a story that has a significant effect on the tourist economy and its personnel. These developments and other social changes indicate that firms in the tourist industry have to do some rethinking, and sometimes modify their strategy and system of management of resources and work processes. In order to gain insight into the present state and method of managing the processes of developing human resources, we have cond...
Hankins, D.E.; Homann, S.; Westermark, J.
We developed a personnel neutron dosimetry system based on the electrochemical etching of CR-39 plastic at elevated temperatures. The doses obtained using this dosimeter system are more accurate than those obtained using other dosimetry systems, especially when varied neutron spectra are encountered. This CR-39 dosimetry system does not have the severe energy dependence that exists with albedo neutron dosimeters or the fading and reading problems encountered with NTA film. 3 refs., 4 figs
This report examined specific functional components of the routine external personnel dosimeter program at Hanford. Components studied included: dosimeter readout; dosimeter calibration; dosimeter field response; dose calibration algorithm; dosimeter design; and TLD chip acceptance procedures. Additional information is also presented regarding the dosimeter response to light- and medium-filtered x-rays, high energy photons and neutrons. This study was conducted to clarify certain data obtained during the FY-1980 studies
Short, Larry E.
Pinpoints problems associated with personnel operations' inclusion in large complex information systems: personnel information system redesign requirements, potential confidentiality loss, reduced information accessibility, awkward data format requirements, and psychological problems. Discusses single chip micro-processor and micro-computer…
This bibliography contains references on: specific thermoluminescent dosemeters used for personnel dosimetry; comparisons of thermoluminescent and other dosemeters for personnel monitoring and read-out apparatus for thermoluminescent dosemeters. An appendix contains selected foreign language references. (author)
... Component administrative regulations. These latter categories of allegations lie outside the DoD personnel... organizations, Component personnel security authorities, or DIS. (4) Allegations of criminal activity. Any... appropriate military department investigative organization. Only postadjudication investigations involving an...
..., or bachelor's degree in a chemical, physical, biological or clinical laboratory science, or medical... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Personnel for Nonwaived Testing Laboratories Performing Moderate Complexity Testing § 493.1423 Standard; Testing personnel...
Walker Sewill, Danielle K; Van Sell, Sharon; Kindred, Chris
The purpose of this article is to provide education to the RN regarding pressure ulcer prevention and best practice interventions. This investigation focuses on the definition of a pressure ulcer, risk factors for pressure ulcers, and the benefits and importance of using unlicensed assistive personnel to help prevent pressure ulcers. A comprehensive literature review was completed using the Texas Woman's University Library, the Texas Christian University Library, and the World Wide Web. The search engine used was Google. The databases included were CINAHL, Academic Search Complete, Cochrane Library, MEDLINE, and ProQuest Nursing & Allied Health Source. The literature was current, defined as from the last 10 years, and the primary language searched was English. Full-text articles from these databases were included as well as print publications from the university collections. The key search terms from the literature review included (a) pressure ulcer, (b) prevention, (c) unlicensed assistive personnel, (d) nursing assistant, (e) theory of nursing knowledge, (f) incidence, (g) prevalence, (h) Braden scale, (i) moisture, and (j) repositioning. Best practice guidelines were reviewed via the Joanna Briggs database, National Guideline Clearinghouse, Cochrane Library, the Centers for Medicare & Medicaid Services, and the National Institutes of Health. Literature was synthesized to define evidence-based practices that would justify the use of unlicensed assistive personnel for the prevention and care of pressure ulcers.
Wagnerova, M.; Skokanova, K.; Wagner, V.; Zikmundova, L.
The levels were studied of immunoglobulins IgG, IgM and IgA in the blood serum and of IgA in the saliva of personnel of radiodiagnostic and nuclear medicine units in the Central Bohemian Region (Czechoslovakia). The purpose of the experiment was to find the effect of ionizing radiation on the immunity mechanism in man. It was observed that the average levels of immunoglobulins IgG and IgA were lower in personnel exposed to occupational radiation hazards than in the controls. Age dependent differences in the levels of IgG and IgA were not significant in the exposed personnel while the length of employment significantly affected the distribution curve which showed several peaks. Radiation doses little affected the immunoglobulin levels in the blood serum while the levels of IgA in the saliva showed a significant variation with the radiation dose. Age dependent and length of employment dependent differences were insignificant. The study thus verified different immunological behaviour induced by radiation in man. (L.O.)
Temporary work for children of members of the personnel During the period mid-June to mid-September 2002, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1564.- for this period. Application form can be obtained from Martine PLAZA, Personnel Management Group (by using the slip below or by electronic mail to Martine.Plaza@cern.ch)) or on the web. Completed application forms must be returned to this service by 3 May 2002 at the l...
In the first period of the development of nuclear technology specialists received mainly theoretical training in brief study courses and training sessions. These courses did not place high demands on training methods. In the subsequent period long-term, well-conceived and costly systems of training were developed placing emphasis on specialized knowledge and especially on practical training. The third stage has now been launched which is characterized by the departure from classical control rooms to data collection and processing in centralized information systems, selective recording according to situation and choice, etc. This stage is passing on to the system of the minimization of the human factor error. A significant problem of the human factor in nuclear technology is the time aspect. Schools specializing in the education and training of specialists, technical personnel and workers for the nuclear programme have been established. Following such education personnel are selected for specialized training in training centres which have been equipped with costly training equipment including simulators. With regard to the importance of the human factor in nuclear installations, control computers are being introduced to an increasing extent and individuals and groups of workers and personnel are trained in operation. (E.S.)
Pribozic, F.; Krajnc, J.
Acquisition of a full scope replica simulator represents an important achievement for Nuclear power Plant Krsko. Operating nuclear power plant systems is definitely a set of demanding and complex tasks. The most important element in the goal of assuring capabilities for handling such tasks is efficient training of operations personnel who manipulate controls in the main control room. Use of a simulator during the training process is essential and can not be substituted by other techniques. This article gives an overview of NPP Krsko licensed personnel training historical background, current experience and plans for future training activities. Reactor operator initial training lasts approximately two and a half years. Training is divided into several phases, consisting of theoretical and practical segments, including simulator training. In the past, simulator initial training and annual simulator retraining was contracted, thus operators were trained on non-specific full scope simulators. Use of our own plant specific simulator and associated infrastructure will have a significant effect on the operations personnel training process and, in addition, will also support secondary uses, with the common goal to improve safe and reliable plant operation. A regular annual retraining program has successfully started. Use of the plant specific simulator assures consistent training and good management oversight, enhances conformity of operational practices and supports optimization of operating procedures. (author)
Temporary work for children of members of the personnel During the period mid-June to mid-September 2005, a limited number of vacancies for temporary work at CERN (normally unskilled work of a routine nature) will be available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children having previously worked at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks and the allowance for the period will be CHF 1621.- net. Candidates should apply via the HR Department's electronic recruitment system (E-rt) : http://humanresources.web.cern.ch/humanresources/internal/personnel/pmd/cr/Staff-kids-05.pdf Completed application forms must be returned to this Service by 8 April 2005 ...
Temporary work for children of members of the personnel During the period mid-June to mid-September 2003, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1582.- for this period. Application form can be obtained from Martine PLAZA, HR Division (by using the slip in the bulletin or by electronic mail to Martine.Plaza@cern.ch) or at http://cern.ch/hr-web/internal/general/HN-personnel/ Completed application forms must be returne...
Temporary work for children of members of the personnel During the period mid-June to mid-September 2003, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1582.- for this period. Application form can be obtained from Martine PLAZA, HR Division (by electronic mail to Martine.Plaza@cern.ch) or at http://cern.ch/hr-web/internal/general/HN-personnel/ Completed application forms must be returned to this service by 2 May 2003 at th...
Temporary work for children of members of the personnel During the period mid-June to mid-September 2003, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1582.- for this period. Application form can be obtained from Martine PLAZA, HR Division (by electronic mail to Martine.Plaza@cern.ch) or at http://cern.ch/hr-web/internal/general/HN-personnel/ Completed application forms must be returned to this service by 2 May 2003 at t...
... 25 Indians 1 2010-04-01 2010-04-01 false Leave system for education personnel. 38.12 Section 38.12 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION EDUCATION PERSONNEL § 38.12 Leave system for education personnel. (a) Full-time school-term employees. Employees on a full-time school-term...
Lagos State Civil Service (LSCS) exists to implement policies of government. To realize this goal, personnel are needed, which are products of personnel recruitment and retention strategies (PR & RSs) of the civil service (CS). This study empirically examined personnel recruitment and retention strategies in LSCS.
... 45 Public Welfare 2 2010-10-01 2010-10-01 false Personnel merit system review. 201.11 Section 201... STATES FOR PUBLIC ASSISTANCE PROGRAMS Review and Audits § 201.11 Personnel merit system review. A personnel merit system review is carried out by the Office of State Merit Systems of the Office of the...
... 42 Public Health 4 2010-10-01 2010-10-01 false Standards of personnel administration. 432.10 Section 432.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE PERSONNEL ADMINISTRATION General Provisions § 432.10 Standards of personnel administration. (a)...
Williams, C. A.
Staff development, one of the nine main functions in personnel management, is not an isolated function. Administrators with whom the ultimate responsibility for personnel management rests, determine the extent to which the personnel and staff development specialists can be utilized. The staff development specialist has three major roles, as…
Background: False alarms and sounds in the operating theatre (OT) that alert personnel to a crisis can be irritating. This can result in personnel ignoring genuine alarm warnings. This study was carried out to determine how alert OT personnel are in response to the pulse oximeter alarm. Method: For the purposes of the ...
... 34 Education 1 2010-07-01 2010-07-01 false Use of public school personnel. 76.659 Section 76.659... Be Met by the State and Its Subgrantees? Participation of Students Enrolled in Private Schools § 76.659 Use of public school personnel. A subgrantee may use program funds to make public personnel...
function in the SADF was given to the Chief of. Staff Personnel in ... and Finance. During the ensuing re-organisation. Personnel Division emerged at CSADF Head- quarters level and in each Arm of Service. These. Personnel Divisions were meant to embrace the functions of ... sonnel officer" playing a relatively minor role.
... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Personnel hoists and elevators. 77.1400 Section... MINES Personnel Hoisting § 77.1400 Personnel hoists and elevators. Except as provided in § 77.1430, the sections in this Subpart O apply only to hoists and elevators, together with their appurtenances, that are...
... 32 National Defense 1 2010-07-01 2010-07-01 false Evaluation of personnel security information... SECURITY DEPARTMENT OF DEFENSE PERSONNEL SECURITY PROGRAM REGULATION Adjudication § 154.42 Evaluation of personnel security information. (a) The criteria and adjudicative policy to be used in applying the...
Activities of IAEA concerning training and qualification of NPP personnel consider the availability of sufficient number of competent personnel which is one of the most critical requirements for safe and reliable NPP operation and maintenance. Competence of personnel is essential for reducing the frequency of events connected to human errors and equipment failures. The IAEA Guidebook on Nuclear Power Plant Personnel Training and its Evaluation incorporates the experience gained worldwide and provides recommendations on the use of SAT being the best practice for attaining and maintaining the qualification and competence of NPP personnel and for quality assurance of training
Full Text Available At the present stage, the effectiveness of the organization activity directly depends on the properly organized personnel policy. The article presents the results of the problem diagnosis in the personnel policy of one of the organizations. The analysis of the use of labor resources, procedures and methods of implementing the personnel policy is performed. Measures to improve the effectiveness of the personnel policy of the organization are developed and recommended The ultimate goal of the personnel policy is to create a cohesive, responsible, high-performance team that is able to solve any tasks that correspond to the mission and strategy of the organization.
Vles, G.F.; Soudant, D.L.; Hoving, M.A.; Vermeulen, R.J.; Bonouvrié, L.A.; van Oostenbrugge, R.J.; Vles, J.S.
Background: Little is known about the long-term effects of Continuous intrathecal Baclofen (CITB) therapy in non-ambulant children with intractable spastic Cerebral Palsy (CP). Aim: To determine whether short-term beneficial effects of CITB therapy are present at the long-term, and whether
Paul, Serene S; Harvey, Lara; Carroll, Therese; Li, Qiang; Boufous, Soufiane; Priddis, Annabel; Tiedemann, Anne; Clemson, Lindy; Lord, Stephen R; Muecke, Sandy; Close, Jacqueline Ct; Lo, Serigne; Sherrington, Catherine
Objective and importance of study: To describe characteristics and temporal trends of fall-related ambulance service use and hospital admission in older adults in New South Wales (NSW), Australia. Such information will facilitate a more targeted approach to planning and delivery of health services to prevent falls and their adverse sequelae in different groups of older adults. Retrospective population-based descriptive study. Fall-related ambulance use and hospital admissions for all falls and injurious falls in NSW residents aged ≥65 years between 2006 and 2013 were obtained from two discrete sources of routinely collected data. Rates of use are presented descriptively. There were 314 041 occasions of fall-related ambulance use by older adults and 331 311 fall-related hospitalisations, of which 69% (n = 227 753) were for injurious falls. Fractures accounted for 57% of injurious hospitalisations. Slips and trips were the most common mechanism of falls requiring hospitalisation (52%). Residents of aged care facilities had a greater proportion of fall injury hospitalisations compared with people living in the community (85% and 65%, respectively). Rates of fall-related ambulance use and hospitalisation were similar and continued to increase over time. Increased effort is needed to prevent falls and associated injury among older people in NSW, particularly among people living in aged care facilities. Ongoing monitoring of rates and the characteristics of people who fall are needed to determine the long-term impact of fall prevention interventions.
Serene S Paul
Full Text Available Objective and importance of study: To describe characteristics and temporal trends of fall-related ambulance service use and hospital admission in older adults in New South Wales (NSW, Australia. Such information will facilitate a more targeted approach to planning and delivery of health services to prevent falls and their adverse sequelae in different groups of older adults. Study type: Retrospective population-based descriptive study. Methods: Fall-related ambulance use and hospital admissions for all falls and injurious falls in NSW residents aged ≥65 years between 2006 and 2013 were obtained from two discrete sources of routinely collected data. Rates of use are presented descriptively. Results: There were 314 041 occasions of fall-related ambulance use by older adults and 331 311 fall-related hospitalisations, of which 69% (n = 227 753 were for injurious falls. Fractures accounted for 57% of injurious hospitalisations. Slips and trips were the most common mechanism of falls requiring hospitalisation (52%. Residents of aged care facilities had a greater proportion of fall injury hospitalisations compared with people living in the community (85% and 65%, respectively. Conclusions: Rates of fall-related ambulance use and hospitalisation were similar and continued to increase over time. Increased effort is needed to prevent falls and associated injury among older people in NSW, particularly among people living in aged care facilities. Ongoing monitoring of rates and the characteristics of people who fall are needed to determine the long-term impact of fall prevention interventions.
Full Text Available Abstract Background We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting. Methods A systematic review of the literature on randomised controlled trials in ambulance settings was undertaken. A search of eight databases identified published studies involving recruitment of ambulance service users. Four independent authors undertook abstract and full-text reviews to determine eligibility and extract relevant data. The data extraction concentrated on ethical considerations, with any discussion of ethics being included for further analysis. The resultant data were combined to form a narrative synthesis. Results In all, 56 papers were identified as meeting the inclusion criteria. Issues relating to consent were the most significant theme identified. Type of consent differed depending on the condition or intervention being studied. The country in which the research took place did not appear to influence the type of consent, apart from the USA where exception from consent appeared to be most commonly used. A wide range of terms were used to describe consent. Conclusions Consent was the main ethical consideration in published ambulance based research. A range of consent models were used ranging from informed consent to exception from consent (waiver of consent. Many studies cited international guidelines as informing their choice of consent model but diverse and sometimes confused terms were used to describe these models. This suggests that standardisation of consent models and the terminology used to describe them is warranted.
Ringh, Mattias; Fredman, David; Nordberg, Per; Stark, Tomas; Hollenberg, Jacob
In a two-parted study, evaluate a new concept were mobile phone technology is used to dispatch lay responders to nearby out-of-hospital cardiac arrests (OHCAs). Mobile phone positioning systems (MPS) can geographically locate selected mobile phone users at any given moment. A mobile phone service using MPS was developed and named Mobile Life Saver (MLS). Simulation study: 25 volunteers named mobile responders (MRs) were connected to MLS. Ambulance time intervals from 22 consecutive OHCAs in 2005 were used as controls. The MRs randomly moved in Stockholm city centre and were dispatched to simulated OHCAs (identical to controls) if they were within a 350 m distance. Real life study: during 25 weeks 1271-1801 MRs trained in CPR were connected to MLS. MLS was activated at the dispatch centre in parallel with ambulance dispatch when an OHCA was suspected. The MRs were dispatched if they were within 500 m from the suspected OHCA. Simulation study: mean response time for the MRs compared to historical ambulance time intervals was reduced by 2 min 20s (44%), pMobile phone technology can be used to identify and recruit nearby CPR-trained citizens to OHCAs for bystander CPR prior to ambulance arrival. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Bolster, E.A.M.; van Schie, P.E.M.; Becher, J.G.; van Ouwerkerk, W.J.R.; Strijers, R.L.M.; Vermeulen, R.J.
Aim: The aim of this study was to evaluate the long-term effect of selective dorsal rhizotomy (SDR) on the gross motor function of ambulant children with spastic bilateral cerebral palsy (CP), compared with reference centiles. Method: The study used a prospective cohort design and participants
Armstrong, Stephanie; Langlois, Adele; Laparidou, Despina; Dixon, Mark; Appleton, Jason P; Bath, Philip M; Snooks, Helen; Siriwardena, A Niroshan
We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting. A systematic review of the literature on randomised controlled trials in ambulance settings was undertaken. A search of eight databases identified published studies involving recruitment of ambulance service users. Four independent authors undertook abstract and full-text reviews to determine eligibility and extract relevant data. The data extraction concentrated on ethical considerations, with any discussion of ethics being included for further analysis. The resultant data were combined to form a narrative synthesis. In all, 56 papers were identified as meeting the inclusion criteria. Issues relating to consent were the most significant theme identified. Type of consent differed depending on the condition or intervention being studied. The country in which the research took place did not appear to influence the type of consent, apart from the USA where exception from consent appeared to be most commonly used. A wide range of terms were used to describe consent. Consent was the main ethical consideration in published ambulance based research. A range of consent models were used ranging from informed consent to exception from consent (waiver of consent). Many studies cited international guidelines as informing their choice of consent model but diverse and sometimes confused terms were used to describe these models. This suggests that standardisation of consent models and the terminology used to describe them is warranted.
Nantel, Marc; Fox, Bradley; Gelsthorpe, Leanne; Hamilton, Roxy; Marshall, Robert; Williamson, Guida
Employers clamour for more "Highly-Qualified Personnel" (HQP) to hire, and photonics is no exception. The challenge facing all new graduates lies in what actually constitutes a Highly-Qualified Person. Yesterday, an HQP was often understood to be a graduate with a Bachelor's, Master's or Ph.D. degree. Today, industry is demanding that an HQP be either a university or college graduate with strong academic standing AND a sound business and communications skill set. In this paper, we introduce the concept of "Value-Added Personnel" (VAP), which marries both scientific and "soft-skills" aspects, and we present a new program in Ontario to produce VAPs.
One of the lessons learned from the Three Mile Island (TMI) accident was that the nuclear industry was ineffective in learning from previous events at other plants. As training programs and methods have improved since TMI, the nuclear industry has searched for effective methods to teach the lessons learned from industry events. The case study method has great potential as a solution. By reviewing actual plant events in detail, trainees can be challenged with solving actual problems. When used in a seminar or discussion format, these case studies also help trainees compare their decision-making processes with other trainees, the instructor, and the personnel involved in the actual case study event
Estorce, Thiago Puliesi; Kurcgant, Paulina
Sick leaves in the nursing team demand immediate managerial actions when health care has quality as a goal. This descriptive-exploratory, quantitative study was performed with the purpose of characterizing that phenomenon in a university hospital between 2003 and 2007. The medical leaves added up to 3,207 leaves and 32,022 days lost. Leaves lasting up to two days accounted for 54% of the total leaves and to 7% of the days lost; leaves of more than 15 days, 5% of the total, and 66% of the lost days. Hence, sick leaves consist of an important tool in nursing personnel management.
Johnson, L D
Quality of care is an espoused yet in some ways elusive objective in the provision of health services. In this paper, a marketing framework is utilized to outline the characteristics of services which create difficulties for quality assurance and to examine service quality as perceived by the consumer. Two key concepts are explored: interactive marketing, the management of the production-consumption process, and internal marketing, the consideration of employees as an internal client group. The view is advanced that attention to these concepts highlights the importance of personnel management functions in ensuring quality in the provision of health services.
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The safe operation of a research reactor requires that reactor personnel be fully trained and certified by the relevant authorities. Reactor operators at PUSPATI TRIGA Reactor underwent extensive training and are certified, ever since the reactor first started its operation in 1982. With the emphasis on enhancing reactor safety in recent years, reactor operator training and certification have also evolved. This paper discusses the changes that have to be implemented and the challenges encountered in developing a new training programme to be in line with the national standards. (author)
Stasolla, Fabrizio; Caffò, Alessandro O; Perilli, Viviana; Boccasini, Adele; Stella, Anna; Damiani, Rita; Albano, Vincenza; Damato, Concetta
We assessed the use of a microswitch-based program for promoting ambulation responses by two children with multiple disabilities. The goals of the study were to: (a) evaluate the importance of the contingency between the target behavior (forward step) and the programmed consequence (preferred stimuli), (b) measure effects of the intervention on indices of happiness, and (c) assess the social validation of the procedure using 20 physiotherapists as external raters. The intervention involved the automatic delivery of preferred stimuli contingent on forward steps. Results showed that both participants improved their performance (forward steps and indices of happiness) during contingent reinforcement phases compared to baseline and noncontingent reinforcement phases. Moreover, physiotherapists rated the intervention as socially valid. © 2017 Society for the Experimental Analysis of Behavior.
The Emergency Medical Video Multiplexing Transport System (EMTS) is designed to support prehospital cares by delivering high quality live video streams of patients in an ambulance to emergency doctors in a remote hospital via satellite communications. The important feature is that EMTS divides a patient's live video scene into four pieces and transports the four video streams on four separate network channels. By multiplexing four video streams, EMTS is able to transport high quality videos through low data transmission rate networks such as satellite communications and cellular phone networks. In order to transport live video streams constantly, EMTS adopts Real-time Transport Protocol/Real-time Control Protocol as a network protocol and video stream data are compressed by Moving Picture Experts Group 4 format. As EMTS combines four video streams with checking video frame numbers, it uses a refresh packet that initializes server's frame numbers to synchronize the four video streams.
Francinaldo do Monte Pinto
Full Text Available Objetivo: analisar a atividade dos motoristas de ambulância do Serviço Móvel de Urgência (SAMU. Métodos: foi empregada a perspectiva ergológica, que se opera a partir da concepção de vida-saúde-doença postulada por George Canguilhem, e a Ergonomia da Atividade. Foram realizadas onze entrevistas dialógicas com motoristas da Unidade de Terapia Intensiva Móvel, em 2010, no estado da Paraíba. Resultados: os motoristas atribuem as principais dificuldades para realizar o trabalho ao modo de organização prescrita do trabalho no SAMU, à gestão temporal da atividade, à atividade no trânsito, à relação com a população usuária e ao risco de contrair doenças. Em contraposição, os motoristas adquirem sentido no trabalho ao salvarem vidas, em uma conjunção de valores – solidariedade, confiança e cooperação – em relação aos socorridos e aos seus acompanhantes. Quando essa possibilidade não se concretiza, o coletivo de trabalho serve de apoio para que permaneçam na profissão, apesar das frustrações. Conclusão: evidenciou-se que, mesmo diante das variabilidades cotidianas da atividade de trabalho, os motoristas de ambulâncias produzem modos operatórios para dar conta das situações de trabalho, cooperando para solução dos problemas e/ou manejando as imprevisibilidades no trabalho em equipe.
Myers, J A; Powell, D M C; Aldington, S; Sim, D; Psirides, A; Hathaway, K; Haney, M F
The relationship between fatigue-related risk and impaired clinical performance is not entirely clear. Non-technical factors represent an important component of clinical performance and may be sensitive to the effects of fatigue. The hypothesis was that the sum score of overall non-technical performance is degraded by fatigue. Nineteen physicians undertook two different simulated air ambulance missions, once when rested, and once when fatigued (randomised crossover design). Trained assessors blinded to participants' fatigue status performed detailed structured assessments based on expected behaviours in four non-technical skills domains: teamwork, situational awareness, task management, and decision making. Participants also provided self-ratings of their performance. The primary endpoint was the sum score of overall non-technical performance. The main finding, the overall non-technical skills performance rating of the clinicians, was better in rested than fatigued states (mean difference with 95% CI, 2.8 [2.2-3.4]). The findings remained consistent across individual non-technical skills domains; also when controlling for an order effect and examining the impact of a number of possible covariates. There was no difference in self-ratings of clinical performance between rested and fatigued states. Non-technical performance of critical care air transfer clinicians is degraded when they are fatigued. Fatigued clinicians may fail to recognise the degree to which their performance is compromised. These findings represent risk to clinical care quality and patient safety in the dynamic and isolated environment of air ambulance transfer. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Sinclair, Neil; Swinton, Paul A; Donald, Michael; Curatolo, Lisa; Lindle, Peter; Jones, Steph; Corfield, Alasdair R
Trauma remains the fourth leading cause of death in western countries and is the leading cause of death in the first four decades of life. NICE guidance in 2016 advocated the attendance of pre-hospital critical care trauma team (PHCCT) in the pre-hospital stage of the care of patients with major trauma. Previous publications support dispatch by clinicians who are also actively involved in the delivery of the PHCCT service; however there is a lack of objective outcome measures across the current reviewed evidence base. In this study, we aimed to assess the accuracy of PHCCT clinician led dispatch, when measured by Injury Severity Score (ISS). A retrospective cohort study over a 2 year period pre and post implementation of a PHCCT clinician led dispatch of PHCCT for potential major trauma patients, using national ambulance data combined with national trauma registry data. A total of 99,702 trauma related calls were made to SAS including 495 major trauma patients with an ISS >15, and a total of 454 dispatches of a PHCCT. Following the introduction of a PHCCT clinician staffed trauma desk, the sensitivity for major trauma was increased from 11.3% to 25.9%. The difference in sensitivity between the pre and post trauma desk group was significant at 14.6% (95% CI 7.4%-21.4%, p < .001). The results from the study support the results from other studies recommending that a PHCCT clinician should be located in ambulance control to identify major trauma patients as early as possible and co-ordinate the response. Copyright © 2018. Published by Elsevier Ltd.
Shaw, T A; De Risio, L; Laws, E J; Rose, J H; Harcourt-Brown, T R; Granger, N
Limited information is available about prognostic factors for recovery after spinal cord injury (SCI) to the L4-S3 segments. Previous research suggests that L4-S3 SCI does not have a worse prognosis than T3-L3 SCI. To elucidate prognostic factors for regaining urinary continence and ambulation in dogs with L4-S3 SCI and compare prognosis to T3-L3 SCI. A retrospective study on 61 nonambulatory dogs with L4-S3 SCI, matched to dogs with T3-L3 SCI, compared 3 weeks after onset. Prognostic factors explored using logistic regression and used for matching: nonchondrodystrophic dogs >15 kg versus dogs that were chondrodystrophic or dogs regained continence compared to T3-L3 dogs (64 vs 85%, P = .0033), but no difference existed for regaining ambulation (66 vs 75%, P = .1306). In L4-S3 SCI dogs, fewer dogs regained continence with loss of CPP (P Dogs with L4-S3 SCI have a poorer short-term prognosis than do dogs with T3-L3 SCI. Dogs with L4-S3 SCI had a poor prognosis with loss of CPP, or noncompressive lesions combined with LMN incontinence. Small-breed or chondrodystrophic dogs with retained CPP, compressive lesions, and UMN incontinence had an excellent prognosis. These findings may help guide decision-making in L4-S3 SCI. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
Olia, P M; Mollica, T V; Querci, A
The aim of the present study was to analyse the types of calls attended by the authors in their ambulance, assigned to one sector of the urban area of Prato. We analysed 1060 consecutive calls carried out by our ambulance; 33 calls (3.1%), cancelled for various reasons, were excluded from statistical analysis. The calls regarded 1027 patients, 549 (53.5%) males and 478 (46.5%) females. 46% of calls concerned non trauma cases, 17% trauma cases and 7.2% transfers between hospitals. Calls in the non trauma group were for dyspnea (16.7%), unconsciousness (16.6%), chest pain (11.8%), cerebrovascular pathology (7.7%), mental disorders (7.1%), abdominal pain (5.1%), use of psychotropic substances (4%) and convulsions (3.2%). Support to patients with terminal cancer accounted for 2.3% of cases, metabolic disorders 2.2%, hypertensive events 2.1%, tachycardia 1.9%, vertigo 1.9%, allergies 1%, obstetric pathology 0.5% and cardiorespiratory resuscitation 2,2%. Thirteen point seven percent were miscellaneous, including poisonings, migraines, haemorrhages and flu syndromes. Trauma cases included road accidents (62.6%), falls (27%), aggression (6.9%), work-related accidents (3.5%). The percentage of trauma cases (17%) was similar to that reported for a Swedish urban area (20%). Cases of cardiorespiratory resuscitation were 1.65% of our calls, compared to 1.73% and 1.8% reported in Northeastern Germany and Taiwan. Although prehospital emergency medical services are organised differently in different countries, our data suggest that emergency medical services in our area have a percentage distribution of case types similar to services in other countries.
Alvarado-Socarras, Jorge Luis; Idrovo, Alvaro Javier; Bermon, Anderson
To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS), and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead) at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations. A total of 176 neonates were transported by ambulance (10.22% by air) over six months. The transport distances were longer by air (median: 237.5km) than by ground (median: 11.3km). Mortality was higher among neonates transported by air (33.33%) than by ground (7.79%). No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted. Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation) to obtain good clinical outcomes according type of ambulance. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
Chemperek, Ewa; Mikuła, Agnieszka; Goniewicz, Mariusz; Krawczyk, Wojciech
The major causes of deaths all over the world are circulatory system diseases, neoplasms and injuries. Each man can become a participant of the event which results in life-threatening emergencies and the most immediate possible actions are essential. The period of time for starting efficient life-restoration actions is very short, estimated at 4-5 minutes. Ambulance Service is a medical organization created to apply aid in life-threatening emergencies. The standards of the developed western countries determine the arrival time at 7-10 minutes from the call time. Both first-aid applied by the accident witnesses and efficient actions of ambulance service have significance for effective pre-hospital aid and increasing the chances of survival of people in need. The study analysed emergency records of the ambulance cars of the Regional Unit of Ambulance Service - Sródmieście Station in Lublin in the year 2000. 3,723 calls were recorded. In 142 cases complete resuscitation actions were carried out due to circulatory and respiratory arrest. The records selected this way went through a detailed analysis. In 3.8% of the interventions of emergency teams the necessity of applying advanced life support was observed. The time of arrival at the scene, transport of the patient to the admission room as well as efficiency of resuscitation comply with the European standards. The efficiency of resuscitation actions estimated at 51.4% depended on the age of the patient, the cause of circulatory and respiratory arrest and ambulance arrival time. Taking up basic life support by witnesses of the event was observed in 2.8% of cases, in 8.5% aid was applied by the medical staff members who happened to be at the scene.
Stacey, Michael John; Hill, N; Woods, D
Military employment commonly exposes personnel to strenuous physical exertion. The resulting interaction between occupational stress and individual susceptibility to illness demands careful management. This could extend to prospective identification of high physiological strain in healthy personnel, in addition to recognition and protection of vulnerable individuals. The emergence and ubiquitous uptake of 'wearable' physiological and medical monitoring devices might help to address this challenge, but requires that the right questions are asked in sourcing, developing, validating and applying such technologies. Issues that must be addressed include system requirements, such as the likelihood of end users deploying and using technology as intended; interpretation of data in relation to pretest probability, including the potential for false-positive results; differentiation of pathological states from normal physiology; responsibility for and consequences of acting on abnormal or unexpected results and cost-effectiveness. Ultimately, the performance of a single monitoring system, in isolation or alongside other measures, should be judged by whether any improvement is offered versus existing capabilities and at what cost to mission effectiveness. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full text: Renentech Laboratories is the first Private Enterprise in India to have been chosen to provide Personnel radiation monitoring services to radiation workers at different parts of the country. Since 1992 the Company has been manufacturing TLD phosphor powder of requisite quality and from 1995 commenced the production of TLD cards for radiation monitoring. After getting the necessary approval from the competent authorities in the country, the company undertook a rigorous quality assurance programme and received the accreditation in 1999 to carry out the personnel monitoring of radiation. Since then the trained staff of the Company is covering 1200 institutions in 16 states where radiation is being used. This translates to processing of 60,000 Till cards annually, the maximum limit permitted by BARC. Processing of exposure data is done strictly according well-laid guidelines. Any cases of overexposure are immediately referred to Calibration and Dose Record Section of BARC to meet the regulatory requirements. Necessary procedural guidelines are followed to handle such cases. In this lecture, learning, operation and implementation experience of a typical Private Company in a task, which, hitherto had been regarded as exclusive responsibility of state owned institution, is enumerated
During the period mid-June to mid-September 2001, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of a routine nature) which will be made available to children of members of the personnel (that is, anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1538.- net for this period. Application forms can be obtained via the Web at the following address: http://cern.web.cern.ch/CERN/Divisions/PE/ under the heading 'Other Useful Links' or from Paula Barriere, Personnel Management Group (by using the slip below or by electronic mail to Paula.Barriere@.cern.ch). Completed applic...
Vazquez Lopez, C.; Saez, J.C.; Labarta, T.
Various tests carried out to characterize a Thermoluminiscence Personnel Dosimetry Automatic System, based on the optical heating of a multielement dosemeter are presented. The dosemeter consists of Lithium Borate (Copper) and Calcium Sulphate (Thallium) phosphors. The Dosimetric System shows some outstanding features, such as its simplicity (no aditional annealing procedures are required), its short reading cycle (160 TLD per hour and its data handling capabilities (RS-232C and Parallel Printer digital ports and four analigic outputs for Glow Curve Adquisition). The tests performed have been designed to conform with the different existing international Standards and Recommendations (ANSI: N13.11-1983; IEC:Draft 45B-1987, ISO:DP 8034-1984) The new radiological quantities (I.C.R.U.-19855) have been used for calibration. The results obtained (linearity, repeatibility, detection threshold, residue, stability of stored information, etc) show the optimum performance of this dosimetric system in its aplication to routine personnel dose monitoring. Based on the dosemeter energy discriminating response, an algorithm for dose assesment has been developed. The method allows personal dose calculations within 10% and gives valuable information on the quality and energy of incident radiation, for photons from 30 to 2000 keV and for Beta penetrating radiation (Sr/Y, U). (Author)
Temporary work for children of members of the personnel During the period from 15 June to 11 September 2009 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of a routine nature), which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of all appointments will be 4 weeks and the allowance will be CHF 1717. - for this period. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6970 Completed application forms must be returned by 10 April 2009 at the latest. The results of the selection will be available on 22 May 2009. For further information, please contact: mailto:Inger.Carriero...
Summer work for children of members of the personnel During the period from 13 June to 16 September 2011 inclusive, there will be a limited number of jobs for summer work at CERN (normally unskilled work of a routine nature), which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of all contracts will be 4 weeks and the allowance will be 1717 CHF for this period. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_intranet/wd_pds?p_web_site_id=1&p_web_page_id=8886&p_no_apply=&p_show=N Completed application forms must be returned by 11 April 2011 at the latest. The results of the selection will be available by the end of May 2011. For further information, please con...
Summer work for children of members of the personnel During the period from 14 June to 17 September 2010 inclusive, a limited number of jobs for summer work at CERN (normally unskilled work of a routine nature) will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of all contracts will be 4 weeks and the allowance will be 1717 CHF for this period. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=7716 Completed application forms must be returned by 9 April 2010 at the latest. The results of the selection will be available on 21 May 2010. For further information, please contact: Inger.Carriero@cern.ch Tel. 71372
Temporary work for children of members of the personnelDuring the period 12 June to 15 September 2006 included, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of jobs available, no children who have previously worked at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1640.- for this period. Candidates should apply via HR department's electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=4691 Completed application forms must be returned to this service by 17 April 2006 at the latest. The results of t...
Temporary work for children of members of the personnelDuring the period 12 June to 15 September 2006 included, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of jobs available, no children who have previously worked at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1640.- for this period. Candidates should apply via HR department's electronic recruitment system (E-rt) : https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=4691 Completed application forms must be returned to this service by 17 April 2006 at the latest. The results of ...
Temporary work for children of members of the personnel During the period from 15 June to 11 September 2009 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of a routine nature), which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of all appointments will be 4 weeks and the allowance will be CHF 1717. - for this period. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6970 Completed application forms must be returned by 10 April 2009 at the latest. The results of the selection will be available on 22 May 2009. For further information, please contact: mailto:Inger.Carriero@...
Temporary work for children of members of the personnel During the period from 16 June to 12 September 2008 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of a routine nature), which will be open to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of appointments will be 4 weeks and the allowance for this period will be 1663.- CHF. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6160 Completed application forms must be made on-line by 13 April 2008 at the latest. The results of the selection will be available on 18 May 2008. For further information, please contact: Geraldine.Ballet@cern.ch HR ...
Temporary work for children of members of the personnel During the period from 16 June to 12 September 2008 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of routine nature), which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of appointments will be 4 weeks and the allowance for this period will be 1663.- CHF. Candidates should apply via HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6160 Completed application forms must be made on-line by 13 April 2008 at the latest. The results of the selection will be available on 18 May 2008. For further information, please contact: mailto:Geraldine.Ballet@cer...
Temporary work for children of members of the personnel During the period from 16 June to 12 September 2008 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of a routine nature), which will be open to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of appointments will be 4 weeks and the allowance for this period will be 1663 CHF. Candidates should apply via the HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6160 Completed application forms must be submitted on-line by 13 April 2008 at the latest. The results of the selection will be available on 18 May 2008. For further information, please contact: mailto:Geraldine.Ballet@cern....
Temporary work for children of members of the personnel During the period from 15 June to 11 September 2009 inclusive, there will be a limited number of jobs for temporary work at CERN (normally unskilled work of routine nature), which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with the Organization). Candidates must be aged between 18 and 24 inclusive on the first day of the contract, and must have insurance coverage for both illness and accident. The duration of all appointments will be 4 weeks and the allowance will be CHF 1717. - for this period. Candidates should apply via HR Department’s electronic recruitment system (E-rt): https://ert.cern.ch/browse_www/wd_pds?p_web_page_id=6970 Completed application forms must be returned by 10 April 2009 at the latest. The results of the selection will be available on 22 May 2009. For further information, please contact: mailto:Inger.Carriero@cern.c...
A survey is given about those essential aspects of qualification and organization of personnel in nuclear power plants, that are already regulated in laws or guidelines. The considerations of the BMI concerning further developments of these requirements are outlined. (orig.) [de
In 1999 the Nuclear Regulatory Authority of the Slovak Republic (UJD) focused on the overall training system and on developing programmes for individual categories for NPP V-1 Bohunice, NPP V-2 Bohunice, NPP Mochovce and SE-VYZ. The fundamental theoretical and periodical training for both Bohunice and Mochovce NPPs personnel, simulator training for NPP Bohunice, and periodical simulator training for Bohunice personnel is carried out by the VUJE Training center in Trnava, whereas the simulator training and periodical training for NPP Mochovce is carried at Mochovce plant. Based on a successful passing of examination before the examining committee, UJD issues, a certificate on special professional skills of selected staff of nuclear installations for specific activity for the given type of nuclear installation and for the following positions: (a)Shift manager for scientific start up with the right of manipulation; (b) Shift supervisor; (c) Unit supervisor; (d) Primary circuit operator; (e) Secondary circuit operator; (f) Reactor physicist; (g) Shift manager for scientific start up without the right of manipulation. Examination of selected personnel is described. Last year the examining committee held twelve session for oral theoretical examination. The number of licenses issued in 1999 and the total number of valid licenses is given.Conclusions from inspections carried out by UJD and inspections and tests carried out by the NPP operators in 1999, as well as results from operation and start up of nuclear units confirm that the standard of professional skills of the staff at nuclear installations a high standard of operational safety is being achieved on a permanent basis. Increasing the qualification of UJD staff was done in a form of training and courses scheduled in the plan of training for the staff for 1999. These training, composed of specialized qualification study, functional study, as well as study aimed at maintaining qualification. Training courses organized
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Responsibilities of the Office of Personnel Management. 451.203 Section 451.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS AWARDS Presidential Awards § 451.203 Responsibilities of the Office of Personnel Management. (a) The Office of Personnel...
Anatoliy Alexandrovich Malyuk
Full Text Available During the formation of information society the problem of determining the demand for IS personnel (DfISP, consisting of IS specialists and IS practitioners, is of particular relevance at present. The goal of the paper is to calculate the demand for IS specialists (DfISS. To achieve it we used the informal heuristic methods and introduced some important indicators for DfISP forecast. As a validation of the conceptual approach proposed we show how to apply it on the regional level of one country on one real-world example. All the reasoning and calculations can be narrowed down to the DfISS forecasting within one corporation or IS professionals of a specific profile.
Since its formation, the Office of Health (EH-40) has stressed the importance of the exchange of information related to and improvements in neutron dosimetry. This Workshop was the eleventh in the series sponsored by the Department of Energy (DOE). It provided a forum for operational personnel at DOE facilities to discuss current issues related to neutron dosimetry and for leading investigators in the field to discuss promising approaches for future research. A total of 26 papers were presented including the keynote address by Dr. Warren K. Sinclair, who spoke on, ''The 1990 Recommendations of the ICRP and their Biological Background.'' The first several papers discussed difficulties in measuring neutrons of different energies and ways of compensating or deriving correction factors at individual facilities. Presentations were also given by the US Navy and Air Force. Current research in neutron dosimeter development was the subject of the largest number of papers. These included a number on the development of neutron spectrometers
The code of practice presented here as part of the Agency's Safety Standards deals with the problem of personnel monitoring in establishments in which, or in part of which, work is primarily with radiation sources. It is a development of the fundamental requirements on the subject contained in the Agency's Basic Safety Standards. The code has been prepared by the Secretariat of the Agency on the basis of the work of a panel of experts drawn from a number of Member States. In addition, representatives of several interested international organizations participated in the work of the panel. The Board of Governors of the Agency considered this code of practice in September 1964 and authorized its application to Agency and Agency-assisted operations and recommended to Member States that it be taken into account in the formulation of national regulations or recommendations.
The NPP engineering support functional area comprises seven common positions: reactor engineer, in-service inspection engineer, performance reliability engineer, system-maintenance engineer, station modification engineer, quality assurance engineer, and regulatory compliance engineer. The primary duties and tasks of each was presented. In Spain, a simplified SAT approach was used to analyze the training needs of these positions. The basic difference between the comprehensive SAT and the simplified method is that the simplified approach uses no taxonomy codes and the task elements are not analyzed to obtain the knowledge and skills. Resulting in an economy of time and personnel resources, this process makes use of job competencies and a top table analysis conducted by subject matter experts. An example of a JPM prepared using the simplified SAT approach was shown. Examples of the simplified approaches used in Russia, France, and USA were also discussed
This Code of Practice sets forth the objectives of an adequate system of personnel monitoring for radiation workers. It covers individual dosimetry, including internal radiation monitoring, and area monitoring to the extent required for the assessment of individual radiation doses. The responsibilities of authorities for organizing monitoring of radiation workers are discussed, together with brief descriptions of monitoring methods and the rules governing their application. The general principles to be considered in selecting instrumentation and the appropriate monitoring techniques are described, as well as calibration techniques, methods of data handling and record keeping. Current concepts and recommendations of the International Commission on Radiological Protection, as presented in ICRP Publication No.26, have been incorporated. New developments in techniques and instruments have been reflected, and several sections such as calibration and record keeping have been elaborated. The bibliography has been updated and new annexes added.
Landauer, Inc. has gained approval to provide personnel dosimetry services in several countries. Each experiene reflects the different concerns adopted by national approval agencies. None have adopted ISO 9000 registration as evidence of a suitable quality system of management. Instead, each organization has prepared its own set of requirements with no provisions for recognizing the results of performance tests or audits conducted by other approval organizations. As ISO 9000 has become a communication symbol for commercial organizations dealing with each other, it has not been similarly viewed by radiation regulation bodies. A key reason arises from a tradition to regulate bodies. A key reason arises from a tradition to regulate, not promote, international trade, not encourage innovation, nor foster economic competition. A second reason is the inability to separate the technical requirements from quality assurance. ISO 9000 may become useful once the national technical organizations learn to trust those of other countries
Maxwell, R.L.; Wright, L.J.
Personnel identity verification devices, which are based on the examination and assessment of a body feature or a unique repeatable personal action, are steadily improving. These biometric devices are becoming more practical with respect to accuracy, speed, user compatibility, reliability and cost, but more development is necessary to satisfy the varied and sometimes ill-defined future requirements of the security industry. In an attempt to maintain an awareness of the availability and the capabilities of identity verifiers for the DOE security community, Sandia Laboratories continues to comparatively evaluate the capabilities and improvements of developing devices. An evaluation of several recently available verifiers is discussed in this paper. Operating environments and procedures more typical of physical access control use can reveal performance substantially different from the basic laboratory tests
Burt, G.L.; Stibbs, W.
The decade of the 1980s saw dramatic changes in the Drilling Industry worldwide; from record high utilization rates for mobile rigs to total depression and bankruptcies; from a strong market in the Gulf of Mexico to the steady flow of rigs to operating locations outside North America. A major drilling contractor operating on land and offshore, long known as an industry leader in training, has tripled its employee development efforts in the last five years to prepare for this challenge. This paper describes the Contractor's current program of training and highlights the commitment in resources required in order to provide for the operational continuity, manpower capability and safety objectives of the future. The paper clarifies the relationship it anticipates between the coming manpower shortage, development of personnel and the safety of its people and environment. It discusses plans already in place to effectively develop drilling expertise in lesser developed countries of operation
Kunz, W.E.; Chambers, W.H.; Henry, C.N.; France, S.W.; Millegan, D.R.; Hastings, R.D.; Worth, G.M.
A light, rugged monitor has been developed for special nuclear materials (SNM) searches at material-access and protection-area exits. This monitor accepts gamma-ray pulses from a NaI(Tl) detector, integrates for a preset counting interval (typically 0.3 s), and produces an audible alarm whenever the counts in the interval exceed the trip level that is a preset multiple of the stored background count. Because the monitor is silent except when the alarm is operating, personnel with little special training can conduct more effective searches in a noisy and distracting environment than they can with conventional audible monitoring of individual radiation counts. The monitor is also more sensitive than conventional monitors that provide audible indication of the count rate
Busick, D.D.; Warren, G.J.
Within a few months of the discovery of x-rays the first radiation injuries were reported (ta71). During the past thirty years both the number and complexity of x-ray analytical units have increased markedly. The world-wide number of incidents leading to severe injury has also increased. For analytical x-ray machines the need for engineered and administrative safeguards has long been recognized. At Stanford Synchrotron Radiation Laboratory (SSRL) the personnel protection system has been carefully designed to maximize safety and minimize experimental interference. However, all possible experimental configurations cannot be anticipated and some interference is to be expected. There are means by which safeguards can be substituted as long as these substitutions do not degrade the existing degree of safety. any substitutions must be evaluated by the Radiation Safety Committee, the SSRL staff and Operational Health Physics. Some studies have indicated that between fifty and ninety percent of serious radiation accidents are directly related to human errors, i.e., ignoring administrative proccedures, by-passing engineered safeguards or by inadequate training. Lindell has estimated the annual probability of serious injury to be about 1:100 per macchine. No matter what the real probability of serious injury is the personnel protection system should reduce this risk to a value that approaches zero. It is hoped that this manual will bring into sharper focus some of the more serious results of unnecessary risk taking. We also hope that it will convey the very real necessity for safeguards which may at times appear to be arbitrary and unnecessary impediments to experimental purposes.
Swaja, R.E.; Chou, T.L.; Sims, C.S.; Greene, R.T.
The Tenth Personnel Dosimetry Intercomparison Study was conducted at the Oak Ridge National Laboratory during April 9-11, 1984. Dosemeter badges from 31 participating organizations were mounted on 40cm Lucite phantoms and exposed to a range of dose equivalents which could be encountered during routine personnel monitoring in mixed radiation fields. The Health Physics Research Reactor served as the only source of radiation for eight of the ten irradiations which included a low (approx. 0.50 mSv) and high (approx. 10.00 mSv) neutron dose equivalent run for each of four shield conditions. Two irradiations were also conducted for which concrete- and Lucite-shield reactor irradiations were gamma-enhanced using a 137 Cs source. Results indicated that some participants had difficulty obtaining measurable indication of neutron and gamma exposures at dose equivalents less than about 0.50 mSv and 0.20 mSv, respectively. Albedo dosemeters provided the best overall accuracy and precision for the neutron measurements. Direct interaction TLD systems showed significant variation in accuracy with incident spectrum, and threshold neutron dosemeters (film and recoil track) underestimated reference values by more than 50%. Gamma dose equivalents estimated in the mixed fields were higher than reference values with TL gamma dosemeters generally yielding more accurate results than film. Under the conditions of this study in which participants had information concerning exposure conditions and radiation field characteristics prior to dosemeter evaluation, only slightly more than half of all reported results met regulatory standards for neutron and gamma accuracy. 19 refs., 2 figs., 29 tabs
Brackenbush, L.W.; Endres, G.W.R.; Selby, J.M.; Vallario, E.J.
This study assesses the state of personnel neutron dosimetry at DOE facilities. A survey of the personnel dosimetry systems in use at major DOE facilities was conducted, a literature search was made to determine recent advances in neutron dosimetry, and several dosimetry experts were interviewed. It was concluded that personnel neutron dosimeters do not meet current needs and that serious problems exist now and will increase in the future if neutron quality factors are increased and/or dose limits are lowered
Turilo Anatoliy M.; Adamenko Marina V.
The article improves classification of innovation potential of the company personnel and provides a characteristic of its types. It justifies a necessity of determination of criteria of classification and types of innovation potential of the personnel with consideration of its belonging to the innovation potential of a company and dependence on innovation abilities and possibilities of its workers. It offers to improve classification of the innovation potential of the personnel with the follo...
Neetzel, C.R.; Rochetti, Luis
An operative system for the measurement and on-line processing of personnel dosimetry data is described. The aim is to organize and rationalize the work involved in a personnel dosimetry service. The method considers the application to other areas of radiation protection, as well as the connection and exchange of files among the different personnel monitoring groups. The system can be interfaced with different computers (M.E.L.) [es
of Secretary of Defense PAPA DET Pay and Personnel Afloat Detachment PASS Pay/Personnel Administrative Support System PASSMAN PASS Management Manual ...made manually face-to-face. Current efforts are focused in developing the Integrated Personnel and Pay System-Army (IPPS-A), the Army specific solution...Association, 2017). It is a pioneer of direct marketing , self-service transactions, and online banking services with its patent on remote
TRUST FOLEY P* NAVY PERSONNEL RESEARCH AND DEVELOPMENT CENTER 619-553-9263 P&P-ASVAB GREEN B* JOHNS HOPKINS UNIV BALTIMORE 301-338-7074 PERSONNEL...PERSONNEL ASSIGNMENT SYSTEMS BOWLBY L NAVAL RESEARCH LABORATORY 202-767-9811 CLASSIFICATION OF CRYPTOLOGIC TECHNICIANS (TECHNICAL)-CTECH CONWAY T* NAVAL...MAGNETOENCEPHALOGRAPHY BY LEAD FIELD SYNTHESIS EGETH H* JOHNS HOPKINS UNIV BALTIMORE 301-338-7078 PREATTENTIVE AND ATTENTIVE VISUAL INFORMATION
Darchenko Nataliya D.
The goal of the article lies in the study of a possibility to manage fluctuation of personnel at a modern enterprise through application of the motivational monitoring and in identification of some methodical aspects of formation of the system of monitoring the fluctuation of personnel. The article considers the essence, tasks and main directions of motivational monitoring at an enterprise and offers its classification. It proves urgency of the problem of fluctuation of personnel at enterpris...
Myers, Julia A; Powell, David M C; Psirides, Alex; Hathaway, Karyn; Aldington, Sarah; Haney, Michael F
In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. In the first phase of the project the anaesthetists' non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors. The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (r(s) = 0.4, p = 0
NĂSTASIE MIHAELA – ANDREEA
Full Text Available General research area of this article is the motivation of personnel, essential tool in the management process, and also a component derived from human resource management. In economic activity, personnel motivation should be regarded as an internal process, not as an imperative that can be imposed from outside the economic entity. Managers of economic entities must, first, understand personnel motivation strategies, how they influence positively or negatively the internal motivations of employees. Personnel motivation by itself attracts an end, just as profitable and moral, individual and social welfare making.
...: Organizational Environment § 418.114 Condition of participation: Personnel qualifications. (a) General... Work Education; or a baccalaureate degree in psychology, sociology, or other field related to social...
Uses Getzels and Guba's view of social behavior as theoretical framework for discussion. Points out importance of bureaucratic structure and personnel functions as factors affecting coordinator's role. (CJ)
Frengopoulos, Courtney; Payne, Michael W C; Holmes, Jeffrey D; Viana, Ricardo; Hunter, Susan W
Gait is a complex process that involves coordinating motor and sensory systems through higher-order cognitive processes. Walking with a prosthesis after lower extremity amputation challenges these processes. However, the factors that influence the cognitive-motor interaction in gait among lower extremity amputees has not been evaluated. To assess the interaction of cognition and mobility, individuals must be evaluated using the dual-task paradigm. To investigate the effect of etiology and time with prosthesis on dual-task performance in those with lower extremity amputations. Cross-sectional study. Outpatient and inpatient amputee clinics at an academic rehabilitation hospital. Sixty-four individuals (aged 58.20±12.27 years; 74.5% male) were stratified into 3 groups; 1 group of new prosthetic ambulators with transtibial amputations (NewPA) and 2 groups of established ambulators: transtibial amputations of vascular etiology (TTA-vas), transtibial amputations of nonvascular etiology (TTA-nonvas). Not applicable. Time to complete the L Test measured functional mobility under single and dual-task conditions. A serial arithmetic task (subtraction by 3s) was paired with the L Test to create the dual-task test condition. Single-task performance on the cognitive arithmetic task was also recorded. Dual-task costs (DTCs) were calculated for performance on the cognitive and gait tasks. Analysis of variance determined differences between groups. A performance-resource operating characteristic (POC) graph was used to graphically display DTCs. Gait performance was worse under dual-task conditions for all groups. Gait was significantly slower under dual-task conditions for the TTA-vas (P Dual-task conditions also had a negative impact on cognitive task performance for the TTA-nonvas (P = .02) and NewPA groups (P dual-task conditions and has a positive DTCcog as a result (P = .04). However, no between-group differences were seen for DTCcog. The POC graph demonstrated that many
The overall training system and the development of projects for training of all categories of NPP V-1, NPP V-2 Bohunice, SE-VYZ and NPP Mochovce staff were the subject of Nuclear Regulatory Authority of the Slovak Republic (UJD) attention. During 2000, the following inspections were carried out on nuclear personnel training: (a) NPP Bohunice: an inspection focused on compliance with requirements for staff qualifications and compliance with the prescribed training of Bohunice plant staff ; (b) NPP Mochovce: an inspection focused on compliance with the requirements for staff qualifications and compliance with the prescribed training of NPP Mochovce staff; an inspection focused on verifying the simulator aided training; an inspection focused on checking the preparedness of NPP Mochovce operation and technical personnel for NPP Mochovce Unit 2 operation; (c) Technology for treatment and conditioning of radioactive waste Bohunice (BSC): an inspection focused on compliance with the requirements for staff qualifications and compliance with the prescribed training of SE-VYZ staff; VUJE Trnava: verification of technical equipment and professional skills of VUJE Trnava staff and tasks arising out of the 'Authorisation on nuclear installation staff training'. Examinations of selected personnel were scheduled according to the plan of examining committee meetings. For each examined person written tests are generated by the computer from the database of test questions at the Training Centre of VUJE Trnava for individual positions - categories of selected staff of NPP V-1 and NPP V-2 Bohunice and NPP Mochovce so that the examination questions both in written and oral part equally cover individual facilities and regimes of operation of NPP. The database is continuously updated, thereby containing new questions resulting from the recent changes carried out at NPPs. A part of the examination in case of promotion to a higher position is the practical part, which is conducted under
Shimizu, Yukiyo; Kadone, Hideki; Kubota, Shigeki; Suzuki, Kenji; Abe, Tetsuya; Ueno, Tomoyuki; Soma, Yuichiro; Sankai, Yoshiyuki; Hada, Yasushi; Yamazaki, Masashi
Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Ass...
Francis, E. E.
Niles Township School District 219, Skokie, Illinois, has rebuilt its personnel and payroll program. The new system provides a data bank for storage of any and all information required by both the personnel and payroll departments on each district employee. (Author/MLF)
... of extension personnel of 0.411 at 0.01level of significance, with more of the extension personnel with ESFJ (Extroverted feeling with sensing) (29.82%) personality type followed by ISFJ (Introverted sensing with feeling) (19.3%) and ENFJ (Extroverted feeling with intuiting) (12.28), ENFP (Extroverted intuiting with feeling), ...
All of the utilities, Ontario Hydro, Hydro Quebec and New Brunswick Power, operating Nuclear Power Plants in Canada have Training Centres which provide training for all of their plant personnel whose job activities could affect plant and personnel safety. This report points out the methods used for training, which generally conform to that described by the IAEA as a Systematic Approach to Training (SAT)
This study examines and describes the need for pre-retirement education programme for Nigerian Army personnel in 1 Mechanised Division, Kaduna. An investigation was carried out into the contents of such pre-retirement programme. A sample of 78 male and female army personnel was purposively selected from the ...
Morano, Richard A.
This article introduces a new personnel development concept and attempts to correct the notion that personnel development is largely a training function. Implicit is the notion that by enhancing the utilization of existing manpower and providing opportunities for career development, we foster good employee relations and contribute to…
This situation may be due to the perceived lack of interest and lack of cooperation from management of their facilities.The personnel also felt that they did not have sufficient training to implement QC and that QC results were difficult to analyse. Keywords: perception, quality control, personnel, management, diagnostic ...
Poplavskij, K.K.; Popov, A.O.
Problems of deontology in the process of liquidation of radiation accident consequences are considered in the article. It is noted, that shortages of ethical nature in the activities of physicians are related to insufficient qualification of medical personnel in the area of radiation medicine. Problems of medical personnel participation in the large scale propaganda activities among various groups of population are considered. 5 refs
Objective: The aim of this study was to determine the frequency of use of protective eye wear and hazards related to non compliance with recommended eye safety practice among the dental personnel of University of Benin Teaching Hospital. Methods: A questionnaire was distributed to the dental personnel of University of ...
virtue of huge purchases from international arms markets .”5 The Iraqi Army was also battle hardened from its eight year war with Iran, and it had...timelines for CRCs as well as the communication responsibilities to inform the Theater Personnel Command of inbound personnel. These doctrinal
Psychology 14. ABSTRACT A Shortened Stress Measure with Military Nursing Personnel Abstract Stress is a psychological construct with important... psychological construct with important consequences for human health. A substantial number of stress measures are available that vary in length and...that were similar in strength to longer versions of the PSQ. Keywords: psychological stress, psychometrics, military personnel The views expressed are
Regionalizing the Recruitment of Health Personnel in Burkina Faso. Human resources are essential to attaining the objectives of the Millennium development goals with respect to national health systems. In low-income countries, human health resources are characterized by a deficit of qualified personnel and an unequal ...
Civil Service Commission, Washington, DC. Bureau of Training.
The Personnel Management Training Center's Course Schedule for Fiscal Year 1973 lists all courses available to government employees. Interagency training programs include courses in employee relations, counseling, personnel management, and instructor training. Courses are also offered by the Equal Employment Opportunity Training Institute, and…
California State Dept. of Motor Vehicles, Sacramento.
The development of a 6-hour motorcycle course of instruction for personnel responsible for motorcycle licensing is described in this project report. The primary goals are stated and include (1) training driver licensing personnel in motorcycle safety and principles of operation, and (2) purchasing and installing appropriate motorcycle skill…
... 39 Postal Service 1 2010-07-01 2010-07-01 false Interim personnel regulations. 211.4 Section 211.4... under the Postal Reorganization Act. (b) Continuation of Personnel Provisions of Former title 39, U.S.C... collective bargaining agreement under the Postal Reorganization Act, all provisions of former title 39, U.S.C...
McCormack-Brown, K. R.; And Others
To promote good personal hygiene practices in students, school health personnel must be informed about dental pit and fissure sealants and related programs. Adoption and maintenance of such programs may depend on the success of school health personnel in educating administrators and policymakers. (SM)
S.T. Mol (Stefan)
textabstractPersonnel selection is one of the main activities of the industrial and organizational psychologist. Yet, little is known about whether principles of personnel selection that have been developed in domestic and mainly Western (i.e., North American and European) contexts will apply in
The study examined the determinants of job effectiveness of extension personnel of OYSADEP and FADU organizations. Disproportionate sampling procedure was used to select 94% and 81% from the population of extension personnel in the two organizations to obtain 120 respondents for the study. Structured and ...
In low-income countries, human health resources are characterized by a deficit of qualified personnel and an unequal distribution of existing personnel. To address these problems, the Burkina Faso Ministry of Health has adopted a number of reforms aimed at improving the quality and quantity of health workers, and ...
Darchenko Nataliya D.
Full Text Available The goal of the article lies in the study of a possibility to manage fluctuation of personnel at a modern enterprise through application of the motivational monitoring and in identification of some methodical aspects of formation of the system of monitoring the fluctuation of personnel. The article considers the essence, tasks and main directions of motivational monitoring at an enterprise and offers its classification. It proves urgency of the problem of fluctuation of personnel at enterprises of the country and a possibility of its management through application of the motivational monitoring. It offers methodical principles of monitoring of fluctuation of personnel of an enterprise. It provides results of application of the motivational monitoring in managerial practice of a real enterprise for analysis and study of fluctuation of personnel, which show that monitoring of fluctuation of personnel, development and introduction on its basis of the programme of management of fluctuation of personnel, improvement of the motivational mechanism of management of an enterprise would allow increase of business efficiency, introduce the proactive practice with respect to the personnel, and become a more attractive employer in the labour market. The direction of further studies is development and improvement of organisational and technical aspects of the motivational monitoring and development of recommendations on application of its results with the aim of development of the motivational mechanism that exists at an enterprise.
Дарченко, Наталія Дмитрівна
The essence, tasks and basic directions of the motivational monitoring at an enterprise have been examined, its classification has been offered. The topicality of problem of personnel fluctuation at an enterprise and management possibility from application of the motivational monitoring have been proved. The methodical bases of monitoring the personnel fluctuation of an enterprise have been proposed.
The study examined personnel management and job satisfaction in academic libraries: A case study of the Federal College of Education Yola, Adamawa State. The objectives of the study were to: determine the methods used for personnel recruitment, determine the level of staff development, identify the motivational factors ...
The study examined personnel management and job satisfaction in academic libraries: A case study of the Federal College ... library Management of the Federal College of Education Yola library should widely recruit personnel and device the method of ..... salaries as the process of planning, organizing and controlling all ...
... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Training of sales personnel. 1314.35 Section 1314.35 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE RETAIL SALE OF SCHEDULED LISTED CHEMICAL PRODUCTS Sales by Regulated Sellers § 1314.35 Training of sales personnel. Each regulated...
Perreault, J R; Geigle, P R; Gorman, P H; Scott, W H
To measure body mass index (BMI) and ambulation changes for a morbidly obese, 47-year-old man with chronic motor-incomplete tetraplegia after gastric sleeve surgery. A morbidly obese man, BMI=44 kg m(-)(2), with chronic C5 AIS D tetraplegia underwent elective gastric sleeve surgery. Assessment of BMI and function via the 6-minute walk test (6MWT), 10-meter walk test (10MWT) and ambulation parameters (CIR Systems/GAITRite, Franklin, NJ, USA) was performed preoperatively and at 12, 24, 36 and 52 weeks postoperatively, and additionally after 3 weeks of both a prescribed coached (3 × /week facility based) and a non-coached (3 × /week home based) walking program initiated at 52 weeks. A step activity monitor assessed daily ambulation preoperatively, prior to and during the third and sixth week of the walking program. Results included a 34.3% peak BMI decrease at 52 weeks post surgery and a peak increase in 6MWT distance of 58% at 52 weeks post surgery, 10MWT preferred speed of 56% at 55 weeks and step activity monitor of 82% at 58 weeks post surgery. At 58 weeks, gait data demonstrated a decrease in double limb stance of 38% and decrease in base of support of 72%. This empirical case assessment of BMI and functional mobility before and after gastric sleeve surgery may encourage further investigation into mobility and general health effects post gastric procedures for people with chronic motor-incomplete spinal cord injury.
Bååth, Carina; Engström, Maria; Gunningberg, Lena; Muntlin Athlin, Åsa
The aim was to investigate the effect of an early intervention, a heel suspension device boot, on the incidence of heel pressure ulcers among older patients (aged 70+). Pressure ulcers are a global healthcare issue; furthermore, the heel is an exposed location. Research indicates that preventive nursing interventions starting during the ambulance care and used across the acute care delivery chain are seldom used. A multi-centre randomized control study design was used. Five ambulance stations, two emergency departments and 16 wards at two Swedish hospitals participated. Altogether, 183 patients were transferred by ambulance to the emergency department and were thereafter admitted to one of the participating wards. Significantly fewer patients in the intervention group (n=15 of 103; 14.6%) than the control group (n=24 of 80; 30%) developed heel pressure ulcers during their hospital stay (p=0.017). Pressure ulcer prevention should start early in the acute care delivery chain to increase patient safety. Copyright © 2015 Elsevier Inc. All rights reserved.
Fothergill, Rachael T; Watson, Lynne R; Virdi, Gurkamal K; Moore, Fionna P; Whitbread, Mark
This study reports survival outcomes for patients resuscitated from out-of-hospital cardiac arrest (OHCA) subsequent to ST-elevation myocardial infarction (STEMI), and who were conveyed directly by ambulance clinicians to a specialist Heart Attack Centre for expert cardiology assessment, angiography and possible percutaneous coronary intervention (PCI). This is a retrospective descriptive review of data sourced from the London Ambulance Service's OHCA registry over a one-year period. We observed excellent survival rates for our cohort of patients with 66% of patients surviving to be discharged from hospital, the majority of whom were still alive after one year. Those who survived tended to be younger, to have had a witnessed arrest in a public place with an initial cardiac rhythm of VF/VT, and to have been transported to the specialist centre more quickly than those who did not. A system allowing ambulance clinicians to autonomously convey OHCA STEMI patients who achieve a return of spontaneous circulation directly to a Heart Attack Centre is highly effective and yields excellent survival outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Resumo: A configuração de redes logísticas para serviços de emergência é questão estratégica de imensa importância, visto que pequenas variações no tempo de resposta podem implicar na morte do solicitante. Partindo dessa premissa, o trabalho propõe novas alternativas de posicionamento para as ambulâncias do sistema SAMU na cidade de Duque de Caxias, RJ, capazes de reduzir o tempo de resposta do serviço. Essas propostas de reposicionamento das ambulâncias foram construídas em duas etapas: na primeira, dois modelos de Programação Inteira foram aplicados para se obter soluções que provejam maior cobertura à população. Posteriormente, o Modelo do Hipercubo foi empregado para avaliar a disponibilidade dos servidores, dentre outros indicadores de desempenho relevantes, como o tempo médio de resposta e a taxa de ocupação das ambulâncias.
Byrne, Eamonn; Bury, Gerard
Incident reporting is vital to identifying pre-hospital medication safety issues because literature suggests that the majority of errors pre-hospital are self-identified. In 2016, the National Ambulance Service (NAS) reported 11 medication errors to the national body with responsibility for risk management and insurance cover. The Health Information and Quality Authority in 2014 stated that reporting of clinical incidents, of which medication errors are a subset, was not felt to be representative of the actual events occurring. Even though reporting systems are in place, the levels appear to be well below what might be expected. Little data is available to explain this apparent discrepancy. To identify, investigate and document the barriers to medication error reporting within the NAS. An independent moderator led four focus groups in March of 2016. A convenience sample of 18 frontline Paramedics and Advanced Paramedics from Cork City and County discussed medication errors and the medication error reporting process. The sessions were recorded and anonymised, and the data was analysed using a process of thematic analysis. Practitioners understood the value of reporting errors. Barriers to reporting included fear of consequences and ridicule, procedural ambiguity, lack of feedback and a perceived lack of both consistency and confidentiality. The perceived consequences for making an error included professional, financial, litigious and psychological. Staff appeared willing to admit errors in a psychologically safe environment. Barriers to reporting are in line with international evidence. Time constraints prevented achievement of thematic saturation. Further study is warranted.
To examine the effects of "Comfort upon Rising" care (CUR) as a new type of early morning care. This was a quasi-experimental study using a convenience sampling and non-random assignment of 80 orthopedic postoperative inpatients needing ambulation assistance. The intervention group of 40 inpatients was given CUR designed to support the patients' needs. The control group of 40 inpatients was given conventional early morning care (CMC). Floor nurses conducted either CMC or CUR for subjects beginning the morning after surgery and continuing for 3 days. Mood was measured by the Wake-up Questionnaire (question I) and Profile of Mood States (POMS). Morning activities, which were daily living activities, breakfast behaviors including breakfast intake rate, were measured by Wake-up Questionnaire (question IV) and observation. Completing the study were 36 patients from the control group and 36 patients from the intervention group. Mood and activities in the morning were improved in the CUR group. CUR is a patient-centered care based on patients' individual needs and promotes self-care. CUR is more effective than CMC in promoting natural recovery after an operation. © 2013 The Author. Japan Journal of Nursing Science © 2013 Japan Academy of Nursing Science.
Full Text Available Abstract Background Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientifical evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients. Methods Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored. Results Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C to 36.0°C (95% CI; 35.7-36.3°C (p Conclusions In mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response. Trial Registration ClinicalTrials.gov: NCT01400152
Geue, K; Richter, R; Buttstädt, M; Brähler, E; Singer, S
Art therapy in psycho-oncology is gaining increasing importance, but systematic evaluations of its effects are rare. The aim of this study is to investigate the effects of an art therapy intervention for cancer patients in ambulant aftercare on psychological distress and coping. The intervention consisted of 22 sessions. At three points of measurement (t1: before intervention, t2: following intervention, t3: 6 months after t2), participants responded to questionnaires (Freiburg Questionnaire on Coping with Illness, Perceived Adjustment to Chronic Illness Scale, Hospital Anxiety and Depression Scale). A group of haemato-oncological patients served as the comparison group (CG). Pre-post comparisons and analyses of variance were applied for statistical analysis. Relevant confounders were controlled. Fifty-four patients (intervention group, IG) with various cancer diagnoses completed the intervention. One hundred and twenty-nine data sets were available for the CG. Analyses of variance included group membership (IG vs. CG) and the following factors: gender, other psychosocial help and major life events. None of these variables was a predictor for changes in depression, anxiety and coping. Therefore, we could not prove intervention effects over time. Our results contradict those of preliminary studies and raise important questions. Further work on evaluating art therapy is necessary to explore which intervention concepts in which setting at which treatment stage show significant effects. Therefore, controlling for relevant confounders is needed. © 2013 Blackwell Publishing Ltd.
Badiali, Stefano; Giugni, Aimone; Marcis, Lucia
START (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether "last-minute" START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients. In this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group). The START group received last-minute START training. Each group examined 6000 patients, obtained from the Emergo Train System (ETS Italy, Bologna, Italy) victims database, and assigned patients a triage code (black-red-yellow-green) along with a reason for the assignment. Each rescuer triaged 30 patients within a 30-minute time frame. Results were analyzed according to Fisher's exact test for a P valueSTART group completed the evaluations in 15 minutes, whereas the non-START group took 30 minutes. The START group correctly triaged 94.2% of their patients, as opposed to 59.83% of the non-START group (PSTART group versus 13.67% and 26.5% for the non-START group. The non-START group had 458 "preventable deaths" on 6000 cases because of incorrect triage, whereas the START group had 91. Even a "last-minute" training on the START triage protocol allows nonmedical personnel to better identify and triage the victims of a disaster or MCI, resulting in more effective and efficient medical intervention. (Disaster Med Public Health Preparedness. 2017;11:305-309).
Hagsgaard, S.; Widell, C.O.
The routine personnel monitoring of fast neutrons is carried out by the counting of tracks in a nuclear emulsion. The tracks are counted in a microscope on a projection screen. This is a very tedious job and is only done on irradiated films which are counted over 6 mm 2 . The irradiated films are selected according to the recorded dose on the gamma film. It is often difficult to tell how much the visible tracks have faded during a two-weeks period. Fortunately the fading does not often exceed 20 % for this period. If the dosimeter has been gamma-irradiated, it may be difficult to recognize the proton tracks. If the film is stored for some time before being developed, this gamma fog will to some extent fade away. For large neutron doses a foil activation dosimeter is used. This dosimeter consists of a cadmium-shielded phosphorus foil, a cadmium shielded gold foil and an unshielded gold foil. The phosphorus foil has to be counted shortly after exposure
Barton, T.P.; Easterly, C.E.
The increasing development of fusion reactor technology warrants an evaluation of personnel neutron dosimetry systems to aid in the concurrent development of a radiation protection program. For this reason, current state of knowledge neutron dosimeters have been reviewed with emphasis placed on practical utilization and the problems inherent in each type of dosimetry system. Evaluations of salient parameters such as energy response, latent image instability, and minimum detectable dose equivalent are presented for nuclear emulsion films, track etch techniques, albedo and other thermoluminescent dosimetry techniques, electrical conductivity damage effects, lyoluminescence, thermocurrent, and thermally stimulated exoelectron emission. Brief summaries of dosimetry regulatory requirements and intercomparison study results help to establish compliance and recent trends, respectively. Spectrum modeling data generated by the Neutron Physics Division of Oak Ridge National Laboratory for the Princeton Tokamak Fusion Test Reactor (TFTR) Facility have been analyzed by both International Commission on Radiological Protection fluence to dose conversion factors and an adjoint technique of radiation dosimetry, in an attempt to determine the applicability of current neutron dosimetry systems to deuterium and tritium fusion reactor leakage spectra. Based on the modeling data, a wide range of neutron energies will probably be present in the leakage spectra of the TFTR facility, and no appreciable risk of somatic injury to occupationally exposed workers is expected. The relative dose contributions due to high energy and thermal neutrons indicate that neutron dosimetry will probably not be a serious limitation in the development of fusion power
Since its formation, the Office of Health (EH-40) has stressed the importance of the exchange of information related to and improvements in neutron dosimetry. This Workshop was the eleventh in the series sponsored by the Department of Energy (DOE). It provided a forum for operational personnel at DOE facilities to discuss current issues related to neutron dosimetry and for leading investigators in the field to discuss promising approaches for future research. A total of 26 papers were presented including the keynote address by Dr. Warren K. Sinclair, who spoke on, ``The 1990 Recommendations of the ICRP and their Biological Background.`` The first several papers discussed difficulties in measuring neutrons of different energies and ways of compensating or deriving correction factors at individual facilities. Presentations were also given by the US Navy and Air Force. Current research in neutron dosimeter development was the subject of the largest number of papers. These included a number on the development of neutron spectrometers. Selected papers were processed separately for inclusion in the Energy Science and Technology Database.
Ketteler, T; Krahwinkel, W; Gödke, J; Wolfertz, J; Scheuble, L; Hoffmeister, T; Gülker, H
In recent years, stress echocardiography has gained broad acceptance as a non-invasive method for the diagnosis of coronary artery disease. Facing different protocols, dosages and instrumentation, official guidelines for the performance, standardization and quality control of stress echocardiograms are needed; however, so far they are not available. This paper recommends the type of personnel and technical equipment needed for stress echocardiography laboratories, based on experience gained during more than 2000 stress echocardiographic procedures. To perform stress echocardiography, a cardiologist and a technical assistant--both well trained over a large number of tests--should be involved. The laboratory must have basic equipment such as a 12-lead ECG, blood pressure monitoring capacity, a treadmill or bicycle for ergometry, a precision intravenous delivery system for pharmacological stress testing as well as an adequate echo table; additionally, emergency equipment is mandatory. The ultrasound machine should contain transducers with high 2-D resolution; most important is a digital image acquisition system which facilitates performance and interpretation through side-by-side display of synchronized rest and stress images. Finally, there is a need for proper patient preparation and the obtaining of informed consent.
Mlynarek, S; Corn, M; Blake, C
The exposures of building maintenance personnel and occupants to airborne asbestos fibers, and the effects of operations and maintenance programs on those exposures, continue to be an important public health issue. The subject of this investigation was a large metropolitan county with numerous public buildings which routinely conducted air sampling for asbestos. A total of 302 personal air samples in nine task categories collected during maintenance worker activities in proximity to asbestos-containing materials were analyzed; 102 environmental air samples in four task categories were also analyzed. The arithmetic means of the 8-hr time weighted average exposures for personal sampling for each task category were all below the Occupational Safety and Health Administration permissible exposure level of 0.1 fibers (f)/cc > 5 microm. The highest mean 8-hr time weighted average exposure was 0.030 f/cc > 5 microm for ceiling tile replacement. The maximum asbestos concentration during sample collection for environmental samples was 0.027 f/cc > 5 microm. All asbestos-related maintenance work was done within the framework of an Operations and Maintenance Program (OMP) which utilized both personal protective equipment and controls against fiber release/dispersion. Results are presented in association with specific OMP procedures or controls. These results support the effectiveness of using Operations and Maintenance Programs to manage asbestos in buildings without incurring unacceptable risk to maintenance workers performing maintenance tasks.
How are the various players in research experiencing the run-up to the restart of the LHC? How do they feel their work is perceived outside CERN? After interviewing the inhabitants of Meyrin, Divonne-les-Bains and Geneva on the subject of the LHC and CERN, the Bulletin went to put its questions to the CERN personnel themselves. For some, working at CERN had always been a childhood dream. Today, as we approach the restart of the largest particle accelerator in the world, everybody is very enthusiastic about taking part in this adventure. In the words of a CMS physicist: "This is something that happens once in a scientist’s lifetime!" But what do the researchers consider to be the most important thing we do at CERN? It’s difficult to pin them down to any one specific thing, so this question gets the virtually unanimous general reply: "the advancement of knowledge". Many also mention the concrete spin-offs of technology transfer. However, nobody can anticipate what developments will arise in this field: wh...
McDonald, J.C.; Akabani, G.; Loesch, R.M.
An intercomparison of high-energy neutron personnel dosimeters was performed to evaluate the uniformity of the response characteristics of typical neutron dosimeters presently in use at US Department of Energy (DOE) accelerator facilities. It was necessary to perform an intercomparison because there are no national or international standards for high-energy neutron dosimetry. The testing that is presently under way for the Department of Energy Laboratory Accreditation Program (DOELAP) is limited to the use of neutron sources that range in energy from about 1 keV to 2 MeV. Therefore, the high-energy neutron dosimeters presently in use at DOE accelerator facilities are not being tested effectively. This intercomparison employed neutrons produced by the 9 Be(p,n) 9 B interaction at the University of Washington cyclotron, using 50-MeV protons. The resulting neutron energy spectrum extended to a maximum of approximately 50-MeV, with a mean energy of about 20-MeV. Intercomparison results for currently used dosimeters, including Nuclear Type A (NTA) film, thermoluminescent dosimeter (TLD)-albedo, and track-etch dosimeters (TEDs), indicated a wide variation in response to identical doses of high-energy neutrons. Results of this study will be discussed along with a description of plans for future work
McDonald, J.C.; Fix, J.J.; Hadley, R.T.; Holbrook, K.L.; Yoder, R.C.; Roberson, P.L.; Endres, G.W.R.; Nichols, L.L.; Schwartz, R.B.
Performance characteristics of selected personnel neutron dosimeters in current use at Department of Energy (DOE) facilities were determined from their evaluation of neutron dose equivalent received after irradiations with specific neutron sources at either the National Bureau of Standards (NBS) or the Pacific Northwest Laboratory (PNL). The characteristics assessed included: lower detection level, energy response, precision and accuracy. It was found that when all of the laboratories employed a common set of calibrations, the overall accuracy was approximately +-20%, which is within uncertainty expected for these dosimeters. For doses above 80 mrem, the accuracy improved to better than 10% when a common calibration was used. Individual differences found in this study may reflect differences in calibration technique rather than differences in the dose rates of actual calibration standards. Second, at dose rates above 100 mrem, the precision for the best participants was generally below +-10% which is also within expected limits for these types of dosimeters. The poorest results had a standard deviation of about +-25%. At the lowest doses, which were sometimes below the lower detection limit, the precision often approached or exceeded +-100%. Third, the lower level of detection for free field 252 Cf neutrons generally ranged between 20 and 50 mrem. Fourth, the energy dependence study provided a characterization of the response of the dosimeters to neutron energies far from the calibration energy. 11 references, 22 figures, 26 tables
Anastasiya Yu. Timofeeva
Full Text Available The study of factors that influence the occurrence of threats is of particular importance in the theory and practice of ensuring personnel security in the organization. The article aims at the identification of major threats to the organizational personnel security. As the latter, we suggest considering a set of causes related to the intention of the employee/ employer to harm each other and determine the ability to causes harm. Based on the content analysis of publications we identified the main causes of threats to the personnel security of organization, sources of hazardous factors origin. Consequently, we compiled a list of personnel security threats consisting of 18 items. The authors assessed the acuteness and urgency of threats, their impact on the state of personnel security in the organizations (a study was carried out on the example of Irkutsk region. Using the technique of factor analysis, we extracted factors of personnel security threats in the organization, interpreted as the existence of vulnerabilities in the security system, poor quality of the labor force and its moral and ethical capacities, shortcomings and mistakes in the area of implemented personnel policy and in the policy of personnel security. The applied methods of analysis are as follows: content analysis; analysis of frequency tables and contingency tables; correlation and factor analysis. Materials of the expert survey conducted in the Irkutsk region (2015 serves as the analysis base. Kendall’s coefficient of concordance confirmed agreement among the experts. Obtained results can be used to investigate and identify personnel security threats in the organization, can form the basis for prediction and analysis of personnel security threats, for development of methods of their prevention.
This study has been prepared for the Department of Energy's Nuclear Facilities Personnel Qualification and Training (NFPQT) Committee. Its purpose is to provide the Committee with background information on, and assessment of, the selection, training, and qualification of nuclear reactor operating personnel at DOE-owned facilities
Morgan, Prue E; Soh, Sze-Ee; McGinley, Jennifer L
Despite an increasing number of studies examining the profile of falls and mobility decline in adults with cerebral palsy (CP), little is known about its impact on an individual's life quality. The aim of this preliminary study was to assess the wellbeing and health status aspects of health-related quality of life (HRQOL) in ambulant adults with CP and explore the relationship of falls and mobility decline with HRQOL. Ambulant adults with CP completed postal surveys which sought demographic data, mobility (Gross Motor Function Classification System; GMFCS-E&R), presence of mobility decline, falls history, and HRQOL (Personal Wellbeing Index (PWI), Short Form-36 Health Survey (SF-36)). Thirty-four community-dwelling ambulant adults with CP with a mean age of 44.2 years (SD; 8.6; range 26-65) participated. Twenty-eight (82%) participants reported mobility decline since reaching adulthood, and a similar proportion of individuals (82%) reported having had more than two falls in the previous year. The health status and wellbeing of this sample of ambulant adults with CP were generally lower compared with the Australian normative population. Mobility decline was found by univariate regression analysis to be associated with mental health status (β = 0.52; p = 0.002), but not when other predictor variables were included in the multivariate model (β = 0.27; p = 0.072). In contrast, self-reported history of falls was found to be a significant contributing factor for both physical health status (β = -0.55; p = 0.002) and personal wellbeing (β = -0.43; p = 0.006). This sample of ambulant adults with CP perceived their HRQOL to be poor, with some health status and wellbeing domains below that of population wide comparisons. A majority of these individuals also experienced a fall in the last year and a decline in their mobility since reaching adulthood. While further research is required, this preliminary study has highlighted the potential implications of falls and mobility
As the share of hybrid, plug-in hybrid (PHEV), electric (EV) and fuel-cell (FCV) vehicles grows in the national automotive fleet, an entirely new set of diagnostic and technical skills needs to be obtained by the maintenance workforce. Electrically-powered vehicles require new diagnostic tools, technique and vocabulary when compared to existing internal combustion engine-powered models. While the manufacturers of these new vehicles train their own maintenance personnel, training for students, independent working technicians and fleet operators is less focused and organized. This DOE-funded effort provided training to these three target groups to help expand availability of skills and to provide more competition (and lower consumer cost) in the maintenance of these hybrid- and electric-powered vehicles. Our approach was to start locally in the San Francisco Bay Area, one of the densest markets in the United States for these types of automobiles. We then expanded training to the Los Angeles area and then out-of-state to identify what types of curriculum was appropriate and what types of problems were encountered as training was disseminated. The fact that this effort trained up to 800 individuals with sessions varying from 2- day workshops to full-semester courses is considered a successful outcome. Diverse programs were developed to match unique time availability and educational needs of each of the three target audiences. Several key findings and observations arising from this effort include: • Recognition that hybrid and PHEV training demand is immediate; demand for EV training is starting to emerge; while demand for FCV training is still over the horizon • Hybrid and PHEV training are an excellent starting point for all EV-related training as they introduce all the basic concepts (electric motors, battery management, controllers, vocabulary, testing techniques) that are needed for all EVs, and these skills are in-demand in today’s market. • Faculty
The overall training system and the development projects of training the staff of all categories from NPP V-1, NPP V-2 Bohunice, SE-VYZ and NPP Mochovce were the subject of UJD's attention. During 2001 following inspections were carried out on nuclear personnel training: - PP's Bohunice: an inspection focused on compliance with requirements for staff qualifications and compliance with the prescribed training of Bohunice plant staff; - Mochovce NPP: an inspection focused on compliance with the requirements for staff qualifications and compliance with the prescribed training of NPP Mochovce staff; - SE-VYZ: an inspection focused on compliance with the requirements for staff qualifications and compliance with the prescribed training of SE-VYZ staff. Training the staff of the NPP's Bohunice: - The fundamental and periodical theoretical training as sure as the fundamental and periodical simulator training is carried out by the VUJE Training centre in Trnava. - The fundamental practical training in the workplace and training for the change work- rank is carried at Bohunice plant. Training of the staff of the NPP Mochovce: - The fundamental and periodical theoretical training is carried out by the VUJE Training centre in Trnava. The fundamental practical training in the workplace and training for the change work- rank as well as the fundamental and periodical simulator training is carried at Mochovce plant. Based on a successful passing of examination before the examining committee, UJD issues a certificate on special professional skills of selected staff members of nuclear installations for specific activity for the given type of nuclear installation and for the following positions: 1. Scientific shift manager for start up with the right of manipulation; 2. Shift supervisor; 3. Unit supervisor; 4. Primary circuit operator; 5. Secondary circuit operator; 6. Reactor physicist; 7. Scientific shift manager for start up without the right of manipulation. Examinations of
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false OPM authority to review personnel management programs and practices. 10.3 Section 10.3 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES AGENCY ACCOUNTABILITY SYSTEMS; OPM AUTHORITY TO REVIEW PERSONNEL MANAGEMENT PROGRAMS (RULE X) § 10.3 OPM authority to review...
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Responsibilities of the Office of Personnel Management. 451.305 Section 451.305 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS AWARDS Presidential Rank Awards § 451.305 Responsibilities of the Office of Personnel Management. (a) Annually, OPM shall...
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Appeal to the Office of Personnel Management. 532.705 Section 532.705 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS Job Grading Reviews and Appeals § 532.705 Appeal to the Office of Personnel Management. (a)(1) An employee may...
... § 792.104 Responsibilities of the Office of Personnel Management. OPM shall provide overall leadership... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Responsibilities of the Office of Personnel Management. 792.104 Section 792.104 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT...
Full Text Available The main purpose of study is to define the health behaviour profile of the personnel of primary schools as well as to define the topics to be given priority in health education activities. The research population consisted of all personnel of 564 primary schools in Ankara province. The study group (30 schools was estimated by cluster sampling method. The Health Behaviours Questionnaire, which consists of 47 items on health behaviours and demographic characteristics, was used for data collection. In the study, 849 school workers (67,5% female were interviewed. Teachers constituted the largest group (82,3% while the cleaning staff (7.0%, school administrators (6.3%, and other personnel (4.4% were sharing the rest in small proportions. Of the study group 41,7 % are cigarette smokers and of them 67.3% smoke every time and 11,9% sometime in school. Very few school personnel (14,8% do physical exercise regularly. Majority of school personnel (71,3% stated that they brush their teeth at least twice a day regularly. However, only 23,7% of school personnel go to have regular dental control. All results were discussed in details considering the effects of health behaviours of school personnel on students, and some recommendations were developed for health education activities in schools. [TAF Prev Med Bull 2006; 5(2.000: 83-93
Chou, Han-Wei; Tzeng, Wen-Chii; Chou, Yu-Ching; Yeh, Hui-Wen; Chang, Hsin-An; Kao, Yu-Chen; Huang, San-Yuan; Yeh, Chin-Bin; Chiang, Wei-Shan; Tzeng, Nian-Sheng
The military is a unique occupational group and, because of this, military personnel face different kinds of stress than civilian populations. Sleep problems are an example. The purpose of this study was to investigate the relationship between sleep problems, depression level and coping strategies among military personnel. In this cross-sectional study, military personnel completed the Beck Depression Inventory, the Pittsburgh Sleep Quality Index and the Jalowiec Coping Scale. An evaluation of the test scores showed that officers had better sleep quality and fewer depressive symptoms than enlisted personnel. Military personnel with higher educational levels and less physical illness also had fewer depressive symptoms. Officers and noncommissioned officers preferred problem-focused strategies. Those with higher Beck Depression Inventory and Pittsburgh Sleep Quality Index scores and those who drank alcohol frequently preferred affective-focused strategies. Our results revealed that sleep quality, physical illness and alcohol consumption were associated with the mental health of military personnel. Treating these factors may improve the mental health of military personnel and enhance effective coping strategies. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
Full Text Available Background: The first step in cultivating the culture of safety in the operating room is the assessment of safety culture among operating room personnel. Objective: To assess the patient safety culture of operating room personnel at the Department of Surgery, Faculty of Medicine Siriraj Hospital, and compare attitudes among different groups of personnel, and compare them with the international standards. Methods: We conducted a cross-sectional survey of safety attitudes among 396 operating room personnel, using a short form of the Safety Attitudes Questionnaire (SAQ. The SAQ employed 30 items to assess safety culture in six dimensions: teamwork climate, safety climate, stress recognition, perception of hospital management, working conditions, and job satisfaction. The subscore of each dimension was calculated and converted to a scale score with a full score of 100, where higher scores indicated better safety attitudes. Results: The response rate was 66.4%. The overall safety culture score of the operating room personnel was 65.02, higher than an international average (61.80. Operating room personnel at Siriraj Hospital had safety attitudes in teamwork climate, safety climate, and stress recognition lower than the international average, but had safety attitudes in the perception of hospital management, working conditions, and job satisfaction higher than the international average. Conclusion: The safety culture attitudes of operating room personnel at the Department of Surgery, Siriraj Hospital were comparable to international standards. The safety dimensions that Siriraj Hospital operating room should try to improve were teamwork climate, safety climate, and stress recognition.
Arjona Vazquez, Orison; Venegas Bernal, Maria del Carmen; Armeteros Lopez, Ana L.
The system in charge the management of the training process personnel from a nuclear power plant was designed taking into account all the requirements stated in the training guide for nuclear power plant personnel and their evaluation, which were prepared by the IAEA in 1995 in order to implement the SAT in the training programs for nuclear plant personnel. In the preparations of formats and elements that shape the system, account has been taken of the views expressed in such a guide, in some other bibliography that was consulted, and in the authors own opinion mainly with regard to those issues which the guide does not go deeper into
Bartley, H.J.; Bocast, A.K.; Deppner, F.O.; Harrison, O.J.; Kraas, I.W.
The full title of this study is 'Development of Qualification Requirements, Training Programs, Career Plans, and Methodologies for Effective Management and Training of Inspection and Enforcement Personnel.' Task V required the development of an automated personnel data base system for NRC/IE. This system is identified as the NRC/IE Personnel, Assignment, Qualifications, and Training System (PAQTS). This Task V report provides the documentation for PAQTS including the Functional Requirements Document (FRD), the Data Requirements Document (DRD), the Hardware and Software Capabilities Assessment, and the Detailed Implementation Schedule. Specific recommendations to facilitate implementation of PAQTS are also included
Mi-Cho-Cho, Daw; Hla-Hla-Win, Daw; Thin-Thin-Kraing
Thermoluminescence dosimetry service was introduced in 1991. Personnel who exposed directly or indirectly to radiation is monitored by thermoluminescent dosimeter. TL materials used for thermoluminescent dosimeter are in the form of thin disc. Personnel whole-body and extremity doses are measured by thermoluminescence dosimetry. The Harshaw Model 4500 TLD reader and Vinten 654E TLD reader are used for TLD evaluation. At present about 600 radiation workers are provided with TLD for routine monitoring. It was found that most personnel had received within permissible dose recommended by the International Commission on Radiological Protection (ICRP). (author)
Training to achieve and maintain the qualification and competence of nuclear power personnel is essential for safe and economic nuclear power. Technical Cooperation Meeting on Training-Related Activities for Nuclear Power Plant (NPP) Personnel in the countries of Central and Eastern Europe (CEEC) and of the former Soviet Union (FSU) has as its main objective the identification, through information exchange and discussion, of possible Technical Cooperation (TC) projects to assist Member States in meeting NPP personnel training needs and priorities, including the enhancing of training capabilities
Grund, Christian; Bryson, Alex; Dur, Robert
The application of economic theory and principles to firms’ human resource problems is commonplace today. Personnel economics has come a long way since its early days in the late 1970s and 1980s, when scholars developed its theoretical foundations. In this contribution and introduction...... to the Special Issue ‘Advances in personnel economics’ of the German Journal of Human Resource Management, we would like to illustrate the origins of the field, outline how personnel economics relates to other research areas, describe major developments in the field and address its future challenges....
Hadlock, D.E.; Brackenbush, L.W.; Griffith, R.V.; Hankins, D.E.; Parkhurst, M.A.; Stroud, C.M.; Faust, L.G.; Vallario, E.J.
This report provides guidance on the characteristics, use, and calibration criteria for personnel neutron dosimeters. The report is applicable for neutrons with energies ranging from thermal to less than 20 MeV. Background for general neutron dosimetry requirements is provided, as is relevant federal regulations and other standards. The characteristics of personnel neutron dosimeters are discussed, with particular attention paid to passive neutron dosimetry systems. Two of the systems discussed are used at DOE and DOE-contractor facilities (nuclear track emulsion and thermoluminescent-albedo) and another (the combination TLD/TED) was recently developed. Topics discussed in the field applications of these dosimeters include their theory of operation, their processing, readout, and interpretation, and their advantages and disadvantages for field use. The procedures required for occupational neutron dosimetry are discussed, including radiation monitoring and the wearing of dosimeters, their exchange periods, dose equivalent evaluations, and the documenting of neutron exposures. The coverage of dosimeter testing, maintenance, and calibration includes guidance on the selection of calibration sources, the effects of irradiation geometries, lower limits of detectability, fading, frequency of calibration, spectrometry, and quality control. 49 refs., 6 figs., 8 tabs
During the period mid-June to mid-September 2004, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of routine nature) which will be made available to children of members of the personnel (i.e. anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1600.- for this period. An application form can be obtained from Martine PLAZA, HR Department (by using the slip below or by electronic mail to Martine.Plaza@cern.ch) or at: http://humanresources.web.cern.ch/HumanResources/internal/personnel/pmd/cr.asp Completed application forms must be returned to this service by 2 April 2004 a...
F. A. Dudueva
Full Text Available The article is based on dissertation papers of PhD and Ph.D. defended in the last decade on the subject of human resource management and employment in general. The article discusses the features of professional development in modern Russia. In view of the development of information technology the need to use knowledge management technologies as a basis for professional development of the individual is highlighted. In this regard, particular attention is paid to the development of the ICT sector personnel, and it is noted the importance of the impact of the transformation of the national education system in the development of personnel in Russia, in particular the transition to a competence-based approach. The article also highlights key factors of motivation of different categories of employees, current models of material and immaterial motivation, special attention is paid to the destructive model of motivation. In the conditions of transitive economy it is important to highlight the features of a new type of employment and the corresponding ways of organizing work in a globalized, postindustrial society. In this regard, special attention is paid to the mechanisms for effective management of employment in the social market economy. Moreover, there is a need of an active employment policy in Russia, resulting in the need to fill labor shortages in the country. One of the most effective ways to solve this problem is the labor migration.
During the period mid-June to mid-September 2001, there will be a limited number of vacancies for temporary work at CERN (normally unskilled work of a routine nature) which will be made available to children of members of the personnel (that is, anyone holding an employment or association contract with CERN). It should be noted that candidates must be aged between 18 and 24 inclusive on the first day of the contract, and that they must have insurance cover for both illness and accident. In view of the limited number of vacancies available, no children previously appointed at CERN under this scheme can be considered. The duration of all appointments will be 4 weeks, the allowance being CHF 1538.- net for this period. Application forms can be obtained via the Web at the following address: http://cern.web.cern.ch/CERN/Divisions/PE/ under the heading 'Other Useful Links' or from Paula Barriere, Personnel Management Group (by using the slip below or by electronic mail to Paula.Barriere@.cern.ch). Completed applic...
Full Text Available Circadian rhythm influences the physiology of the cardiovascular system, inducing diurnal variation of blood pressure. We investigated the association between daily emergency ambulance calls (EACs for elevated arterial blood pressure during the time intervals of 8:00–13:59, 14:00–21:59, and 22:00–7:59 and weekly fluctuations of air temperature (T, barometric pressure, relative humidity, wind speed, geomagnetic activity (GMA, and high-speed solar wind (HSSW. We used the Poisson regression to explore the association between the risk of EACs and weather variables, adjusting for seasonality and exposure to CO, PM10, and ozone. An increase of 10 °C when T > 1 °C on the day of the call was associated with a decrease in the risk of EACs during the time periods of 14:00–21:59 (RR (rate ratio = 0.78; p < 0.001 and 22:00–7:59 (RR = 0.88; p = 0.35. During the time period of 8:00–13:59, the risk of EACs was positively associated with T above 1 °C with a lag of 5–7 days (RR = 1.18; p = 0.03. An elevated risk was associated during 8:00–13:59 with active-stormy GMA (RR = 1.22; p = 0.003; during 14:00–21:59 with very low GMA (RR = 1.07; p = 0.008 and HSSW (RR = 1.17; p = 0.014; and during 22:00–7:59 with HSSW occurring after active-stormy days (RR = 1.32; p = 0.019. The associations of environmental variables with the exacerbation of essential hypertension may be analyzed depending on the time of the event.
Floegel, Theresa A; Dickinson, Jared M; DerAnanian, Cheryl; McCarthy, Marianne; Hooker, Steven P; Buman, Matthew P
The aim of this work was to investigate the predictive value of in-hospital posture and ambulatory activity for 30 days following discharge on functional status in older patients with heart failure. We undertook a prospective observational pilot study of 27 patients (78 ± 9.8 y, 51.8% female) admitted with heart failure. Participants wore 2 inclinometric accelerometers to record posture in-hospital and an ankle accelerometer to record ambulatory activity in-hospital and 30 days after discharge. Function was assessed on the day after discharge (Timed Up and Go [TUG], Short Physical Performance Battery [SPPB], hand grip strength) and 30 days after discharge. Length of stay was 5.1 ± 3.9 days. Participants spent 63.0 ± 19.2% of their hospital time lying down, 30.2 ± 18.7% sitting, 5.3 ± 4.2% standing, and 1.9 ± 8.6% ambulating. Thirty-day mean post-discharge stepping was 4890 ± 2285 steps/day. Each 10% increase in hospital lying time was associated with 0.7 s longer TUG time (95% confidence interval [CI] 0.2-1.9) at 30 days. Each 1000 additional daily steps in the post-discharge period was associated with a 0.8-point higher SPPB score (95% CI 0.1-1.0) at 30 days. Handgrip strength was unchanged. Older patients with heart failure were sedentary during hospitalization, which may contribute to decreased functional performance. Physical activity after discharge may minimize this negative effect. Copyright © 2018 Elsevier Inc. All rights reserved.
Lovach-Chepujnoska, Margarita; Nojkov, Jordan; Joshevska-Jovanovska, Slagjana; Domazetov, Robert
The advantages of patient-controlled epidural analgesia (PCEA) for delivery compared with continuous epidural analgesia (CEA) have been a point of interest in research obstetric anaesthesia for more than two decades. The aim of this single blind randomized controlled study was to evaluate the incidence of motor block and ability to perform partial knee flexion in women who received CEA or PCEA. Fifty-one healthy nulliparous women were included in this study. After an initial dose and established sensory block at Th 10, parturients were randomized into two groups: group CEA (10 ml/h), and group PCEA (bolus - 5 ml, lockout interval - 15 minutes, basal rate - 0 ml) with bupivacaine 0.08% and fentanyl 2 µg/ml. The motor function of the lower limbs was evaluated by modified Bromage scale at regular hourly intervals until full cervical dilatation. The quality of analgesia was assessed using a visual analogue pain scale (VAPS) and maternal satisfaction. Mode of delivery, the total number of additional rescue boluses, foetal and neonatal outcomes were recorded. Motor block was significantly lower in the third (33.3% vs. 4.35%; p = 0.008), fourth (57.9% vs. 6.3%; p = 0.003) and fifth hour (75.0% vs. 18.2%; p = 0.001) in the PCEA group. Ambulation occurred in 18% in the CEA and 46% in the PCEA group (p = 0.036). VAPS was with borderline significance in the second (p = 0.076) and significantly lower in the fourth hour (p = 0.034). Compared with CEA, PCEA provided less motor block and better first-stage analgesia, which leads to the conclusion that patient-controlled analgesia techniques are the preferred model in obstetric anesthesia.
Labruyère, Rob; van Hedel, Hubertus J
To investigate whether a figure-of-8-shaped walking test can estimate various domains of walking in subjects with incomplete spinal cord injury (iSCI) better than the 10-meter walk test (10MWT), and to explore similarities and differences between the 2 tests and between subjects with iSCI and age-matched, healthy controls. Case-control study. Spinal cord injury center of a university hospital. A convenience sample of subjects with iSCI (n=15; mean age, 50y; 40% women; neurologic level from C3 to L5; median time since injury, 5mo) was compared with an age-matched control group (47% women). Not applicable. The figure-of-8 test (FET) included 6 conditions to test the subjects' ability to adapt their gait to several circumstances. These conditions covered normal and maximal walking speed, constrained vision, obstacles, foamed soles, and a dual task. Additionally, subjects were tested for lower extremity muscle strength, gait capacity (10MWT) and balance, independence, and fear of falling. (1) Preferred straight-walking speed correlated with the different FET conditions in both groups; (2) if normalized to preferred straight-walking speed, FET conditions showed significant differences between both groups; (3) if normalized to preferred curve-walking speed, these differences seemed to disappear; and (4) the 10MWT appeared superior to the different conditions of the FET in estimating various walking-related functions. Subjects with iSCI seem to have difficulties with curve walking compared with straight walking. We therefore recommend the implementation of curve walking into rehabilitation training programs. However, the FET did not provide a better estimate of functional ambulation performance after an iSCI compared with the 10MWT. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.