Rimstad, Rune; Braut, Geir Sverre
It is not known what constitutes the optimal emergency management system, nor is there a consensus on how effectiveness and efficiency in emergency response should be measured or evaluated. Literature on the role and tasks of commanders in the prehospital emergency services in the setting of mass-casualty incidents has not been summarized and published. This comprehensive literature review addresses some of the needs for future research in emergency management through three research questions: (1) What are the basic assumptions underlying incident command systems (ICSs)? (2) What are the tasks of ambulance and medical commanders in the field? And (3) How can field commanders' performances be measured and assessed? A systematic literature search in MEDLINE, PubMed, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, ISI Web of Science, Scopus, International Security & Counter Terrorism Reference Center, Current Controlled Trials, and PROSPERO covering January 1, 1990 through March 1, 2014 was conducted. Reference lists of included literature were hand searched. Included papers were analyzed using Framework synthesis. The literature search identified 6,049 unique records, of which, 76 articles and books where included in qualitative synthesis. Most ICSs are described commonly as hierarchical, bureaucratic, and based on military principles. These assumptions are contested strongly, as is the applicability of such systems. Linking of the chains of command in cooperating agencies is a basic difficulty. Incident command systems are flexible in the sense that the organization may be expanded as needed. Commanders may command by direction, by planning, or by influence. Commanders' tasks may be summarized as: conducting scene assessment, developing an action plan, distributing resources, monitoring operations, and making decisions. There is considerable variation between authors in nomenclature and what tasks are included or highlighted
Hart, Alexander; Chai, Peter R; Griswold, Matthew K; Lai, Jeffrey T; Boyer, Edward W; Broach, John
This study seeks to understand the acceptability and perceived utility of unmanned aerial vehicle (UAV) technology to Mass Casualty Incidents (MCI) scene management. Qualitative questionnaires regarding the ease of operation, perceived usefulness, and training time to operate UAVs were administered to Emergency Medical Technicians (n = 15). A Single Urban New England Academic Tertiary Care Medical Center. Front-line emergency medical service (EMS) providers and senior EMS personnel in Incident Commander roles. Data from this pilot study indicate that EMS responders are accepting to deploying and operating UAV technology in a disaster scenario. Additionally, they perceived UAV technology as easy to adopt yet impactful in improving MCI scene management.
... 32 National Defense 5 2010-07-01 2010-07-01 false Commander, Naval Medical Command. 724.406 Section 724.406 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NAVAL DISCHARGE REVIEW BOARD Principal Elements of the Navy Department Discharge Review System § 724.406 Commander...
Hillman, S. O.
The Incident Command System (ICS) for crisis management, used for response to oil spills by the Alyeska Pipeline Service Company throughout its facilities, including the Trans Alaska Pipeline and the Valdez Marine Terminal, was described. Special attention was given to the Environmental Unit within the ICS which functions as a primary support unit for the Incident Operations Section. Details of the Unit's function were provided. These include the collection, evaluation and dissemination of information on all environmental issues concerning the crisis, provision of advice and direction on environmental aspects, and up-front agency interaction. A checklist of tasks is included. 7 refs
The most vital element for responding emergency personnel to a CBRN attack is the incident command linkup and dissemination of information. Incident Command, the basic foundation of the National Incident Management System (NIMS), is the first thing that must be effectively established when a response is required in any emergency. When initial evaluation of the scene determines that the incident involves CBRN, specialized resources from a wide array of assets must be activated quickly to mitigate the hazards. In this paper, we examine the information that the Incident Commander must be prepared to convey to those specialized assets responding. We will also look at what questions those specialized resources may ask while en route and upon arrival. Another key element that will be discussed is the placement of those resources in the hierarchy of the National Incident Management System. The information that the Incident Commander (IC) must be prepared to convey to those specialized assets responding is crucial for an efficient response and effective deployment. What questions might those specialized CBRN resources ask while en route and upon arrival? At a bare minimum, the four basic questions of who is in charge of the incident, where is the incident located, what transpired to trigger a response, and when did the incident occur must be answered. These questions should be answered while en route to the scene so that the Commander of the responding CBRN unit can formulate a plan on the move and prepare his response accordingly. While in transit, the CBRN responders should maintain contact with a representative of the Incident Command at the scene so that the latest information is available. Discussions should include anticipated logistical requirements such as personal protective equipment (PPE), decon requirements, communications protocols, and medical care issues. The CBRN Commander will need to know if the site is secure, has it been cleared of explosive hazards
... process medical malpractice claims arising at Army medical centers under the Commander's control. In... investigate and process medical malpractice claims and affirmative claims and will be provided with the... 32 National Defense 3 2010-07-01 2010-07-01 true Commanding General, U.S. Army Medical Command...
the wire diagram included in the draft organizational chart failed to include a UMC Commander, it did identify many areas to consolidate common...educations, while contributing to the dental readiness of their respective populations. The Orthodontic program at Wilford Hall is an example of a joint
William B. Samuels; Rakesh Bahadur; Michael C. Monteith; David E. Amstutz; Jonathan M. Pickus; Katherine Parker; Douglas. Ryan
This project involved the development of an information tool that gives Incident Commanders the critical information they need to make informed decisions regarding the consequences of threats to public water supply intakes.
This conference is about the main action guides responses implemented by the incident commander in a radiological emergency. The public exposure, the contamination, the radioactive sources and suspicious material are important aspects to be considered by the first responders
Knipper, W. [NSTec
This presentation builds on our response to events that pose, or have the potential to pose, a serious security or law enforcement risk and must be responded to and controlled in a clear a decisive fashion. We will examine some common concepts in the command and control of security-centric events.
Full Text Available Hospital Incident Command System (HICS has been established with the mission of prevention, response, and recovery in hazards. Regarding the key role of hospitals in medical management of events, the present study is aimed at investigating benefits, barriers, and limitations of applying HICS in hospital. Employing a review study, articles related to the aforementioned subject published from 1995 to 2016 were extracted from accredited websites and databases such as PubMed, Google Scholar, Elsevier, and SID by searching keywords such as HICS, benefits, barriers, and limitations. Then, those articles were summarized and reported. Using of HICS can cause creating preparedness in facing disasters, constructive management in strategies of controlling events, and disasters. Therefore, experiences indicate that there are some limitations in the system such as failure to assess the strength and severity of vulnerabilities of hospital, no observation of standards for disaster management in the design, constructing and equipping hospitals, and the absence of a model for evaluating the system. Accordingly, the conducted studies were investigated for probing the performance HICS. With regard to the role of health in disaster management, it requires advanced international methods in facing disasters. Using accurate models for assessing, the investigation of preparedness of hospitals in precrisis conditions based on components such as command, communications, security, safety, development of action plans, changes in staff's attitudes through effective operational training and exercises and creation of required maneuvers seems necessary.
AIMS: Approximately 20% of deaths from adverse events are related to medication incidents, costing the NHS an additional £500 million annually. Less than 5% of adverse events are reported. This study aims to assess the reporting rate of medication incidents in NHS facilities in the north east of Scotland, and to describe the types and outcomes of reported incidents among different services. Furthermore, we wished to quantify the proportion of reported incidents according to the reporters\\' profession. METHODS: A retrospective description was made of medication incidents reported to an online reporting system (DATIX) over a 46-month-period (July 2005 to April 2009). Reports originated from acute and community hospitals, mental health, and primary care facilities. RESULTS: Over the study period there were 2,666 incidents reported with a mean monthly reporting rate of 78.2\\/month (SD±16.9). 6.1% of all incidents resulted in harm, with insulin being the most commonly implicated medication. Nearly three-quarters (74.2%, n=1,978) of total incidents originated from acute hospitals. Administration incidents were implicated in the majority of the reported medication incidents (59%), followed by prescribing (10.8%) and dispensing (9.9%), while the nondescript "other medication incidents" accounted for 20.3% of total incidents. The majority of reports were made by nursing and midwifery staff (80%), with medical and dental professionals reporting the lowest number of incidents (n=56, 2%). CONCLUSIONS: The majority of medication incidents in this study were reported by nursing and midwifery staff, and were due to administration incidents. There is a clear need to elucidate the reasons for the limited contribution of the medical and dental professionals to reporting medication incidents.
Boersma, F.K.; Comfort, L.K.; Groenendaal, J.; Wolbers, J.J.
This special issue examines the process of implementation, change and adaptation of Incident Command Systems (ICS) as a strategy for mobilizing and managing disaster operations in comparative perspective, focusing on ICS in practice in the United States, France, the Netherlands and Norway. Shorter
Djalali, Ahmadreza; Hosseinijenab, Vahid; Peyravi, Mahmoudreza; Nekoei-Moghadam, Mahmood; Hosseini, Bashir; Schoenthal, Lisa; Koenig, Kristi L
Effectiveness of hospital management of disasters requires a well-defined and rehearsed system. The Hospital Incident Command System (HICS), as a standardized method for command and control, was established in Iranian hospitals, but it has performed fairly during disaster exercises. This paper describes the process for, and modifications to HICS undertaken to optimize disaster management in hospitals in Iran. In 2013, a group of 11 subject matter experts participated in an expert consensus modified Delphi to develop modifications to the 2006 version of HICS. The following changes were recommended by the expert panel and subsequently implemented: 1) A Quality Control Officer was added to the Command group; 2) Security was defined as a new section; 3) Infrastructure and Business Continuity Branches were moved from the Operations Section to the Logistics and the Administration Sections, respectively; and 4) the Planning Section was merged within the Finance/Administration Section. An expert consensus group developed a modified HICS that is more feasible to implement given the managerial organization of hospitals in Iran. This new model may enhance hospital performance in managing disasters. Additional studies are needed to test the feasibility and efficacy of the modified HICS in Iran, both during simulations and actual disasters. This process may be a useful model for other countries desiring to improve disaster incident management systems for their hospitals.
Mohammad Hossein Yarmohammadian
Full Text Available Background: Applying an effective management system in emergency incidents provides maximum efficiency with using minimum facilities and human resources. Hospital Emergency Incident Command System (HEICS is one of the most reliable emergency incident command systems to make hospitals more efficient and to increase patient safety. This research was to study requirements, barriers, and strategies of HEICS in hospitals affiliated to Isfahan University of Medical Sciences (IUMS. Methods: This was a qualitative research carried out in Isfahan Province, Iran during 2008-09. The study population included senior hospital managers of IUMS and key informants in emergency incident management across Isfahan Province. Sampling method was in non-random purposeful form and snowball technique was used. The research in-strument for data collection was semi-structured interview; collected data was analyzed by Colaizzi Technique. Results: Findings of study were categorized into three general categories including requirements (organizational and sub-organizational, barriers (internal and external of HEICS establishment, and providing short, mid and long term strategies. These categories are explained in details in the main text. Conclusions: Regarding the existing barriers in establishment of HEICS, it is recommended that responsible authori-ties in different levels of health care system prepare necessary conditions for implementing such system as soon as possible via encouraging and supporting systems. This paper may help health policy makers to get reasonable frame-work and have comprehensive view for establishing HEICS in hospitals. It is necessary to consider requirements and viewpoints of stakeholders before any health policy making or planning.
Approximately 30.2 million litres of oil were discharged during Hurricanes Katrina and Rita. A total of 230 incidents were reported to the state's spill response community, including ruptured pipelines, damaged and moved storage tanks, refineries, and sunken vessels. By January 2006, industry had reported the recovery of 14.7 million litres of oil. After Hurricane Rita, a further 234 off- and onshore incidents were reported. This paper presented a chronology from August 26 2005 through to June 2006 of clean-up activities for both hurricanes, with specific reference to logistic and communications issues associated with working in environments that are difficult to access due to damaged transportation infrastructure. An outline of the Louisiana Oil Spill Coordinator's Office's role in the incidents was presented, as well as an overview of the Louisiana State Contingency Plan. It was noted that the lack of communications systems caused considerable difficulties for responders. It was concluded that responses to hurricanes can be made more effective by having all response communities incident command structure (ICS)-trained with a thorough knowledge of the National Response Plan as it relates to the National Contingency Plan. Ensuring that plans are operational, having clear lines of authority on all hurricane-related issues, and having a robust communications plan were recommended, as well as the ability to respond without communications
Full Text Available Abstract Background Timely decisions concerning mobilization and allocation of resources and distribution of casualties are crucial in medical management of major incidents. The aim of this study was to evaluate documented initial regional medical responses to major incidents by applying a set of 11 measurable performance indicators for regional medical command and control and test the feasibility of the indicators. Methods Retrospective data were collected from documentation from regional medical command and control at major incidents that occurred in two Swedish County Councils. Each incident was assigned to one of nine different categories and 11 measurable performance indicators for initial regional medical command and control were systematically applied. Two-way analysis of variance with one observation per cell was used for statistical analysis and the post hoc Tukey test was used for pairwise comparisons. Results The set of indicators for regional medical command and control could be applied in 102 of the130 major incidents (78%, but 36 incidents had to be excluded due to incomplete documentation. The indicators were not applicable as a set for 28 incidents (21.5% due to different characteristics and time frames. Based on the indicators studied in 66 major incidents, the results demonstrate that the regional medical management performed according to the standard in the early phases (1–10 min after alert, but there were weaknesses in the secondary phase (10–30 min after alert. The significantly lowest scores were found for Indicator 8 (formulate general guidelines for response and Indicator 10 (decide whether or not resources in own organization are adequate. Conclusions Measurable performance indicators for regional medical command and control can be applied to incidents that directly or indirectly involve casualties provided there is sufficient documentation available. Measurable performance indicators can enhance follow- up and be
Härkänen, Marja; Tiainen, Maijaterttu; Haatainen, Kaisa
To describe the factors pertaining to medication being administered to the wrong patient and to describe how patient identification is mentioned in wrong-patient incident reports. Although patient identification has been given high priority to improve patient safety, patient misidentifications occur, and wrong-patient incidents are common. A descriptive content analysis. Incident reports related to medication administration (n = 1,012) were collected from two hospitals in Finland between 1 January 2013-31 December 2014. Of those, only incidents involving wrong-patient medication administration (n = 103) were included in this study. Wrong-patient incidents occurred due for many reasons, including nurse-related factors (such as tiredness, a lack of skills or negligence) but also system-related factors (such as rushing or heavy workloads). In 77% (n = 79) of wrong-patient incident reports, the process of identifying of the patient was not described at all. There is need to pay more attention to and increase training in correct identification processes to prevent wrong-patient incidents, and it is important to adjust system factors to support nurses. Active patient identification procedures, double-checking and verification at each stage of the medication process should be implemented. More attention should also be paid to organisational factors, such as division of work, rushing and workload, as well as to correct communication. The active participation of nurses in handling incidents could increase risk awareness and facilitate useful protection actions. © 2017 John Wiley & Sons Ltd.
they will also depend on the MHS. There are cost / benefit issues associated with deferring patients to the Department of Veterans Affairs ( DVA ...whether efficiencies can be gained by better integrating the two largest government institutional health systems. Should, for instance, the DVA take...over institutional health care in its entirety; operating Military and DVA Medical Treatment Facilities and training physicians, nurses, medics and
Djalali, Ahmadreza; Castren, Maaret; Hosseinijenab, Vahid; Khatib, Mahmoud; Ohlen, Gunnar; Kurland, Lisa
Hospitals are cornerstones for health care in a community and must continue to function in the face of a disaster. The Hospital Incident Command System (HICS) is a method by which the hospital operates when an emergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own management systems before the occurrence of an actual disaster. The main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises. This observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19) of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04). The decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.
Full Text Available Abstract Background Hospitals are cornerstones for health care in a community and must continue to function in the face of a disaster. The Hospital Incident Command System (HICS is a method by which the hospital operates when an emergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own management systems before the occurrence of an actual disaster. The main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises. Methods This observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as Results None of the participating hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19 of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04. Conclusions The decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.
eds., Reorganizing the Military Health System (Santa Monica, CA: RAND, 2001), 57. 115 Ibid. 116 Ibid., 58-61. 117 Tom Philpott, “Military Update...armedforcesjournal.com/unified- medical-command-an-old-idea-whose-time-has-come/ June 1, 2013, (accessed June 19, 2017). 121 Tom Philpott, Healthcare to be single...accessed June 12, 2017). 122 Tom Philpott, Military Update: Merger of three services’ medical bureaucracies is rejected. 123 Ibid. 124 Hosek and
Stetz, Melba C; Folen, Raymond A; Van Horn, Sandra; Ruseborn, Daniel; Samuel, Kevin M
The Tripler Army Medical Center is the only federal tertiary care hospital serving the Pacific Regional Medical Command. Due to Tripler's large area of responsibility, many behavioral health professionals are starting to employ more technology during their sessions. As explained in this article, virtual reality and telepsychology efforts are proving to benefit military service members and their families in the Pacific Rim. PsycINFO Database Record (c) 2013 APA, all rights reserved.
Castulik, P.; Slabotinsky, J.; Kralik, L.; Bradka, S.
During CBR incidents with releases of hazardous materials (HazMat), there is extremely urgent aim of first rescuing responders to safe the life for as much as possible victims and reducing health consequences from the exposure of the HazMat. Highest priority of the response is to be applied, if victims are exposed with chemicals through their airways and/or mucous membranes. There is general approach in the emergency medical services (EMS) stated that the victims being in critical status have to receive emergency medical care on-site even prior the transportation to a medical facility. However, in a case of CBR events the EMS prefer to provide the First Aid for victims to be already decontaminated as mass casualties, e.g. by the firemen and transferred to a safe zone. This approach is to be time consuming and thus creating delays in medical care not in the favor of a victim's successful survival. In order to overcome this approach, there are needs for eminent ceasing of the victims exposure, protection of breathing tract/ventilation support and administration of antidotes, if available. All this have to be done in shortest time since HazMat incident/accident occurs. This presentation is focusing on emergency provisions for saving victims directly in contaminated environment through the assistance by responders, concentrating on search and rescue of victims, their emergency decontamination, breathing protection, clothing removal, ventilation support, antidote administration, fixing and bandage of trauma injuries prior transportation and/or mass decontamination. This experience is shared based on a field exercise with the EMS volunteers (Red Cross), fire brigade volunteers and university's students.(author)
Cheung, K.C.; Bemt, P.M. van den; Bouvy, M.L.; Wensing, M.J.P.; Smet, P.A.G.M. de
Objective Many Dutch hospitals have established internal systems for reporting incidents. However, such internal systems do not allow learning from incidents that occur in other hospitals. Therefore a multicenter, information technology (IT) supported reporting system named central medication
NSTec Environmental Restoration
Homeland Security Presidential Directive HSPD-5 requires all federal departments and agencies to adopt a National Incident Management System (NIMS)/Incident Command System (ICS) and use it in their individual domestic incident management and emergency prevention, preparedness, response, recovery, and mitigation programs and activities, as well as in support of those actions taken to assist state and local entities. This system provides a consistent nationwide template to enable federal, state, local, and tribal governments, private-sector, and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism. This document identifies the operational concepts of the Federal Radiological Monitoring and Assessment Center's (FRMAC) implementation of the NIMS/ICS response structure under the National Response Plan (NRP). The construct identified here defines the basic response template to be tailored to the incident-specific response requirements. FRMAC's mission to facilitate interagency environmental data management, monitoring, sampling, analysis, and assessment and link this information to the planning and decision staff clearly places the FRMAC in the Planning Section. FRMAC is not a mitigating resource for radiological contamination but is present to conduct radiological impact assessment for public dose avoidance. Field monitoring is a fact-finding mission to support this effort directly. Decisions based on the assessed data will drive public protection and operational requirements. This organizational structure under NIMS is focused by the mission responsibilities and interface requirements following the premise to provide emergency responders with a flexible yet standardized structure for incident response activities. The coordination responsibilities outlined in the NRP are based on the NIMS
NSTec Environmental Restoration
Homeland Security Presidential Directive HSPD-5 requires all federal departments and agencies to adopt a National Incident Management System (NIMS)/Incident Command System (ICS) and use it in their individual domestic incident management and emergency prevention, preparedness, response, recovery, and mitigation programs and activities, as well as in support of those actions taken to assist state and local entities. This system provides a consistent nationwide template to enable federal, state, local, and tribal governments, private-sector, and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism. This document identifies the operational concepts of the Federal Radiological Monitoring and Assessment Center's (FRMAC) implementation of the NIMS/ICS response structure under the National Response Plan (NRP). The construct identified here defines the basic response template to be tailored to the incident-specific response requirements. FRMAC's mission to facilitate interagency environmental data management, monitoring, sampling, analysis, and assessment and link this information to the planning and decision staff clearly places the FRMAC in the Planning Section. FRMAC is not a mitigating resource for radiological contamination but is present to conduct radiological impact assessment for public dose avoidance. Field monitoring is a fact-finding mission to support this effort directly. Decisions based on the assessed data will drive public protection and operational requirements. This organizational structure under NIMS is focused by the mission responsibilities and interface requirements following the premise to provide emergency responders with a flexible yet standardized structure for incident response activities. The coordination responsibilities outlined in the NRP are based on the
Cohen-Hatton, Sabrina R; Butler, Philip C; Honey, Robert C
The aim of this study was to better understand the nature of decision making at operational incidents in order to inform operational guidance and training. Normative models of decision making have been adopted in the guidance and training for emergency services. In these models, it is assumed that decision makers assess the current situation, formulate plans, and then execute the plans. However, our understanding of how decision making unfolds at operational incidents remains limited. Incident commanders, attending 33 incidents across six U.K. Fire and Rescue Services, were fitted with helmet-mounted cameras, and the resulting video footage was later independently coded and used to prompt participants to provide a running commentary concerning their decisions. The analysis revealed that assessment of the operational situation was most often followed by plan execution rather than plan formulation, and there was little evidence of prospection about the potential consequences of actions. This pattern of results was consistent across different types of incident, characterized by level of risk and time pressure, but was affected by the operational experience of the participants. Decision making did not follow the sequence of phases assumed by normative models and conveyed in current operational guidance but instead was influenced by both reflective and reflexive processes. These results have clear implications for understanding operational decision making as it occurs in situ and suggest a need for future guidance and training to acknowledge the role of reflexive processes. © 2015, Human Factors and Ergonomics Society.
Noiesen, Eline; Trosborg, Ingelise; Bager, Louise
To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients.......To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients....
Lichtner, Valentina; Gerrett, David; Slee, Ann; Gul, Noreen; Cornford, Tony
This is a study of medication safety incidents reported to the NHS in England (UK) associated with the use of digital technology. An interpretative analysis of 888 incidents reports offers insight into uses and features of this technology associated with medication errors and potential patient harm.
Lichtner, V.; Gerrett, D.; Slee, A.; Gul, N.; Cornford, T.
This is a study of medication safety incidents reported to the NHS in England (UK) associated with the use of digital technology. An interpretative analysis of 888 incidents reports offers insight into uses and features of this technology associated with medication errors and potential patient harm.
Adini, B; Bodas, M; Nilsson, H; Peleg, K
Diverse decision-making is needed in managing mass casualty incidents (MCIs), by emergency medical services (EMS). The aim of the study was to review consensus among international experts concerning policies of EMS management during MCIs. Applicability of 21 EMS policies was tested through a 2-cycle modified e-Delphi process, in which 38 multi-disciplinary experts from 10 countries participated. Threshold for approving proposed solutions was defined as consensus of >80%. Policies that did not achieve the targeted consensus were reviewed to detect variability according to respondents' origin country. 16 policies were endorsed in the first cycle including collaboration between ambulance service providers; implementing a unified mode of operation; preparing criteria for ground versus aerial evacuation; and, developing support systems for caregivers exposed to violence. An additional policy which proposed that senior EMS officers should not necessarily act as on-site MCI commanders was endorsed in the second cycle. Demographic breakdown of views concerning non-consensual policies revealed differences according to countries of origin. Assigning ambulances to off-duty team members was highly endorsed by experts from Israel and South Africa and strongly rejected by European respondents. Avoiding entry to risk areas until declared safe was endorsed by European, Asian and Oceanic experts, but rejected by Israeli, South African and North American experts. Despite uniqueness of countries and EMS agencies, solutions to most dilemmas were applicable to all organizations, regardless of location or affiliation. Cultural diversity was found concerning readiness to implement military-civilian collaboration in MCIs and a rigid separation between work-leisure responsibilities. Copyright © 2017 Elsevier Ltd. All rights reserved.
Reynolds, Penny S; Michael, Mary J; Spiess, Bruce D
Clinical trial success depends on appropriate management, but practical guidance to trial organisation and planning is lacking. The Incident Command System (ICS) is the 'gold standard' management system developed for managing diverse operations in major incident and public health arenas. It enables effective and flexible management through integration of personnel, procedures, resources, and communications within a common hierarchical organisational structure. Conventional ICS organisation consists of five function modules: Command, Planning, Operations, Logistics, and Finance/Administration. Large clinical trials will require a separate Regulatory Administrative arm, and an Information arm, consisting of dedicated data management and information technology staff. We applied ICS principles to organisation and management of the Prehospital Use of Plasma in Traumatic Haemorrhage (PUPTH) trial. This trial was a multidepartmental, multiagency, randomised clinical trial investigating prehospital administration of thawed plasma on mortality and coagulation response in severely injured trauma patients. We describe the ICS system as it would apply to large clinical trials in general, and the benefits, barriers, and lessons learned in utilising ICS principles to reorganise and coordinate the PUPTH trial. Without a formal trial management structure, early stages of the trial were characterised by inertia and organisational confusion. Implementing ICS improved organisation, coordination, and communication between multiple agencies and service groups, and greatly streamlined regulatory compliance administration. However, unfamiliarity of clinicians with ICS culture, conflicting resource allocation priorities, and communication bottlenecks were significant barriers. ICS is a flexible and powerful organisational tool for managing large complex clinical trials. However, for successful implementation the cultural, psychological, and social environment of trial participants must be
Summary: Biomechanical and Psychosocial stresses are capable of destabilizing any health care professional. The current health sector reform in Nigeria, which lays emphasis on service delivery on a background of very few radiographers, may lead to an increase in stress level. This study investigated the incidence of ...
federal agencies that were the early adopters. This chapter also discusses the development of the ICS in Australia . The development of the Australian ...ICS is a key parallel to the United States system and the lessons learned from Australia can be applied here. This chapter concludes with incidents...morning. After the full area was surveyed for damage assessment, the number of people left homeless was estimated at close to 10,000, and damage estimates
Fattah, Sabina; Johnsen, Anne Siri; Sollid, Stephen J M
OBJECTIVE: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences...
Cheung, Ka-Chun; van den Bemt, Patricia M L A; Bouvy, Marcel L; Wensing, Michel; De Smet, Peter A G M
Many Dutch hospitals have established internal systems for reporting incidents. However, such internal systems do not allow learning from incidents that occur in other hospitals. Therefore a multicenter, information technology (IT) supported reporting system named central medication incidents registration (CMR) was developed. This article describes the architecture, implementation and current status of the CMR in The Netherlands and compare it with similar systems in other countries. Adequate IT is required to sufficiently support a multicenter reporting system. The CMR system consists of a website, a database, a web-based reporting form, an application to import reports generated in other reporting systems, an application to generate an overview of reported medication incidents, and a national warning system for healthcare providers. From the start of CMR 90 of all 93 (96.8%) hospitals and 872 of 1948 (44.8%) community pharmacies participated. Between March 2006 and March 2010 the CMR comprised 15,694 reports of incidents. In the period from March 2010 to March 2011, 1642 reports were submitted by community pharmacies in CMR and the hospitals submitted 2517 reports. CMR is similar to various systems in other countries, but it seems to use more IT applications. The CMR is developing into a nationwide reporting system of medication incidents in The Netherlands, in which hospitals, community pharmacies, mental healthcare organizations and general practitioners participate. The architecture of the system met the requirements of a nationwide reporting system across different healthcare providers.
Yu, Wenya; Lv, Yipeng; Hu, Chaoqun; Liu, Xu; Chen, Haiping; Xue, Chen; Zhang, Lulu
Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command. Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people. The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise.
Cheung, Ka-Chun; van der Veen, Willem; Bouvy, Marcel L.; Wensing, Michel; van den Bemt, Patricia M. L. A.; de Smet, Peter A. G. M.
Introduction Information technology (IT) plays a pivotal role in improving patient safety, but can also cause new problems for patient safety. This study analyzed the nature and consequences of a large sample of IT-related medication incidents, as reported by healthcare professionals in community
Gariel, C; Cogniat, B; Desgranges, F-P; Chassard, D; Bouvet, L
Medication errors are not uncommon in hospitalized patients. Paediatric patients may have increased risk for medication errors related to complexity of weight-based dosing calculations or problems with drug preparation and dilution. This study aimed to determine the incidence of medication errors in paediatric anaesthesia in a university paediatric hospital, and to identify their characteristics and potential predictive factors. This prospective incident monitoring study was conducted between November 2015 and January 2016 in an exclusively paediatric surgical centre. Children medication error (2.6%). Drugs most commonly involved in medication errors were opioids and antibiotics. Incorrect dose was the most frequently reported type of error (n=27, 67.5%), with dilution error involved in 7/27 (26%) cases of incorrect dose. Duration of procedure >120 min was the only factor independently associated with medication error [adjusted odds ratio: 4 (95% confidence interval: 2-8); P=0.0001]. Medication errors are not uncommon in paediatric anaesthesia. Identification of the mechanisms related to medication errors might allow preventive measures that can be assessed in further studies. Copyright © 2017 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
Majority of Emergency Medical Services (EMS) have daily extensive experience with rescue of casualties having trauma injuries, resulting from conventional incidents. In the case of non-conventional incidents involving chemical, bacteriological or radiological (CBR) hazardous materials operational scene for all responders is begin to be more complicated due contamination of casualties, equipment and environment. Especially EMS personnel and receiving staff at the hospital have to work under very demanding condition due to burden of personal protective equipment (PPE) and awareness to avoiding cross-contamination during handling casualties. Those conditions require significantly different approaches for search and rescue of victims from incident site, through transportation and effective treatment at medical facilities. In cases when chemicals will be major hazard materials, the speed of rescue and treatment of victims is a major challenge. Each minute matter, and any delay of response could seriously complicated saving of lives and successful recovery of exposed victims. Success in rescue victims is finally measured thorough the ability of the first responders to save people... ALIVE..., no matter what surrounding condition is. The presentation is providing a view and suggestions on more rapid immediate medical response during non-conventional incidents. It names basic concept based on preparedness, early identification of CBR hazards through signs and symptoms of casualties, priorities of rescue procedures and care on-site, needs of decontamination, rapid evacuation casualties from a scene and immediate hospital response.(author)
House, R.A.; Sax, S.E.; Rumack, E.R.; Holness, D.L.
The medical management of three individuals involved in an exposure incident to whole-body radiation at a nuclear generating plant of a Canadian electrical utility is described. The exposure incident resulted in the two highest whole-body radiation doses ever received in a single event by workers in a Canadian nuclear power plant. The individual whole-body doses (127.4 mSv, 92.0 mSv, 22.4 mSv) were below the threshold for acute radiation sickness but the exposures still presented medical management problems related to assessment and counseling. Serial blood counting and lymphocyte cytogenetic analysis to corroborate the physical dosimetry were performed. All three employees experienced somatic symptoms due to stress and one employee developed post-traumatic stress disorder. This incident indicates that there is a need in such radiation exposure accidents for early and continued counseling of exposed employees to minimize the risk of development of stress-related symptoms
House, R.A.; Sax, S.E.; Rumack, E.R.; Holness, D.L. (Department of Occupational and Environmental Health, St. Michael' s Hospital, Toronto, Ontario (Canada))
The medical management of three individuals involved in an exposure incident to whole-body radiation at a nuclear generating plant of a Canadian electrical utility is described. The exposure incident resulted in the two highest whole-body radiation doses ever received in a single event by workers in a Canadian nuclear power plant. The individual whole-body doses (127.4 mSv, 92.0 mSv, 22.4 mSv) were below the threshold for acute radiation sickness but the exposures still presented medical management problems related to assessment and counseling. Serial blood counting and lymphocyte cytogenetic analysis to corroborate the physical dosimetry were performed. All three employees experienced somatic symptoms due to stress and one employee developed post-traumatic stress disorder. This incident indicates that there is a need in such radiation exposure accidents for early and continued counseling of exposed employees to minimize the risk of development of stress-related symptoms.
Thompson, Julian; Rehn, Marius; Lossius, Hans Morten; Lockey, David
As the threat of international terrorism rises, there is an increasing requirement to provide evidence-based information and training for the emergency personnel who will respond to terrorist incidents. Current major incident training advises that emergency responders prioritize their own personal safety above that of the 'scene and survivors'. However, there is limited information available on the nature of these threats and how they may be accurately evaluated. This study reviews the published medical literature to identify the hazards experienced by emergency responders who have attended previous terrorist incidents. A PubMed literature search identified 10,894 articles on the subject of 'terrorism', and there was a dramatic increase in publications after the 9/11 attacks in 2001. There is heterogeneity in the focus and quality of this literature, and 307 articles addressing the subject of scene safety were assessed for information regarding the threats encountered at terrorist incidents. These articles demonstrate that emergency responders have been exposed to both direct terrorist threats and environmental scene hazards, including airborne particles, structural collapse, fire, and psychological stress. The emphasis of training and preparedness for terrorist incidents has been primarily on the direct threats, but the published literature suggests that the dominant causes of mortality and morbidity in responders after such incidents are the indirect environmental hazards. If the medical response to terrorist incidents is to be based on evidence rather than anecdote, analysis of the current literature should be incorporated into major incident training, and consistent collection of key data from future incidents is required.
Full Text Available Abstract Background Although disasters and major incidents are difficult to predict, the results can be mitigated through planning, training and coordinated management of available resources. Following a fire in a disco in Gothenburg, causing 63 deaths and over 200 casualties, a medical disaster response centre was created. The center was given the task to coordinate risk assessments, disaster planning and training of staff within the region and on an executive level, to be the point of contact (POC with authority to act as "gold control," i.e. to take immediate strategic command over all medical resources within the region if needed. The aim of this study was to find out if the centre had achieved its tasks by analyzing its activities. Methods All details concerning alerts of the regional POC was entered a web-based log by the duty officer. The data registered in this database was analyzed during a 3-year period. Results There was an increase in number of alerts between 2006 and 2008, which resulted in 6293 activities including risk assessments and 4473 contacts with major institutions or key persons to coordinate or initiate actions. Eighty five percent of the missions were completed within 24 h. Twenty eight exercises were performed of which 4 lasted more than 24 h. The centre also offered 145 courses in disaster and emergency medicine and crisis communication. Conclusion The data presented in this study indicates that the center had achieved its primary tasks. Such regional organization with executive, planning, teaching and training responsibilities offers possibilities for planning, teaching and training disaster medicine by giving immediate feed-back based on real incidents.
Jones, D Neil; Benveniste, Klee A; Schultz, Timothy J; Mandel, Catherine J; Runciman, William B
Radiology incident reporting systems provide one source of invaluable patient safety data that, when combined with appropriate analysis and action, can result in significantly safer health care, which is now an urgent priority for governments worldwide. Such systems require integration into a wider safety, quality, and risk management framework because many issues have global implications, and they also require an international classification scheme, which is now being developed. These systems can be used to inform global research activities as identified by the World Health Organization, many of which intersect with the activities of and issues seen in medical imaging departments. How to ensure that radiologists (and doctors in general) report incidents, and are engaged in the process, is a challenge. However, as demonstrated with the example of the Australian Radiology Events Register, this can be achieved when the reporting system is integrated with their professional organization and its other related activities (such as training and education) and administered by a patient safety organization. Copyright 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Coleman, C. Norman; Sullivan, Julie M.; Bader, Judith L.; Murrain-Hill, Paula; Koerner, John F.; Garrett, Andrew L.; Weinstock, David M.; Case, Cullen; Hrdina, Chad; Adams, Steven A.; Whitcomb, Robert C.; Graeden, Ellie; Shankman, Robert; Lant, Timothy; Maidment, Bert W.; Hatchett, Richard C.
Resilience and the ability to mitigate the consequences of a nuclear incident are enhanced by (1) effective planning, preparation and training; (2) ongoing interaction, formal exercises, and evaluation among the sectors involved; (3) effective and timely response and communication; and (4) continuous improvements based on new science, technology, experience and ideas. Public health and medical planning require a complex, multi-faceted systematic approach involving federal, state, local, tribal and territorial governments, private sector organizations, academia, industry, international partners, and individual experts and volunteers. The approach developed by the U.S. Department of Health and Human Services Nuclear Incident Medical Enterprise (NIME) is the result of efforts from government and nongovernment experts. It is a “bottom-up” systematic approach built on the available and emerging science that considers physical infrastructure damage, the spectrum of injuries, a scarce resources setting, the need for decision making in the face of a rapidly evolving situation with limited information early on, timely communication and the need for tools and just-in-time information for responders who will likely be unfamiliar with radiation medicine and uncertain and overwhelmed in the face of the large number of casualties and the presence of radioactivity. The components of NIME can be used to support planning for, response to, and recovery from the effects of a nuclear incident. Recognizing that it is a continuous work-in-progress, the current status of the public health and medical preparedness and response for a nuclear incident is provided. PMID:25551496
Coleman, C Norman; Sullivan, Julie M; Bader, Judith L; Murrain-Hill, Paula; Koerner, John F; Garrett, Andrew L; Weinstock, David M; Case, Cullen; Hrdina, Chad; Adams, Steven A; Whitcomb, Robert C; Graeden, Ellie; Shankman, Robert; Lant, Timothy; Maidment, Bert W; Hatchett, Richard C
Resilience and the ability to mitigate the consequences of a nuclear incident are enhanced by (1) effective planning, preparation and training; (2) ongoing interaction, formal exercises, and evaluation among the sectors involved; (3) effective and timely response and communication; and (4) continuous improvements based on new science, technology, experience, and ideas. Public health and medical planning require a complex, multi-faceted systematic approach involving federal, state, local, tribal, and territorial governments; private sector organizations; academia; industry; international partners; and individual experts and volunteers. The approach developed by the U.S. Department of Health and Human Services Nuclear Incident Medical Enterprise (NIME) is the result of efforts from government and nongovernment experts. It is a "bottom-up" systematic approach built on the available and emerging science that considers physical infrastructure damage, the spectrum of injuries, a scarce resources setting, the need for decision making in the face of a rapidly evolving situation with limited information early on, timely communication, and the need for tools and just-in-time information for responders who will likely be unfamiliar with radiation medicine and uncertain and overwhelmed in the face of the large number of casualties and the presence of radioactivity. The components of NIME can be used to support planning for, response to, and recovery from the effects of a nuclear incident. Recognizing that it is a continuous work-in-progress, the current status of the public health and medical preparedness and response for a nuclear incident is provided.
Nnaemeka G. Okafor
Full Text Available Introduction: Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods: A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results: The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion: Error reporting frequency can be dramatically improved by using a web-based, userfriendly, voluntary, and non-punitive reporting system.
nonmilitary vehicle incidents. While this category also includes accidents involving bicycles and railways, the majority of land transport-related injuries...injury cause coding are needed to provide robust data for the establishment of data-driven injury prevention priorities, tracking of effects of
.... Class VIII medical materiel inventories are maintained as part of the U.S. war reserve stocks to ensure military readiness and to provide needed health care during wartime or contingencies. The U.S...
Halbig, J.K.; Klosterbuer, S.F.; Martinez, V.A. Jr.
The Pion Generation for Medical Irradiations (PIGMI) program at the Los Alamos Scientific Laboratory is developing the technology to build smaller, less expensive, and more reliable proton linear accelerators for medical applications, and has designed a powerful, simple, inexpensive, and reliable control and data acquisition system that is central to the program development. The system is a NOVA-3D minicomputer interfaced to several outlying microprocessor-based controllers, which accomplish control and data acquisition through data I/O chasis. The equipment interface chassis, which can issue binary commands, read binary data, issue analog commands, and read timed and untimed analog data is described.
Full Text Available Nowadays, wireless communication systems are exploited in most health care systems. Implantable Medical Systems (IMS also have wireless communication capability. However, it is very important that secure wireless communication should be provided in terms of both patient rights and patient health. Therefore, wireless transmission systems of IMS should also be robust against to eavesdroppers and adversaries. In this study, a specific overlapped and coded frequency shift keying (FSK modulation technique is developed and security containing with low complexity is provided by this proposed technique. The developed method is suitable for wireless implantable medical systems since it provides low complexity and security as well as bandwidth efficiency.
K.C. Cheung (Ka Chun); P.M.L.A. van den Bemt (Patricia); M.L. Bouvy (Marcel); M.E. Wensing (Michel); P.A. de Smet (Peter)
textabstractObjective Many Dutch hospitals have established internal systems for reporting incidents. However, such internal systems do not allow learning from incidents that occur in other hospitals. Therefore a multicenter, information technology (IT) supported reporting system named central
Full Text Available Effective workplace-based interventions after critical incidents (CIs are needed for emergency medical technicians (EMT/paramedics. The evidence for a period out of service post-CI (downtime is sparse; however it may prevent posttraumatic stress disorder (PTSD and burnout symptoms. We examined the hypothesis that downtime post-CI is associated with fewer symptoms of four long-term emotional sequelae in EMT/paramedics: depression, PTSD, burnout, and stress-related emotional symptoms (accepted cut-offs defined high scores. Two hundred and one paramedics completed questionnaires concerning an index CI including downtime experience, acute distress, and current emotional symptoms. Nearly 75% received downtime; 59% found it helpful; 84% spent it with peers. Downtime was associated only with lower depression symptoms, not with other outcomes. The optimal period for downtime was between 1 day being less effective. Planned testing of mediation of the association between downtime and depression by either calming acute post-CI distress or feeling helped by others was not performed because post-CI distress was not associated with downtime and perceived helpfulness was not associated with depression. These results suggest that outcomes of CIs follow different pathways and may require different interventions. A brief downtime is a relatively simple and effective strategy in preventing later depression symptoms.
Industrial Hygienist Industrial Hygienist Infectious Disease Specialist Infection Control Epidemiology Chief of Staff Chief of...0 Receive briefing from Casualty Care Unit Leader 0 Establish Minor Care in Cafeteria -Obtain Minor Casualty Care Cache 0 Organize and lead medical
Rice, William A
... submitted from each Army medical treatment facility (MTF). Using hierarchical multiple linear regression, these variables were tested as potential predictors of the average total cost per case of an injured civilian employee in each MTF...
A six-year (2002 – 2007) retrospective study of hospital records (in-patients) was carried out to investigate the incidence of Diabetes Mellitus in Katsina. The records showed that a total of 754 cases were attended within the study period. The study showed yearly increase in the incidence of the disease with the highest ...
Wong, Leah Y; Lange, Douglas S; Sebastyn, Jerome T; Roof, William H
.... The Command World scenario was expressly designed as a crisis action planning exercise in order to replicate the communications, collaboration, and information requirements inherent in a military...
Valdez, Michelle M; Liwanag, Maureen; Mount, Charles; Rodriguez, Rechell; Avalos-Reyes, Elisea; Smith, Andrew; Collette, David; Starsiak, Michael; Green, Richard
Inefficiencies in the command approval process for publications and/or presentations negatively impact DoD Graduate Medical Education (GME) residency programs' ability to meet ACGME scholarly activity requirements. A preliminary review of the authored works approval process at Naval Medical Center San Diego (NMCSD) disclosed significant inefficiency, variation in process, and a low level of customer satisfaction. In order to facilitate and encourage scholarly activity at NMCSD, and meet ACGME requirements, the Executive Steering Council (ESC) chartered an interprofessional team to lead a Lean Six Sigma (LSS) Rapid Improvement Event (RIE) project. Two major outcome metrics were identified: (1) the number of authored works submissions containing all required signatures and (2) customer satisfaction with the authored works process. Primary metric baseline data were gathered utilizing a Clinical Investigations database tracking publications and presentations. Secondary metric baseline data were collected via a customer satisfaction survey to GME faculty and residents. The project team analyzed pre-survey data and utilized LSS tools and methodology including a "gemba" (environment) walk, cause and effect diagram, critical to quality tree, voice of the customer, "muda" (waste) chart, and a pre- and post-event value stream map. The team selected an electronic submission system as the intervention most likely to positively impact the RIE project outcome measures. The number of authored works compliant with all required signatures improved from 52% to 100%. Customer satisfaction rated as "completely or mostly satisfied" improved from 24% to 97%. For both outcomes, signature compliance and customer satisfaction, statistical significance was achieved with a p customer satisfaction with the authored works approval process, leading to 100% signature compliance, a comprehensive longitudinal repository of all authored work requests, and a 97% "completely or mostly satisfied
Schwartz, Oren; Kanevsky, Boris; Kutikov, M A J Sergey; Olsen, Cara H; Dudkiewicz, Israel
Attrition from training is associated with substantial financial and personnel loss. There is a plethora of medical literature and research of attrition rates related to initial/phase 1 training (basic combat training); however, the analysis of second phase training (commanders training, consisting of schools that qualify junior commanders and officers for infantry and non-infantry combat units) is limited. The purpose of this study is to perform a comprehensive survey regarding to medical attrition from commanders training in the IDF (Israeli Defense Forces) in order to present the commanders of the IDF a detailed situation report that will serve as an evidence-based platform for future policy planning and implementation. A cross-sectional study including all soldiers (23,841) who participated in commanders training in the IDF in the period of 2012-2015 was performed. Soldiers for whom the attrition reason (medical or not medical) was missing were excluded from this study. Data were collected from the adjutancy-computerized system as well as the IDF's computerized medical consultation records package (CPR). Descriptive statistics were performed using mean, standard deviation, and median in order to express results. For the determination of statistical significance, chi-square test, Student's t-test, and Poisson regression models were used. Out of 23,841 soldiers that participated in this study, 75% (17,802) were males and 25% (6,039) were females. The overall attrition rate was 0.7% (164). The attrition rate for males was 0.86% (148 out of 17,082 males) and 0.26% (16 out of 6,039 females) for females. After adjusting for training unit, age, and BMI, the risk for attrition was 1.6 (160%) times higher for males as compared with females, and this result was statistically significant (IRR = 1.6, p = 0.01, CI 1.1, 2.2). The re-injury rate was 41% (68 out of 164 soldiers). The three most frequent diagnoses for attrition were orthopedics (66%), general surgery diagnoses
Biomechanical and Psychosocial stresses are capable of destabilizing any health care professional. The current health sector reform in Nigeria, which lays emphasis on service delivery on a background of very few radiographers, may lead to an increase in stress level. This study investigated the incidence of occupational ...
Russ, Alissa L; Militello, Laura G; Glassman, Peter A; Arthur, Karen J; Zillich, Alan J; Weiner, Michael
Cognitive task analysis (CTA) can yield valuable insights into healthcare professionals' cognition and inform system design to promote safe, quality care. Our objective was to adapt CTA-the critical decision method, specifically-to investigate patient safety incidents, overcome barriers to implementing this method, and facilitate more widespread use of cognitive task analysis in healthcare. We adapted CTA to facilitate recruitment of healthcare professionals and developed a data collection tool to capture incidents as they occurred. We also leveraged the electronic health record (EHR) to expand data capture and used EHR-stimulated recall to aid reconstruction of safety incidents. We investigated 3 categories of medication-related incidents: adverse drug reactions, drug-drug interactions, and drug-disease interactions. Healthcare professionals submitted incidents, and a subset of incidents was selected for CTA. We analyzed several outcomes to characterize incident capture and completed CTA interviews. We captured 101 incidents. Eighty incidents (79%) met eligibility criteria. We completed 60 CTA interviews, 20 for each incident category. Capturing incidents before interviews allowed us to shorten the interview duration and reduced reliance on healthcare professionals' recall. Incorporating the EHR into CTA enriched data collection. The adapted CTA technique was successful in capturing specific categories of safety incidents. Our approach may be especially useful for investigating safety incidents that healthcare professionals "fix and forget." Our innovations to CTA are expected to expand the application of this method in healthcare and inform a wide range of studies on clinical decision making and patient safety.
Huckels-Baumgart, Saskia; Manser, Tanja
Research into the distribution of medication errors usually focuses on isolated stages within the medication use process. Our study aimed to provide a novel process-oriented approach to medication incident analysis focusing on medication error chains. Our study was conducted across a 900-bed teaching hospital in Switzerland. All reported 1,591 medication errors 2009-2012 were categorized using the Medication Error Index NCC MERP and the WHO Classification for Patient Safety Methodology. In order to identify medication error chains, each reported medication incident was allocated to the relevant stage of the hospital medication use process. Only 25.8% of the reported medication errors were detected before they propagated through the medication use process. The majority of medication errors (74.2%) formed an error chain encompassing two or more stages. The most frequent error chain comprised preparation up to and including medication administration (45.2%). "Non-consideration of documentation/prescribing" during the drug preparation was the most frequent contributor for "wrong dose" during the administration of medication. Medication error chains provide important insights for detecting and stopping medication errors before they reach the patient. Existing and new safety barriers need to be extended to interrupt error chains and to improve patient safety. © 2014, The American College of Clinical Pharmacology.
Advanced Life Support Group
Major Incident Medical Management and Support (MIMMS) is the coursebook for the Advanced Life Support Group's internationally taught training for health care professionals responding to major incidents. The practical approach employed in MIMMS has proved an invaluable aid to both civilian and military doctors, nurses and paramedics working in disaster management worldwide.
van der Togt, Remko; van Lieshout, Erik Jan; Hensbroek, Reinout; Beinat, E; Binnekade, J M; Bakker, P J M
Health care applications of autoidentification technologies, such as radio frequency identification (RFID), have been proposed to improve patient safety and also the tracking and tracing of medical equipment. However, electromagnetic interference (EMI) by RFID on medical devices has never been reported. To assess and classify incidents of EMI by RFID on critical care equipment. Without a patient being connected, EMI by 2 RFID systems (active 125 kHz and passive 868 MHz) was assessed under controlled conditions during May 2006, in the proximity of 41 medical devices (in 17 categories, 22 different manufacturers) at the Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. Assessment took place according to an international test protocol. Incidents of EMI were classified according to a critical care adverse events scale as hazardous, significant, or light. In 123 EMI tests (3 per medical device), RFID induced 34 EMI incidents: 22 were classified as hazardous, 2 as significant, and 10 as light. The passive 868-MHz RFID signal induced a higher number of incidents (26 incidents in 41 EMI tests; 63%) compared with the active 125-kHz RFID signal (8 incidents in 41 EMI tests; 20%); difference 44% (95% confidence interval, 27%-53%; P RFID signal induced EMI in 26 medical devices, including 8 that were also affected by the active 125-kHz RFID signal (26 in 41 devices; 63%). The median distance between the RFID reader and the medical device in all EMI incidents was 30 cm (range, 0.1-600 cm). In a controlled nonclinical setting, RFID induced potentially hazardous incidents in medical devices. Implementation of RFID in the critical care environment should require on-site EMI tests and updates of international standards.
... Analysis of the Toronto SARS Outbreak, Vertical Integration, Vertical Integration in a Military Command Hierarchy, Information flows for a domestic incident, C2 for Homeland Security will benefit...
Ghaleb, Maisoon Abdullah; Barber, Nick; Franklin, Bryony Dean; Wong, Ian Chi Kei
To determine the incidence and nature of prescribing and medication administration errors in paediatric inpatients. Prospective review of drug charts to identify prescribing errors and prospective observation of nurses preparing and administering drugs to identify medication administration errors. In addition, incident reports were collected for each ward studied. Paediatric patients admitted to hospitals and nurses administering medications to these patients. 11 wards (prescribing errors) and 10 wards (medication administration errors) across five hospitals (one specialist children's teaching hospital, one nonteaching hospital and three teaching hospitals) in the London area (UK). Number, types and incidence of prescribing and medication administration errors, using practitioner-based definitions. 391 prescribing errors were identified, giving an overall prescribing error rate of 13.2% of medication orders (95% CI 12.0 to 14.5). There was great variation in prescribing error rates between wards. Incomplete prescriptions were the most common type of prescribing error, and dosing errors the third most common. 429 medication administration errors were identified; giving an overall incidence of 19.1% (95% CI 17.5% to 20.7%) erroneous administrations. Errors in drug preparation were the most common, followed by incorrect rates of intravenous administration. Prescribing and medication administration errors are not uncommon in paediatrics, partly as a result of the extra challenges in prescribing and administering medication to this patient group. The causes and extent of these errors need to be explored locally and improvement strategies pursued.
Samaranayake, N R; Cheung, S T D; Chui, W C M; Cheung, B M Y
Healthcare technology is meant to reduce medication errors. The objective of this study was to assess unintended errors related to technologies in the medication use process. Medication incidents reported from 2006 to 2010 in a main tertiary care hospital were analysed by a pharmacist and technology-related errors were identified. Technology-related errors were further classified as socio-technical errors and device errors. This analysis was conducted using data from medication incident reports which may represent only a small proportion of medication errors that actually takes place in a hospital. Hence, interpretation of results must be tentative. 1538 medication incidents were reported. 17.1% of all incidents were technology-related, of which only 1.9% were device errors, whereas most were socio-technical errors (98.1%). Of these, 61.2% were linked to computerised prescription order entry, 23.2% to bar-coded patient identification labels, 7.2% to infusion pumps, 6.8% to computer-aided dispensing label generation and 1.5% to other technologies. The immediate causes for technology-related errors included, poor interface between user and computer (68.1%), improper procedures or rule violations (22.1%), poor interface between user and infusion pump (4.9%), technical defects (1.9%) and others (3.0%). In 11.4% of the technology-related incidents, the error was detected after the drug had been administered. A considerable proportion of all incidents were technology-related. Most errors were due to socio-technical issues. Unintended and unanticipated errors may happen when using technologies. Therefore, when using technologies, system improvement, awareness, training and monitoring are needed to minimise medication errors. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Cerqueira, Charlotte; Knudsen, Nils; Ovesen, Lars
iodine fortification program on incidence of hyperthyroidism as measured by the incident use of antithyroid medication. Design: We conducted a register study. Using the unique identification number of all Danes, we linked data from the Register of Medicinal Product Statistics and the Civil Registration......: In the region with moderate iodine deficiency, the number of incident users of antithyroid medication increased 46% in the first 4 yr of iodine fortification. The use increased the most among the youngest age group (younger than 40 yr) and the oldest age group (older than 75 yr). In the mildly iodine......-deficient region, the number of incident users increased only 18%, and only in the youngest age groups (below 40 and 40-59 yr). After 4 yr of fortification, the incidence rates started to fall and reached baseline, for most groups, 6 yr after onset of fortification. Conclusions: This study shows that iodine...
St Peter, Wendy L.; Sozio, Stephen M.; Shafi, Tariq; Ephraim, Patti L.; Luly, Jason; McDermott, Aidan; Bandeen-Roche, Karen; Meyer, Klemens B.; Crews, Deidra C.; Scialla, Julia J.; Miskulin, Dana C.; Tangri, Navdeep; Jaar, Bernard G.; Michels, Wieneke M.; Wu, Albert W.; Boulware, L. Ebony
Several observational studies have evaluated the effect of a single exposure window with blood pressure (BP) medications on outcomes in incident dialysis patients, but whether BP medication prescription patterns remain stable or a single exposure window design is adequate to evaluate effect on
Gnädinger, Markus; Conen, Dieter; Herzig, Lilli; Puhan, Milo A; Staehelin, Alfred; Zoller, Marco; Ceschi, Alessandro
To describe the type, frequency, seasonal and regional distribution of medication incidents in primary care in Switzerland and to elucidate possible risk factors for medication incidents. Prospective surveillance study. Swiss primary healthcare, Swiss Sentinel Surveillance Network. Patients with drug treatment who experienced any erroneous event related to the medication process and interfering with normal treatment course, as judged by their physician. The 180 physicians in the study were general practitioners or paediatricians participating in the Swiss Federal Sentinel reporting system in 2015. Primary: medication incidents; secondary: potential risk factors like age, gender, polymedication, morbidity, care-dependency, previous hospitalisation. The mean rates of detected medication incidents were 2.07 per general practitioner per year (46.5 per 1 00 000 contacts) and 0.15 per paediatrician per year (2.8 per 1 00 000 contacts), respectively. The following factors were associated with medication incidents (OR, 95% CI): higher age 1.004 per year (1.001; 1.006), care by community nurse 1.458 (1.025; 2.073) and care by an institution 1.802 (1.399; 2.323), chronic conditions 1.052 (1.029; 1.075) per condition, medications 1.052 (1.030; 1.074) per medication, as well as Thurgau Morbidity Index for stage 4: 1.292 (1.004; 1.662), stage 5: 1.420 (1.078; 1.868) and stage 6: 1.680 (1.178; 2.396), respectively. Most cases were linked to an incorrect dosage for a given patient, while prescription of an erroneous medication was the second most common error. Medication incidents are common in adult primary care, whereas they rarely occur in paediatrics. Older and multimorbid patients are at a particularly high risk for medication incidents. Reasons for medication incidents are diverse but often seem to be linked to communication problems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No
Liu, Ruiqi; Chao, Aijun; Wang, Ke; Wu, Jing
We analyzed the incidence of medical complications after osteoporotic fractures and estimated its risk factors and cost impacts. Osteoporotic fractures can result in lots of serious medical complications, which is associated with patients' baseline characteristics such as patients' disease history and significantly increased patients' direct medical costs. The purpose of the study is to investigate the incidence and identify the risk factors of medical complications after osteoporotic fracture, and quantify patients' economic burden. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2009-2014). Patients aged ≥ 50 years, had ≥ 1 diagnoses of hip or vertebral fracture between 2010 and 2012, and continuously enrolled from 12 months before to 24 months after the first identified fracture were included. The incidence of medical complications was estimated within 12 months before and after fracture. Direct medical costs were measured and compared between patients with at least one medical complication and without any medical complications. Logistic regression was applied to identify risk factors for any medical complications. Three thousand seven hundred nineteen patients were identified; 45.0% had hip fracture, and 56.2% had vertebral fracture. After osteoporotic fracture, the accumulative incidence of the most common medical complications including constipation (25.6%, RR 1.38 [1.28, 1.48]), stroke (25.2%, 1.16 [1.09, 1.24]), pneumonia (17.0%, 1.55 [1.40, 1.73]), urinary tract infection (16.3%, 1.23 [1.12, 1.36]), and arrhythmia (11.8%, 1.39 [1.23, 1.56]) was significantly higher than that before fracture. Advanced age; male sex; retirement status; diagnosis of hypertension, chronic heart disease, cerebrovascular disease, hemiplegia, or Parkinson's disease; and higher direct medical costs at baseline were significant predictors of complications. The all-cause direct medical cost during 24-month follow-up was $5665. Medical
Härkänen, Marja; Saano, Susanna; Vehviläinen-Julkunen, Katri
To describe ways of preventing medication administration errors based on reporters' views expressed in medication administration incident reports. Medication administration errors are very common, and nurses play important roles in committing and in preventing such errors. Thus far, incident reporters' perceptions of how to prevent medication administration errors have rarely been analysed. This is a qualitative, descriptive study using an inductive content analysis of the incident reports related to medication administration errors (n = 1012). These free-text descriptions include reporters' views on preventing the reoccurrence of medication administration errors. The data were collected from two hospitals in Finland and pertain to incidents that were reported between 1 January 2013 and 31 December 2014. Reporters' views on preventing medication administration errors were divided into three main categories related to individuals (health professionals), teams and organisations. The following categories related to individuals in preventing medication administration errors were identified: (1) accuracy and preciseness; (2) verification; and (3) following the guidelines, responsibility and attitude towards work. The team categories were as follows: (1) distribution of work; (2) flow of information and cooperation; and (3) documenting and marking the drug information. The categories related to organisation were as follows: (1) work environment; (2) resources; (3) training; (4) guidelines; and (5) development of the work. Health professionals should administer medication with a high moral awareness and an attempt to concentrate on the task. Nonetheless, the system should support health professionals by providing a reasonable work environment and encouraging collaboration among the providers to facilitate the safe administration of medication. Although there are numerous approaches to supporting medication safety, approaches that support the ability of individual health
Maupomé, Gerardo; Peters, Dawn; Rush, William A; Rindal, D Brad; White, B Alex
This retrospective, longitudinal cohort study quantified the strength of the association between xerogenic cardiovascular medication use and dental restorations, using the latter as a proxy measure for dental caries experience. Study data were collected from 11 years of electronic clinical/pharmacy records in two large dental group practices associated with managed care organizations (MCO). Records were extracted for all members who were at least 55 years old at the end of the 11 year window, and had at least 48 months of concurrent dental, medical, and pharmacy coverage. The authors identified 4448 individuals whose only xerogenic medication exposure was to drugs treating a cardiovascular condition. This group was compared to a group not taking any medications (n=1183), and a group taking medications with no known xerostomic side effect (n=5622). Poisson regression compared restoration incidence and mean restoration rates among the three groups. MCO members taking cardiovascular or nonxerogenic medications had higher restoration incidence and mean restoration rates than individuals taking no medications. A small difference in mean restoration rate between the non-xerogenic medication group and the cardiovascular drug group was observed; no significant difference in restoration incidence was seen between these two groups. This study provides objective quantification of cardiovascular medication's long-term effects on increased restorations in older adults. When grouped under a single category labeled "cardiovascular", drugs with effects targeting the cardiovascular system did not appear to unequivocally lead to higher restorative experiences.
Hesselgreaves, Hannah; Watson, Anne; Crawford, Andy; Lough, Murray; Bowie, Paul
Medication-related safety incidents are a source of concern to patients, policy makers and clinicians. The role of education in improving safety-critical practices in health care is poorly appreciated. This pilot study aimed to initiate collective discussion among professional groups of clinical staff about a range of medicine-related patient safety issues which were identified from a local incident reporting system. In engaging staff to collectively reflect on reported medication incidents we attempted to uncover a deeper understanding of local contextual issues and potential educational needs. A mixed method study was conducted involving categorical analysis of 1058 medication incident reports (Phase 1) and the use of three mixed focus groups of clinical staff (Phase 2) in three acute hospitals in one locality in NHS Scotland. Focus group transcript analysis produced four main themes (e.g. the medical role) and 12 related sub-themes (e.g. pharmacological education and skill mix for administration of medicines) concerning medication-related practices and possible educational interventions. While it is necessary to review reported incident data and disseminate the educational messages for the improvement of quality, this traditional risk management process is inadequate on its own. Reporting systems can be enhanced by collective examination of reported information about medicines by local clinical teams. We identified a strong message from the focus groups for learning about each other and from each other, and that the method piloted may be an important inter-professional mechanism for improvement. © 2011 Blackwell Publishing Ltd.
Lee, Deog-Yong; Lee, Esther; Park, Hyemin; Kim, Seonghan
In this study, the factors that induced a decrease in the incidence of typhoid fever were analyzed. Based on the study results, we propose a quantitative and concrete solution to reduce the incidence of typhoid fever. We analyzed the incidence and fatality rate of typhoid fever in Korea. Tap water service rate and the number of pharmacies, which affect the incidence rate of typhoid fever, were used as environmental factors. To prevent typhoid fever in the community, it is necessary to provide clean tap water service to 35.5% of the population, with an individual requiring 173 L of clean water daily. Appropriate access to clean water (51% service coverage, 307 L) helped the population to maintain individual hygiene and food safety practices, which brought about a decrease in the incidence of typhoid fever, and subsequently a decrease in fatality rate, which was achieved twice. During the 8-year study period, the fatality rate decreased to 1% when the population has access to proper medical service. The fatality rate was primarily affected by the availability of medical services as well as by the incidence of typhoid fever. However, an analysis of the study results showed that the incidence of typhoid fever was affected only by the availability of clean water through the tap water system.
Full Text Available INTRODUCTION: Automated dose dispensing (ADD is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. METHODS: The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR reporting system were selected and characterized independently by two researchers. MAIN OUTCOME MEASURES: Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. RESULTS: From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4% incidents from community pharmacies and 11,428 (75.6% incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8% were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2% were related to ADD than in hospitals (41/11,428 = 0.4%. The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. CONCLUSION: A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an
Hinkelbein, Jochen; Neuhaus, Christopher; Böhm, Lennert; Kalina, Steffen; Braunecker, Stefan
Background Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society. Materials and methods Using unipark.de (QuestBack GmbH, Cologne, Germany), an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM) were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015). Chi-square test was used for statistical analysis (pemergency. Demographic parameters in this survey were in concordance with the society members’ demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median). Cardiovascular (40.0%) and neurological disorders (17.8%) were the most frequent diagnoses. The medical equipment (78.7%) provided was sufficient. An emergency diversion was undertaken in 10.6% of the cases. Although using a different method of data acquisition, this survey confirms previous data on the nature of emergencies and gives plausible numbers. Conclusion Our data strongly argue for the establishment of a standardized database for recording the incidence and nature of in-flight medical emergencies. Such a database could inform on required medical equipment and cabin crew training. PMID:28260956
Hannaford, N; Mandel, C; Crock, C; Buckley, K; Magrabi, F; Ong, M; Allen, S; Schultz, T
To determine the type and nature of incidents occurring within medical imaging settings in Australia and identify strategies that could be engaged to reduce the risk of their re-occurrence. 71 search terms, related to clinical handover and communication, were applied to 3976 incidents in the Radiology Events Register. Detailed classification and thematic analysis of a subset of incidents that involved handover or communication (n=298) were undertaken to identify the most prevalent types of error and to make recommendations about patient safety initiatives in medical imaging. Incidents occurred most frequently during patient preparation (34%), when requesting imaging (27%) and when communicating a diagnosis (23%). Frequent problems within each of these stages of the imaging cycle included: inadequate handover of patients (41%) or unsafe or inappropriate transfer of the patient to or from medical imaging (35%); incorrect information on the request form (52%); and delayed communication of a diagnosis (36%) or communication of a wrong diagnosis (36%). The handover of patients and clinical information to and from medical imaging is fraught with error, often compromising patient safety and resulting in communication of delayed or wrong diagnoses, unnecessary radiation exposure and a waste of limited resources. Corrective strategies to address safety concerns related to new information technologies, patient transfer and inadequate test result notification policies are relevant to all healthcare settings. Handover and communication errors are prevalent in medical imaging. System-wide changes that facilitate effective communication are required.
Mandel, C; Crock, C; Buckley, K; Magrabi, F; Ong, M; Allen, S; Schultz, T
Objective: To determine the type and nature of incidents occurring within medical imaging settings in Australia and identify strategies that could be engaged to reduce the risk of their re-occurrence. Methods: 71 search terms, related to clinical handover and communication, were applied to 3976 incidents in the Radiology Events Register. Detailed classification and thematic analysis of a subset of incidents that involved handover or communication (n=298) were undertaken to identify the most prevalent types of error and to make recommendations about patient safety initiatives in medical imaging. Results: Incidents occurred most frequently during patient preparation (34%), when requesting imaging (27%) and when communicating a diagnosis (23%). Frequent problems within each of these stages of the imaging cycle included: inadequate handover of patients (41%) or unsafe or inappropriate transfer of the patient to or from medical imaging (35%); incorrect information on the request form (52%); and delayed communication of a diagnosis (36%) or communication of a wrong diagnosis (36%). Conclusion: The handover of patients and clinical information to and from medical imaging is fraught with error, often compromising patient safety and resulting in communication of delayed or wrong diagnoses, unnecessary radiation exposure and a waste of limited resources. Corrective strategies to address safety concerns related to new information technologies, patient transfer and inadequate test result notification policies are relevant to all healthcare settings. Advances in knowledge: Handover and communication errors are prevalent in medical imaging. System-wide changes that facilitate effective communication are required. PMID:23385994
Dedefo, Mohammed Gebre; Mitike, Abraham Haileamlak; Angamo, Mulugeta Tarekegn
Background Medication errors cause a large number of adverse drug events with negative patient health outcomes and are a major public-health burden contributing to 18.7?56?% of all adverse drug events among hospitalized patients. The aim of this study was to assess the incidence and determinants of medication errors and adverse drug events among hospitalized children. Methods A prospective observational study was conducted among hospitalized children in the pediatrics ward of Nekemte Referral...
Younker, D.R.; Daniels, V.R.; Boyd, J.L.; Putcha, L.
An objective of this data compilation and analysis project is to examine incidence and treatment efficacy of common patho-physiological disturbances during spaceflight. Analysis of medical debriefs data indicated that astronauts used medications to alleviate symptoms of four major ailments for which astronauts received treatment for sleep disturbances, space motion sickness (SMS), pain (headache, back pain) and sinus congestion. In the present data compilation and analysis project on SMS treatment during space missions, subject demographics (gender, age, first-time or repeat flyer), incidence and severity of SMS symptoms and subjective treatment efficacy from 317 crewmember debrief records were examined from STS-1 through STS-89. Preliminary analysis of data revealed that 50% of crew members reported SMS symptoms on at least one flight and 22% never experienced it. In addition, there were 387 medication dosing episodes reported, and promethazine was the most commonly used medication. Results of analysis of symptom check lists, medication use/efficacy and gender and flight record differences in incidence and treatment efficacy will be presented. Evidence gaps for treatment efficacy along with medication use trend analysis will be identified.
Full Text Available Jochen Hinkelbein,1,2 Christopher Neuhaus,2,3 Lennert Böhm,1 Steffen Kalina,1 Stefan Braunecker1,2 1Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, 2Working group “Emergency Medicine and Air Rescue”, German Society for Aviation and Space Medicine (DGLRM, Munich, 3Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany Background: Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society.Materials and methods: Using unipark.de (QuestBack GmbH, Cologne, Germany, an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015. Chi-square test was used for statistical analysis (p<0.05 was considered significant.Results: Altogether, 121 members of the society responded to the survey (n=335 sent out. Of the 121 respondents, n=54 (44.6% of the participants (89.9% male and 10.1% female; mean age, 54.1 years; n=121 were involved in at least one in-flight medical emergency. Demographic parameters in this survey were in concordance with the society members’ demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median. Cardiovascular (40.0% and neurological disorders (17.8% were the most frequent diagnoses. The medical equipment (78.7% provided was sufficient. An emergency diversion was
Rivera-Luna, Roberto; Correa-González, Cecilia; Altamirano-Alvarez, Eduardo; Sánchez-Zubieta, Fernando; Cárdenas-Cardós, Rocio; Escamilla-Asian, Gabriela; Olaya-Vargas, Alberto; Bautista-Marquez, Aurora; Aguilar-Romo, Manuel
Prior to 2005, 51% of children in Mexico diagnosed with cancer received no standardized optimal multidisciplinary medical care. A government-subsidized national cancer treatment program was therefore created for these patients and a National Cooperative Childhood Cancer Treatment Group was consequently formed for these patients. Pediatric patients with a proven diagnosis of leukemia, lymphoma or solid tumor and who were registered in the Popular Medical Insurance (PMI) program from January 2007 to December 2010, are described in this report. These patients had been enrolled and registered in one of the 49 nationwide certified medical institutions in Mexico. The national incidence and frequency data for childhood cancers were analyzed for the whole program. At the end of a 4-year study, the analysis revealed that 8,936 children from across Mexico had been diagnosed with cancer. The incidence rate for the PMI patients was 150.3/million/year (2010) for children of 0-18 years. The highest age incidence rate was 51.9 between 0 and 4 years and boys were the predominant group for all types of cancer. The leukemia incidence was 75.3/million/year (2010), and an average frequency of 50.75% throughout the 4 years. The overall mortality rate was measured at 5.4/100,000/year (2010). This study demonstrates a high frequency and incidence of childhood cancer and a beneficial impact of the PMI program over the quality of life in these children. Copyright © 2012 UICC.
Snijders, C.; van der Schaaf, T.; Klip, H.; van Lingen, R.A.; Fetter, W.P.F.; Molendijk, H.A.
Aims and objectives: In this study, the feasibility and reliability of the Prevention Recovery Information System for Monitoring and Analysis (PRISMA)-Medical method for systematic, specialty-based analysis and classification of incidents in the neonatal intensive care unit (NICU) were determined.
Snijders, C.; van der Schaaf, T. W.; Klip, H.; van Lingen W P F Fetter, R. A.; Molendijk, A.; Kok, J. H.; te Pas, E.; Pas, H.; van der Starre, C.; Bloemendaal, E.; Cardozo, Lopes; Molenaar, A. M.; van Lingen, R. A.; Maat, H. E.; Lavrijssen, S.; Mulder, A. L. M.; de Kleine, M. J. K.; Koolen, A. M. P.; Schellekens, M.; Verlaan, W.; Vrancken, S.; Fetter, W. P. F.; Schotman, L.; van der Zwaan, A.; van der Tuijn, Y.; Tibboel, D.
AIMS AND OBJECTIVES: In this study, the feasibility and reliability of the Prevention Recovery Information System for Monitoring and Analysis (PRISMA)-Medical method for systematic, specialty-based analysis and classification of incidents in the neonatal intensive care unit (NICU) were determined.
Onatade, Raliat; Sawieres, Sara; Veck, Alexandra; Smith, Lindsay; Gore, Shivani; Al-Azeib, Sumiah
Background Errors in discharge prescriptions are problematic. When hospital pharmacists write discharge prescriptions improvements are seen in the quality and efficiency of discharge. There is limited information on the incidence of errors in pharmacists' medication orders. Objective To investigate the extent and clinical significance of errors in pharmacist-written discharge medication orders. Setting 1000-bed teaching hospital in London, UK. Method Pharmacists in this London hospital routinely write discharge medication orders as part of the clinical pharmacy service. Convenient days, based on researcher availability, between October 2013 and January 2014 were selected. Pre-registration pharmacists reviewed all discharge medication orders written by pharmacists on these days and identified discrepancies between the medication history, inpatient chart, patient records and discharge summary. A senior clinical pharmacist confirmed the presence of an error. Each error was assigned a potential clinical significance rating (based on the NCCMERP scale) by a physician and an independent senior clinical pharmacist, working separately. Main outcome measure Incidence of errors in pharmacist-written discharge medication orders. Results 509 prescriptions, written by 51 pharmacists, containing 4258 discharge medication orders were assessed (8.4 orders per prescription). Ten prescriptions (2%), contained a total of ten erroneous orders (order error rate-0.2%). The pharmacist considered that one error had the potential to cause temporary harm (0.02% of all orders). The physician did not rate any of the errors with the potential to cause harm. Conclusion The incidence of errors in pharmacists' discharge medication orders was low. The quality, safety and policy implications of pharmacists routinely writing discharge medication orders should be further explored.
Ramanathan, Rajesh; Lee, Nathaniel; Duane, Therese M; Gu, Zirui; Nguyen, Natalie; Potter, Teresa; Rensing, Edna; Sampson, Renata; Burrows, Mandy; Banas, Colin; Hartigan, Sarah; Grover, Amelia
Venous thromboembolism events are potentially preventable adverse events. We investigated the effect of interruptions and delays in pharmacologic prophylaxis on venous thromboembolism incidence. Additionally, we evaluated the utility of electronic medical record alerts for venous thromboembolism prophylaxis. Venous thromboembolisms were identified in surgical patients retrospectively through Core Measure Venous ThromboEmbolism-6-6 and Patient Safety Indicator 12 between November 2013 and March 2015. Venous thromboembolism pharmacologic prophylaxis and prescriber response to electronic medical record alerts were recorded prospectively. Prophylaxis was categorized as continuous, delayed, interrupted, other, and none. Among 10,318 surgical admissions, there were 131 venous thromboembolisms; 23.7% of the venous thromboembolisms occurred with optimal continuous prophylaxis. Prophylaxis, length of stay, age, and transfer from another hospital were associated with increased venous thromboembolism incidence. Compared with continuous prophylaxis, interruptions were associated with 3 times greater odds of venous thromboembolism. Delays were associated with 2 times greater odds of venous thromboembolism. Electronic medical record alerts occurred in 45.7% of the encounters and were associated with a 2-fold increased venous thromboembolism incidence. Focus groups revealed procedures as the main contributor to interruptions, and workflow disruption as the main limitation of the electronic medical record alerts. Multidisciplinary strategies to decrease delays and interruptions in venous thromboembolism prophylaxis and optimization of electronic medical record tools for prophylaxis may help decrease rates of preventable venous thromboembolism. Copyright © 2016 Elsevier Inc. All rights reserved.
Gale, Robert Peter
The purpose of this review is to address the increasing medical and public concern regarding the health consequences of radiation exposure, a concern shaped not only by fear of another Chernobyl or Fukushima nuclear power facility accident but also by the intentional use of a nuclear weapon, a radiological dispersion device, a radiological exposure device, or an improved nuclear device by rogue states such as North Korea and terrorist organizations such as Al Qaeda and ISIS. The United States has the medical capacity to respond to a limited nuclear or radiation accident or incident but an effective medical response to a catastrophic nuclear event is impossible. Dealing effectively with nuclear and radiation accidents or incidents requires diverse strategies, including policy decisions, public education, and medical preparedness. I review medical consequences of exposures to ionizing radiations, likely concomitant injuries and potential medical intervention. These data should help haematologists and other healthcare professionals understand the principles of medical consequences of nuclear terrorism. However, the best strategy is prevention.
Davari, Fereshteh; Zahed, Arash
Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.
Full Text Available Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.
Pols, J; Boendermaker, PM; Muntinghe, H
Purpose Students often act as subjects during practical and clinical skills training sessions. This routine seems to be quite acceptable for them but may present side-effects. Disorders, sometimes of a serious nature, have been discovered in medical students during clinical skills training. Because
Dedefo, Mohammed Gebre; Mitike, Abraham Haileamlak; Angamo, Mulugeta Tarekegn
Medication errors cause a large number of adverse drug events with negative patient health outcomes and are a major public-health burden contributing to 18.7-56 % of all adverse drug events among hospitalized patients. The aim of this study was to assess the incidence and determinants of medication errors and adverse drug events among hospitalized children. A prospective observational study was conducted among hospitalized children in the pediatrics ward of Nekemte Referral Hospital from February 24 to March 28, 2014. Data were collected by using checklist guided observation and review of medication order sheets, medication administration records, and other medical charts of the patients. To identify the independent predictors of medication errors and adverse drug events, backward logistic regression analysis was used. Statistical significance was considered at p-value Nekemte Referral Hospital. In particular, children with multiple medications and longer hospital stays, and those with co-morbidities and longer hospital stays, were at greater risk for medication errors and adverse drug events, respectively.
Khorram-Manesh, A; Lönroth, H; Rotter, P; Wilhelmsson, M; Aremyr, J; Berner, A; Andersson, A Nero; Carlström, E
Disasters and major incidents demand a multidisciplinary management. Recent experiences from terrorist attacks worldwide have resulted in a search for better assessment of the needs, resources, and knowledge in the medical and non-medical management of these incidents and also actualized the need for collaboration between civilian and military healthcare. The aim of this study was to evaluate the impact of the civilian-military collaboration in a Swedish context with the main focus on its non-medical management. An exercise, simulating a foreign military attack centrally on Swedish soil, was designed, initiated, and conducted by a team consisting of civilian and military staff. Data were collected prospectively and evaluated by an expert team. Specific practical and technical issues were presented in collaboration between civilian and military staffs. In addition, shortcomings in decision-making, follow-up, communication, and collaboration due to prominent lack of training and exercising the tasks and positions in all managerial levels of the hospital were identified. Current social and political unrests and terror attacks worldwide necessitate civilian-military collaboration. Such collaboration, however, needs to be synchronized and adjusted to avoid preventable medical and non-medical consequences. Simulation exercises might be one important source to improve such collaboration.
Matisane, L.; Carpenter, L.; Venables, K.
Medical radiation workers belong to one of the oldest occupational groups exposed to external radiation. Since the various radiological protection recommendations have been introduced, now ths process has resulted in low-dose exposure, regular monitoring of exposure and establishment of national dose registration bodies. In order to provide additional information to studies on cancer incidence among medical radiation workers (specially female workers) and in order to assess all cancer incidence in female medical radiation workers in Latvia, a retrospective cohort study based on the National Dose Register was set up in Latvia. The study cohort consisted of all workers employed in health care, occupationally exposed to ionising radiation for more than one year in any of the public health care establishments in Latvia, except military ones, between 1 January 1972 and 1 January 2002 and who were registered in the National Dose Register of Latvia. The cohort consisted of 1416 female medical radiation workers either in hospitals or outpatient departments, or both. The cohort included diagnostic and therapeutic radiologists with predominantly medical qualification, it also included radiotechnologits, nurses, junior nurses, but it did not include academic, physicists and dentists. In all cases the calculated SIR was over than expected or close to expected. Several major differences in study design makes ir difficult to compare the results of this study with the results of the studies carried out in other countries
Full Text Available Abstract Background Medication incident reporting (MIR is a key safety critical care process in residential aged care facilities (RACFs. Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a design MIR artefacts that facilitate identification of the root causes of medication incidents, b integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.
Ho, An; Raja, Bronson; Waldhorn, Richard; Baez, Valentina; Mohammed, Idiris
ABSTRACT Background: Insomnia is common in hospitalized patients. However, no study has examined new onset of insomnia in patients without a prior history of insomnia. Objectives: Incidence of new onset of insomnia in inpatients, associated factors and resolution rate after 2 weeks. Method: This is a prospective observational study conducted at a community hospital. We used the Insomnia Severity Index questionnaire to screen for insomnia in all patients located in the general medical floors f...
Lennquist Montán, K; Hreckovski, B; Dobson, B; Örtenwall, P; Montán, C; Khorram-Manesh, A; Lennquist, S
The need for and benefit of simulation models for interactive training of the response to major incidents and disasters has been increasingly recognized during recent years. One of the advantages with such models is that all components of the chain of response can be trained simultaneously. This includes the important communication/coordination between different units, which has been reported as the most common cause of failure. Very few of the presently available simulation models have been suitable for the simultaneous training of decision-making on all levels of the response. In this study, a new simulation model, originally developed for the scientific evaluation of methodology, was adapted to and developed for the postgraduate courses in Medical Response to Major Incidents (MRMI) organized under the auspices of the European Society for Trauma and Emergency Surgery (ESTES). The aim of the present study was to describe this development process, the model it resulted in, and the evaluation of this model. The simulation model was based on casualty cards giving all information normally available for the triage and primary management of traumatized patients. The condition of the patients could be changed by the instructor according to the time passed since the time of injury and treatments performed. Priority of the casualties as well as given treatments could be indicated on the cards by movable markers, which also gave the time required for every treatment. The exercises were run with real consumption of time and resources for all measures performed. The magnetized cards were moved by the trainees through the scene, through the transport lines, and through the hospitals where all functions were trained. For every patient was given the definitive diagnosis and the times within certain treatments had to be done to avoid preventable mortality and complications, which could be related to trauma-scores. The methodology was tested in nine MRMI courses with a total of
Yousef, Nadin; Yousef, Farah
Whereas one of the predominant causes of medication errors is a drug administration error, a previous study related to our investigations and reviews estimated that the incidences of medication errors constituted 6.7 out of 100 administrated medication doses. Therefore, we aimed by using six sigma approach to propose a way that reduces these errors to become less than 1 out of 100 administrated medication doses by improving healthcare professional education and clearer handwritten prescriptions. The study was held in a General Government Hospital. First, we systematically studied the current medication use process. Second, we used six sigma approach by utilizing the five-step DMAIC process (Define, Measure, Analyze, Implement, Control) to find out the real reasons behind such errors. This was to figure out a useful solution to avoid medication error incidences in daily healthcare professional practice. Data sheet was used in Data tool and Pareto diagrams were used in Analyzing tool. In our investigation, we reached out the real cause behind administrated medication errors. As Pareto diagrams used in our study showed that the fault percentage in administrated phase was 24.8%, while the percentage of errors related to prescribing phase was 42.8%, 1.7 folds. This means that the mistakes in prescribing phase, especially because of the poor handwritten prescriptions whose percentage in this phase was 17.6%, are responsible for the consequent) mistakes in this treatment process later on. Therefore, we proposed in this study an effective low cost strategy based on the behavior of healthcare workers as Guideline Recommendations to be followed by the physicians. This method can be a prior caution to decrease errors in prescribing phase which may lead to decrease the administrated medication error incidences to less than 1%. This improvement way of behavior can be efficient to improve hand written prescriptions and decrease the consequent errors related to administrated
.... All command designees attend the PreCommand Course (PCC). PCC provides common understanding of current doctrine, and up-to-date information on Army-wide policy, programs and special items of interest...
Full Text Available Endoscopic lung volume reduction (ELVR with valves has been shown to improve COPD patients with severe emphysema. However, a major complication is pneumothoraces, occurring typically soon after valve implantation, with severe consequences if not managed promptly. Based on the knowledge that strain activity is related to a higher risk of pneumothoraces, we asked whether modifying post-operative medical care with the inclusion of strict short-term limitation of strain activity is associated with a lower incidence of pneumothorax.Seventy-two (72 emphysematous patients without collateral ventilation were treated with bronchial valves and included in the study. Thirty-two (32 patients received standard post-implantation medical management (Standard Medical Care (SMC, and 40 patients received a modified medical care that included an additional bed rest for 48 hours and cough suppression, as needed (Modified Medical Care (MMC.The baseline characteristics were similar for the two groups, except there were more males in the SMC cohort. Overall, ten pneumothoraces occurred up to four days after ELVR, eight pneumothoraces in the SMC, and only two in the MMC cohorts (p=0.02. Complicated pneumothoraces and pneumothoraces after upper lobe treatment were significantly lower in MMC (p=0.02. Major clinical outcomes showed no significant differences between the two cohorts.In conclusion, modifying post-operative medical care to include bed rest for 48 hours after ELVR and cough suppression, if needed, might reduce the incidence of pneumothoraces. Prospective randomized studies with larger numbers of well-matched patients are needed to confirm the data.
Da Silva, Carolyn P; Zuckerman, Bianca; Olkin, Rhoda
The purpose of this study was to determine if falls in polio survivors, with or without post-polio syndrome (PPS), are related to number of medications taken, use of anti-depressant or psychoactive medications, or self-report of depression. A survey was sent to 300 members of a regional polio support group, asking them to document their fall history, medications used, and the presence of depression. Depression was measured by self-report and with the Geriatric Depression Scale, short form (GDS-15). One hundred and seventy-two usable surveys were returned with 146 of those completing the medication list. Sixty-two percent reported at least one fall in the past year. The multiple logistic regression was significant (p = 0.023), and it indicated depression to be a significant predictor (p = 0.012) of falls in polio survivors with and without PPS. The number of total medications or anti-depressant or psychoactive medications used was not related to fall incidence. Routine screening and treatment for depression may be one aspect of fall prevention which can be implemented through primary care.
Taber, David J; Pilch, Nicole A; Bratton, Charles F; McGillicuddy, John W; Chavin, Kenneth D; Baliga, Prabhakar K
To determine the incidence, risk factors, and clinical outcomes associated with clinically significant medication errors or adverse drug events in kidney transplant recipients. Retrospective observational study. Transplant center at an academic medical center. A total of 476 adults who received kidney transplants between June 2006 and July 2009. Severe or significant medication errors and adverse drug events (medication-related problems [MRPs]) were identified by medical record review. Only patient-induced medication errors (e.g., took wrong dose or frequency of drug, took drug not prescribed) were captured. Clinical outcomes included patient and graft survival, infections (including cytomegalovirus), readmissions, and acute rejection episodes. Thirty-seven (8%) of the 476 patients developed a clinically significant MRP. Univariate and confirmatory multivariate analyses revealed that female sex, African-American race, pretransplantation diabetes mellitus, delayed graft function, and retransplant recipients were independent risk factors for developing an MRP. Patients with MRPs had significantly higher rates of acute rejection (11% vs 30%, p=0.004), cytomegalovirus infection (15% vs 30%, p=0.033), and 30-day readmissions (5% vs 16%, p=0.018). Graft survival was also significantly lower in patients who had MRPs (pmedication errors and associated adverse drug events were common in kidney transplant recipients. General and transplant-specific risk factors were associated with the development of these MRPs, and MRPs were associated with increased risk of rejection and graft loss. © 2012 Pharmacotherapy Publications, Inc.
Approximately one year prior, Fire Chief Gary Marrs and many key personnel from the city attended a course in incident management at the National...added to the vision of leadership unprepared and unable to handle the disaster. Despite all of the heroic and competent efforts across Louisiana and...fit the “normal” ICS conventions. One example of this was during the Oklahoma City bombing. In a 1996 presentation by Fire Chief Gary Marrs , he
Coleman, C. Norman; Koerner, John F.
The public health and medical response to a radiological or nuclear incident requires the capability to sort, assess, treat, triage and to ultimately discharge, refer or transport people to their next step in medical care. The size of the incident and scarcity of resources at the location of each medical decision point will determine how patients are triaged and treated. This will be a rapidly evolving situation impacting medical responders at regional, national and international levels. As capabilities, diagnostics and medical countermeasures improve, a dynamic system-based approach is needed to plan for and manage the incident, and to adapt effectively in real time. In that the concepts and terms can be unfamiliar and possibly confusing, resources and a concept of operations must be considered well in advance. An essential underlying tenet is that medical evaluation and care will be managed by health-care professionals with biodosimetry assays providing critical supporting data. (authors)
Gordon, Morris; Parakh, Dillan
Errors in healthcare are a major patient safety issue, with incident reporting a key solution. The incident reporting system has been integrated within a new medical curriculum, encouraging medical students to take part in this key safety process. The aim of this study was to describe the system and assess how students perceived the reporting system with regards to its role in enhancing safety. Employing a thematic analysis, this study used interviews with medical students at the end of the first year. Thematic indices were developed according to the information emerging from the data. Through open, axial and then selective stages of coding, an understanding of how the system was perceived was established. Analysis of the interview specified five core themes: (1) Aims of the incident reporting system; (2) internalized cognition of the system; (3) the impact of the reporting system; (4) threshold for reporting; (5) feedback on the systems operation. Selective analysis revealed three overriding findings: lack of error awareness and error wisdom as underpinned by key theoretical constructs, student support of the principle of safety, and perceptions of a blame culture. Students did not interpret reporting as a manner to support institutional learning and safety, rather many perceived it as a tool for a blame culture. The impact reporting had on students was unexpected and may give insight into how other undergraduates and early graduates interpret such a system. Future studies should aim to produce interventions that can support a reporting culture.
Tang, Karen L; Quan, Hude; Rabi, Doreen M
Though pharmacy claims data are commonly used to study medication adherence, there remains no standard operational definition for adherence especially for patients on multiple medications. Even when studies use the same terminology, the actual methods of calculating adherence can differ drastically. It is unclear whether the use of different definitions results in different conclusions regarding adherence and associated outcomes. The objective of our study was to compare adherence rates and associations with mortality using different operational definitions of adherence, and using various methods of handling concurrent medication use. We conducted a cohort study of patients aged ≥65 years from Manitoba, Canada, with incident hypertension diagnosed in 2004 and followed to 2009. We calculated adherence rates to anti-hypertensive medications using different operational definitions of medication adherence (including interval and prescription based medication possession ratios [MPR] and proportion of days covered [PDC]). For those on concurrent medications, we calculated adherence rates using the different methods of handling concurrent medication use, for each definition. We used logistic regression to determine the association between adherence and mortality for each operational definition. Among 2199 patients, 24.1% to 90.5% and 71.2% to 92.7% were considered adherent when using fixed interval and prescription-based interval medication possession ratios [MPRi and MPRp] respectively, depending on how concurrent medications were handled. Adherence was inversely associated with death, with the strongest association for MPRp measures. This association was significant only when considering adherence to any anti-hypertensive [aOR 0.70, 95% CI 0.51, 0.97], or when the mean of the class-specific MPRp's [adjusted OR 0.71, 95% CI 0.53, 0.95] was used. No significant association existed when the highest or lowest class-specific MPRp was used as the adherence estimate. The
Salcedo-Diego, Isabel; de Andrés-Gimeno, Begoña; Ruiz-Antorán, Belén; Layunta, Rocío; Serrano-Gallardo, Pilar
To design and perform a face and content validation of a questionnaire to measure the competence of hospital RN to report medication incidents. Content and face questionnaire validation descriptive study. A review of the literature was performed for the creation of ítems. A panel of six experts assessed the relevance of the inclusion of each ítem in the questionnaire by calculating the position index; ítems with position index >0.70 were selected. The questionnaire was piloted by 59 RN. Finally, a meeting was convened with experts, in order to reduce the length of the piloted questionnaire through review, discussion and decision by consensus on each item. From the literature review, a battery of 151 ítems grouped into three elements of competence: attitudes, knowledge and skills was created. 52.9% (n=80) of the ítems received a position index > 0.70. The response rate in the pilot study was 40.65%. The median time to complete the questionnaire was 23:35minutes. After reduction by the experts, the final questionnaire comprised 45 ítems grouped into 32 questions. The NORMA questionnaire, designed to explore the competence of hospital RN to report medication incidents, has adequate face and content validity and is easy to administer, enabling its institutional implementation. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Krüger, A; Gillmann, B; Hardt, C; Döring, R; Beckers, S K; Rossaint, R
Physicians have to demonstrate non-technical skills, such as communication and team leading skills, while coping with critical incidents. These skills are not taught during medical education. A crisis resource management (CRM) training was established for 4th to 6th year medical students using a full-scale simulator mannikin (Emergency Care Simulator, ECS, METI). The learning objectives of the course were defined according to the key points of Gaba's CRM concept. The training consisted of theoretical and practical parts (3 simulation scenarios with debriefing). Students' self-assessment before and after the training provided the data for evaluation of the training outcome. A total of 65 students took part in the training. The course was well received in terms of overall course quality, debriefings and didactic presentation, the mean overall mark being 1.4 (1: best, 6: worst). After the course students felt significantly more confident when facing incidents in clinical practice. The main learning objectives were achieved. The effectiveness of applying the widely used ECS full-scale simulator in interdisciplinary teaching has been demonstrated. The training exposes students to crisis resource management issues and motivates them to develop non-technical skills.
Palese, Alvisa; Trevisani, Barbara; Guarnier, Annamaria; Barelli, Paolo; Zambiasi, Paola; Allegrini, Elisabetta; Bazoli, Letizia; Casson, Paola; Marin, Meri; Padovan, Marisa; Picogna, Michele; Taddia, Patrizia; Salmaso, Daniele; Chiari, Paolo; Marognolli, Oliva; Federica, Canzan; Saiani, Luisa; Ambrosi, Elisa
To describe the prevalence and incidence density of hospital-acquired unavoidable pressure sores among patients aged ≥65 years admitted to acute medical units. A secondary analysis of longitudinal study data collected in 2012 and 2013 from 12 acute medical units located in 12 Italian hospitals was performed. Unavoidable pressure ulcers were defined as those that occurred in haemodynamically unstable patients, suffering from cachexia and/or terminally ill and were acquired after hospital admission. Data at patient and at pressure ulcer levels were collected on a daily basis at the bedside by trained researchers. A total of 1464 patients out of 2080 eligible (70.4%) were included. Among these, 96 patients (6.5%) hospital-acquired a pressure ulcer and, among 19 (19.7%) were judged as unavoidable. The incidence of unavoidable pressure ulcer was 8.5/ 100 in hospital-patient days. No statistically significant differences at patient and pressure ulcers levels have emerged between those patients that acquired unavoidable and avoidable pressure sores. Although limited, evidence on unavoidable pressure ulcer is increasing. More research in the field is recommended to support clinicians, managers and policymakers in the several implications of unavoidable pressure ulcers both at the patient and at the system levels. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.
Härkänen, Marja; Turunen, Hannele; Vehviläinen-Julkunen, Katri
This study aimed to compare medication administration errors detected by 3 different methods in terms of severity, type, and contributing factors. The study was performed in one university hospital in Finland. A convenience sample of medication administration errors (n = 451) reported on incident reports or detected by reviewing randomly selected patient records via the Global Trigger Tool method and direct observations of patient record reviews were collected for reanalysis. The severity of the medication administration errors, the types thereof, and factors contributing to such errors were reclassified using the National Coordinating Council for Medication Error Reporting and Prevention's taxonomy of medication errors. The observational method revealed fewer medication errors that were more likely to cause harm to patients than did the incident reports or the Global Trigger Tool method. The incident reports and the Global Trigger Tool method mainly revealed wrong doses, whereas most medication administration errors in the observational data were errors involving the use of the incorrect technique. In addition, each method produced different information regarding the factors contributing to medication administration errors. Based on the study's findings and the limitations of each method, a combination of different methods should be used to discover representative information concerning medication administration errors. To increase medication administration safety, advanced multiprofessional collaboration, effective communication, adequate skills, more systematic medication processes, and distraction-free work environments are needed.
Latha, S; Choon, S E
Cutaneous adverse drug reactions (cADRs) are common. There are only few studies on the incidence of cADRs in Malaysia. To determine the incidence, clinical features and risk factors of cADRs among hospitalized patients. A prospective study was conducted among medical inpatients from July to December 2014. A total of 43 cADRs were seen among 11 017 inpatients, yielding an incidence rate of 0.4%. cADR accounted for hospitalization in 26 patients. Previous history of cADR was present in 14 patients, with 50% exposed to the same drug taken previously. Potentially lifethreatening severe cutaneous adverse reactions (SCAR), namely drug reaction with eosinophilia and systemic symptoms (DRESS: 14 cases) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN: 6 cases) comprise almost 50% of cADRs. The commonest culprit drug group was antibiotics (37.2%), followed by anticonvulsants (18.6%). Cotrimoxazole, phenytoin and rifampicin were the main causative drugs for DRESS. Anticonvulsants were most frequently implicated in SJS/TEN (66.7%). Most cases had "probable" causality relationship with suspected drug (69.8%). The majority of cases were of moderate severity (65.1%), while 18.6% had severe reaction with 1 death recorded. Most cases were not preventable (76.7%). Older age (> 60 years) and mucosal involvement were significantly associated with a more severe reaction. The incidence of cADRs was 0.4%, with most cases classified as moderate severity and not preventable. The commonest reaction pattern was DRESS, while the main culprit drug group was antibiotics. Older age and mucosal membrane involvement predicts a severe drug reaction.
Palojoki, Sari; Saranto, Kaija; Lehtonen, Lasse
The European Union Medical Device Directive 2007/47/EC1 defines software with a medical purpose as a medical device. The implementation of health information technology suffers from patient safety problems that require effective post-market surveillance. The purpose of this study was to review, classify and discuss the incident data submitted to a nationwide database of the Finnish National Competent Authority with other forms of data. We analysed incident reports submitted to the authority database by users of electronic health records from 2010 to 2015. We identified 138 valid reports. Adverse events associated with electronic health record vulnerabilities, clustered around certain error types, cause serious harm and occur in all types of healthcare settings. The low rate of reported incidents raises questions about not only the challenges associated with medical software oversight but also the obstacles for reporting.
Mpogoro, Filbert J; Mshana, Stephen E; Mirambo, Mariam M; Kidenya, Benson R; Gumodoka, Balthazar; Imirzalioglu, Can
Surgical site infection (SSI) is the second most common infectious complication after urinary tract infection following a delivery by caesarean section (CS). At Bugando Medical Centre there has no study documenting the epidemiology of SSI after CS despite the large number of CSs performed and the relatively common occurrence of SSIs. This was a prospective cohort study involving pregnant women who underwent a CS between October 2011 and February 2012 at Bugando Medical Centre. A total of 345 pregnant women were enrolled. Preoperative, intraoperative and postoperative data were collected using a standardized questionnaire. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was carried out using a disc diffusion technique. Data was analyzed using STATA version 11. The overall cumulative incidence of SSI was 10.9% with an incidence rate of 37.5 per 10,000 people/day (95% CI, 26.8-52.4). The median time from CS to the development of SSI was 7 days (interquartile range [IQR] = 6-9 days). Six independent risk factors for post caesarean SSI as identified in this study by multivariate analysis are: hypertensive disorders of pregnancy (HR: 2.5; 95% CI, 1.1-5.6; P = 0.021), severe anaemia (HR: 3.8; 95% CI, 1.2-12.4, P = 0.028), surgical wound class III (HR: 2.4; 95% CI, 1.1-5.0; P = 0.021), multiple vaginal examinations (HR: 2.5; 95% CI, 1.2-5.1; P = 0.011), prolonged duration of operation (HR: 2.6; 95% CI, 1.2-5.5; P = 0.015) and an operation performed by an intern or junior doctor (HR: 4.0; 95% CI, 1.7-9.2; P = 0.001). Staphylococcus aureus was the most common organism (27.3%), followed by Klebsiella pneumoniae (22.7%). Patients with a SSI had a longer average hospital stay than those without a SSI (12.7 ± 6.9 vs. 4 ± 1.7; P < 0.0001) and the case fatality rate among patients with a SSI was 2.9%. SSIs are common among women undergoing CSs at Bugando Medical Centre. SSIs were commonly associated with multiple
Bobo, William V; Pathak, Jyotishman; Kremers, Hilal Maradit; Yawn, Barbara P; Brue, Scott M; Stoppel, Cynthia J; Croarkin, Paul E; St Sauver, Jennifer; Frye, Mark A; Rocca, Walter A
We validated an algorithm designed to identify new or prevalent users of antidepressant medications via population-based drug prescription records. We obtained population-based drug prescription records for the entire Olmsted County, Minnesota, population from 2011 to 2012 (N=149,629) using the existing electronic medical records linkage infrastructure of the Rochester Epidemiology Project (REP). We selected electronically a random sample of 200 new antidepressant users stratified by age and sex. The algorithm required the exclusion of antidepressant use in the 6 months preceding the date of the first qualifying antidepressant prescription (index date). Medical records were manually reviewed and adjudicated to calculate the positive predictive value (PPV). We also manually reviewed the records of a random sample of 200 antihistamine users who did not meet the case definition of new antidepressant user to estimate the negative predictive value (NPV). 161 of the 198 subjects electronically identified as new antidepressant users were confirmed by manual record review (PPV 81.3%). Restricting the definition of new users to subjects who were prescribed typical starting doses of each agent for treating major depression in non-geriatric adults resulted in an increase in the PPV (90.9%). Extending the time windows with no antidepressant use preceding the index date resulted in only modest increases in PPV. The manual abstraction of medical records of 200 antihistamine users yielded an NPV of 98.5%. Our study confirms that REP prescription records can be used to identify prevalent and incident users of antidepressants in the Olmsted County, Minnesota, population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Full Text Available Background: Academic failure, conceived of as lack of success in one’s education, is of paramount importance for students of medical sciences and it might lead to more acute problems. The present study set out to investigate the prevalence and underlying reasons of academic failure in Lorestan University of medical sciences. Materials and Methods: In this cohort study, academic records of all students of Lorestan University of Medical Sciences during the academic years of 2006-2011 were collected from education and student affair center and also, demographic and educational records were entered into a checklist. Inappropriate grade point average, being a provisional student, prolonged graduation, expulsion and dropout were taken into account as academic failure. To model the related effective factors, logistic regression was adopted and significance level was set at 0.05. Results: The cumulative incidence of academic failure was about 25.1%. Factors such as department, being self-funded or government-funded student, academic grade students are pursuing, the elapsed time between academic grades, gender and location of residence were related to academic failure (P<0.05. It is worth mentioning that no relationship was observed between the academic failure and being accepted based on quota system. Conclusion: The most important at risk groups were students of department of medicine and health, associate or medical doctoral students, self-funded students, students with a considerable time elapsed between their academic grades, male students and students living in dormitory. It is suggested that these students refer to consulting centers of university or educational supervisors and receive particular attention.
Roberts, Simon P.; Trewartha, Grant; England, Mike; Stokes, Keith A.
Background: Previous research has identified injury patterns during community-level rugby union match play, but none have investigated the frequency and reasons for on-field injury management. Purpose: To establish the frequency, reasons, and patterns of on-field injury management in English community rugby, including differences between different levels of play. Study Design: Descriptive epidemiology study. Methods: Over 3 seasons, injury information was collected from 46 (2009-2010), 67 (2010-2011), and 76 (2011-2012) English community clubs (Rugby Football Union [RFU] levels 3-9). Club injury management staff reported information for all medical attendances during match play, including details on the injury site and type, playing position (seasons 2010-2011 and 2011-2012 only), and whether the player was removed from play. Clubs were subdivided into groups A (RFU levels 3 and 4 [mainly semiprofessional]; n = 39), B (RFU levels 5 and 6 [mainly amateur]; n = 71), and C (RFU levels 7-9 [social and recreational]; n = 79) to differentiate playing levels. Results: The overall medical attendance incidence was 229 per 1000 player-match hours (95% CI, 226-232), with 45 players removed per 1000 player-match hours (95% CI, 44-46). Attendance incidence for group A (294 per 1000 player-match hours; 95% CI, 287-301) was higher compared with group B (213; 95% CI, 208-218; P < .001) and C (204; 95% CI, 200-209; P < .001). There was a higher incidence of attendances to forwards (254; 95% CI, 249-259) compared with backs (191; 95% CI, 187-196; P < .001). The head was the most common specific site of injury (55 per 1000 player-match hours; 95% CI, 53-57) but the lower limb region overall accounted for most attendances (87; 95% CI, 85-89) and the greatest chance of removal from the pitch (22; 95% CI, 21-23). Conclusion: With the likelihood of 1 injury for each team per match severe enough for the player to leave the pitch and with at least 1 attendance for a head injury per match
Morrow, H E
The medical/surgical hospital environment presents numerous challenges to a Critical Incident Stress Management (CISM) Team Coordinator responsible for implementing a psychological crisis intervention. Often this person is responsible for managing a response to a large in-house multiple-casualty incident, sometimes involving fatalities. Many mental health professionals have not had the opportunity to work in a medical/surgical healthcare facility and consequently are not familiar with the environment (and agency culture) that exists within these employment settings. This article will review important factors to be considered during the initial assessment of a critical incident in a hospital setting, logistical concerns that are unique to this setting, and the subsequent planning of the Critical Incident Stress Management Team crisis management response.
Kenneth Anene Agu
Full Text Available This study assessed the incidence and types of medication errors, interventions and outcomes in patients on antiretroviral therapy (ART in selected HIV treatment centres in Nigeria.Of 69 health facilities that had program for active screening of medication errors, 14 were randomly selected for prospective cohort assessment. All patients who filled/refilled their antiretroviral medications between February 2009 and March 2011 were screened for medication errors using study-specific pharmaceutical care daily worksheet (PCDW. All potential or actual medication errors identified, interventions provided and the outcomes were documented in the PCDW. Interventions included pharmaceutical care in HIV training for pharmacists amongst others. Chi-square was used for inferential statistics and P0.05. The major medications errors identified were 26.4% incorrect ART regimens prescribed; 19.8% potential drug-drug interaction or contraindication present; and 16.6% duration and/or frequency of medication inappropriate. Interventions provided included 67.1% cases of prescriber contacted to clarify/resolve errors and 14.7% cases of patient counselling and education; 97.4% of potential/actual medication error(s were resolved.The incidence rate of medication errors was somewhat high; and majority of identified errors were related to prescription of incorrect ART regimens and potential drug-drug interactions; the prescriber was contacted and the errors were resolved in majority of cases. Active screening for medication errors is feasible in resource-limited settings following a capacity building intervention.
Ball, D.; Bethe, H.A.; Blair, B.G.; Bracken, P.; Carter, A.B.; Dickinson, H.; Garwin, R.L.; Holloway, D.; Kendall, H.W.
In essence, the United States still relies on the strategic command system erected during the 1960s and 1970s, but as we have seen, this system suffers from a number of serious weaknesses. Among these the authors emphasized the vulnerability of vital communications even before any warheads impact directly on U.S. targets, as well as the systems; heavy reliance on a relatively small number of limited-endurance aircraft as command posts and radio relays. This paper focuses on the committed improvement program, assess its impact on command vulnerability, and offer suggestions for further command improvements designed to enhance crisis stability and to facilitate ware termination should deterrence fail. The reader should note that this chapter is rather more technical than the remainder of this book
Isaac, Gayle; Moore, Brian
Preparing for every possible contingency seems daunting, but with teamwork and some help from the government, it's almost do-able. There is a great system out there that will help business professionals and educators develop a strong, effective emergency preparedness plan. If they haven't done a good job of implementing a solid emergency response…
J M Lucca; M Ramesh; G Parthasarathi; D Ram
Background: In spite of the progress made in the treatment of psychiatric disorders during the last few decades, nonadherence continues to be a frequent phenomenon, often associated with potentially severe clinical consequences and increased health-care costs. There are numerous factors associated with medication nonadherence in patients with mental illness. The aim of the study was to determine the incidence and factors associated with medication nonadherence among psychiatric outpatients. M...
Macharia, W M; Muteshi, C M; Wanyonyi, S Z; Mukaindo, A M; Ismail, A; Ekea, H; Abdallah, A; Tole, J M; Ngugi, A K
Information on adverse events (AEs) in hospitalised patients in developing countries is scanty. To compare the magnitude and characteristics of inpatient AEs in a tertiary, not-for-profit healthcare facility in Kenya, using medical records review and incident reporting. Estimation of prevalence was done using incidents reported in 2010 from a random sample of medical records for hospital admissions. Nurse reviewers used 18 screening criteria, followed by physician reviewers to confirm occurrence. An AE was defined as an unexpected clinical event (UE) associated with death, disability or prolonged hospitalisation not explained by the disease condition. The kappa statistic was used to estimate inter-rater agreement, and analysis was done using logistic regression. The study identified 53 UEs from 2 000 randomly selected medical records and 33 reported UEs from 23 026 admissions in the index year. The prevalences of AEs from medical records review and incident reports were 1.4% (95% confidence interval (CI) 0.9 - 2.0) and 0.03% (95% CI 0.012 - 0.063), respectively. Compared with incident reporting, review of medical records identified more disability (13.2% v. 0%; p=0.03) and prolonged hospital stays (43.4% v. 18.2%; p=0.02). Review of medical records is preferable to incident reporting in determining the prevalence of AEs in health facilities with limited inpatient quality improvement experience. Further research is needed to determine whether staff education and a positive culture change through promotion of non-punitive UE reporting or a combination of approaches would improve the comprehensiveness of AE reporting.
Lee, Deog-Yong; Lee, Esther; Park, HyeMin; Kim, SeongHan
Objective: In this study, the factors that induced a decrease in the incidence of typhoid fever were analyzed. Based on the study results, we propose a quantitative and concrete solution to reduce the incidence of typhoid fever. Methods: We analyzed the incidence and fatality rate of typhoid fever in Korea. Tap water service rate and the number of pharmacies, which affect the incidence rate of typhoid fever, were used as environmental factors. Results: To prevent typhoid fever in the communit...
van Eck van der Sluis, J.F.; Ten Have, M.; Rijnders, C.A.Th.; van Marwijk, H.W.J.; de Graaf, R.; Cornelis, Christina
Background Clinical studies have shown that Medically Unexplained Symptoms (MUS) are related to common mental disorders. It is unknown how often common mental disorders occur in subjects who have explained physical symptoms (PHY), MUS or both, in the general population, what the incidence rates are,
van der Sluijs, J.V.; ten Have, M.; Rijnders, C.; van Marwijk, H.W.J.; de Graaf, R.; van der Feltz-Cornelis, C.
Background Clinical studies have shown that Medically Unexplained Symptoms (MUS) are related to common mental disorders. It is unknown how often common mental disorders occur in subjects who have explained physical symptoms (PHY), MUS or both, in the general population, what the incidence rates are,
Full Text Available Abstract Background Even though electronic prescribing systems are widely advocated as one of the most effective means of improving patient safety, they may also introduce new risks that are not immediately obvious. Through the study of specific incidents related to the processes involved in the administration of medication, we sought to find out if the prescribing system had unintended consequences in creating new errors. The focus of this study was a large acute hospital in the Midlands in the United Kingdom, which implemented a Prescribing, Information and Communication System (PICS. Methods This exploratory study was based on a survey of routinely collected medication incidents over five months. Data were independently reviewed by two of the investigators with a clinical pharmacology and nursing background respectively, and grouped into broad types: sociotechnical incidents (related to human interactions with the system and non-sociotechnical incidents. Sociotechnical incidents were distinguished from the others because they occurred at the point where the system and the professional intersected and would not have occurred in the absence of the system. The day of the week and time of day that an incident occurred were tested using univariable and multivariable analyses. We acknowledge the limitations of conducting analyses of data extracted from incident reports as it is widely recognised that most medication errors are not reported and may contain inaccurate data. Interpretation of results must therefore be tentative. Results Out of a total of 485 incidents, a modest 15% (n = 73 were distinguished as sociotechnical issues and thus may be unique to hospitals that have such systems in place. These incidents were further analysed and subdivided into categories in order to identify aspects of the context which gave rise to adverse situations and possible risks to patient safety. The analysis of sociotechnical incidents by time of day and day of
Howard, Michelle, E-mail: Mhoward24601@yahoo.com [University of Wisconsin—La Crosse, WI 54601 (United States)
ABSTRACT: Burnout and compassion fatigue (CF) adversely affect medical professionals, including those employed in radiation oncology. Previously conducted research acknowledged the presence of burnout in populations of radiation therapists, radiation oncologists, and oncology nursing staff. The aim of the following research was to measure the incidence of burnout or CF in the specific population of medical dosimetrists surveyed. As professional members of the radiation oncology team, this group had not been included in published research data to date. The hypothesis of the subsequent study stated that a comparable incidence of burnout would be observed among medical dosimetrists as had been reported by earlier researchers for a population of radiation therapists. A survey tool based on the Maslach Burnout Inventory (MBI) and distributed to full members of the American Association of Medical Dosimetrists (AAMD) was utilized as the research measurement method. Results obtained indicated an incidence rates of burnout or CF for medical dosimetrists were less than the rates previously measured for radiation therapists (53% vs 11% for emotional exhaustion [EE] and 45% vs 27% for depersonalization [DP]). The incidence of burnout was based on the Burnout Inventory (BI) developed for the research project. Each of the subscales, EE, DP, and decreased personal accomplishment (PA), was considered and analyzed independently. Although not as prevalent among medical dosimetrists as a variety of additional radiation oncology professionals, a significant portion of the population demonstrated signs of burnout or CF. Future concerns abound for the population of medical dosimetrists as a large number of members scored positive for intermediate risk of burnout and CF. Additionally, a large portion of the population was found to be rapidly approaching retirement.
ABSTRACT: Burnout and compassion fatigue (CF) adversely affect medical professionals, including those employed in radiation oncology. Previously conducted research acknowledged the presence of burnout in populations of radiation therapists, radiation oncologists, and oncology nursing staff. The aim of the following research was to measure the incidence of burnout or CF in the specific population of medical dosimetrists surveyed. As professional members of the radiation oncology team, this group had not been included in published research data to date. The hypothesis of the subsequent study stated that a comparable incidence of burnout would be observed among medical dosimetrists as had been reported by earlier researchers for a population of radiation therapists. A survey tool based on the Maslach Burnout Inventory (MBI) and distributed to full members of the American Association of Medical Dosimetrists (AAMD) was utilized as the research measurement method. Results obtained indicated an incidence rates of burnout or CF for medical dosimetrists were less than the rates previously measured for radiation therapists (53% vs 11% for emotional exhaustion [EE] and 45% vs 27% for depersonalization [DP]). The incidence of burnout was based on the Burnout Inventory (BI) developed for the research project. Each of the subscales, EE, DP, and decreased personal accomplishment (PA), was considered and analyzed independently. Although not as prevalent among medical dosimetrists as a variety of additional radiation oncology professionals, a significant portion of the population demonstrated signs of burnout or CF. Future concerns abound for the population of medical dosimetrists as a large number of members scored positive for intermediate risk of burnout and CF. Additionally, a large portion of the population was found to be rapidly approaching retirement
Liese, J G; Silfverdal, S A; Giaquinto, C; Carmona, A; Larcombe, J H; Garcia-Sicilia, J; Fuat, A; Garces-Sanchez, M; Basanta, M L Arroba; Hiraldo, E Muñoz; Cantarutti, L; Kroeniger, W; Vollmar, J; Holl, K; Pirçon, J Y; Rosenlund, M R
We conducted an epidemiological, observational cohort study to determine the incidence and complications of acute otitis media (AOM) in children aged <6 years. Data on physician-diagnosed AOM were collected from retrospective review of medical charts for the year preceding enrolment and then prospectively in the year following enrolment. The study included 5776 children in Germany, Italy, Spain, Sweden, and the UK. AOM incidence was 256/1000 person-years [95% confidence interval (CI) 243-270] in the prospective study period. Incidence was lowest in Italy (195, 95% CI 171-222) and highest in Spain (328, 95% CI 296-363). Complications were documented in <1% of episodes. Spontaneous tympanic membrane perforation was documented in 7% of episodes. Both retrospective and prospective study results were similar and show the high incidence during childhood in these five European countries. Differences by country may reflect true differences and differences in social structure and diagnostic procedures.
Mace, Jonathan Lee; Seitz, Gerald J.; Echave, John A.; Le Bas, Pierre-Yves
The detonation of one or more explosive charges and propellant charges by a detonator in response to a fire control signal from a command and control system comprised of a command center and instrumentation center with a communications link therebetween. The fire control signal is selectively provided to the detonator from the instrumentation center if plural detonation control switches at the command center are in a fire authorization status, and instruments, and one or more interlocks, if included, are in a ready for firing status. The instrumentation and command centers are desirably mobile, such as being respective vehicles.
Boyle, Todd A; Mahaffey, Thomas; Mackinnon, Neil J; Deal, Heidi; Hallstrom, Lars K; Morgan, Holly
Evidence suggests that the underreporting of medication errors and near misses, collectively referred to as medication incidents (MIs), in the community pharmacy setting, is high. Despite the obvious negative implications, MIs present opportunities for pharmacy staff and regulatory authorities to learn from these mistakes and take steps to reduce the likelihood that they reoccur. However, these activities can only take place if such errors are reported and openly discussed. This research proposes a model of factors influencing the reporting, service recovery, and organizational learning resulting from MIs within Canadian community pharmacies. The conceptual model is based on a synthesis of the literature and findings from a pilot study conducted among pharmacy management, pharmacists, and pharmacy technicians from 13 community pharmacies in Nova Scotia, Canada. The purpose of the pilot study was to identify various actions that should be taken to improve MI reporting and included staff perceptions of the strengths and weaknesses of their current MI-reporting process, desired characteristics of a new process, and broader external and internal activities that would likely improve reporting. Out of the 109 surveys sent, 72 usable surveys were returned (66.1% response rate). Multivariate analysis of variance found no significant differences among staff type in their perceptions of the current or new desired system but were found for broader initiatives to improve MI reporting. These findings were used for a proposed structural equation model (SEM). The SEM proposes that individual-perceived self-efficacy, MI process capability, MI process support, organizational culture, management support, and regulatory authority all influence the completeness of MI reporting, which, in turn, influences MI service recovery and learning. This model may eventually be used to enable pharmacy managers to make better decisions. By identifying risk factors that contribute to low MI
Keers, Richard N; Williams, Steven D; Cooke, Jonathan; Ashcroft, Darren M
To investigate the underlying causes of intravenous medication administration errors (MAEs) in National Health Service (NHS) hospitals. Two NHS teaching hospitals in the North West of England. Twenty nurses working in a range of inpatient clinical environments were identified and recruited using purposive sampling at each study site. Semistructured interviews were conducted with nurse participants using the critical incident technique, where they were asked to discuss perceived causes of intravenous MAEs that they had been directly involved with. Transcribed interviews were analysed using the Framework approach and emerging themes were categorised according to Reason's model of accident causation. In total, 21 intravenous MAEs were discussed containing 23 individual active failures which included slips and lapses (n=11), mistakes (n=8) and deliberate violations of policy (n=4). Each active failure was associated with a range of error and violation provoking conditions. The working environment was implicated when nurses lacked healthcare team support and/or were exposed to a perceived increased workload during ward rounds, shift changes or emergencies. Nurses frequently reported that the quality of intravenous dose-checking activities was compromised due to high perceived workload and working relationships. Nurses described using approaches such as subconscious functioning and prioritising to manage their duties, which at times contributed to errors. Complex interactions between active and latent failures can lead to intravenous MAEs in hospitals. Future interventions may need to be multimodal in design in order to mitigate these risks and reduce the burden of intravenous MAEs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Lars J. Grimm
Full Text Available Purpose: This study aims to assess the incidence of major life events during graduate medical education (GME training and to establish any associations with modifiable activities and career planning. Methods: The authors surveyed graduating GME trainees from their parent institution in June 2013. Demographic information (clinical department, gender, training duration and major life events (marriage, children, death/illness, home purchase, legal troubles, property loss were surveyed. Respondents were queried about the relationship between life events and career planning. A multivariable logistic regression model tested for associations. Results: A total of 53.2% (166/312 of graduates responded to the survey. 50% (83/166 of respondents were female. Major life events occurred in 96.4% (160/166 of respondents. Male trainees were more likely (56.1% [46/82] vs. 30.1% [25/83] to have a child during training (p=0.01. A total of 41.6% (69/166 of responders consciously engaged or avoided activities during GME training, while 31.9% (53/166 of responders reported that life events influenced their career plans. Trainees in lifestyle residencies (p=0.02, those who experienced the death or illness of a close associate (p=0.01, and those with legal troubles (p=0.04 were significantly more likely to consciously control life events. Conclusion: Major life events are very common and changed career plans in nearly a third of GME trainees. Furthermore, many trainees consciously avoided activities due to their responsibilities during training. GME training programs should closely assess the institutional support systems available to trainees during this difficult time.
Jackson, Michael L.; Jackson, Lisa A.; Kieke, Burney; McClure, David; Gaglani, Manjusha; Murthy, Kempapura; Malosh, Ryan; Monto, Arnold; Zimmerman, Richard K.; Foppa, Ivo M.; Flannery, Brendan; Thompson, Mark G.
Background We estimated the burden of outpatient influenza and cases prevented by vaccination during the 2011/12 and 2012/13 influenza seasons using data from the United States Influenza Vaccine Effectiveness (US Flu VE) Network. Methods We defined source populations of persons who could seek care for acute respiratory illness (ARI) at each of the five US Flu VE Network sites. We identified all members of the source population who were tested for influenza during US Flu VE influenza surveillance. Each influenza-positive subject received a sampling weight based on the proportion of source population members who were tested for influenza, stratified by site, age, and other factors. We used the sampling weights to estimate the cumulative incidence of medically attended influenza in the source populations. We estimated cases averted by vaccination using estimates of cumulative incidence, vaccine coverage, and vaccine effectiveness. Results Cumulative incidence of medically attended influenza ranged from 0.8% to 2.8% across sites during 2011/12 and from 2.6% to 6.5% during the 2012/13 season. Stratified by age, incidence ranged from 1.2% among adults 50 years of age and older in 2011/12 to 10.9% among children 6 months to 8 years of age in 2012/13. Cases averted by vaccination ranged from 4 to 41 per 1,000 vaccinees, depending on the study site and year. Conclusions The incidence of medically attended influenza varies greatly by year and even by geographic region within the same year. The number of cases averted by vaccination varies greatly based on overall incidence and on vaccine coverage. PMID:26271827
van Weel Chris
Full Text Available Abstract Background Patient safety can be at stake in both hospital and general practice settings. While severe patient safety incidents have been described, quantitative studies in large samples of patients in general practice are rare. This study aimed to assess patient safety in general practice, and to show areas where potential improvements could be implemented. Methods We conducted a retrospective review of patient records in Dutch general practice. A random sample of 1,000 patients from 20 general practices was obtained. The number of patient safety incidents that occurred in a one-year period, their perceived underlying causes, and impact on patients' health were recorded. Results We identified 211 patient safety incidents across a period of one year (95% CI: 185 until 241. A variety of types of incidents, perceived causes and consequences were found. A total of 58 patient safety incidents affected patients; seven were associated with hospital admission; none resulted in permanent disability or death. Conclusions Although this large audit of medical records in general practices identified many patient safety incidents, only a few had a major impact on patients' health. Improving patient safety in this low-risk environment poses specific challenges, given the high numbers of patients and contacts in general practice.
... VA Form 21-8416b to report compensation awarded by another entity or government agency for personal... incident to the injury or death, or incident to the collection or recovery of the compensation may be... direction of the Secretary. Denise McLamb, Program Analyst, Enterprise Records Service. BILLING CODE 8320-01...
J M Lucca
Full Text Available Background: In spite of the progress made in the treatment of psychiatric disorders during the last few decades, nonadherence continues to be a frequent phenomenon, often associated with potentially severe clinical consequences and increased health-care costs. There are numerous factors associated with medication nonadherence in patients with mental illness. The aim of the study was to determine the incidence and factors associated with medication nonadherence among psychiatric outpatients. Materials and Methods: A cross-sectional study was carried out in the outpatient psychiatric department of an Indian tertiary care private hospital over a period of 1 year. Patients aged 18 years and above who presented with mental illness as diagnosed by the International Classification of Diseases (ICD-10 and who were receiving at least one psychotropic medication for at least 1 month were included in the study. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS. Results: Of the 400 patients, 172 (43% were nonadherent to their prescribed medications. There is a statistically significant association between the education (P = 0.001, number of drugs (P = 0.002, family income (P = 0.013, and nonadherence. Among the 172 patients, 33.5 % were nonadherent to their therapy due to patient-related factors followed by drug-related factors (32% and disease-related factors (31%. Conclusion: The overall incidence of medication nonadherence in patients with mental illness was 43%. Numerous factors contributed to medication nonadherence. Strategies need to be developed and implemented to enhance medication adherence, and thereby achieve a better therapeutic outcome in patients with mental illness.
Lucca, J M; Ramesh, M; Parthasarathi, G; Ram, D
In spite of the progress made in the treatment of psychiatric disorders during the last few decades, nonadherence continues to be a frequent phenomenon, often associated with potentially severe clinical consequences and increased health-care costs. There are numerous factors associated with medication nonadherence in patients with mental illness. The aim of the study was to determine the incidence and factors associated with medication nonadherence among psychiatric outpatients. A cross-sectional study was carried out in the outpatient psychiatric department of an Indian tertiary care private hospital over a period of 1 year. Patients aged 18 years and above who presented with mental illness as diagnosed by the International Classification of Diseases (ICD)-10 and who were receiving at least one psychotropic medication for at least 1 month were included in the study. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). Of the 400 patients, 172 (43%) were nonadherent to their prescribed medications. There is a statistically significant association between the education (P = 0.001), number of drugs (P = 0.002), family income (P = 0.013), and nonadherence. Among the 172 patients, 33.5 % were nonadherent to their therapy due to patient-related factors followed by drug-related factors (32%) and disease-related factors (31%). The overall incidence of medication nonadherence in patients with mental illness was 43%. Numerous factors contributed to medication nonadherence. Strategies need to be developed and implemented to enhance medication adherence, and thereby achieve a better therapeutic outcome in patients with mental illness.
Maupin, Genny M; Tvaryanas, Anthony P; White, Edward D; Lysfjord, Heather J
The prevalence of postdeployment mental health (PDMH) conditions in military health care personnel appears to be on par with that of other military personnel. However, there is no comprehensive analysis of incident PDMH conditions within the overall population of U.S. Air Force Medical Service personnel. This study explored the epidemiology of incident PDMH conditions among Air Force Medical Service personnel returning from deployment. A cohort survival analysis was conducted of 24,409 subjects without preexisting mental health conditions and at least one deployment during 2003-2013. Electronic health record data were used to ascertain the diagnosis of a PDMH condition. The primary outcome measure was an incident PDMH condition defined as a mental health diagnosis on at least two separate clinical encounters. The incidence of PDMH conditions was 59.74 per 1,000 person-years. Adjustment, anxiety, mood, sleep, and post-traumatic stress disorders accounted for 78% diagnoses. Protective factors included officer, surgeon, specific enlisted career fields, Air National Guard or Air Force Reserve, and multiple deployments. Risk factors included nurse, other specific enlisted career fields, female, and unmarried with dependents. Most subjects (73%) were diagnosed within the standard 30-month surveillance time period; median time to diagnosis was 13 months. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
van der Togt, Remko; van Lieshout, Erik Jan; Hensbroek, Reinout; Beinat, E.; Binnekade, J. M.; Bakker, P. J. M.
CONTEXT: Health care applications of autoidentification technologies, such as radio frequency identification (RFID), have been proposed to improve patient safety and also the tracking and tracing of medical equipment. However, electromagnetic interference (EMI) by RFID on medical devices has never
Togt, R. van der; Lieshout, E.J. van; Hensbroek, R.; Beinat, E.; Binnekade, J.M.; Bakker, P.J.M.
Context: Health care applications of autoidentification technologies, such as radio frequency identification (RFID), have been proposed to improve patient safety and also the tracking and tracing of medical equipment. However, electromagnetic interference (EMI) by RFID on medical devices has never
Henriksen, Daniel Pilsgaard; Laursen, Christian B; Jensen, Thøger Gorm
OBJECTIVE:: Sepsis is a frequent cause of admission, but incidence rates based on administrative data have previously produced large differences in estimates. The aim of the study was to estimate the incidence of community-acquired sepsis based on patients' symptoms and clinical findings at arrival...... to define the presence of systemic inflammatory response syndrome and organ dysfunction. MEASUREMENTS AND MAIN RESULTS:: Incidence rate of sepsis of any severity. Among 8,358 admissions to the medical emergency department, 1,713 patients presented with an incident admission of sepsis of any severity, median...... age 72 years (5-95%; range, 26-91 yr), 793 (46.3%) were men, 728 (42.5%) presented with a Charlson comorbidity index greater than 2,621 (36.3%) were admitted with sepsis, 1,071 (62.5%) with severe sepsis, and 21 (1.2%) with septic shock. Incidence rate was 731/100,000 person-years at risk (95% CI, 697...
Full Text Available Abstract Background Medication errors have been reported to be a leading cause of death in hospitalized patients. In this study we focused on identifying and quantifying errors in the handwritten drug ordering and dispensing documentation processes which could possibly lead to adverse drug events. Methods We studied 1,934 ordered agents (165 consecutive patients retrospectively for medication documentation errors. Errors were categorized into: Prescribing errors, transcription errors and administration documentation errors on the nurses' medication lists. The legibility of prescriptions was analyzed to explore its possible influence on the error rate in the documentation process. Results Documentation errors occurred in 65 of 1,934 prescribed agents (3.5%. The incidence of patient charts showing at least one error was 43%. Prescribing errors were found 39 times (37%, transcription errors 56 times (53%, and administration documentation errors 10 times (10%. The handwriting readability was rated as good in 2%, moderate in 42%, bad in 52%, and unreadable in 4%. Conclusions This study revealed a high incidence of documentation errors in the traditional handwritten prescription process. Most errors occurred when prescriptions were transcribed into the patients' chart. The readability of the handwritten prescriptions was generally bad. Replacing the traditional handwritten documentation process with information technology could potentially improve the safety in the medication process.
Jonna van Eck van der Sluijs
Full Text Available Clinical studies have shown that Medically Unexplained Symptoms (MUS are related to common mental disorders. It is unknown how often common mental disorders occur in subjects who have explained physical symptoms (PHY, MUS or both, in the general population, what the incidence rates are, and whether there is a difference between PHY and MUS in this respect.To study the prevalence and incidence rates of mood, anxiety and substance use disorders in groups with PHY, MUS and combined MUS and PHY compared to a no-symptoms reference group in the general population.Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, a nationally representative face-to-face survey of the general population aged 18-64 years. We selected subjects with explained physical symptoms only (n=1952, with MUS only (n=177, with both MUS and PHY (n=209, and a reference group with no physical symptoms (n=4168. The assessment of common mental disorders was through the Composite International Diagnostic Interview 3.0. Multivariate logistic regression analyses were used to examine the association between group membership and the prevalence and first-incidence rates of comorbid mental disorders, adjusted for socio-demographic characteristics.MUS were associated with the highest prevalence rates of mood and anxiety disorders, and combined MUS and PHY with the highest prevalence rates of substance disorder. Combined MUS and PHY were associated with a higher incidence rate of mood disorder only (OR 2.9 (95%CI:1.27,6.74.In the general population, PHY, MUS and the combination of both are related to mood and anxiety disorder, but odds are highest for combined MUS and PHY in relation to substance use disorder. Combined MUS and PHY are related to a greater incidence of mood disorder. These findings warrant further research into possibilities to improve recognition and early intervention in subjects with combined MUS and PHY.
K.C. Cheung (Ka Chun); P.M.L.A. van den Bemt (Patricia); M.L. Bouvy (Marcel); M.E. Wensing (Michel); P.A. de Smet (Peter)
textabstractIntroduction: Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but
Cheung, Ka Chun; Van Den Bemt, Patricia M L A; Bouvy, Marcel L.; Wensing, Michel; De Smet, Peter A G M
Introduction: Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may
Cheung, K.C.; Bemt, P.M. van den; Bouvy, M.L.; Wensing, M.J.; Smet, P.A. de
INTRODUCTION: Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may
Ham, Annelies C.; Swart, Karin M. A.; Enneman, Anke W.; van Dijk, Suzanne C.; Oliai Araghi, Sadaf; van Wijngaarden, Janneke P.; van der Zwaluw, Nikita L.; Brouwer-Brolsma, Elske M.; Dhonukshe-Rutten, Rosalie A. M.; van Schoor, Natasja M.; van der Cammen, Tischa J. M.; Lips, Paul; de Groot, Lisette C. P. G. M.; Uitterlinden, André G.; Witkamp, Renger F.; Stricker, Bruno H.; van der Velde, Nathalie
Background Medication use is a potentially modifiable risk factor for falling; psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk. However, evidence is mainly based on studies that recorded falls retrospectively and/or did not determine medication
Thomas, A N; Taylor, R J
Incident reporting is promoted as a key tool for improving patient safety in healthcare. We analysed 2238 patient safety incidents involving medications submitted from up to 29 critical care units each year in the North West of England between 2009 and 2012; 452 (20%) of these incidents led to harm to patients. Although 1461 (65%) incidents were judged to have been preventable, there was no reduction in the rate of incidents per 1000 days between 2009 and 2012 (5.9 in 2009, 6.6 in 2012). Furthermore, in the 2012 data, there were wide variations in the incident rates between units, the median (IQR [range]) rate per 1000 patient days for individual units being 6.8 (3.8-11.0 [1.3-37.1]). The variation in the percentage that could have been avoided was narrower, with a median (IQR [range]) of 70% (61-80% [38-100%]). The most commonly reported drugs were noradrenaline (161 incidents, 92 with harm), heparins (153 incidents, 29 with harm), morphine (131 incidents, 14 with harm) and insulin (111 incidents, 54 with harm). The administration of drugs was the stage in the process where incidents were most commonly reported; it was also the stage most likely to harm patients. We conclude that the wide range in reported rates between units, and the scope for preventing many incidents, suggest that quality improvement initiatives could improve medication safety in the units studied. © 2014 The Association of Anaesthetists of Great Britain and Ireland.
...) Investigate, process and settle, and supervise the field office investigation and processing of, medical malpractice claims arising in Army medical centers within the United States; provide medical claims judge... Medical Command (MEDCOM) on matters relating to medical malpractice claims. (x) Issue an accounting...
... report compensation awarded by another entity or government agency for personal injury or death. Such... injury or death, or incident to the collection or recovery of the compensation may be deducted from the..., Program Analyst, Enterprise Records Service. BILLING CODE 8320-01-P ...
... of force situations, staff shall seek the assistance of mental health or qualified health personnel... identify physical or mental problems. When mental health staff or qualified health personnel determine that... application of restraints incidents. 552.26 Section 552.26 Judicial Administration BUREAU OF PRISONS...
Liang, Chih-Chia; Muo, Chih-Hsin; Wang, I-Kuan; Chang, Chiz-Tzung; Chou, Che-Yi; Liu, Jiung-Hsiun; Yen, Tzung-Hai; Huang, Chiu-Ching; Chung, Chi-Jung
We aimed at determining peptic ulcer disease (PUD) incidence among chronic kidney disease (CKD) patients during 1998-2008, compared to patients without CKD, and at examining associations between CKD and PUD. Data for 1998-2008 were extracted from the National Health Insurance Research Database in Taiwan. The annual PUD incidence (cases per thousand persons per year) was calculated separately for patients with and without CKD. Characteristics of patients with newly diagnosed PUD (n = 16322) were compared to those of a control group without PUD (n = 32644). The 2 groups were matched for age, sex, and index year. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by logistic regression. Over the 10-year period, the PUD incidence was ∼10-12 times higher in CKD patients than in those without CKD. Its incidence in elderly CKD patients increased rapidly over time. For CKD patients, most PUD events (>95%) were managed during hospitalization. Peptic ulcer risk, adjusted for all potential confounders, was much higher in CKD patients undergoing hemodialysis (adjusted OR, 9.74; 95% CI, 7.11-13.31). Maintenance hemodialysis patients were 2 times more likely to have gastric ulcers than duodenal ulcers, while CKD patients not on dialysis had similar risks for both. There were no significant interactions between medications and CKD status on the peptic ulcer risk. Unlike CKD patients on nonsteroidal anti-inflammatory drugs and clopidogrel, those on aspirin did not have a higher peptic ulcer risk (adjusted OR, 0.88; 95% CI, 0.44-1.77). CKD patients have a substantially increased PUD risk, and the majority of CKD patients with PUD require hospital management. Further, peptic ulcer risk is affected by hemodialysis therapy, patient status (inpatient vs. outpatient), and ulcerogenic medications.
Monique S. Roy
Conclusions. The development of hypertension in African-Americans living with type 1 diabetes appears to be multifactorial and includes both medical (overt proteinuria as well as psychological (high hostility risk factors.
Martens, Eimo; Sinner, Moritz F.; Siebermair, Johannes; Raufhake, Carsten; Beckmann, Britt M.; Veith, Stefan; Düvel, Dieter; Steinbeck, Gerhard; Kääb, Stefan
Aims Sudden cardiac death (SCD) is among the most common causes of death in western countries including Germany. Whereas risk stratification and primary prevention is still insufficient, we also lack accurate incidence estimates. Current estimates vary widely (18.6–128/100 000/year), but data on SCD incidence in Germany are missing. Depending on SCD definitions, death needs to occur between 1 and 24 h after the onset of symptoms. Methods and results In the district of Aurich (190 000 inhabitants, Lower Saxony, Germany), emergency medical service (EMS) is provided by a district government operated single carrier and two hospitals. To evaluate all EMS calls in this district from 2002 to 2009, we obtained EMS protocols, medical records, and death certificates for data analysis and adjudication of SCD. We defined SCD according to the definition of the World Health Organization, considering patients with cardiac arrest within ≤1 h after the onset of symptoms. We also required cardiopulmonary resuscitation being performed by EMS personnel. The overall mortality rate in the district of Aurich (1060/100 000/year) corresponded well with the average mortality rate in Germany (1030/100 000/year). During the observation period, we adjudicated 1212 SCD cases, equivalent to an annual rate of 151 SCD cases (81 cases/100 000/year). Rates remained remarkably stable over time, and affected a considerable number of individuals of working age (32/100 000/year). Conclusion Consistent with prior reports, the SCD incidence in a district of Germany is substantial. Despite an elaborate EMS system and advanced medical care, SCD rates remain stable and necessitate improved, individualized risk stratification. PMID:25061228
Martens, Eimo; Sinner, Moritz F; Siebermair, Johannes; Raufhake, Carsten; Beckmann, Britt M; Veith, Stefan; Düvel, Dieter; Steinbeck, Gerhard; Kääb, Stefan
Sudden cardiac death (SCD) is among the most common causes of death in western countries including Germany. Whereas risk stratification and primary prevention is still insufficient, we also lack accurate incidence estimates. Current estimates vary widely (18.6-128/100,000/year), but data on SCD incidence in Germany are missing. Depending on SCD definitions, death needs to occur between 1 and 24 h after the onset of symptoms. In the district of Aurich (190,000 inhabitants, Lower Saxony, Germany), emergency medical service (EMS) is provided by a district government operated single carrier and two hospitals. To evaluate all EMS calls in this district from 2002 to 2009, we obtained EMS protocols, medical records, and death certificates for data analysis and adjudication of SCD. We defined SCD according to the definition of the World Health Organization, considering patients with cardiac arrest within ≤1 h after the onset of symptoms. We also required cardiopulmonary resuscitation being performed by EMS personnel. The overall mortality rate in the district of Aurich (1060/100,000/year) corresponded well with the average mortality rate in Germany (1030/100,000/year). During the observation period, we adjudicated 1212 SCD cases, equivalent to an annual rate of 151 SCD cases (81 cases/100,000/year). Rates remained remarkably stable over time, and affected a considerable number of individuals of working age (32/100,000/year). Consistent with prior reports, the SCD incidence in a district of Germany is substantial. Despite an elaborate EMS system and advanced medical care, SCD rates remain stable and necessitate improved, individualized risk stratification. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology.
Juergens, Jr., Richard A
...: European Command, Southern Command, Northern Command, Central Command, and Pacific Command, as the Department of Defense's unified command structure responsible for specific geographical regions of the world...
Background Tuberculosis (TB) in migrants is an ongoing challenge in several low TB incidence countries since a large proportion of TB in these countries occurs in migrants from high incidence countries. To meet these challenges, several countries utilize TB screening programs. The programs attempt to identify and treat those with active and/or infectious stages of the disease. In addition, screening is used to identify and manage those with latent or inactive disease after arrival. Between nations, considerable variation exists in the methods used in migration-associated TB screening. The present study aimed to compare the TB immigration medical examination requirements in selected countries of high immigration and low TB incidence rates. Methods Descriptive study of immigration TB screening programs Results 16 out of 18 eligible countries responded to the written standardized survey and phone interview. Comparisons in specific areas of TB immigration screening programs included authorities responsible for TB screening, the primary objectives of the TB screening program, the yield of detection of active TB disease, screening details and aspects of follow up for inactive pulmonary TB. No two countries had the same approach to TB screening among migrants. Important differences, common practices, common problems, evidence or lack of evidence for program specifics were noted. Conclusions In spite of common goals, there is great diversity in the processes and practices designed to mitigate the impact of migration-associated TB among nations that screen migrants for the disease. The long-term goal in decreasing migration-related introduction of TB from high to low incidence countries remains diminishing the prevalence of the disease in those high incidence locations. In the meantime, existing or planned migration screening programs for TB can be made more efficient and evidenced based. Cooperation among countries doing research in the areas outlined in this study should
Full Text Available Abstract Background Tuberculosis (TB in migrants is an ongoing challenge in several low TB incidence countries since a large proportion of TB in these countries occurs in migrants from high incidence countries. To meet these challenges, several countries utilize TB screening programs. The programs attempt to identify and treat those with active and/or infectious stages of the disease. In addition, screening is used to identify and manage those with latent or inactive disease after arrival. Between nations, considerable variation exists in the methods used in migration-associated TB screening. The present study aimed to compare the TB immigration medical examination requirements in selected countries of high immigration and low TB incidence rates. Methods Descriptive study of immigration TB screening programs Results 16 out of 18 eligible countries responded to the written standardized survey and phone interview. Comparisons in specific areas of TB immigration screening programs included authorities responsible for TB screening, the primary objectives of the TB screening program, the yield of detection of active TB disease, screening details and aspects of follow up for inactive pulmonary TB. No two countries had the same approach to TB screening among migrants. Important differences, common practices, common problems, evidence or lack of evidence for program specifics were noted. Conclusions In spite of common goals, there is great diversity in the processes and practices designed to mitigate the impact of migration-associated TB among nations that screen migrants for the disease. The long-term goal in decreasing migration-related introduction of TB from high to low incidence countries remains diminishing the prevalence of the disease in those high incidence locations. In the meantime, existing or planned migration screening programs for TB can be made more efficient and evidenced based. Cooperation among countries doing research in the areas
Alvarez, Gonzalo G; Gushulak, Brian; Abu Rumman, Khaled; Altpeter, Ekkehardt; Chemtob, Daniel; Douglas, Paul; Erkens, Connie; Helbling, Peter; Hamilton, Ingrid; Jones, Jane; Matteelli, Alberto; Paty, Marie-Claire; Posey, Drew L; Sagebiel, Daniel; Slump, Erika; Tegnell, Anders; Valín, Elena Rodríguez; Winje, Brita Askeland; Ellis, Edward
Tuberculosis (TB) in migrants is an ongoing challenge in several low TB incidence countries since a large proportion of TB in these countries occurs in migrants from high incidence countries. To meet these challenges, several countries utilize TB screening programs. The programs attempt to identify and treat those with active and/or infectious stages of the disease. In addition, screening is used to identify and manage those with latent or inactive disease after arrival. Between nations, considerable variation exists in the methods used in migration-associated TB screening. The present study aimed to compare the TB immigration medical examination requirements in selected countries of high immigration and low TB incidence rates. Descriptive study of immigration TB screening programs. 16 out of 18 eligible countries responded to the written standardized survey and phone interview. Comparisons in specific areas of TB immigration screening programs included authorities responsible for TB screening, the primary objectives of the TB screening program, the yield of detection of active TB disease, screening details and aspects of follow up for inactive pulmonary TB. No two countries had the same approach to TB screening among migrants. Important differences, common practices, common problems, evidence or lack of evidence for program specifics were noted. In spite of common goals, there is great diversity in the processes and practices designed to mitigate the impact of migration-associated TB among nations that screen migrants for the disease. The long-term goal in decreasing migration-related introduction of TB from high to low incidence countries remains diminishing the prevalence of the disease in those high incidence locations. In the meantime, existing or planned migration screening programs for TB can be made more efficient and evidenced based. Cooperation among countries doing research in the areas outlined in this study should facilitate the development of improved
O'Brien, Hannah; Kiely, Fiona; Carmichael, Ann
Patients receiving palliative care and those at the end of life are known to be susceptible to medical errors. Errors related to medications are the most avoidable cause of patient harm. This retrospective study examined reported anonymized medication safety incidents, related to physician errors, assessed by the risk committee in a specialist palliative care unit over a 3-year time period. The aim of the study was to describe medication errors, with specific attention paid to what type of errors occurred and when these errors happened. Of the 218 reported medication safety incidents 28% (n = 62) were related to doctor prescribing. The data showed that there was a wide variation per year in the numbers of reported medication safety incidents. Medication prescribing errors were the most common error, followed by medication omissions. Medication safety incidents are at least in part dependent on staff reporting. Fostering a culture of openness that is blame free is crucial to medication error reporting. Formal reporting may help to increase patient safety and forms an essential element in the clinical governance and risk management of an institution.
Koning, S. W.; Ellerbroek, P. M.; Leenen, L. P. H.
This retrospective study reports the outcome of a mass casualty incident (MCI) caused by a fire in a nursing home. Data from the medical charts and registration system of the Major Incident Hospital (MIH) and ambulance service were analyzed. The evaluation reports from the MIH and an independent
Brandt, Theresa; Murphy, C. W.; Kuntz, Jon; Barlett, Tom
The design and implementation of a command management system (CMS) for a NASA control center, is described. The technology innovations implemented in the CMS provide the infrastructure required for operations cost reduction and future development cost reduction through increased operational efficiency and reuse in future missions. The command management design facilitates error-free operations which enables the automation of the routine control center functions and allows for the distribution of scheduling responsibility to the instrument teams. The reusable system was developed using object oriented methodologies.
Lima, Camila M. Araujo; Silva, Francisco C.A. da; Araujo, Rilton A.; Pelegrineli, Samuel Q.
The man's exposure to ionizing radiation in health are has increased considerably due not only the great request of medical examinations as well as the improvement of the techniques used in diagnostic imaging, for example, equipment for conventional X-rays, CT scans, mammography, hemodynamic and others. Although the benefits of using of radiology techniques are unquestionable, the lack of training in radiation protection of the workers, associated with procedure errors, have been responsible for the increasing number of radiation overexposures of these workers. Sometimes these high doses are real and there is a true radiological accident. The radiation workers, named occupationally Exposed Individual (IOE), must comply with two national regulations: Governmental Decree 453/1998 of the National Agency of Sanitary Surveillance (Portaria 453/1998 ANVISA Agencia Nacional de Vigilancia Sanitaria), which establishes the basic guidelines for radiation protection in medial and dental radiology and; the Governmental Decree NR-32/2002 of the Ministry of Labour and Employment (Ministerio do Trabalho e Emprego), which establishes the basic guidelines for the worker's health. The two mandatory regulations postulate a detailed investigation in the event of radiation overexposure of an IOE. In order to advice the diagnostic institution to perform an efficient analysis, investigation and report of high doses, it is proposed the use of a computational tool named 'Medical SisRadiologia'. This software tool enables the compilation and record of radiological abnormal data occurred in a diagnostic institution. It will also facilitate the detailed analysis of the event and will increase the effectiveness and development of work performed by the Radiation Protection Service. At the end, a technical report is issued, in accordance with the regulations of the technical regulations, which could also be used as training tool to avoid another event in the future. (author)
... attendees on the concept of medical utilization and response integration. The overall goal is to engage... Oak Campus, 10903 New Hampshire Ave., Building 31 Conference Center, the Great Room (rm. 1503A), Silver Spring, MD 20993. Entrance for the public meeting participants (non-FDA-employees) is through...
Timler, Dariusz; Bogusiak, Katarzyna; Kasielska-Trojan, Anna; Neskoromna-Jędrzejczak, Aneta; Gałązkowski, Robert; Szarpak, Łukasz
The aim of the study was to verify the effectiveness of short text messages (short message service, or SMS) as an additional notification tool in case of fire or a mass casualty incident in a hospital. A total of 2242 SMS text messages were sent to 59 hospital workers divided into 3 groups (n=21, n=19, n=19). Messages were sent from a Samsung GT-S8500 Wave cell phone and Orange Poland was chosen as the telecommunication provider. During a 3-month trial period, messages were sent between 3:35 PM and midnight with no regular pattern. Employees were asked to respond by telling how much time it would take them to reach the hospital in case of a mass casualty incident. The mean reaction time (SMS reply) was 36.41 minutes. The mean declared time of arrival to the hospital was 100.5 minutes. After excluding 10% of extreme values for declared arrival time, the mean arrival time was estimated as 38.35 minutes. Short text messages (SMS) can be considered an additional tool for notifying medical staff in case of a mass casualty incident.
Vadera, Sumeet; Griffith, Sandra D; Rosenbaum, Benjamin P; Chan, Alvin Y; Thompson, Nicolas R; Kshettry, Varun R; Kelly, Michael L; Weil, Robert J; Bingaman, William; Jehi, Lara
The Accreditation Council for Graduate Medical Education (ACGME) established duty-hour regulations for accredited residency programs on July 1, 2003. It is unclear what changes occurred in the national incidence of medication errors in surgical patients before and after ACGME regulations. Patient and hospital characteristics for pre- and post-duty-hour reform were evaluated, comparing teaching and nonteaching hospitals. A difference-in-differences study design was used to assess the association between duty-hour reform and medication errors in teaching hospitals. We used the Nationwide Inpatient Sample database, which consists of approximately annual 20% stratified sample of all the United States nonfederal hospital inpatient admissions. A query of the database, including 4 years before (2000-2003) and 8 years after (2003-2011) the ACGME duty-hour reform of July 2003, was performed to extract surgical inpatient hospitalizations (N = 13,933,326). The years 2003 and 2004 were discarded in the analysis to allow for a wash-out period during duty-hour reform (though we still provide medication error rates). The Nationwide Inpatient Sample estimated the total national surgical inpatients (N = 135,092,013) in nonfederal hospitals during these time periods with 68,736,863 patients in teaching hospitals and 66,355,150 in nonteaching hospitals. Shortly after duty-hour reform (2004 and 2006), teaching hospitals had a statistically significant increase in rate of medication error (p = 0.019 and 0.006, respectively) when compared with nonteaching hospitals even after accounting for trends across all hospitals during this period. After 2007, no further statistically significant difference was noted. After ACGME duty-hour reform, medication error rates increased in teaching hospitals, which diminished over time. This decrease in errors may be related to changes in training program structure to accommodate duty-hour reform. Copyright © 2015 Association of Program Directors in
Gathright, Molly M; Thrush, Carol; Guise, J Benjamin; Krain, Lewis; Clardy, James
In order to better understand the professional development of medical students during their psychiatry clerkship, this study identifies common themes and characteristics of students' critical incident narratives which are designed to capture a recount of clerkship experiences they perceived as meaningful. A total of 205 narratives submitted by psychiatry clerkship students in 2010-2011 were subjected to a thematic analysis using a methodological approach and adaptation of categories derived from prior similar research. Descriptive content analysis was also carried out to assess the valence of the narrative content, characters involved, and whether there was evidence that the experience changed students' perspectives in some way. Narratives contained a variety of positive (19%) and negative content (24%) and many contained a hybrid of both (57%). The most common theme (29%) concerned issues of respect and disrespect in patient, clinical, and coworker interactions. In general, the majority (68%) of students' meaningful experience narratives reflected a change in their perspective (e.g., I learned that...). Narratives containing positive and hybrid content were associated with a change in students' perspective (χ(2) = 10.61, df = 2, p learning environment. Positive and hybrid critical incident narratives were associated with a stated change in their beliefs, attitudes, or behaviors due to the experience. Understanding the events that are meaningful to students can also provide rich feedback to medical educators regarding the ways in which students perceive clinical learning environments and how to best foster their professional development.
camp. Capt Saunders and the two companies. (58th Regiment) under his command resisted a strong attack on 22 February in which one of his. men, Private Osborne, gallantly saved a fellow- soldier (he was awarded the Victoria Cross afterwards). Saunders, who was promoted to. Major in July 1881, received the brevity ...
Marine Corps Tiaining Systems (CBESS) memorization training Inteligence Center, Dam Neck Threat memorization training Commander Tactical Wings, Atlantic...News Shipbuilding Technical training AEGIS Training Center, Dare Artificial Intelligence (Al) Tools Computerized firm-end analysis tools NETSCPAC...Technology Department and provides computational and electronic mail support for research in areas of artificial intelligence, computer-assisted instruction
CFAR Constant False Alarm Rate CWIE Command Wire-Improvised Explosive Device EMI Electromagnetic Induction GPR Ground Penetrating Radar...this, some type of constant false alarm rate ( CFAR ) receiver is required. CFAR automatically raises the threshold level to keep clutter echoes and
Full Text Available Recent studies suggested that insulin glargine use could be associated with increased risk of cancer. We compared the incidence of cancer in new users of glargine versus new users of NPH in a longitudinal clinical cohort with diabetes for up to 6 years.From all patients who had been regularly followed at Massachusetts General Hospital from 1/01/2005 to 12/31/2010, 3,680 patients who had a medication record for glargine or NPH usage were obtained from the electronic medical record (EMR. From those we selected 539 new glargine users (age: 60.1±13.6 years, BMI: 32.7±7.5 kg/m2 and 343 new NPH users (61.5±14.1 years, 32.7±8.3 kg/m2 who had no prevalent cancer during 19 months prior to glargine or NPH initiation. All incident cancer cases were ascertained from the EMR requiring at least 2 ICD-9 codes within a 2 month period. Insulin exposure time and cumulative dose were validated. The statistical analysis compared the rates of cancer in new glargine vs. new NPH users while on treatment, adjusted for the propensity to receive one or the other insulin. There were 26 and 28 new cancer cases in new glargine and new NPH users for 1559 and 1126 person-years follow-up, respectively. There were no differences in the propensity-adjusted clinical characteristics between groups. The adjusted hazard ratio for the cancer incidence comparing glargine vs. NPH use was 0.65 (95% CI: 0.36-1.19.Insulin glargine is not associated with development of cancers when compared with NPH in this longitudinal and carefully retrieved EMR data.
Moore, Jennifer; Mello, Michelle M
Despite the investment in exploring patient-centred alternatives to medical malpractice in New Zealand (NZ), the UK and the USA, patients' experiences with these processes are not well understood. We sought to explore factors that facilitate and impede reconciliation following patient safety incidents and identify recommendations for strengthening institution-led alternatives to malpractice litigation. We conducted semistructured interviews with 62 patients injured by healthcare in NZ, administrators of 12 public hospitals, 5 lawyers specialising in Accident Compensation Corporation (ACC) claims and 3 ACC staff. NZ was chosen as the research site because it has replaced medical malpractice litigation with a no-fault scheme. Thematic analysis was used to identify key themes from interview transcripts. Interview responses converged on five elements of the reconciliation process that were important: (1) ask, rather than assume, what patients and families need from the process and recognise that, for many patients, being heard is important and should occur early in the reconciliation process; (2) support timely, sincere, culturally appropriate and meaningful apologies, avoiding forced or tokenistic quasi-apologies; (3) choose words that promote reconciliation; (4) include the people who patients want involved in the reconciliation discussion, including practitioners involved in the harm event; and (5) engage the support of lawyers and patient relations staff as appropriate. Policymakers and healthcare institutions are keenly interested in non-litigation approaches to resolving malpractice incidents. Interviewing participants involved in patient safety incident reconciliation processes suggests that healthcare institutions should not view apology as a substitute for other remedial actions; use flexible guidelines that distil best-practice principles, ensuring that steps are not missed, while not prescribing a 'one size fits all' communication approach. Published by the
Putcha, Lakshmi; Younker, D.; Daniels, V.
Astronauts use medications for the treatment of a variety of illnesses during space travel. Data mining efforts to assess minor clinical conditions occurring during Shuttle flights STS-1 through STS-94 revealed that space motion sickness (SMS) was the most common ailment during early flight days, occurring in approx.40% of crewmembers, followed by digestive system disturbances (9%) and infectious diseases, which most commonly involved the respiratory or urinary tracts. A more recent analysis of postflight medical debriefs data to examine trends with respect to medication use by astronauts during spaceflights indicated that 37% of all prescriptions recorded was for pain followed by sleep (22%), SMS (18%), decongestion (14%), and all others (14%). Further analysis revealed that about 150 of 317 crewmembers experienced symptoms of SMS. Nearly all (132 of 150) crewmembers took medication for the treatment of symptoms with a total of 387 doses. Promethazine was taken most often (201 doses); in most cases this resulted in alleviation of symptoms with 130 crewmembers (65%) reporting feeling much or somewhat better. Although fewer total doses of the combination of promethazine and dextroamphetamine (Phen/Dex) were taken (45 doses), slightly more than half of these doses resulted in improvement. The combination of scopolamine and dextroamphetamine (Scop/Dex) was reported to be effective in only 37% of cases, with 36 of 97 total doses resulting in improvement. A higher percentage (24%) of Scop/Dex doses was reported to be ineffective compared with promethazine alone or as Phen/Dex (10% and 7%, respectively). Comparisons of the effectiveness of the different dosage forms of promethazine revealed that intramuscular injection was most effective in alleviating symptoms with 55% feeling much better, 16% feeling somewhat better, and only 7% feeling no effect or worse. Overall, it appears that promethazine alone was used more frequently during flight and was reported effective for
Full Text Available Abstract Background Hospitals have a critically important role in the management of mass causality incidents (MCI, yet there is little information to assist emergency planners. A significantly limiting factor of a hospital's capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations. Methods The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission. Results From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%, pelvic injuries (11.5%, thoracic injuries (5.0% and major amputations (3.1%. The mean cut to suture time was 130 min (IQR 65-165 min. Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00, ISS ≥ 35 (OR 2,94, hemoglobin level ≤ 8 mg/dL (OR 1,40, pulse rate on hospital admission 120/min (OR 1,39, blood pressure on hospital admission Conclusions The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.
Neurology 24340 26867 23863 BAL Nutrition 23513 19809 24565 BAQ Infectious Desease 15786 17286 18642 BAZ Medicine Clinic 575 1661 1151 HB Medical...Clinic Source CHAMPUS Hospital Source 0 0 C Allergy 0____ ____ ____ ____ _ _ _ e Cardiology (heart) _ Dermatology ( skin ) C) Diet 0 Emergency Room
Mansouri, Mohammad; Aran, Shima; Shaqdan, Khalid W.; Abujudeh, Hani H.
Our goal is to present our multi-year experience in incident reporting in CT in a large medical centre. This is an IRB-approved, HIPAA-compliant study. Informed consent was waived for this study. The electronic safety incident reporting system of our hospital was searched for the variables from April 2006 to September 2012. Incident classifications were diagnostic test orders, ID/documentation, safety/security/conduct, service coordination, surgery/procedure, line/tube, fall, medication/IV safety, employee general incident, environment/equipment, adverse drug reaction, skin/tissue and diagnosis/treatment. A total of 1918 incident reports occurred in the study period and 843,902 CT examinations were performed. The rate of safety incident was 0.22 % (1918/843,902). The highest incident rates were due to adverse drug reactions (652/843,902 = 0.077 %) followed by medication/IV safety (573/843,902 = 0.068 %) and diagnostic test orders (206/843,902 = 0.024 %). Overall 45 % of incidents (869/1918) caused no harm and did not affect the patient, 33 % (637/1918) caused no harm but affected the patient, 22 % (420/1918) caused temporary or minor harm/damage and less than 1 % (10/1918) caused permanent or major harm/damage or death. Our study shows a total safety incident report rate of 0.22 % in CT. The most common incidents are adverse drug reaction, medication/IV safety and diagnostic test orders. (orig.)
Gatwood, Justin D; Chisholm-Burns, Marie; Davis, Robert; Thomas, Fridtjof; Potukuchi, Praveen; Hung, Adriana; Kovesdy, Csaba P
Medication nonadherence is a prevalent public health issue, particularly among patients with diabetes mellitus (DM), and negatively affects health outcomes. Because of the prevalence of DM among U.S. veterans, it is crucial to understand how well these patients adhere to oral antidiabetic (OAD) medication and whether certain subgroups are more likely to be nonadherent. To assess initial OAD medication use among veterans with uncomplicated DM and determine factors associated with adherence in the first 2 years of treatment. This was a retrospective cohort study using data from the Veterans Affairs (VA) Corporate Data Warehouse from 2002 through 2014. The first diagnosis for uncomplicated DM was determined, and then medication use was assessed following OAD initiation. OAD use was assessed by proportion of days covered (PDC) for the first 2 years of therapy using outpatient VA pharmacy records. Adherence was determined both continuously and categorically, with a PDC of ≥ 80% used to indicate adherence. Logistic regression was used to determine if certain patient characteristics were associated with being adherent to OADs. A total of 148,544 veterans with uncomplicated DM were assessed, most of whom were white, aged ≥ 55 years, and initiated OAD therapy on metformin. A large portion resided in the southern part of the United States. In the first year, PDC averaged 79.2% (SD = 25.9), and 63.2% were adherent to OAD therapy; however, these numbers declined in the second year, when the average PDC was 71.3% (SD = 35.8), and only 59.1% were adherent. Over the course of both years, PDC averaged 75.3% (SD = 28.4), and 50.9% were adherent. The odds of being adherent were higher among older adults and significantly lower among veterans self-identifying as either African American (OR = 0.61; 95% CI = 0.59-0.63), Native American (OR = 0.67; 95% CI = 0.61-0.75), or Hawaiian/Pacific Islander (OR = 0.84; 95% CI = 0.76-0.92) when compared with whites. Veterans who were either
Kosiński, Sylweriusz; Bryja, Magdalena; Wojtaszowicz, Rafał; Górka, Andrzej
Experience of pain associated with both chronic as well as acute medical conditions is a main cause for call for ambulance. The aim of this study was to establish both frequency and characteristics of pain reported by patients treated in pre-hospital environment in a single operational area. The supplementary goal was an analysis of methods of pain alleviation applied by medical personnel in the above described scenario. The written documentation of 6 months of year 2009 provided by doctor-manned as well as paramedic-only ambulances operating in Tatra county, Małopolska, Poland was analyzed. Medical personnel inquired about pain experienced in 57.4% of cases, 10-point numerical rating scale was used in 22.3% of patients. Pain was reported by 43.8% of patients, the most frequent reasons of experienced pain were trauma and cardiovascular diseases. In almost half of the cases pain was referred to the areas of chest and abdomen. Non-traumatic pain was reported by 47.7% of patients, post-traumatic in 41.3% of cases, 11% of subjects reported ischemic chest pain. 42.3% of pain-reporting patients received some form of analgesia, yet only 3% of subjects in this group received opiates. Personnel of paramedic-only ambulances tended to use pain intensity scale more often (P pain alleviating drugs noticeably less often than the doctor-manned teams (P pain alleviating drugs, opiates especially, was inadequate in proportion to frequency and intensity of pain reported by patients. General, nation-wide standards of pain measurement and treatment in pre-hospital rescue are suggested as a means to improve the efficacy of pain reduction treatment.
Prat, Dominique; Messika, Jonathan; Avenel, Alexandre; Jacobs, Frédéric; Fichet, Jérome; Lemeur, Matthieu; Ricard, Jean-Damien; Sztrymf, Benjamin
Constipation incidence and impact remain controversial in the ICU. This may depend on the definition criterion used in the previous studies on the field. We aimed to determine the frequency and significance of constipation according to its definition criterion. This is a prospective observational study. Adult patients without a cause of transit time modification and laxative intake within the first 3 days were screened. Constipation was defined by a first stool passage occurring after 3 days of ICU stay. Thereafter, we identified two subgroups of patients: absence of stool passage more than 3 days but less than 6 days (3-day subgroup), and no stool passage for 6 days or more (6-day subgroup). Survival, length of stay and time spent under mechanical ventilation (MV) were compared according to constipation status. Among 189 included patients [age 60.8 (49.5-74.2) years, SAPS II 44 (34-53)], 98 (51.9%) exhibited constipation (3-day subgroup n=53, 6-day subgroup n=45). Constipated patients were more likely to receive MV, sedation, vasopressors, enteral nutrition and neuromuscular blocking agents. ICU length of stay and time spent under MV was longer in the 6-day subgroup but not in the 3-day subgroup of patients. With regard to outcomes, defining constipation by the absence of stool passage less than 6 days after ICU admission does not identify a specific subset of population. Further studies on the management of this condition should focus on these 'long-term' constipated patients.
Isaac, Gayle; Moore, Brian
Tornados, shootings, fires--these are emergencies that require fast action by school district personnel, but they are not the only incidents that require risk management. The authors have introduced the National Incident Management System (NIMS) and the Incident Command System (ICS) and assured that these systems can help educators plan for and…
Jacobsen, Christian Bøtcher; Hvidtved, Johan; Andersen, Lotte Bøgh
Motivated employees are crucial to organizations, but external interventions such as command systems and financial incentives may decrease motivation. If these external interventions are perceived to be controlling, they are expected to crowd out intrinsic motivation, and this may also apply...... to other types of autonomous motivation such as public service motivation. The perception of external interventions is thus expected to be vital. This article investigates how the perception of a specific command system (obligatory student plans) is associated with intrinsic motivation and public service...... motivation. Using a dataset with 3,230 school teachers in Denmark, a structural equation model shows that the perception of obligatory student plans as controlling is negatively associated with all of the investigated types of employee motivation, supporting that motivation crowding can occur....
Shimada, Yutaka; Fujimoto, Makoto; Nogami, Tatsuya; Watari, Hidetoshi; Kitahara, Hideyuki; Misawa, Hiroki; Kimbara, Yoshiyuki
Kampo medicine is traditional Japanese medicine, which originated in ancient traditional Chinese medicine, but was introduced and developed uniquely in Japan. Today, Kampo medicines are integrated into the Japanese national health care system. Incident reporting systems are currently being widely used to collect information about patient safety incidents that occur in hospitals. However, no investigations have been conducted regarding patient safety incident reports related to Kampo medicines. The aim of this study was to survey and analyse incident reports related to Kampo medicines in a Japanese university hospital to improve future patient safety. We selected incident reports related to Kampo medicines filed in Toyama University Hospital from May 2007 to April 2017, and investigated them in terms of medication errors and adverse drug events. Out of 21,324 total incident reports filed in the 10-year survey period, we discovered 108 Kampo medicine-related incident reports. However, five cases were redundantly reported; thus, the number of actual incidents was 103. Of those, 99 incidents were classified as medication errors (77 administration errors, 15 dispensing errors, and 7 prescribing errors), and four were adverse drug events, namely Kampo medicine-induced interstitial pneumonia. The Kampo medicine (crude drug) that was thought to induce interstitial pneumonia in all four cases was Scutellariae Radix, which is consistent with past reports. According to the incident severity classification system recommended by the National University Hospital Council of Japan, of the 99 medication errors, 10 incidents were classified as level 0 (an error occurred, but the patient was not affected) and 89 incidents were level 1 (an error occurred that affected the patient, but did not cause harm). Of the four adverse drug events, two incidents were classified as level 2 (patient was transiently harmed, but required no treatment), and two incidents were level 3b (patient was
Baker, Meghan A; Butler, Melissa G; Seymour, Sally; Zhang, Fang; Wu, Yute; Wu, Ann Chen; Levenson, Mark S; Wu, Pingsheng; Iyer, Aarthi; Toh, Sengwee; Iyasu, Solomon; Zhou, Esther H
Evidence of safety issues associated with long-acting beta 2 -agonist (LABA) treatment has led to multiple regulatory activities by the U.S. Food and Drug Administration (FDA) on this class of medications. This study describes the impact of the regulatory activities on incident LABA-containing medication dispensing. A monthly rolling cohort of asthma patients who were eligible to initiate a LABA-containing product was created in the Mini-Sentinel Distributed Database between January 2005 and June 2011. Cohorts of individuals who initiated LABA were examined for the changes in the proportions of single-ingredient to fixed-dose inhaled corticosteroid (ICS)-LABA initiators, appropriate initiation of LABA-containing products, and use of controller medications. The impact of the 2005 and 2010 FDA regulatory activities associated with LABA-containing products was measured using interrupted time series with segmented regression. LABA-containing product initiation was declining prior to the 2005 regulatory activities and continued to decline over the study period, accompanied by increased initiation of fixed dose ICS-LABA among LABA initiators. While the 2010 regulatory activities had no immediate impact on the proportion of LABA initiation in patients with prior controller medication dispensing and/or poor asthma control, there was an increasing positive trend toward LABA initiation in the appropriate patient population after the regulatory activities. The 2005 and 2010 FDA regulatory activities likely had an impact on communicating the safety concerns of LABA products. However, the impact cannot be viewed independent of scientific publications, guidelines for asthma treatment and other regulatory activities.
Full Text Available Norovirus is a leading cause of gastroenteritis episodes and outbreaks in US military deployments, but estimates of endemic disease burden among military personnel in garrison are lacking.Diagnostic codes from gastroenteritis-associated medical encounters of active duty military personnel and their beneficiaries from July 1998-June 2011 were obtained from the Armed Forces Health Surveillance Center. Using time-series regression models, cause-unspecified encounters were modeled as a function of encounters for specific enteropathogens. Model residuals (representing unexplained encounters were used to estimate norovirus-attributable medical encounters. Incidence rates were calculated using population data for both active duty and beneficiary populations.The estimated annual mean rate of norovirus-associated medically-attended visits among active duty personnel and their beneficiaries was 292 (95% CI: 258 to 326 and 93 (95% CI: 80 to 105 encounters per 10,000 persons, respectively. Rates were highest among beneficiaries <5 years of age with a median annual rate of 435 (range: 318 to 646 encounters per 10,000 children. Norovirus was estimated to cause 31% and 27% of all-cause gastroenteritis encounters in the active duty and beneficiary populations, respectively, with over 60% occurring between November and April. There was no evidence of any lag effect where norovirus disease occurred in one population before the other, or in one beneficiary age group before the others.Norovirus is a major cause of medically-attended gastroenteritis among non-deployed US military active duty members as well as in their beneficiaries.
Full Text Available Clostridium difficile is the most common cause of nosocomial diarrhea. It is usually a consequence of antibiotic treatment, But sporadic cases can occur. This study was aimed to determine the frequency of the nosocomial Clostridium difficile (C. difficile associated diarrhea in Tehran University of Medical Sciences hospitals and study of antibacterial susceptibility of isolates. In this study a total of 942 stool samples from patients with nosocomial diarrhea that were hospitalized in Imam Khomeini hospital, Shariati hospital and Children clinical center were collected. The samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA and incubated in anaerobic conditions, at 37°C for 5 days. Isolates were characterized to species level by conventional biochemical tests. Bacterial cytotoxicity was assayed on tissue culture (vero. Antimicrobial sensitivity of isolated toxigenic C. difficile were investigated by kirby Beuer method (disk diffusion. Our findings show that, of the total patients, 57 toxigenic C. difficile (6.1% were isolated. Results of statistical analysis show significant differences between the rate of isolated toxigenic C. difficile and age group of patients (P
Baird, Katherine Elizabeth
Health care policy seeks to ensure that citizens are protected from the financial risk associated with needing health care. Yet rising health care costs in many countries are leading to a greater reliance on out-of-pocket (OOP) measures. This paper uses 2010 household survey data from seven countries to measure and compare the burden OOP expenses place on individuals. It compares countries based on the extent to which citizens with health problems devote a large share of their income to OOP expenses. The paper finds that in all countries but France, and to a lesser extent Slovenia, citizens with health problems face considerably higher medical costs than do those without. As many as one-quarter of less healthy citizens in the US, Poland, Russia and Israel devote a large share of their income to OOP expenses. The paper also finds a strong cross-national correlation between the degree to which citizens face high OOP expenses, and the disparities in OOP expenses between those with and without health problems. The levels of high OOP spending uncovered, and their inequitable impact on those with health problems in the seven countries, underscore the potential for OOP measures to undermine core objectives of health care systems, including those of equitable financing, equal access, and improved health among the population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Maglogiannis, I; Hadjiefthymiades, S
Recent developments in positioning systems and telecommunications have provided the technology needed for the development of location aware medical applications. We developed a system, named EmerLoc, which is based upon this technology and uses a set of sensors that are attached to the patient's body, a micro-computing unit which is responsible for processing the sensor readings and a central monitoring unit, which coordinates the data flow. To demonstrate that the proposed system is technically feasible and acceptable for the potential users. Transmission speed is assessed mostly by means of transmission of DICOM compliant images in various operational scenarios. The positioning functionality was established both outdoor using GPS and indoor using the UCLA Nibble system. User acceptability was assessed in a hospital setting by 15 physicians who filled in a questionnaire after having used the system in an experimental setting. Transmission speeds ranged from 88kB/s for a IEEE 802.11 infrastructure to 2.5kB/s for a GSM/GPRS scenario. Positioning accuracy based on GPS was 5-10m. The physicians rated the technical aspects on average above 3 on a 5-point scale. Only the data presentation was assessed to be not satisfactory (2.81 on a 5-point scale). The reported results prove the feasibility of the proposed architecture and its alignment with widely established practices and standards, while the reaction of potential users who evaluated the system is quite positive.
Jee, Sun Ha; Boulware, L Ebony; Guallar, Eliseo; Suh, Il; Appel, Lawrence J; Miller, Edgar R
Proteinuria is a major risk factor for the progression of kidney disease and the development of cardiovascular disease. Little is known, however, about risk factors for incident proteinuria. We conducted a 10-year prospective cohort study of 104,523 Korean men and 52,854 women, aged 35 to 59 years, who attended Korea Medical Insurance Corporation health examinations and who did not have proteinuria at baseline. Incident proteinuria was assessed at biennial examinations during the next 10 years. We performed Cox proportional hazards analyses. During 10 years of follow-up, proteinuria developed in 3951 men (3.8%) and 1527 women (2.9%). The adjusted relative risk (RR) of proteinuria associated with diabetes was 3.27 (95% confidence interval [CI], 2.98-3.58) in men and 2.60 (95% CI, 1.98-3.43) in women; with body mass index (calculated as weight in kilograms divided by the square of height in meters), it was 1.43 (95% CI, 1.35-1.50) in men and 1.45 (95% CI, 1.35-1.55) in women per 5-U increment. Compared with subjects with serum cholesterol levels of less than 200 mg/dL ( or = 6.22 mmol/L) were 1.13 (95% CI, 1.05-1.21) and 1.40 (95% CI, 1.27-1.54), respectively, in men and 1.14 (95% CI, 1.01-1.28) and 1.22 (95% CI, 1.00-1.37), respectively, in women. Persons with stages 1 and 2 hypertension had a greater adjusted RR of incident proteinuria compared with those with normal blood pressure (1.62 [95% CI, 1.47-1.79] and 2.06 [95% CI, 1.81-2.34], respectively, in men and 1.37 [95% CI, 1.14-1.65] and 2.10 [95% CI, 1.59-2.76], respectively, in women). Fasting glucose and cholesterol levels, body mass index, and blood pressure were direct and independent predictors of incident proteinuria in Korean adults. These associations were present even at low levels of exposure, emphasizing the importance of early detection and management of these modifiable risk factors.
elephant grass . Local Montagnard tribesmen called Ap Bia “the mountain of the crouching beast.“” Lieutenant Colonel Weldon Honeycutt, commander of the...for an orchestral composition .“35 In asserting this, Monash brought to bear his extensive experience as a civil engineer. He valued detailed...ould stioned f they alistic i se unist neral, n V er 8, i i se l r, n d i sar, , stioned r i se nist nd se nist rt ’ tral litary i sion
Major incident medical management and support: The practical approach at the scene Kevin Mackway-Jones Major Incident Medical Management and Support: The Practical Approach at the Scene Wiley-Blackwell £41.99 196pp 9781405187572 1405187573 [Formula: see text].
ALTHOUGH THIS excellent, informative book is intended primarily to be a manual for the pre-major incident medical management and support course, it would be a useful resource in any emergency department and a useful guide for individual nurses who provide care at major incident scenes.
Bradley, M.M.; Baskett, R.L.; Ellis, J.S.
The Atmospheric Release Advisory Capability (ARAC) at Lawrence Livermore National Laboratory (LLNL) is a centralized federal facility designed to provide real-time, world-wide support to military and civilian command and control centers by predicting the impacts of inadvertent or intentional releases of nuclear, biological, or chemical materials into the atmosphere. ARAC is a complete response system consisting of highly trained and experienced personnel, continually updated computer models, redundant data collection systems, and centralized and remote computer systems. With over 20 years of experience responding to domestic and international incidents, strong linkages with the Department of Defense, and the ability to conduct classified operations, ARAC is a unique command and control resource
Dees, D Dustin; Spahn, Kate J; Wagner, Lynsey Smith; Greller, Andrew; Paglia, Danielle; Armour, Micki D; Madsen, Richard
To determine whether topical hypotensive medications prevent postoperative ocular hypertension (POH) after phacoemulsification. 52 client-owned dogs (88 eyes). Diabetic and nondiabetic dogs having undergone phacoemulsification were included in this retrospective study. The control group received no ocular hypotensive medications. The treatment groups received latanoprost, dorzolamide, or dorzolamide/timolol, beginning immediately after surgery, for 2-week duration. IOPs were obtained at initial examination followed by 4 h, 24 h, 7 days, and 14 days postoperatively. POH was defined as an IOP above 20 mmHg (POH20) or 25 mmHg (POH25). POH20 occurred in 33 of 87 eyes (37.93%), including 11 of 21 eyes (52.38%) in the control group, three of 23 eyes (13.04%) in the latanoprost group, eight of 15 eyes (53.33%) in the dorzolamide group, and 11 of 28 eyes (39.29%) in the dorzolamide/timolol group. Active treatment groups were compared to the control group, and the overall group effect was not significant (P = 0.11). POH25 occurred in 22 of 86 eyes (25.58%), including seven of 21 eyes (33.33%) in the control group, two of 23 eyes (8.70%) in the latanoprost group, five of 15 eyes (33.33%) in the dorzolamide group, and eight of 27 eyes (29.63%) in the dorzolamide/timolol group. Active treatment groups were compared to the control group, and the overall group effect was not significant (P = 0.31). Intraoperative use of intracameral tissue plasminogen activator significantly decreased the chances of POH25 (P = 0.0063). The latanoprost group had a substantially lower percentage of POH 20 and POH25 compared to the control and other active treatment groups, although statistical significance was not achieved. Intraoperative intracameral tissue plasminogen activator decreased the incidence of POH25. © 2017 American College of Veterinary Ophthalmologists.
Borst, Jorien M.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.
A high prevalence of mental health problems (i.e. depression and/or anxiety) has been found in medical students in comparison with the general population. Therefore, the objective was first to study the prevalence and 1-year incidence of symptoms of depression, anxiety and any mental health problems
Agampodi, Suneth B; Dharmaratne, Samath D; Thevanesam, Vasanthi; Dassanayake, Sameera; Kumarihamy, Prabhashini; Ratnayake, Ashani
The adult population in Sri Lanka is having high level of susceptibility for Varicella Zoster Virus (VZV) infection. Among medical undergraduates, 47% are VZV seronegative. The purpose of the present study was to determine the incidence of VZV infection in medical undergraduates in Sri Lanka, and to describe the effects of VZV infection on their academic activities. A retrospective cohort of medical undergraduates' susceptible for VZV infection was selected from the University of Peradeniya, Sri Lanka. Data on the incidence of VZV infection (Chickenpox) during their undergraduate period was collected using a self-administered structured questionnaire. A second questionnaire was administered to collect data on the details of VZV infection and the impact of it on their academic activities. VZV incidence rate was calculated as the number of infections per 1,000 person years of exposure. Descriptive statistics were used to describe the impact of VZV infection on academic activities. Out of the 172 susceptible cohort, 153 medical undergraduates were followed up. 47 students reported VZV infection during the follow up period and 43 of them participated in the study. The cumulative incidence of VZV infection during the period of five and half years of medical training was 30.7%. Incidence density of VZV infection among medical undergraduates in this cohort was 65.1 per 1,000 person years of follow-up. A total of 377 working days were lost by 43 students due to the VZV infection, averaging 8.8 days per undergraduate. Total academic losses for the study cohort were; 205 lectures, 17 practicals, 13 dissection sessions, 11 tutorials, 124 days of clinical training and 107 days of professorial clinical appointments. According to their perception they lost 1,927 study hours due to the illness (Median 50 hours per undergraduate). The incidence of VZV infection among Sri Lankan medical undergraduates is very high and the impact of this infection on academic activities causes
Background The adult population in Sri Lanka is having high level of susceptibility for Varicella Zoster Virus (VZV) infection. Among medical undergraduates, 47% are VZV seronegative. The purpose of the present study was to determine the incidence of VZV infection in medical undergraduates in Sri Lanka, and to describe the effects of VZV infection on their academic activities. Methods A retrospective cohort of medical undergraduates' susceptible for VZV infection was selected from the University of Peradeniya, Sri Lanka. Data on the incidence of VZV infection (Chickenpox) during their undergraduate period was collected using a self-administered structured questionnaire. A second questionnaire was administered to collect data on the details of VZV infection and the impact of it on their academic activities. VZV incidence rate was calculated as the number of infections per 1,000 person years of exposure. Descriptive statistics were used to describe the impact of VZV infection on academic activities. Results Out of the 172 susceptible cohort, 153 medical undergraduates were followed up. 47 students reported VZV infection during the follow up period and 43 of them participated in the study. The cumulative incidence of VZV infection during the period of five and half years of medical training was 30.7%. Incidence density of VZV infection among medical undergraduates in this cohort was 65.1 per 1,000 person years of follow-up. A total of 377 working days were lost by 43 students due to the VZV infection, averaging 8.8 days per undergraduate. Total academic losses for the study cohort were; 205 lectures, 17 practicals, 13 dissection sessions, 11 tutorials, 124 days of clinical training and 107 days of professorial clinical appointments. According to their perception they lost 1,927 study hours due to the illness (Median 50 hours per undergraduate). Conclusions The incidence of VZV infection among Sri Lankan medical undergraduates is very high and the impact of this
Joshua C Bis
antihypertensive therapy meta-analyses (Pinteraction > 5.0×10-8. Similarly, findings were null for meta-analyses restricted to 66 SNPs with significant main effects on coronary artery disease or blood pressure from large published genome-wide association studies (Pinteraction ≥ 0.01. Our results suggest that there are no major pharmacogenetic influences of common SNPs on the relationship between blood pressure medications and the risk of incident CVD.
Fondevila, Damian; Arbiser, Silvio; Sansogne, Rosana; Brunetto, Monica; Dosoretz, Bernardo
Primary barrier determinations for the shielding of medical radiation therapy facilities are generally made assuming normal beam incidence on the barrier, since this is geometrically the most unfavorable condition for that shielding barrier whenever the occupation line is allowed to run along the barrier. However, when the occupation line (for example, the wall of an adjacent building) runs perpendicular to the barrier (especially roof barrier), then two opposing factors come in to play: increasing obliquity angle with respect to the barrier increases the attenuation, while the distance to the calculation point decreases, hence, increasing the dose. As a result, there exists an angle (α max ) for which the equivalent dose results in a maximum, constituting the most unfavorable geometric condition for that shielding barrier. Based on the usual NCRP Report No. 151 model, this article presents a simple formula for obtaining α max , which is a function of the thickness of the barrier (t E ) and the equilibrium tenth-value layer (TVL e ) of the shielding material for the nominal energy of the beam. It can be seen that α max increases for increasing TVL e (hence, beam energy) and decreases for increasing t E , with a range of variation that goes from 13 to 40 deg for concrete barriers thicknesses in the range of 50-300 cm and most commercially available teletherapy machines. This parameter has not been calculated in the existing literature for radiotherapy facilities design and has practical applications, as in calculating the required unoccupied roof shielding for the protection of a nearby building located in the plane of the primary beam rotation
In 2001, U.S. amphibious forces abandoned sixty years of established command and control doctrine, replacing the traditional senior-subordinate relationship between Navy and Marine commanders with coequal command. Why did it change...
and outlines the C2 architecture systems, processes, and philosophy of com- mand required to enable mission command effectively. Mission Command...General Dempsey highlights the fact that “trust is the moral sinew that binds the distributed Joint Force 2020 together” and observes that “unless...con- fident about how their subordinates will make decisions and adapt to the dynamic battlespace environment. Processes, Systems, and Philosophy of
Dieckmann, P; Rall, M; Østergaard, Doris
We describe how simulation and incident reporting can be used in combination to make the interaction between people, (medical) technology and organisation safer for patients and users. We provide the background rationale for our conceptual ideas and apply the concepts to the analysis of an actual...... incident report. Simulation can serve as a laboratory to analyse such cases and to create relevant and effective training scenarios based on such analyses. We will describe a methodological framework for analysing simulation scenarios in a way that allows discovering and discussing mismatches between...... conceptual models of the device design and mental models users hold about the device and its use. We further describe how incident reporting systems can be used as one source of data to conduct the necessary needs analyses - both for training and further needs for closer analysis of specific devices or some...
This paper seeks to answer what type of command will best serve the Army's Objective Force in gaining the initiative, building momentum, and exploiting success to achieve land dominance in the future...
Koning, S W; Ellerbroek, P M; Leenen, L P H
This retrospective study reports the outcome of a mass casualty incident (MCI) caused by a fire in a nursing home. Data from the medical charts and registration system of the Major Incident Hospital (MIH) and ambulance service were analyzed. The evaluation reports from the MIH and an independent research institute were used. The protocol for reports from major accidents and disaster was used to standardize the reporting [Lennquist, in Int J Disaster Med 1(1):79-86, 2003]. The emergency services were quickly at the scene. The different levels of pre-hospital management performed a tight coordination. However, miscommunication led to confusion in the registration and tracking of patients. In total, 49 persons needed medical treatment, 46 were treated in the MIH. Because of (possible) inhalation injury nine patients needed mechanical ventilation and nine patients were hospitalized to exclude delayed onset of pulmonary symptoms. No incident related deaths occurred. The intensive care unit of the MIH was initially understaffed despite the efforts of the automated calling system and switchboard operators. The handwritten registration of incoming staff was incomplete and should be performed digitally. Some staff members were unfamiliar with the MIH procedures. The medical chart appeared too extensive. Miscommunication between chain partners resulted in the delayed sharing of (semi) medical information. The different levels of incident managers performed a tight coordination. The MIH demonstrated its potency to provide emergency care for 46 patients and 9 intubated patients. No deaths or persistent disabilities occurred. Areas of improvement were recognized both in the pre-hospital as the hospital phase.
Commanding Errors may be caused by a variety of root causes. It's important to understand the relative significance of each of these causes for making institutional investment decisions. One of these causes is the lack of standardized processes and procedures for command and control. We mitigate this problem by building periodic tables and models corresponding to key functions within it. These models include simulation analysis and probabilistic risk assessment models.
This command and data handling processor is designed to perform mission critical functions for the NEAR and ACE spacecraft. For both missions the processor formats telemetry and executes real-time, delayed and autonomy-rule commands. For the ACE mission the processor also performs spin stabilized attitude control. The design is based on the Harris RTX2010 microprocessor and the UTMC Summit MIL-STD-1553 bus controller. Fault tolerant features added include error detection, correction and write...
Francois P. Viljoen
Full Text Available The Gospel of Matthew was written during a period of dispute between the Matthean community and their fellow Jews, with the Pharisees playing a leading role. The Matthean community was heir to the same scriptures as its opponents. They continued to have a firm commitment to the Torah, but they developed a distinctive understanding of it based on Jesus’ teaching. The formation of this community is investigated in this article, considering the Mediterranean perspectives of group-oriented societies prevalent in the first century. Such a group provided a sense of self and an interactive support system, where love functioned to bind the group together. The subordinates showed their undivided loyalty towards their superiors because of the favours they received from them, whilst they supported and cared for other members within the group as they care for themselves. Reading the double love commandment of Matthew 22:34−40 from this perspective reveals significant aspects of the community’s identity with regard to their commitment to God and their view of their neighbours. Die Dubbele Liefdesgebod. Die Matteusevangelie is gedurende ’n periode van konfliktussen die Matteusgemeenskap en mede-Jode geskryf met die Fariseërs in ’n leidende rol. Die Matteusgemeenskap het van dieselfde geskrifte as hulle opponente gebruik gemaak. Hulle was steeds aan die Torah lojaal, maar het ’n unieke interpretasie daarvan gehuldig, gebaseer op die onderrig van Jesus. In hierdie artikel word die vorming van die Matteusgemeenskap ondersoek met inagneming van die Mediterreense beskouing van die groepgeoriënteerde gemeenskappe wat tipies van die eerste eeu was. So ’n groep het aan individue ’n bewustheid van eie waarde verskaf te midde van ’n interaktiewe ondersteuningsisteem waarin liefde as samebindende faktor gefunksioneer het. Ondergeskiktes het onverdeelde lojaliteit teenoor hulle meerderes betoon vanweë die gunste wat hulle van die meerderes geniet het
Conclusion: The results of present study provided references to healthcare institutes using balanced scorecard management strategies as intervention to reduce to fall incidents and injuries in elderly cancer patients and to prompt patient safety and quality of care.
Borst, Jorien M; Frings-Dresen, Monique H W; Sluiter, Judith K
A high prevalence of mental health problems (i.e. depression and/or anxiety) has been found in medical students in comparison with the general population. Therefore, the objective was first to study the prevalence and 1-year incidence of symptoms of depression, anxiety and any mental health problems among Dutch medical students and, second, to study which study-related and personal factors present a risk of these mental health problems. A 1-year prospective longitudinal study was performed among medical students of two medical faculties in the Netherlands (n=951). Health problems and study-related and personal factors were measured with an online questionnaire. Mental health problems were assessed by depression and/or anxiety symptoms (BSI-DEP and BSI-ANG). Univariate and multivariate hierarchical logistic regression analyses were performed to examine which of the study-related and personal factors predict mental health problems. At follow-up, 36%, 28% and 48% of the medical students reported symptoms of depression, anxiety and mental health problems, respectively. The incidence between 2010 and 2011 for depression was 20%, 17% for anxiety and 25% for mental health problems. Students who are worried about their own health during medical education are at an increased risk of future mental health problems (OR 2.0 [1.3-2.9], p=0.00). Excessive drinking behavior is a protective factor in this study (OR 0.7 [0.5-0.9], p=0.02). This study shows that only two out of nine factors are significantly associated with mental health problems among Dutch medical students, one risk factor and one protective factor.
Morgan, Ethan; Daum, Robert S; David, Michael Z
Background. The incidence of skin and soft tissue infections (SSTIs) in the United States increased sharply after 2000 with the emergence of USA300 methicillin-resistant Staphylococcus aureus . We examined trends in SSTI incidence in 2006-2014 at the University of Chicago Medicine (UCM). Methods. Data were obtained for patient encounters at UCM with an International Classification of Diseases, Ninth Revision -coded SSTI diagnosis between January 1, 2006 and March 31, 2014. Incidence density was calculated per 1000 encounters by quarter and year. Encounters were stratified by inpatient, outpatient clinic and emergency department (ED) encounters and by age group, gender, and race. Poisson regression was used to assess change over time. Results. In 2006-2014, data were collected for 38 201 SSTI-associated encounters among 31 869 subjects. Among all patients treated at UCM, there was a decrease of 1% per year in the incidence of SSTIs during 2006-2013, with an overall decrease of 16%. There was a significant decrease in SSTI-related encounters among inpatients (rate ratio [RR] = 0.97; 95% confidence interval [CI], .96-.98), ED patients (RR = 0.98; 95% CI, .97-.98), adults (RR = 0.98; 95% CI, .97-.98), children (RR = 0.96; 95% CI, .95-.97), and African Americans (RR = 0.99; 95% CI, .98-.99). There was an annual seasonal trend, with the peak incidence occurring during the late summer. Conclusions. The incidence of SSTIs at UCM decreased in children and adults with seasonal variation, peaking during the summer months. This suggests a reversal of the massive increase in SSTI incidence in the United States after 2000.
Full Text Available There have been concerns about the workplace interpersonal conflict (WIC among healthcare workers. As healthcare organizations have applied the incident reporting system (IRS widely for safety-related incidents, we proposed that this system might provide a channel to explore the WICs.We retrospectively reviewed the reports to the IRS from July 2010 to June 2013 in a medical center. We identified the WICs and typed these conflicts according to the two foci (task content/process and interpersonal relationship and the three properties (disagreement, interference, and negative emotion, and analyzed relevant data.Of the 147 incidents with WIC, the most common related processes were patient transfer (20%, laboratory tests (17%, surgery (16% and medical imaging (16%. All of the 147 incidents with WIC focused on task content or task process, but 41 (27.9% also focused on the interpersonal relationship. We found disagreement, interference, and negative emotion in 91.2%, 88.4%, and 55.8% of the cases, respectively. Nurses (57% were most often the reporting workers, while the most common encounter was the nurse-doctor interaction (33%, and the majority (67% of the conflicts were experienced concurrently with the incidents. There was a significant difference in the distribution of worker job types between cases focused on the interpersonal relationship and those without (p = 0.0064. The doctors were more frequently as the reporter when the conflicts focused on the interpersonal relationship (34.1% than not on it (17.0%. The distributions of worker job types were similar between those with and without negative emotion (p = 0.125.The institutional IRS is a useful place to report the workplace interpersonal conflicts actively. The healthcare systems need to improve the channels to communicate, manage and resolve these conflicts.
Gaal, S.; Verstappen, W.H.J.M.; Wolters, R.J.; Lankveld, H.; Weel, C. van; Wensing, M.J.P.
BACKGROUND: Patient safety can be at stake in both hospital and general practice settings. While severe patient safety incidents have been described, quantitative studies in large samples of patients in general practice are rare. This study aimed to assess patient safety in general practice, and to
.... However, along with its benefits, this command, control and communications (C3) network includes the dangerous consequence of eroding the autonomy of tactical command through enhanced micromanagement by risk-averse operational commanders...
officer to explain how she knows when equipment needs calibration. If she stutters and shifts her feet, your calibration program Tip may be non...Important Command Matters quizzes. Remember the sinking feeling in your stomach when a teacher popped an unannounced quiz on you? Well, your platoon
Machado, Andre Wilson
The search for esthetic treatment has persisted in the routine of dental professionals. Following this trend, dental patients have sought treatment with the primary aim of improving smile esthetics. The aim of this article is to present a protocol to assess patient's smile: The 10 Commandments of smile esthetics.
Union army commander Major General Meade arrives on the field after midnight and decides to defend his position on Cemetery Ridge. 0600 Meade orders...returning, and I hope the earnest and beautiful appeal made to the country in your proclamation may stir up the virtue of the whole people, and that they
Andre Wilson Machado
Full Text Available The search for esthetic treatment has persisted in the routine of dental professionals. Following this trend, dental patients have sought treatment with the primary aim of improving smile esthetics. The aim of this article is to present a protocol to assess patient's smile: The 10 Commandments of smile esthetics.
Batra, Rishi; Wolbach-Lowes, Jane; Swindells, Susan; Scarsi, Kimberly K; Podany, Anthony T; Sayles, Harlan; Sandkovsky, Uriel
Previous review of admissions from 2009-2011 in our institution found a 35.1% error rate in antiretroviral (ART) prescribing, with 55% of errors never corrected. Subsequently, our institution implemented a unified electronic medical record (EMR) and we developed a medication reconciliation process with an HIV pharmacist. We report the impact of the EMR on incidence of errors and of the pharmacist intervention on time to error correction. Prospective medical record review of HIV-infected patients hospitalized for >24 h between 9 March 2013 and 10 March 2014. An HIV pharmacist reconciled outpatient ART prescriptions with inpatient orders within 24 h of admission. Prescribing errors were classified and time to error correction recorded. Error rates and time to correction were compared to historical data using relative risks (RR) and logistic regression models. 43 medication errors were identified in 31/186 admissions (16.7%). The incidence of errors decreased significantly after EMR (RR 0.47, 95% CI 0.34, 0.67). Logistic regression adjusting for gender and race/ethnicity found that errors were 61% less likely to occur using the EMR (95% CI 40%, 75%; Perrors were corrected, 65% within 24 h and 81.4% within 48 h. Compared to historical data where only 31% of errors were corrected in errors were 9.4× more likely to be corrected within 24 h with HIV pharmacist intervention (Perror rate by more than 50% but despite this, ART errors remained common. HIV pharmacist intervention was key to timely error correction.
commanders must develop methods and processes to leverage the innovative thinking of all personnel, regardless of rank or position . “The...those of the author and do not reflect the official policy or position of the US government, the Department of Defense, or Air University. In...maintenance officer and has served in numerous positions maintaining C-141B, HC-130P, F-15C/E, E-3B, F-22A, and B-1 aircraft. He served as a
Full Text Available AIM & OBJE CTIVES OF THE STUDY: To diagnose sub - clinical airflow obstruction in apparently healthy medical personnel, and to compare Peak Expiratory Flow Rate (PEFR by using Spirometry and by Wright’s peak flow meter. METHODOLOGY: About 80 apparently healthy medical students including Post Graduates, internees and medical technicians were taken in to the study, all of them had no past history of Bronchial Asthma or any allergies. Spirometry was performed by Spirowin version 0.2 and simultaneously peak expiratory flow rate by Wright’s peak flow meter was done and FVC, FEV1, FEV1/FVC, PEFR were recorded. RESULTS: About 13 subjects (16.25% showed moderate obstruction (FEV1 about 70%, and at that point a family history of atopies and allergies could be elicited in most of them. PEFR showed a variation - 3.42 to 2.76 ltrs/sec ( - 205.74 to 165.62 ltrs/min between Spirometry and Wright’s peak flow meter. INTERPRETATION AND C ONCLUSION : In spite of being medical personnel and having a family history of Bronchial Asthma and other atopies none of the 13 (16.25% subjects with sub clinical obstruction had ever approached us for a pulmonary function test. This shows that Spirometry has to be popularized in medical personnel as well as in lay men as a means to diagnose Bronchial Asthma and COPD. Also there is difference in PEFR measured by Spirometry and Wright’s peak flow metry though the difference is not significant with a p=0.5398 .
Management Control System (AINCS) Briefing 19, Records Management Briefing 20. PCS Funding e.nd PCS Policy Changes Briefing 21. Channels for Assignment...Parsonnel (Dr) S.1 A3signment Policy Changes 2. Civilian Performance Appraisals and Awards 3, Enllisted Retention and Recruitment Programs 4, Family...3. Officer Force Manangement 14. Quality Control (QC) for Enlisted Personnel on Assignment 10. Rated Officer Retention 11. Squadron Commander
German resistance.2 Lack of surprise was not the only Allied shortfall. The Luftwaffe maintained superiority over the Tunisian battlefield with...night. F-Ills used a similar infrared system, known as Pave Tack, and blew up an oil pumping station to stop an ecological disaster. That was truly a...Air-Land Synchroniza- tion at the Operational LeveL Fort Leavenworth, Kans.: Command and General Staff College, 8 May 1989. Lorenz, Oliver E. TACAIR
PHILOSOPHY-After you publish your command philosophy (your overall modus operandi ), publish your training philosophy. It will estab- lish your guidelines... killer for the soldier and damages unit mo- rale. A good first sergeant will handle PLDC preparation for Vou. 126 Trraii ig Develop, where necessary. an...by serial numbers. Sub-hand receipt all weapons to your unit armorer. En- sure no soldier in your unit can draw a weapon from the arms room unless he
Ntiri, Michael Preko; Duque, Jazmin; McMorrow, Meredith L; Frimpong, Joseph Asamoah; Parbie, Prince; Badji, Edem; Nzussouo, Ndahwouh Talla; Benson, Eve-Marie; Adjabeng, Michael; Dueger, Erica; Widdowson, Marc-Alain; Dawood, Fatimah S; Koram, Kwadwo; Ampofo, William
Influenza vaccination is recommended by the World Health Organization for high risk groups, yet few data exist on influenza disease burden in West Africa. We estimated medically attended influenza-associated illness rates among residents of Shai-Osudoku and Ningo Pram-Pram Districts (SONPD), Ghana. From May 2013 to April 2015, we conducted prospective surveillance for severe acute respiratory illness (SARI) and influenza-like illness (ILI) in 17 health facilities. In 2015, we conducted a retrospective assessment at an additional 18 health facilities to capture all SONPD SARI and ILI patients during the study period. We applied positivity rates to those not tested to estimate total influenza cases. Of 612 SARI patients tested, 58 (9%) were positive for influenza. The estimated incidence of influenza-associated SARI was 30 per 100,000 persons (95% CI: 13-84). Children aged 0 to 4 years had the highest influenza-associated SARI incidence (135 per 100,000 persons, 95% CI: 120-152) and adults aged 25 to 44 years had the lowest (3 per 100,000 persons, 95% CI: 1-7) (p < 0.01). Of 2,322 ILI patients tested, 407 (18%) were positive for influenza. The estimated incidence of influenza-associated ILI was 844 per 100,000 persons (95% CI: 501-1,099). The highest incidence of influenza-associated ILI was also among children aged 0 to 4 years (3,448 per 100,000 persons, 95% CI: 3,727 - 3,898). The predominant circulating subtype during May to December 2013 and January to April 2015 was influenza A(H3N2) virus, and during 2014 influenza B virus was the predominant circulating type. Influenza accounted for 9% and 18% of medically attended SARI and ILI, respectively. Rates were substantive among young children and suggest the potential value of exploring the benefits of influenza vaccination in Ghana, particularly in this age group.
Higgins, Janet R; Lin, Feng-Chang; Evans, James P
Plagiarism is common and threatens the integrity of the scientific literature. However, its detection is time consuming and difficult, presenting challenges to editors and publishers who are entrusted with ensuring the integrity of published literature. In this study, the extent of plagiarism in manuscripts submitted to a major specialty medical journal was documented. We manually curated submitted manuscripts and deemed an article contained plagiarism if one sentence had 80 % of the words copied from another published paper. Commercial plagiarism detection software was utilized and its use was optimized. In 400 consecutively submitted manuscripts, 17 % of submissions contained unacceptable levels of plagiarized material with 82 % of plagiarized manuscripts submitted from countries where English was not an official language. Using the most commonly employed commercial plagiarism detection software, sensitivity and specificity were studied with regard to the generated plagiarism score. The cutoff score maximizing both sensitivity and specificity was 15 % (sensitivity 84.8 % and specificity 80.5 %). Plagiarism was a common occurrence among manuscripts submitted for publication to a major American specialty medical journal and most manuscripts with plagiarized material were submitted from countries in which English was not an official language. The use of commercial plagiarism detection software can be optimized by selecting a cutoff score that reflects desired sensitivity and specificity.
Mueller, John Paul
The perfect companion to any book on Windows Server 2008 or Windows 7, and the quickest way to access critical information. Focusing just on the essentials of command-line interface (CLI), Windows Command-Line Administration Instant Reference easily shows how to quickly perform day-to-day tasks of Windows administration without ever touching the graphical user interface (GUI). Specifically designed for busy administrators, Windows Command-Line Administration Instant Reference replaces many tedious GUI steps with just one command at the command-line, while concise, easy to access answers provid
Full Text Available Purpose: to research the breadth and type of the diseases among the primary school pupils aiming on the physical education optimization. Material and Methods: general data of the incidence of disease among the primary school pupils was revealed in the analysis of the medical documentation for 235 pupils of 1–4 grades at the general secondary school-lyceum in urban village Novofyodorovka. Results: it was revealed that the most wide spread health disorders at the primary school pupils are frequent respiratory diseases, functional disorders of locomotor apparatus and visual organs. Conclusions: the need of systematical application of the eyes exercises, breathing exercises as well as exercises for prophylaxis and correction of the skeleton deformations has been shown to increase the health-improving character of the physical education lessons at the primary school
a model highlighting three central presidential roles together constituting supreme command: the supreme political leader, the supreme leader of the military, and the supreme grand strategist. In short, central is the president’s ability to act in all three roles to provide the right balance of strategic...... advisers to assist him as required. The model’s centerpiece – the unequal dialogue – is a close, continuous dialogue between the president and his civilian and military advisers, characterized by mutual respect and trust and with the president encouraging and the advisers offering candid advice, but always...
Machado, Andre Wilson
The search for esthetic treatment has persisted in the routine of dental professionals. Following this trend, dental patients have sought treatment with the primary aim of improving smile esthetics. The aim of this article is to present a protocol to assess patient's smile: The 10 Commandments of smile esthetics. Pacientes em busca de tratamentos estéticos são uma constante na rotina de todos os profissionais que oferecem este tipo de serviço. Seguindo esta tendência, os pacientes odontoló...
moving bodies of forces, it offered a wide field for tactical and strategic moves; but as the masses engaged grew larger, the playground diminished in...completely prevent enemy traffic, defending ?itself and its own traffic from the submarine menace. Nowadays the command of the sea is to be understood only as...the winds of war. A man who is fighting a life-and-death fight-as all wars are nowadays -has the right to use any means to keep his life. War means
Yueh, Hsin-Tien; Sung, Hsien-Yi; Wu, Chia-Feng
Medical social workers apply the theories of "person in the environment" (PIE) and "ecological perspective" as practical foundations. Furthermore, they emphasize the people, the environment, and the interactions between these two. When burn patients from the explosion at Formosa Fun Coast were sent to hospitals, social workers not only provided care and assessed the impact on burn patients but also assisted in supporting the family members of these patients. This article discusses the various roles of social workers within different systems. In the individual system, we use Eric Erickson's theory of psychosocial development to evaluate the patient's crisis and the tasks of social workers. Secondly, in the systems of family, school, and work, we assess the relationships between a patient, his/her significant others, and caregivers as well as the interactions among sub-systems in the family. In the community and cultural systems, we focus on the social resources that may be utilized by the burn patients after discharge. Moreover, we add a time frame to examine our major tasks, including the initial stage, the middle stage, and the preparation-for-discharge stage. We explore the roles of social workers, the applicable theories, and the goals for each stage.
To improve error reporting so as to increase patient safety in a health care environment in which many barriers to reporting exist. Baylor Medical Center at Grapevine, a 104-bed hospital in Northeast Tarrant County that is part of the Baylor Health Care System. Partnering with DoctorQuality to provide a consolidated, Web-based form for error reporting, online education, and a risk analyzer, complemented by efforts toward cultural change including staff training, encouragement of feedback, and the use of financial and non-financial incentives to report errors. After implementing the system, the number of events reported increased 250% to 500% costs for data collection, analysis, and management decreased by dollar 25,000 to dollar 35,000 annually; and the time required to track errors and make improvements was reduced 25% to 50%. Further, managers and staff were very satisfied with the system, ranking it >4 on a 5-point scale. The institution's partnership with DoctorQuality to create a single Web-based form for error reporting was successful in improving efficiency and ease of access in reporting. Further, the institution was successful in creating a new organizational culture around errors. The success was due in part to strong leadership, collaboration of multi-disciplinary staff, the ease of use of the system itself, and the effective educational, motivational, and communication mechanisms used.
DiCarlo, Andrea L; Jackson, Isabel L; Shah, Jui R; Czarniecki, Christine W; Maidment, Bert W; Williams, Jacqueline P
Due to the ever-present threat of a radiological or nuclear accident or attack, the National Institute of Allergy and Infectious Diseases, Radiation Medical Countermeasures Program was initiated in 2004. Since that time, the Program has funded research to establish small and large animal models for radiation damage, as well as the development of approaches to mitigate/treat normal tissue damage following radiation exposure. Because some of these exposures may be high-dose, and yet heterogeneous, the expectation is that some victims will survive initial acute radiation syndromes (e.g. hematopoietic and gastrointestinal), but then suffer from potentially lethal lung complications. For this reason, efforts have concentrated on the development of animal models of lung irradiation damage that mimic expected exposure scenarios, as well as drugs to treat radiation-induced late lung sequelae including pneumonitis and fibrosis. Approaches targeting several pathways are under study, with the eventual goal of licensure by the United States Food and Drug Administration for government stockpiling. This Commentary outlines the status of countermeasure development in this area and provides information on the specifics of licensure requirements, as well as guidance and a discussion of challenges involved in developing and licensing drugs and treatments specific to a radiation lung damage indication.
Full Text Available Abstract Background Almost all studies of pathologic fractures have been conducted based on patients with tumours and hospital-based data; however, in the present study, a nationwide epidemiological survey of pathologic fractures in Taiwan was performed and the medical utilization was calculated. Methods All claimants of Taiwan's National Health Insurance (NHI Program in 2008 were included in the target population of this descriptive cross-sectional study. The registration and inpatient expenditure claims data by admission of all hospitalized subjects of the target population were examined and the concomitant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM diagnosis codes were evaluated and classified into seven major categories of fracture. Results A total of 5,244 incident cases of pathologic fracture were identified from the 2008 hospitalized patient claims data. The incidence of pathologic fracture of the humerus, distal radius/ulna, vertebrae, femoral neck, other part of the femur, and tibia/fibula was 0.67, 0.08, 10.58, 1.11, 0.56, and 0.11 per 100,000 people, respectively, and patients with those fractures were hospitalized for 43.9 ± 42.9, 31.1 ± 32.9, 29. 4 ± 34.4, 43.3 ± 41.2, 42.4 ± 38.1, and 42.0 ± 32.8 days, respectively, incurring an average medical cost of US$11,049 ± 12,730, US$9,181 ± 12,115, US$6,250 ± 8,021, US$9,619 ± 8,906, US$10,646 ± 11,024, and US$9,403 ± 9,882, respectively. The percentage of patients undergoing bone surgery for pathologic fracture of the humerus, radius/ulna, vertebrae, femoral neck, other part of the femur, and tibia/fibula was 31.2%, 44.4%, 11.3%, 46.5%, 48.4%, and 52.5% respectively. Conclusions Comparing Taiwan to other countries, this study observed for Taiwan higher medical utilization and less-aggressive surgical intervention for patients hospitalized with pathologic fractures.
Zhang, Guoming; Yan, Chen; Ji, Xiaoyu; Zhang, Taimin; Zhang, Tianchen; Xu, Wenyuan
Speech recognition (SR) systems such as Siri or Google Now have become an increasingly popular human-computer interaction method, and have turned various systems into voice controllable systems(VCS). Prior work on attacking VCS shows that the hidden voice commands that are incomprehensible to people can control the systems. Hidden voice commands, though hidden, are nonetheless audible. In this work, we design a completely inaudible attack, DolphinAttack, that modulates voice commands on ultra...
A multi-stream command language was implemented to provide the sequential and decision-making operations necessary to run the neutral-beam ion sources connected to the Doublet III tokamak fusion device. A multi-stream command language was implemented in Pascal on a Classic 7870 running under MAX IV. The purpose of this paper is threefold. First, to provide a brief description of the programs comprising the command language including the operating system interaction. Second, to give a description of the language syntax and commands necessary to develop a procedure stream. Third, to provide a description of the normal operating procedures for executing either the sequential or interactive streams
Federal Laboratory Consortium — FUNCTION: The Blossom Point Satellite Command and Tracking Facility (BP) provides engineering and operational support to several complex space systems for the Navy...
The future of the National Aeronautics and Space Administration (NASA) depends on its innovation and efficiency in the coming years. With ambitious goals to reach Mars and explore the vast universe, correct steps must be taken to ensure our space program reaches its destination safely. The interns in the Exploration Systems and Operations Division at the Kennedy Space Center (KSC) have been tasked with building command line tools to ease the process of managing and testing the data being produced by the ground control systems while its recording system is not in use. While working alongside full-time engineers, we were able to create multiple programs that reduce the cost and time it takes to test the subsystems that launch rockets to outer space.
and leader development processes. Further research could also explore the role of the individual Myers - Briggs Type Indicator in an individual’s...Platoon; Captain (CPT) Matthew Myer , Commander of Chosen Company; Lieutenant Colonel (LTC) William Ostlund, Commander of Second Battalion, 503rd...the chain of command for second platoon, and the direct link between the platoon and their company commander, CPT Myer . In a 2011 Vanity Fair article
... 32 National Defense 2 2010-07-01 2010-07-01 false Command relationships. 215.7 Section 215.7 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS EMPLOYMENT OF MILITARY RESOURCES IN THE EVENT OF CIVIL DISTURBANCES § 215.7 Command relationships...
Santos, Eugene; Nguyen, Hien; Russell, Jacob; Kim, Keumjoo; Veenhuis, Luke; Boparai, Ramnjit; Stautland, Thomas Kristoffer
A Commander's decision making style represents how he weighs his choices and evaluates possible solutions with regards to his goals. Specifically, in the naval warfare domain, it relates the way he processes a large amount of information in dynamic, uncertain environments, allocates resources, and chooses appropriate actions to pursue. In this paper, we describe an approach to capture a Commander's decision style by creating a cognitive model that captures his decisionmaking process and evaluate this model using a set of scenarios using an online naval warfare simulation game. In this model, we use the Commander's past behaviors and generalize Commander's actions across multiple problems and multiple decision making sequences in order to recommend actions to a Commander in a manner that he may have taken. Our approach builds upon the Double Transition Model to represent the Commander's focus and beliefs to estimate his cognitive state. Each cognitive state reflects a stage in a Commander's decision making process, each action reflects the tasks that he has taken to move himself closer to a final decision, and the reward reflects how close he is to achieving his goal. We then use inverse reinforcement learning to compute a reward for each of the Commander's actions. These rewards and cognitive states are used to compare between different styles of decision making. We construct a set of scenarios in the game where rational, intuitive and spontaneous decision making styles will be evaluated.
Rice, Kevin; Kizzort, Brad; Simon, Jerry
An XML Telemetry Command Exchange (XTCE) tutoral oriented towards packets or minor frames is shown. The contents include: 1) The Basics; 2) Describing Telemetry; 3) Describing the Telemetry Format; 4) Commanding; 5) Forgotten Elements; 6) Implementing XTCE; and 7) GovSat.
... 32 National Defense 3 2010-07-01 2010-07-01 true Command supervision. 552.65 Section 552.65 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND....65 Command supervision. (a) All insurance business conducted on Army installation will be by...
Convertino, Victor A; Cooke, William H; Salinas, Jose; Holcomb, John B
The US Army Institute of Surgical Research (USAISR) has the lead for directing the Research Program Area for Advanced Triage Capabilities for Combat Medics in the Medical Research and Materiel Command (MRMC...
Arnold, Ross D.; Lieb, Aaron J.; Samuel, Jason M.; Burger, Mitchell A.
The future of command post computing demands an innovative new solution to address a variety of challenging operational needs. The Command Post of the Future is the Army's primary command and control decision support system, providing situational awareness and collaborative tools for tactical decision making, planning, and execution management from Corps to Company level. However, as the U.S. Army moves towards a lightweight, fully networked battalion, disconnected operations, thin client architecture and mobile computing become increasingly essential. The Command Post of the Future is not designed to support these challenges in the coming decade. Therefore, research into a hybrid blend of technologies is in progress to address these issues. This research focuses on a new command and control system utilizing the rich collaboration framework afforded by Command Post of the Future coupled with a new user interface consisting of a variety of innovative workspace designs. This new system is called Tactical Applications. This paper details a brief history of command post computing, presents the challenges facing the modern Army, and explores the concepts under consideration for Tactical Applications that meet these challenges in a variety of innovative ways.
Young, Mark E
.... Army Sustainment Command (ASC), part of the U.S. Army Materiel Command (AMC) team, is available to assist, identify, and resolve equipment and maintenance problems as well as materiel readiness issues for combatant commanders...
National Aeronautics and Space Administration — The command file data set contains a record of all commands sent to the Lunar Prospector spacecraft. The command files document any changes in spacecraft and science...
The authoritative guide to Linux command line and shell scripting?completely updated and revised [it's not a guide to Linux as a whole ? just to scripting] The Linux command line allows you to type specific Linux commands directly to the system so that you can easily manipulate files and query system resources, thereby permitting you to automate commonly used functions and even schedule those programs to run automatically. This new edition is packed with new and revised content, reflecting the many changes to new Linux versions, including coverage of alternative shells to the default bash shel
Shotts, William E
You've experienced the shiny, point-and-click surface of your Linux computer—now dive below and explore its depths with the power of the command line. The Linux Command Line takes you from your very first terminal keystrokes to writing full programs in Bash, the most popular Linux shell. Along the way you'll learn the timeless skills handed down by generations of gray-bearded, mouse-shunning gurus: file navigation, environment configuration, command chaining, pattern matching with regular expressions, and more.
Sherard, Scott H
If a Combatant Commander (CCDR) or Joint Force Commander (JFC) were to take command of the approximately 25,000 security contractors in Iraq, a force of such size and capability would prove to be a valuable operational asset...
To assure unity of command in future multinational air operations, combatant commanders must embrace the necessity of multinational air forces, maximize the integration of allied officers within air...
The question concerning the most effective strategies that should be employed by base commanders to mitigate problems involving the worried well in the event of a biological weapons attack is important and critical...
Norcross, Scott; Grieser, William H.
This paper describes a product called the Intelligent Mission Toolkit (IMT), which was created to meet the changing demands of the spacecraft command and control market. IMT is a command and control system built upon an expert system. Its primary functions are to send commands to the spacecraft and process telemetry data received from the spacecraft. It also controls the ground equipment used to support the system, such as encryption gear, and telemetry front-end equipment. Add-on modules allow IMT to control antennas and antenna interface equipment. The design philosophy for IMT is to utilize available commercial products wherever possible. IMT utilizes Gensym's G2 Real-time Expert System as the core of the system. G2 is responsible for overall system control, spacecraft commanding control, and spacecraft telemetry analysis and display. Other commercial products incorporated into IMT include the SYBASE relational database management system and Loral Test and Integration Systems' System 500 for telemetry front-end processing.
... of the embedded reporter . The Operational Commander is wise to review media relations and the successes and pitfalls of past conflicts, and to examine closely the results of Operation Iraqi Freedom so as to...
Full Text Available This lesson uses a Unix shell, which is a command-line interpreter that provides a user interface for the Unix operating system and for Unix-like systems. This lesson will cover a small number of basic commands. By the end of this tutorial you will be able to navigate through your file system and find files, open them, perform basic data manipulation tasks such as combining and copying files, as well as both reading them and making relatively simple edits. These commands constitute the building blocks upon which more complex commands can be constructed to fit your research data or project. Readers wanting a reference guide that goes beyond this lesson are recommended to read Deborah S. Ray and Eric J. Ray, Unix and Linux: Visual Quickstart Guide, 4th edition (2009.
Mintzlaff, Jeffrey G
.... Military's distribution system -- the parts of the Department of Defense (DoD) that manage and execute the storage and movement of supplies to military customers -- consists of multiple entities and agencies made up of separate Services and commands...
Interrupt and command structures of a real-time system are described through specific examples. References to applications of a real-time system and programing development references are supplied. (auth)
Rerisson Cavalcante de Araújo
Full Text Available In this paper, I analyze negative scope ambiguity in sentences with cause, temporal and purpose adjuncts, in which negation can take scope either over the predicate or over the adjunct. I discuss Huang (1982, Takubo (1985 and Johnston’s (1994 analyses, which propose that the ambiguity is derived from different c-command relations between negation and adjunct, due to an optionality of adjunction to VP or IP. Against this view, I show a set of facts which are problematic for any analysis based only in c-command, i.e., several syntactic contexts where negation should c-command the adjunct, but where the ambiguity surprisingly still holds. Based on this, I argue that c-command is a necessary, but not sufficient condition to establish negative scope. And I suggest that the availability of predicate negation and adjunct negation results from an optionality of the operation of Labeling in adjunction, according Hornstein and Nunes (2008.
Halbig, J.K.; Klosterbuer, S.F.; Martinez, V.A. Jr.
The Pion Generation for Medical Irradiations (PIGMI) program at the Los Alamos Scientific Laboratory is developing the technology to build smaller, less expensive, and more reliable proton linear accelerators for medical applications, and has designed a powerful, simple, inexpensive, and reliable control and data acquisition system that is central to the program development. The system is a NOVA-3D minicomputer interfaced to several outlying microprocessor-based controllers, which accomplish control and data acquisition through data I/O chasis. The equipment interface chassis, which can issue binary commands, read binary data, issue analog commands, and read timed and untimed analog data is described
comprises: • The CG of the unit, * The assistant commander(s), 2 * The Chief of Staff (CoS), " The Asistant Chiefs of Staff for Personnel (G1...operations orders. Items on the "Suggested Reading" list were virtually certain to remain unread. For the material that was read, the primary...Joint and Combined Warfare. At echelons above brigade, virtually all operations will be in large part joint ones, involving at least the Air Force and
unified commands for the Department of Defense, providing air, land , and sea transportation in times of peace and war. USTRANSCOM, established in 1987...Commands [7, 8]. This plan is developed through an iterative process that evolves on the basis of the availability of the planes , ships, trains, and...targeted by cyber attackers includes cleared defense contractors that build and maintain applica- tions used by USTRANSCOM. Adversaries hope that if they
Drongelen AW van; Roszek B; Hilbers-Modderman ESM; Kallewaard M; Wassenaar C; LGM
This RIVM study was performed to gain insight into wheelchair-related incidents with powered and manual wheelchairs reported to the USA FDA, the British MDA and the Dutch Center for Quality and Usability Research of Technical Aids (KBOH). The data in the databases do not indicate that incidents with
the result of an incident that requires (or should require) treatment by a practitioner of medicine , a registered emergency medical technician, or a...UNANNOUNCED AIRCRAFT EMERGENCYS ~~PRIOR TO TAKE OFF OR AFTERLADN 5 FUEL OPERATIONS REQUIRING 1AREING G A FIRE10 ARRESTING GEAR’BARRIER FR . ENGAGEMENTS AND
... 32 National Defense 5 2010-07-01 2010-07-01 false Command of a submarine. 700.1058 Section 700... Command Detail to Duty § 700.1058 Command of a submarine. The officer detailed to command a submarine... submarines. ...
... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Chain of command. 1214.703 Section 1214.703 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SPACE FLIGHT The Authority of the Space Shuttle Commander § 1214.703 Chain of command. (a) The Commander is a career NASA astronaut who has been...
... 32 National Defense 5 2010-07-01 2010-07-01 false Command of a naval base. 700.1054 Section 700.1054 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY UNITED STATES NAVY... Command Detail to Duty § 700.1054 Command of a naval base. The officer detailed to command a naval base...
Wachira, Benjamin W; Abdalla, Ramadhani O; Wallis, Lee A
At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.
Mayott, Gregory; Self, Mid; Miller, Gordon J.; McDonnell, Joseph S.
NVESD is developing a Sensor Data and Management Services (SDMS) Service Oriented Architecture (SOA) that provides an innovative approach to achieve seamless application functionality across simulation and battle command systems. In 2010, CERDEC will conduct a SDMS Battle Command demonstration that will highlight the SDMS SOA capability to couple simulation applications to existing Battle Command systems. The demonstration will leverage RDECOM MATREX simulation tools and TRADOC Maneuver Support Battle Laboratory Virtual Base Defense Operations Center facilities. The battle command systems are those specific to the operation of a base defense operations center in support of force protection missions. The SDMS SOA consists of four components that will be discussed. An Asset Management Service (AMS) will automatically discover the existence, state, and interface definition required to interact with a named asset (sensor or a sensor platform, a process such as level-1 fusion, or an interface to a sensor or other network endpoint). A Streaming Video Service (SVS) will automatically discover the existence, state, and interfaces required to interact with a named video stream, and abstract the consumers of the video stream from the originating device. A Task Manager Service (TMS) will be used to automatically discover the existence of a named mission task, and will interpret, translate and transmit a mission command for the blue force unit(s) described in a mission order. JC3IEDM data objects, and software development kit (SDK), will be utilized as the basic data object definition for implemented web services.
Hart, Stephen W (Inventor); Yamokoski, John D. (Inventor); Wightman, Brian J (Inventor); Dinh, Duy Paul (Inventor); Gooding, Dustin R (Inventor)
A system for developing distributed robot application-level software includes a robot having an associated control module which controls motion of the robot in response to a commanded task, and a robot task commander (RTC) in networked communication with the control module over a network transport layer (NTL). The RTC includes a script engine(s) and a GUI, with a processor and a centralized library of library blocks constructed from an interpretive computer programming code and having input and output connections. The GUI provides access to a Visual Programming Language (VPL) environment and a text editor. In executing a method, the VPL is opened, a task for the robot is built from the code library blocks, and data is assigned to input and output connections identifying input and output data for each block. A task sequence(s) is sent to the control module(s) over the NTL to command execution of the task.
mand group as a whole. These ratings and observations were analyzed to answer the following questions : 1. Which subtasks were rated relatively low...group, or of the staff member that was observed, on a 5-point scale. For the company commanders and the j• TOC monitor, the question was: "Overall, how...U S• Pepare General c6naitions Command group prepares and organizes the and for Tasks 10-1"and battlefield in such a way as to maximize orga- 10-2
Morris, D J
Communication for Command and Control Systems provides a thorough exposition of the basic theoretical and practical features involved in the design of communication networks for command and control systems. This book focuses primarily on the practical side of computer-controlled communication. This text concentrates on the communication sides of the subject by surveying the means of transferring data between the various processing points and by appraising their potential advantages and possible defects in implementation. In this respect, this book should prove useful for the practicing enginee
Talk directly to your system for a faster workflow with automation capability Linux Command Line and Shell Scripting Bible is your essential Linux guide. With detailed instruction and abundant examples, this book teaches you how to bypass the graphical interface and communicate directly with your computer, saving time and expanding capability. This third edition incorporates thirty pages of new functional examples that are fully updated to align with the latest Linux features. Beginning with command line fundamentals, the book moves into shell scripting and shows you the practical application
decay, other pathology). (3) Report number of deciduous , mixed vs. permanent dentition in the patient population. (4) Report any observable dental...who have input on the selection of locations and scheduling of individual MEDRETES, thereby creating another channel for communication between the US...taxpayer because he does not have all the costs involved 8 in maintaining a large permanent party force with the associated costs of dependents and
Executive Officer (Code OOS) Janelle S. Key, Secretary ( Stenography ) Special Assistants: (Code OOC) Roger A. Rich, HMCS(AW) USN, Senior Enlisted...Foster, MAJ USAR VC, Veterinarian (to Sep) Billy W. Howard, MAJ USA VC, Veterinarian (from Sep) Anna D. Johnson, Secretary ( Stenography ) Barry D...Secretary ( Stenography ) Jerry D. Holsapple, HMI USN, General Duty Corpsman (to Sep) Paul W. Kerr, Ph.D., Office of Naval Research Postdoctoral Fellow William
Neurobehavioral Effectiveness during Chronic Sleep Restriction and Total Sleep Deprivation Adviser: Capaldi, Vincent F Research Proposal: ADORA2A SNP...Ehlen JC, Esser KA, Paul KN, Novak CM, 2017, Homeostatic effects of exercise and sleep on metabolic processes in mice with an overexpressed skeletal...loss of consciousness, gait, and cognitive and affective behaviors were performed. Fludeoxyglucose (FDG) Positron Emission Tomography ( PET ) experiments
Jones, Phillip; Drucker, Nich; Mathews, Reejo; Stanton, Laura; Merkle, Ed
This abstract presents the training approach taken to create a management-centered, experiential learning solution for the Virginia Port Authority's Port Command Center. The resultant tool, called the Command Center Training Tool (C2T2), follows a holistic approach integrated across the training management cycle and within a single environment. The approach allows a single training manager to progress from training design through execution and AAR. The approach starts with modeling the training organization, identifying the organizational elements and their individual and collective performance requirements, including organizational-specific performance scoring ontologies. Next, the developer specifies conditions, the problems, and constructs that compose exercises and drive experiential learning. These conditions are defined by incidents, which denote a single, multi-media datum, and scenarios, which are stories told by incidents. To these layered, modular components, previously developed meta-data is attached, including associated performance requirements. The components are then stored in a searchable library An event developer can create a training event by searching the library based on metadata and then selecting and loading the resultant modular pieces. This loading process brings into the training event all the previously associated task and teamwork material as well as AAR preparation materials. The approach includes tools within an integrated management environment that places these materials at the fingertips of the event facilitator such that, in real time, the facilitator can track training audience performance and resultantly modify the training event. The approach also supports the concentrated knowledge management requirements for rapid preparation of an extensive AAR. This approach supports the integrated training cycle and allows a management-based perspective and advanced tools, through which a complex, thorough training event can be developed.
Chedoe, Indra; Molendijk, Harry A.; Dittrich, Suzanne T. A. M.; Jansman, Frank G. A.; Harting, Johannes W.; Brouwers, Jacobus R. B. J.; Taxis, Katja
Neonates are highly vulnerable to medication errors because of their extensive exposure to medications in the neonatal intensive care unit (NICU), the general lack of evidence on pharmacotherapeutic interventions in neonates and the lack of neonate-specific formulations. We searched PubMed and
Prevalence, Cumulative Incidence, Monotherapy and Combination Therapy, and Treatment Duration of Frequently Prescribed Psychoactive Medications in the Netherlands : Retrospective Database Analysis for the Years 2000 to 2005
Ravera, Silvia; Visser, Sipke T.; de Gier, Johan J.; den Berg, Lolkje T. W. de Jong-van
Background: Psychoactive drugs have been reported to impair daily activities (eg, driving), but data regarding the use of such drugs in the Netherlands are lacking. Objective: The aim of this work was to examine the prevalence, cumulative incidence, use of monotherapy and combination therapy, and
We undertook a study programme at the end of 1991. To start with, we performed some exploratory studies aimed at learning some preliminary lessons on this type of analysis: Assessment of the interest of probabilistic incident analysis; possibility of using PSA scenarios; skills and resources required. At the same time, EPN created a working group whose assignment was to define a new approach for analysis of incidents on NPPs. This working group gave thought to both aspects of Operating Feedback that EPN wished to improve: Analysis of significant incidents; analysis of potential consequences. We took part in the work of this group, and for the second aspects, we proposed a method based on an adaptation of the event-tree method in order to establish a link between existing PSA models and actual incidents. Since PSA provides an exhaustive database of accident scenarios applicable to the two most common types of units in France, they are obviously of interest for this sort of analysis. With this method we performed some incident analyses, and at the same time explores some methods employed abroad, particularly ASP (Accident Sequence Precursor, a method used by the NRC). Early in 1994 EDF began a systematic analysis programme. The first, transient phase will set up methods and an organizational structure. 7 figs
power of Adolf Hitler in Germany. Germany's subsequent withdrawal from the Disarmament. Conference and the League of Nations gave impetus to the modernisation of British naval bases throughout the world.3. On 9 December, 1938, the British Admiralty ad- vised the Commander-in-Chief,. South Atlantic that it had been ...
situations than the one he faced in Brittany. He commanded the corps through its transition from a defensive stalemate of hedgerow fighting in...and controlled progress… the exigencies that emerged from rapid succession as a result of the changes from the positional hedgerow warfare in the
iTOUGH2 is a program for parameter estimation, sensitivity analysis, and uncertainty propagation analysis. It is based on the TOUGH2 simulator for non-isothermal multiphase flow in fractured and porous media. This report contains a detailed description of all iTOUGH2 commands.
their supporting Standard Army Information Management System and further enhance the practice of mission command. As one Soldier commented, “ VSAT is...communications up and running] and get combat ready faster. During lulls, they can order what they’ll need during the fight. 17 We’re using VSAT
The purpose of this study is to evaluate the commandant's managerial capacity as if relates to workers productivity with a view to determining whether their calling to the education terrain has been justified and to correct certain areas in need of improvement in the Nigeria Police Education set up. In doing this, the study took ...
Apollo 11 commander Neil Armstrong is going through flight training in the lunar module simulator situated in the flight crew training building at KSC. Armstrong will pilot the lunar module to a moon landing on July 20, following launch from KSC on July 16.
intelligence in general, and DSE !RT STORN in particular-" If one measure6 tbe. ’gap t .r ren comm~anders and intelligence ofticers by what is ~un ii p...intelligence process, or "cycle," is not a rigid procedural checklist , blindly adhered to under all circum- stances; it is simply a description of sequential
Hesselink, Wim H.
Dijkstra's language of guarded commands is extended with recursion and transformed into algebra. The semantics is expressed in terms of weakest preconditions and weakest liberal preconditions. Extreme fixed points are used to deal with recursion. Unbounded nondeterminacy is allowed. The algebraic
Path on Task Network Box Diagram ...................................... 18 Figure 15. Slack Time on a Gantt Chart...Headquarters JMP Statistical Software MC Mission Command PERT Program Evaluation and Review Technique R Statistical Programming Language RPG-7 Rocket... software package designed to create DES by implementing event graph models as Java codes. This application is designed and is still being developed by
Kadri, Sameer S; Rhee, Chanu; Strich, Jeffrey R; Morales, Megan K; Hohmann, Samuel; Menchaca, Jonathan; Suffredini, Anthony F; Danner, Robert L; Klompas, Michael
Reports that septic shock incidence is rising and mortality rates declining may be confounded by improving recognition of sepsis and changing coding practices. We compared trends in septic shock incidence and mortality in academic hospitals using clinical vs claims data. We identified all patients with concurrent blood cultures, antibiotics, and vasopressors for ≥ two consecutive days, and all patients with International Classification of Diseases, 9th edition (ICD-9) codes for septic shock, at 27 academic hospitals from 2005 to 2014. We compared annual incidence and mortality trends. We reviewed 967 records from three hospitals to estimate the accuracy of each method. Of 6.5 million adult hospitalizations, 99,312 (1.5%) were flagged by clinical criteria, 82,350 (1.3%) by ICD-9 codes, and 44,651 (0.7%) by both. Sensitivity for clinical criteria was higher than claims (74.8% vs 48.3%; P Septic shock incidence, based on clinical criteria, rose from 12.8 to 18.6 cases per 1,000 hospitalizations (average, 4.9% increase/y; 95% CI, 4.0%-5.9%), while mortality declined from 54.9% to 50.7% (average, 0.6% decline/y; 95% CI, 0.4%-0.8%). In contrast, septic shock incidence, based on ICD-9 codes, increased from 6.7 to 19.3 per 1,000 hospitalizations (19.8% increase/y; 95% CI, 16.6%-20.9%), while mortality decreased from 48.3% to 39.3% (1.2% decline/y; 95% CI, 0.9%-1.6%). A clinical surveillance definition based on concurrent vasopressors, blood cultures, and antibiotics accurately identifies septic shock hospitalizations and suggests that the incidence of patients receiving treatment for septic shock has risen and mortality rates have fallen, but less dramatically than estimated on the basis of ICD-9 codes. Copyright © 2016 American College of Chest Physicians. All rights reserved.
Most dental practitioners act as their own radiographer and radiologist, unlike their medical colleagues. Virtually all dental surgeons have a dental X-ray machine for intraoral radiography available to them and 40% of dental practices have equipment for dental panoramic tomography. Because of the low energy of X-ray equipment used in dentistry, radiation incidents tend to be less serious than those associated with other aspects of patient care. Details of 47 known incidents are given. The advent of the 1985 and 1988 Ionising Radiation Regulations has made dental surgeons more aware of the hazards of radiation. These regulations, and general health and safety legislation, have led to a few dental surgeons facing legal action. Because of the publicity associated with these court cases, it is expected that there will be a decrease in radiation incidents arising from the practice of dentistry. (author)
physical infrastructure (transport layer), massed data/information (storage, transmittal, and transaction), and the result- ing critical...SCADA, physical infrastructure , and so forth. The cyber domain is suf- ficiently different from other warfighting domains that it requires a command
who make the Command great.” Having served both as Executive Officer and Commanding Officer of NAMRU-6, Petersen was presented a plaque from the...Medical Research Center Commanding Officer, Capt. Jacqueline D. Rychnovsky cut the cake at the NAMRU-6 Change of Command Ceremony, Aug. 6. (Photo...streamline decision- making and business planning processes at the headquarters and improve efficiency across all of Navy Medicine, organizational changes
Briggs, Darryl J
.... The thesis of the paper is as follows: Combatant Commanders and the Services must have specific guidance and appropriate authorities to be able to effectively manage a Chemical Accident and Incident Response and Assistance (CAIRA...
.... It is argued the current Unified Command Plan is ill designed to address the complexities of the continent of Africa and that a proposed United States Africa Command would be better positioned...
...) of the Air Combat Command (ACC), General Richard E. Hawley, the ACC Commander, asked if RAND could offer an analysis of the number of NAFs that were needed by ACC to meet warfighting requirements...
.... Achieving expert levels of proficiency in high-level command reasoning skills-whether for battlefield commanders or for executives in industry-requires extensive practice, coaching, and feedback...
Gahlinger, Gregory J
.... The concepts of Unity of Command, Unity of Effort and Parallel, Lead Nation, or Integrated coalition command structures are viable across a broad spectrum of maritime coalition operations but do have...
Borron, S. W.; Haynes, J.; Young, P.
Poison Control Centers (PCCs) have historically played a limited, parallel role in management of CBRN incidents; they are frequently called for advice by the public or health care providers when such incidents occur, but in many cases are not considered an integral part of the CBRN disaster emergency response team, lacking a 'place' in the Incident Command Structure (ICS). This is unfortunate, as PCCs represent an important public health resource. The roughly 60 centers in the U.S. are available 24/7, 365 days/year. Telephones are manned by professionals, including pharmacists and nurses with additional specialized training in poisoning response. PCC medical directors are generally trained in Emergency Medicine, Pediatrics or Preventive Medicine, with subspecialty training in Medical Toxicology. Many toxicologists attend specialized training in the radiation emergency management at REAC/TS. PCCs have extensive databases for poisoning management coupled with GIS surveillance. This combination of expertise and information renders PCCs well prepared to advice on decontamination and treatment of CBRN-contaminated victims. Their toxicology expertise allows their participation in risk assessment. PCCs are highly trusted by the community, enhancing their role in risk communication. We recently initiated a program that provides guidance on activation of PCCs by the Region 6 Regional Response Team (RRT6), Co-Chaired by the US Environmental Protection Agency (EPA) and the US Coast Guard, serving as the federal component of the National Response System for the states of Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. The program will be described, with emphasis on how PCCs may work within ICS.(author)
Poon, Eric G; Cina, Jennifer L; Churchill, William W; Mitton, Patricia; McCrea, Michelle L; Featherstone, Erica; Keohane, Carol A; Rothschild, Jeffrey M; Bates, David W; Gandhi, Tejal K
We performed a direct observation prepost study to evaluate the impact of barcode technology on medication dispensing errors and potential adverse drug events in the pharmacy of a tertiary-academic medical center. We found that barcode technology significantly reduced the rate of target dispensing errors leaving the pharmacy by 85%, from 0.37% to 0.06%. The rate of potential adverse drug events (ADEs) due to dispensing errors was also significantly reduced by 63%, from 0.19%to 0.069%. In a 735-bed hospital where 6 million doses of medications are dispensed per year, this technology is expected to prevent about 13,000 dispensing errors and 6,000 potential ADEs per year.
Kaufmann, Friedrich; Krabatsch, Thomas
Ventricular assist devices (VAD) are used for mechanical support of the terminally failing heart. Failure of these life supporting systems can be fatal. Early and reliable detection of any upcoming problems is mandatory and is crucial for the outcome. Medical imaging methods are described within this review, which are not only essential for diagnosis of typically VAD-related complications but also for the detection or verification of technical issues. Within this review the utilization of medical imaging equipment for the diagnosis of technical malfunctions or damages of implanted system components is discussed. A newly developed specialized acoustic imaging method for pump thrombosis detection will also be described along with the most common VAD-related medical complications and their respective imaging methods and the limitations induced by the use of the VAD-system.
Command based on mission origin point Another option for command and control when space and cyberspace operations meet is for the geographic...commander to assume C2 where the mission originates . This would likely be at the GCC level since neither space nor cyberspace is frequently delegated...AIR WAR COLLEGE AIR UNIVERSITY COMMAND AND CONTROL ACROSS SPACE AND CYBERSPACE DOMAINS by Jason A. Parish, CDR, USN A Research Report
Kern, Jeffrey A.
Approved for public release; distribution is unlimited An examination is made of the historical antecedents of present day command and control doctrine in the Soviet Union. The continuity of principal characteristics is demonstrated. The ideological determinants shaping the command and control system are first developed. These include centralism, collective decision-making, unity of command, and redundancy. Practical consequences of these are explored. The functioning of Soviet command...
Poon, Eric G; Cina, Jennifer L; Churchill, William W; Mitton, Patricia; McCrea, Michelle L; Featherstone, Erica; Keohane, Carol A; Rothschild, Jeffrey M; Bates, David W; Gandhi, Tejal K
We performed a direct observation pre-post study to evaluate the impact of barcode technology on medication dispensing errors and potential adverse drug events in the pharmacy of a tertiary-academic medical center. We found that barcode technology significantly reduced the rate of target dispensing errors leaving the pharmacy by 85%, from 0.37% to 0.06%. The rate of potential adverse drug events (ADEs) due to dispensing errors was also significantly reduced by 63%, from 0.19% t...
Slama-Belkhodja, I.; De Fornel, B.
Cat article décrit une stratégie de commande adaptive indirecte à Placement de Pôles (PP), appliquée à la commande en vitesse d'une machine asynchrone alimentée par un ensemble hacheur-filtre-onduleur de tension. L'algorithme des Moindres Carrés Récursifs (MCR) est utilisé pour l'identification des modèles de comportement type entrées/sorties. Un intérêt particulier est porté à la mise en oeuvre de cet algorithme et à la discussion de ses résultats, tenant compte des erreurs de modélisation e...
Full Text Available Over the past few years the University of North Texas Libraries' Digital Projects Unit (DPU has developed a set of metadata analysis tools, processes, and methodologies aimed at helping to focus limited quality control resources on the areas of the collection where they might have the most benefit. The key to this work lies in its simplicity: records harvested from OAI-PMH-enabled digital repositories are transformed into a format that makes them easily parsable using traditional Unix/Linux-based command-line tools. This article describes the overall methodology, introduces two simple open-source tools developed to help with the aforementioned harvesting and breaking, and provides example commands to demonstrate some common metadata analysis requests. All software tools described in the article are available with an open-source license via the author's GitHub account.
Horvath, Joan C.; Alkalaj, Leon J.; Schneider, Karl M.; Spitale, Joseph M.; Le, Dang
Robotic spacecraft are controlled by onboard sets of commands called "sequences." Determining that sequences will have the desired effect on the spacecraft can be expensive in terms of both labor and computer coding time, with different particular costs for different types of spacecraft. Specification languages and appropriate user interface to the languages can be used to make the most effective use of engineering validation time. This paper describes one specification and verification environment ("SAVE") designed for validating that command sequences have not violated any flight rules. This SAVE system was subsequently adapted for flight use on the TOPEX/Poseidon spacecraft. The relationship of this work to rule-based artificial intelligence and to other specification techniques is discussed, as well as the issues that arise in the transfer of technology from a research prototype to a full flight system.
Designed to entertain while educating, StenniSphere at the John C. Stennis Space Center in Hancock County, Miss., includes informative displays and exhibits from NASA and other agencies located at Stennis, such as this one from the Naval Meteorology and Oceanography Command. Visitors can 'travel' three-dimensionally under the sea and check on the weather back home in the Weather Center. StenniSphere is open free of charge from 9 a.m. to 5 p.m. daily.
StenniSphere at NASA's John C. Stennis Space Center in Hancock County, Miss., invites visitors to discover why America comes to Stennis Space Center before going into space. Designed to entertain while educating, StenniSphere includes informative displays and exhibits from NASA and other agencies located at Stennis, such as this one from the Naval Meteorology and Oceanography Command. Visitors can 'travel' three-dimensionally under the sea and check on the weather back home in the Weather Center.
Ashcraft, Karen Lee; Muhr, Sara Louise
by translating the vague promise of queering leadership into a tangible method distinguished by specific habits. The article formulates this analytical practice out of empirical provocations encountered by the authors: namely, a striking mismatch between their experiences in military fields and the dominant...... metaphor of leading as military command. Ultimately, the article seeks to move scholarly practices of leadership toward queer performativity, in the hopes of loosening other leadership practices from a binary grip and pointing toward new relational possibilities...
communications over vast distances, and the need for near-real-time coordination means that stakeholders for the distributed lethality concept can encompass a...and methods of effective communication systems. 14. SUBJECT TERMS command and control (C2) distributed lethality system of systems (SOS) model...refinement through simulations of the C2 structure and further research into technologies and methods of effective communication systems. vi THIS PAGE
soldiers for doing something well is a superb, inexpensive, method of building morale and self - esteem . The division was very supportive of awards and...battalion runs and annual PRT’s validated fitness. There are no shortcuts to unit fitness. Soldiers have to exercise aerobically and anaerobically zo...on pride in self and unit. It is nurtured by a mutual trust and respect between the soldier and the chain of command. Exercising the NCO chain of
Piszczek, Marek; Maciejewski, Marcin; Pomianek, Mateusz; Szustakowski, Mieczysław
Information management is an inseparable part of the command process. The result is that the person making decisions at the command post interacts with data providing devices in various ways. Tools virtualization process can introduce a number of significant modifications in the design of solutions for management and command. The general idea involves replacing physical devices user interface with their digital representation (so-called Virtual instruments). A more advanced level of the systems "digitalization" is to use the mixed reality environments. In solutions using Augmented reality (AR) customized HMI is displayed to the operator when he approaches to each device. Identification of device is done by image recognition of photo codes. Visualization is achieved by (optical) see-through head mounted display (HMD). Control can be done for example by means of a handheld touch panel. Using the immersive virtual environment, the command center can be digitally reconstructed. Workstation requires only VR system (HMD) and access to information network. Operator can interact with devices in such a way as it would perform in real world (for example with the virtual hands). Because of their procedures (an analysis of central vision, eye tracking) MR systems offers another useful feature of reducing requirements for system data throughput. Due to the fact that at the moment we focus on the single device. Experiments carried out using Moverio BT-200 and SteamVR systems and the results of experimental application testing clearly indicate the ability to create a fully functional information system with the use of mixed reality technology.
Hazards/ Bioenvironmental engineering/Health Monitoring Environment UNCLASSIFIED United States European Command “Stronger Together” Unclassified EC J4...4.1) - 51 countries in the AOR • Objective 2.1 War Weapon Control • Objective 2.2 Border Crossing • Objective 2.3 Systems; Business Architecture ... Architecture Requirements o Information for users of hazmat – SDS format, additional European HAZCOM o Information for waste generators – HW profile
nuclear command and control and would require the creation of significant new bureaucratic structures and processes. In this model , as with the hy...Artillery, will assume control of the emergent SSBN force, though such a move would entail substantial revision of China’s bureaucratic structures... models implies different requirements for the PLA’s personnel policies, institutional organization, and physical infrastructure. The article then
Concerning temperament, even in the epic wars of our past, commanders who were well known to countenance high losses to accomplish the mission were...constantly recalls epic battles won at hard cost is less likely to balk at present hardships. However, this association with the past also 12 engenders...go home and write poetry . He learned the art of glass blowing because it seemed interesting and built a computer with only a magazine as his guide
... responsibilities. Normally, commanders shall exercise authority through their immediate subordinate commanders, but... the overall efficiency and readiness of naval forces. Commanders shall exercise positive leadership... located, in regard to internal administration and discipline, as to any other ship or shore activity of...
... Memorandum of January 6, 2011--Disestablishment of United States Joint Forces Command #0; #0; #0... of United States Joint Forces Command Memorandum for the Secretary of Defense Pursuant to my... States Joint Forces Command, effective on a date to be determined by the Secretary of Defense. I direct...
... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Command control system requirements. 417... control system requirements. (a) General. When initiated by a flight safety official, a command control... receipt of the signal by the onboard vehicle flight termination system. A command control system must...
Commander, General Michael Moseley, Coalition Forces Land Component Commander, Lieutenant General Da 76 vid McKiernan, Coalition Forces Maritime...Command and Control of Space Assets The unique characteristics of systems operating in the ulti mate high ground present special considerations for the C2
Snell, William E; Overbey, Gail A
Instruments designed to assess various aspects of religion are widespread, but few have been constructed to assess specific religious values and beliefs. The purpose of the present research was to address this limitation by providing preliminary evidence for the reliability and validity of the Multidimensional 10 Commandments Questionnaire (M10CQ), a self-report instrument that measures belief in the 10 Commandments. Data from three separate samples provided evidence supporting the reliability (i.e., internal consistency) of the M10CQ subscales. Other results indicated that women endorsed many of the 10 Commandments more strongly than men, and that various Commandments predicted people's mental health (less hostility), their parenting style (more authoritarian and authoritative parenting), and their interpersonal attachments (a more trusting bond with others). The findings reported in this research help to identify the ways in which religious values and beliefs are integrated with multiple aspects of people's lives. The discussion highlights the usefulness of the Multidimensional 10 Commandments Questionnaire (M10CQ) for studying religious beliefs and values.
Usonis, Vytautas; Jackowska, Teresa; Petraitiene, Sigita; Sapala, Alicja; Neculau, Andrea; Stryjewska, Izabella; Devadiga, Raghavendra; Tafalla, Monica; Holl, Katsiaryna
Although acute otitis media (AOM) remains a major public health problem worldwide and brings economic burden on health care system and caregivers, little information is available about its epidemiology in Eastern Europe. We conducted an epidemiological, prospective, observational, multi-centre cohort study (NCT01365390) in five East European countries (Estonia, Lithuania, Poland, Romania and Slovenia) between June 2011 and January 2013 to determine the incidence and clinical characteristics of AOM among children aged children and a higher risk in those attending school/childcare or with allergies. AOM required 521 visits to the doctor. Antibiotics were prescribed for 276 (74.8 %) episodes with the lowest prescription rate in Estonia (51.4 %) and the highest in Romania (83.7 %). Complications were rare and hospitalisations occurred in 2 % of the cases. The disease burden of AOM in Eastern Europe is relevant and public health initiatives to reduce it should be considered. ClinicalTrial.gov NCT01365390 .
Sullivan Patrick S
Full Text Available Abstract Background Diagnosis of an opportunistic illness (OI in a person with HIV infection is a sentinel event, indicating opportunities for improving diagnosis of HIV infection and secondary prevention efforts. In the past, rates of OIs in the United States have been calculated in observational cohorts, which may have limited representativeness. Methods We used data from a 1998 population-based survey of persons in care for HIV infection to demonstrate the utility of population-based survey data for the calculation of OI rates, with inference to populations in care for HIV infection in three geographic areas: King County Washington, selected health districts in Louisiana, and the state of Michigan. Results The overall OI rate was 13.8 per 100 persons with HIV infection in care during 1998 (95% CI, 10.2–17.3. In 1998, an estimated 11.3% of all persons with HIV in care in these areas had at least one OI diagnosis (CI, 8.8–13.9. The most commonly diagnosed OIs were Pneumocystis jiroveci pneumonia (PCP (annual incidence 2.4 per 100 persons, CI 1.0–3.8 and cytomegalovirus retinitis (annual incidence 2.4 per 100 persons, CI 1.0–3.7. OI diagnosis rates were higher in Michigan than in the other two geographic areas, and were different among patients who were white, black and of other races, but were not different by sex or history of injection drug use. Conclusion Data from population-based surveys – and, in the coming years, clinical outcomes surveillance systems in the United States – can be used to calculate OI rates with improved generalizability, and such rates should be used in the future as a meaningful indicator of clinical outcomes in persons with HIV infection in care.
Using the PDSA Cycle for the Evaluation of Pointing and Calling Implementation to Reduce the Rate of High-Alert Medication Administration Incidents in the United Christian Hospital of Hong Kong, China
Lap Fung Tsang
Full Text Available Introduction: The present study aimed to adopt a Plan-do-Study-Act (PDSA cycle to monitor the implementation of Pointing and Calling (P&C in the United Christian Hospital of Hong Kong, China. Materials and Methods: A workgroup was formed to evaluate the approaches to apply P&C in high-alert medication administration using infusion and syringe devices. A series of promulgations and strategies were implemented to increase the probability of its success and sustainability. In addition, pretest and posttest evaluation was performed to monitor the incident rate associated with high-alert medication administration using infusion and syringe devices. Results:Over 100 briefing sessions were conducted in the hospital wards, and 145 senior managers, ward managers, and advanced practice nurses completed the training and assessment. In total, 217 questionnaires, which were scored based on a six-point Likert scale, were collected from 21 wards, with the response rate estimated at 26.53%. Moreover, an audit was performed to obtain 98.1-100% of the compliance rate of using the P&C for evaluation. Since June 2016, the incident rate due to inaccurate device setting decreased from 0.21 to 0.13 after the P&C implementation. Conclusion: According to the results, P&C is a simple method to facilitate the meticulous assessment of high-alert medication administration by nurses. It is recommended that further improvement be made in this regard in order to address the unidentified other areas. Of note, counter measures were proposed to strengthen P&C compliance.
Schrader, Thomas; Tetzlaff, Laura; Löwe, Katharina; Schröder, Cornelia; Beck, Eberhard
Reporting systems for near misses are necessary to improve patient safety. In Germany, different systems are publicly available on both a national and regional level or as systems related to various medical domains. In contrast with the British Registry, our reporting systems still lack systematic evaluation. Using the Open-Task-Process Model (OPT model) one case of CIRSmedical (www.cirsmedical.de) was selected for a systematic analysis. Case 148384 reports on a patient with a tentative diagnosis of pulmonary embolism with an oxygen saturation of 71 %. The attending physician was ordered to leave the patient to participate in the daily team meeting. After 40minutes, the nurses transferred the patient from the emergency department to the ICU. The OPT model systematically checks the properties of all tasks in a given process and matches them to requirements or solving capacities of the task. The analysis manifests some structural problems: Although the case was not very difficult (high priority, but a frequent problem), the solving capacities were not adequate in order to avoid errors. Since the physician left the patient, the loyalty toward medical standards and the team error correction activity were low. The team did not intervene to prevent the doctor from leaving his patient. The OPT model allows for the analysis of both single cases and complete data sets of CIR systems and is able to disclose structural problems of clinical management. Copyright © 2018. Published by Elsevier GmbH.
Fluor Hanford (FH) is responsible for providing support to the Department of Energy Richland Operations Office (RL) in the implementation of the Hanford Emergency Preparedness (EP) program. During fiscal year 2000, a number of program improvements were identified from various sources including a major range fire (24 Command Fire). Evaluations of the emergency preparedness program have confirmed that it currently meets all requirements and that performance of personnel involved is good, however the desire to effect continuous improvement resulted in the development of this improvement program plan. This program plan defines the activities that will be performed in order to achieve the desired performance improvements
The goal of automated testing is to create and maintain a cohesive infrastructure of robust tests that could be run independently on a software package in its entirety. To that end, the Spaceport Command and Control System (SCCS) project at the National Aeronautics and Space Administration's (NASA) Kennedy Space Center (KSC) has brought in a large group of interns to work side-by-side with full time employees to do just this work. Thus, our job is to implement the tests that will put SCCS through its paces.
Stetson, Howard K.; Frank, Jeremy; Cornelius, Randy; Haddock, Angie; Wang, Lui; Garner, Larry
NASA is investigating a range of future human spaceflight missions, including both Mars-distance and Near Earth Object (NEO) targets. Of significant importance for these missions is the balance between crew autonomy and vehicle automation. As distance from Earth results in increasing communication delays, future crews need both the capability and authority to independently make decisions. However, small crews cannot take on all functions performed by ground today, and so vehicles must be more automated to reduce the crew workload for such missions. NASA's Advanced Exploration Systems Program funded Autonomous Mission Operations (AMO) project conducted an autonomous command and control demonstration of intelligent procedures to automatically initialize a rack onboard the International Space Station (ISS) with power and thermal interfaces, and involving core and payload command and telemetry processing, without support from ground controllers. This autonomous operations capability is enabling in scenarios such as a crew medical emergency, and representative of other spacecraft autonomy challenges. The experiment was conducted using the Expedite the Processing of Experiments for Space Station (EXPRESS) rack 7, which was located in the Port 2 location within the U.S Laboratory onboard the International Space Station (ISS). Activation and deactivation of this facility is time consuming and operationally intensive, requiring coordination of three flight control positions, 47 nominal steps, 57 commands, 276 telemetry checks, and coordination of multiple ISS systems (both core and payload). The autonomous operations concept includes a reduction of the amount of data a crew operator is required to verify during activation or de-activation, as well as integration of procedure execution status and relevant data in a single integrated display. During execution, the auto-procedures provide a step-by-step messaging paradigm and a high level status upon termination. This
Nuclear power plant emergency command system can provide valuable data for emergency personnel, such as the unit data, weather data, environmental radiation data. In the course of emergency response, the emergency command system provides decision support to quickly and effectively control and mitigate the consequences of the nuclear accident, to avoid and reduce the dose received by staff and the public, to protect the environment and the public. There are high performance requirements on the security of the system and the data transmission. Based on the previous project and new demand after the Fukushima incident, the security technology design of emergency system in nuclear power plant was discussed. The results show that the introduction of information security technology can effectively ensure the security of emergency systems, and enhance the capacity of nuclear power plant to deal with nuclear accidents. (author)
Xun, Peng; Zhu, Pei-Dong; Hu, Yi-Fan; Cui, Peng-Shuai; Zhang, Yan
A cyber-physical attack in the industrial Internet of Things can cause severe damage to physical system. In this paper, we focus on the command disaggregation attack, wherein attackers modify disaggregated commands by intruding command aggregators like programmable logic controllers, and then maliciously manipulate the physical process. It is necessary to investigate these attacks, analyze their impact on the physical process, and seek effective detection mechanisms. We depict two different types of command disaggregation attack modes: (1) the command sequence is disordered and (2) disaggregated sub-commands are allocated to wrong actuators. We describe three attack models to implement these modes with going undetected by existing detection methods. A novel and effective framework is provided to detect command disaggregation attacks. The framework utilizes the correlations among two-tier command sequences, including commands from the output of central controller and sub-commands from the input of actuators, to detect attacks before disruptions occur. We have designed components of the framework and explain how to mine and use these correlations to detect attacks. We present two case studies to validate different levels of impact from various attack models and the effectiveness of the detection framework. Finally, we discuss how to enhance the detection framework.
Full Text Available A cyber-physical attack in the industrial Internet of Things can cause severe damage to physical system. In this paper, we focus on the command disaggregation attack, wherein attackers modify disaggregated commands by intruding command aggregators like programmable logic controllers, and then maliciously manipulate the physical process. It is necessary to investigate these attacks, analyze their impact on the physical process, and seek effective detection mechanisms. We depict two different types of command disaggregation attack modes: (1 the command sequence is disordered and (2 disaggregated sub-commands are allocated to wrong actuators. We describe three attack models to implement these modes with going undetected by existing detection methods. A novel and effective framework is provided to detect command disaggregation attacks. The framework utilizes the correlations among two-tier command sequences, including commands from the output of central controller and sub-commands from the input of actuators, to detect attacks before disruptions occur. We have designed components of the framework and explain how to mine and use these correlations to detect attacks. We present two case studies to validate different levels of impact from various attack models and the effectiveness of the detection framework. Finally, we discuss how to enhance the detection framework.
Special Ops aviation unit traverses Bermuda Triangle en route to new home”, News Service Release Number 03082525 (August 2003), http://news.soc.mil...7, 2007). U.S. Army Special Operations Command. “Special Ops Aviation Unit Traverses Bermuda Triangle En Route to New Home.” News Service Release
Economic burden of gastrointestinal cancer under the protection of the New Rural Cooperative Medical Scheme in a region of rural China with high incidence of oesophageal cancer: cross-sectional survey.
Li, Xiang; Cai, Hong; Wang, Chaoyi; Guo, Chuanhai; He, Zhonghu; Ke, Yang
To evaluate the financial burden of oesophageal cancer under the protection of the new Rural Cooperative Medical Scheme (NCMS) and to provide evidence and suggestions to policymakers in a high-incidence region in China. We analysed inpatient claim data for oesophageal cancer, gastric cancer and colorectal cancer from 1 January to 31 December 2013. The data were extracted from the NCMS management system of Hua County, Henan Province, a typical high-risk region for oesophageal cancer in China. Cancer-specific health economic indicators were calculated to evaluate the financial burden under the protection of the local NCMS. The total cost of oesophageal cancer was 2.7-3.6 times higher than that of gastric cancer and colorectal cancer, respectively, due to high incidence of oesophageal cancer. For each hospitalisation to treat oesophageal cancer, the average total cost and out-of-pocket expenses after reimbursement equalled an entire year's gross domestic product per capita and per capita disposable income, respectively, for the local area. The average total cost per hospitalisation for oesophageal cancer increased monotonically with hospital level for surgical hospitalisations, and it increased more rapidly for non-surgical hospitalisations (from $301 to $2589, 860%) than for gastric cancer (from $289 to $1453, 503%) and colorectal cancer (from $359 to $1610, 448%). Vulnerable groups with less access to high-level hospitals were found in different gender and age groups. Oesophageal cancer imposes serious financial burdens on communities and patients' households in this high-incidence region, and no preferential policy from the local NCMS has been designed to address this issue. A special supportive policy should be developed on the basis of local disease profiles and population characteristics to alleviate the financial burden of populations at high risk for certain high-cost diseases. © 2016 John Wiley & Sons Ltd.
Baandrup, Lone; Kruse, Marie
PURPOSE: In Denmark, as well as in many other countries, consumption of antipsychotics is on the rise, partly due to increasing off-label use. The aim of this study was to analyze and quantify the extent of off-label use and polypharmacy in incident users of antipsychotic medication, and to examine...... initial antipsychotic prescribing patterns and associated use of mental health care services. METHOD: Population-based cohort study linking the following Danish national registers: the Central Psychiatric Research Register, the Register of Medicinal Product Statistics, and Statistics Denmark. RESULTS...
The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI – A case report
Full Text Available In 2013 a fire broke out in the Nursing Home (NH in the Henryszew village 5 km away from the district hospital in Żyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI. Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary. Med Pr 2014;65(2:289–295
Barz, C.; Latinovic, T.; Balan, I. B. A.; Pop-Vadean, A.; Pop, P. P.
The present paper intends to highlight the utility and importance of HMI in the control of the robotic arm, commanding a Siemens PLC. The touch screen HMI Weinteke MT3070a is the user interface in the process command of Siemens PLC, in which the distances and displacement speeds are introduced on the three axes. The interface includes monitoring robotic arm movement but also allows its command by incrementing step by step the motion over axis.
Rice, Kevin; Kizzort, Brad
These presentation slides are a tutorial on XML Telemetry and Command Exchange (XTCE). The goal of XTCE is to provide an industry standard mechanism for describing telemetry and command streams (particularly from satellites.) it wiill lower cost and increase validation over traditional formats, and support exchange or native format.XCTE is designed to describe bit streams, that are typical of telemetry and command in the historic space domain.
Berthold, T.; Goerres, G.; Burger, C.
Aim: To evaluate the best breathing command for combined PETCT scanning on a in-line system (Discovery LS, GEMS). Material and Methods: Eight patients underwent FDG PET and CT for attenuation correction and image co-registration on a combined PETCT scanner. CT was acquired during maximum inspiration (MaxInsp) with a starting point at the level of the head. Patients kept their breath for approximately 20 seconds. Then, a CT scan was acquired during normal expiration (NormExp), which corresponded to the respiratory level reached when the patient first inhaled and then exhaled without forcing expiration. Again, CT started at the head and patients kept their breath for approximately 20 seconds. In a third run, patients performed again the NormExp breathing manoeuvre but the breathing command was given after the start of the CT scan. Using this respiration protocol, the hold on time for the patients was between 10 and 15 seconds. All PET images were corrected for attenuation using the CT-based attenuation maps acquired with these three respiration protocols and then were reconstructed using an iterative algorithm. Results: In all patients, attenuation correction of the PET image using the CT scan acquired during MaxInsp caused mis-correction, which mimicked a decrease of FDG concentration in the base of the lungs. During MaxInsp the upper abdominal organs change their position and air filling of the lower lung zone is increased, thus, causing an underestimation of correction values. Subtraction images of the CT scans acquired during MaxInsp and NormExp illustrate the range of organ movements. Subtraction images of the attenuation corrected PET scans illustrate the deterioration of the final PET image. CT acquisition during NormExp provides better PET and co-registered PET/CT images. Using the shorter breath hold time the visual image quality was good in all patients. Conclusion: CT based attenuation correction can severely deteriorate PET image quality, if the CT scan
Schmorrow, Dylan D; Solhan, George; Kruse, Amy A
.... Medical technologies have progressed to the degree that portable, rugged, and wireless designs can be conceived of that could give coalition commanders and medical personnel a view of the health...
Calhoun, Christopher S; Fitzhugh, Elisabeth W; Klinger, David W
...), was to develop and demonstrate human-centered decision-making technologies to improve processes, performance, tools, and training to support a commander's predictive battlespace awareness ability...
Maloney, Kathy J
.... Department of Defense initiatives to adopt a leaner business strategy, increase efficiency, and reduce expenditures have exposed the battlefield commander to additional operational risk centered...
.... Special Operations Command (USCINCSOC), to train assigned forces to meet special operations mission taskings and to ensure interoperability with conventional forces and other special operations forces (SOF...
.... Furthermore, this paper also lists four recommendations for operational commanders and the military on how to better integrate contractors into the military effort, especially during hostile combat situations...
In cases of exceptional medical emergencies, the setting up and organisation of a response to the increased need for medical aid are complex. Command of the operations and responsibilities are assured by specific people depending on the seriousness of the situation. Each role is identified. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Fimmel, R. O.; Baker, T. E.
The MULTIPAC is a central data system developed for deep-space probes with the distinctive feature that it may be repaired during flight via command and telemetry links by reprogramming around the failed unit. The computer organization uses pools of identical modules which the program organizes into one or more computers called processors. The interaction of these modules is dynamically controlled by the program rather than hardware. In the event of a failure, new programs are entered which reorganize the central data system with a somewhat reduced total processing capability aboard the spacecraft. Emphasis is placed on the evolution of the system architecture and the final overall system design rather than the specific logic design.
Clarke, Sean; Redifer, Matthew; Papathakis, Kurt; Samuel, Aamod; Foster, Trevor
This paper describes the power and command system architecture of the X-57 Maxwell flight demonstrator aircraft. The X-57 is an experimental aircraft designed to demonstrate radically improved aircraft efficiency with a 3.5 times aero-propulsive efficiency gain at a "high-speed cruise" flight condition for comparable general aviation aircraft. These gains are enabled by integrating the design of a new, optimized wing and a new electric propulsion system. As a result, the X-57 vehicle takes advantage of the new capabilities afforded by electric motors as primary propulsors. Integrating new technologies into critical systems in experimental aircraft poses unique challenges that require careful design considerations across the entire vehicle system, such as qualification of new propulsors (motors, in the case of the X-57 aircraft), compatibility of existing systems with a new electric power distribution bus, and instrumentation and monitoring of newly qualified propulsion system devices.
Traditionally, any nuclear command system must reckon with conflicting requirements. The system must ensure that weapons will be launched reliably when ordered, a goal known as positive control. But negative control, ensuring that the weapons will not be used without an authentic order, is also essential. These goals are often in tension; steps to make it more difficult to launch without authorization can make it less certain that weapons will be launched when desired, and vice versa. The balance struck between the two naturally shifts, with increased emphasis on negative control in peacetime, and on positive control in a major crisis. Under present circumstances, with virtually no threat of deliberate nuclear attack, both the US and Russia should be putting their emphasis overwhelmingly on ensuring negative control
This report documents the circumstances contributing to the inadvertent melting of cobalt 60 (Co-60) contaminated scrap metal in two Mexican steel foundries and the subsequent distribution of contaminated steel products into the United States. The report addresses mainly those actions taken by US Federal and state agencies to protect the US population from radiation risks associated with the incident. Mexico had much more serious radiation exposure and contamination problems to manage. The United States Government maintained a standing offer to provide technical and medical assistance to the Mexican Government. The report covers the tracing of the source to its origin, response actions to recover radioactive steel in the United States, and return of the contaminated materials to Mexico. The incident resulted in significant radiation exposures within Mexico, but no known significant exposure within the United States. Response to the incident required the combined efforts of the Nuclear Regulatory Commission (NRC), Department of Energy, Department of Transportation, Department of State, and US Customs Service (Department of Treasury) personnel at the Federal level and representatives of all 50 State Radiation Control Programs and, in some instances, local and county government personnel. The response also required a diplomatic interface with the Mexican Government and cooperation of numerous commercial establishments and members of the general public. The report describes the factual information associated with the event and may serve as information for subsequent recommendations and actions by the NRC. 8 figures
Atlases , Accessed December 26, 2014, http://www.westpoint.edu/history/SiteAssets/SitePages/Mexican%20War- /mexican%20war%20map_Talyer%2014.jpg...as General Taylor’s assistant aide on 8 and 9 May 1846. 13 could not keep pace with the speed of the battle and were of little use for the... speed at which combat took place; General Taylor relied on subordinate commanders to operate in a decentralized manner to seize the initiative when
expressed herein are those of the student author and do not neces- sarily represent the views of the US Army Command and General Staff college or any...strengths, the United States and DoD knowledge of cyberspace combined with the United States technical prowess and spirit of entrepreneurship provide us...Evera, Stephen. Guide to Methods for Students of Political Science. Ithaca, NY: Cornell University Press, 1997. Williams, Brett T. “The Joint
knowledgeable officials regarding the authorized personnel at each command and how they meet their assigned missions. We included 5 of the 6 geographic...findings and conclusions based on our audit objectives . We believe that the evidence obtained provides a reasonable basis for our findings and...conclusions based on our audit objectives . In summary, we found data provided by DOD shows that 22,170 total authorized permanent and temporary military and
along with the Indian Ocean islands of Comoros, Madagascar , Mauritius, and Seychelles. U.S. Central Command maintains its traditional relationship...Ocean, the Caribbean Sea, and the waters around Central and South America extending into the Pacific to the Galapagos Island . Marine Corps Forces U.S...responsible for U.S. military relations with 54 African countries including the islands of Cape Verde, Equatorial Guinea, and Sao Tome and Principe
This study identifies possible uses of augmented reality in command and control applications with specific attention to situation awareness in the South African context. Applications across the different command and control functions, as well as at the different levels of military operations are considered. The article concludes ...
Campbell, L.; Garcia, J.R.
A multi-stream command language system was developed to provide control of the dual source neutral beam injectors on the Doublet III experiment at GA Technologies Inc. The Neutral Beam command language system consists of three parts: compiler, sequencer, and interactive task. The command language, which was derived from the Doublet III tokamak command language, POPS, is compiled, using a recursive descent compiler, into reverse polish notation instructions which then can be executed by the sequencer task. The interactive task accepts operator commands via a keyboard. The interactive task directs the operation of three input streams, creating commands which are then executed by the sequencer. The streams correspond to the two sources within a Doublet III neutral beam, plus an interactive stream. The sequencer multiplexes the execution of instructions from these three streams. The instructions include reads and writes to an operator terminal, arithmetic computations, intrinsic functions such as CAMAC input and output, and logical instructions. The neutral beam command language system was implemented using Modular Computer Systems (ModComp) Pascal and consists of two tasks running on a ModComp Classic IV computer. The two tasks, the interactive and the sequencer, run independently and communicate using shared memory regions. The compiler runs as an overlay to the interactive task when so directed by operator commands. The system is succesfully being used to operate the three neutral beams on Doublet III
The research adopted an ex-post-facto design based on a qualitative and quantitative analysis of data. Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs) were conducted with commanding officers. The FGDs were conducted with officers purposively drawn from incumbent commanding officers in the Nigerian ...
commanders always emphasized SHARP ( Sexual Harassment and Response Program) training, the battery commander may vividly recall those events but not the range...searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments...Question .......................................................................................................... 5 Data Collection Plan
Vowels, C. L., Thomas, J. C., & Getchell, F. G. (2016). Assessing sustainment operations in a Decisive Action Training Environment . (ARI Research...Research Report 2001 Measuring Command Post Operations in a Decisive Action Training Environment Michelle N...September 2014 - September 2015 4. TITLE AND SUBTITLE Measuring Command Post Operations in a Decisive Action Training Environment 5a
... authorities as soon as possible. (c) Military forces will ordinarily exercise police powers previously... 32 National Defense 6 2010-07-01 2010-07-01 false Military commanders' responsibilities. 809a.10... Disturbance Intervention and Disaster Assistance § 809a.10 Military commanders' responsibilities. (a...
Cooke, Nancy J.; Gorman, Jamie C.; Duran, Jasmine L.; Taylor, Amanda R.
Team cognition in experienced command-and-control teams is examined in an UAV (Uninhabited Aerial Vehicle) simulation. Five 3-person teams with experience working together in a command-and-control setting were compared to 10 inexperienced teams. Each team participated in five 40-min missions of a simulation in which interdependent team members…
CSSE Combat Service Support Element CSSOC Combat Service Support Operations Center CTAPS Contingency TACS Air Planning System CTE Commander Task Element...maker. b. C2 Analogy To illustrate the C2 process, Coakley uses the analogy of a head coach of a football team and compares it to that of a commander
23 Figure 3. Planning Cells Time Horizon ...........................................................................34 Figure 4. Mission...understand how the MCIS fits into their mission command process. Additionally, it may prevent an overreliance on the MCIS for over the horizon ...timely, usable, complete, precise, and reliable. Commanders must consider how they configure their MCS to account for the increased volume of
Boonekamp, R.C.; Muller, T.J.; Vrijer, J.C. de
With the increasing complexity of current-day military operations, effective education and training of military commanders is of vital importance. Commanders need to perform within a broader range of conflicts; unpredictable threats and civil-military interaction place a great demand on their
Hill, Martin; Galarneau, Mike; Pang, Gerry; Konoske, Paula
... working without their customary infrastructure. Naval Health Research Center (NHRC) was tasked by the Marine Corps Systems Command to review and update the Authorized Medical Allowance Lists (AMALs...
Incidence and outcome of contrast-associated acute kidney injury assessed with Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients of medical and surgical intensive care units: a retrospective study.
Kim, Myoung Hwa; Koh, Shin Ok; Kim, Eun Jung; Cho, Jin Sun; Na, Sung-Won
Contrast medium used for radiologic tests can decrease renal function. However there have been few studies on contrast-associated acute kidney injury in intensive care unit (ICU) patients. The objective of this study was to evaluate the incidence, characteristics, and outcome of contrast-associated acute kidney injury (CA-AKI) patients using the Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients in the ICU. We conducted a retrospective study of adult patients who underwent contrast-enhanced radiologic tests from January 2011 to December 2012 in a 30-bed medical ICU and a 24-bed surgical ICU. The study included 335 patients, and the incidence of CA-AKI was 15.5%. The serum creatinine and estimated glomerular filtration rate values in the CA-AKI patients did not recover even at discharge from the hospital compared with the values prior to the contrast use. Among 52 CA-AKI patients, 55.8% (n = 29) had pre-existing kidney injury and 44.2% (n = 23) did not. The CA-AKI patients were divided into risk (31%), injury (31%), and failure (38%) by the RIFLE classification. The percentage of patients in whom AKI progressed to a more severe form (failure, loss, end-stage kidney disease) increased from 38% to 45% during the hospital stay, and the recovery rate of AKI was 17% at the time of hospital discharge. Because the Acute Physiology and Chronic Health Evaluation (APACHE) II score was the only significant variable inducing CA-AKI, higher APACHE II scores were associated with a higher risk of CA-AKI. The ICU and hospital mortality of patients with CA-AKI was significantly higher than in patients without CA-AKI. CA-AKI is associated with increases in hospital mortality, and can be predicted by the APACHE score. NCT01807195 on March. 06. 2013.
Osgood, Robert; Scanlon, Courtney; Jotwani, Rohan; Rodkey, Daniel; Arshanskiy, Maria; Salem, Deeb
Over the last decade, there has been a rise in the number of mass casualty incidences (MCIs) and their subsequent effect on hospital systems. While there has been much discussion over improving procedures to treat victims of MCIs, there has not been a thorough, systems-based analysis concerning the costs incurred by hospitals during such events. Here the authors examine the history of the Hospital Incident Command Center and how its evolution at Tufts Medical Center helped mitigate the damage following the Boston Marathon Bombings. Tufts' unique variations to the Hospital Incident Command Center include strategic communication hierarchies and a 'zero cost centre' financial system which both provided for a quick and adaptive response. Operating in collaboration with the Conference of Boston Teaching Hospitals encouraged coordination and preparation during emergency situations such as mass casualty events. The direct and indirect effects on Tufts Medical Center stemming from the Boston Marathon Bombings were analysed. Tufts MC treated 36 victims immediately following the MCI. The estimated total cost during the week of April 15 to April 19, 2013 was $776,051. The cost was primarily comprised of lost revenue from cancelled outpatient and inpatient hospital services, as well as expenses incurred due to overtime pay, salary expenses, PPE kits and hospitality services. Finally, the authors examine ways to reduce the future costs during emergency situations through increasing communication with employees, understanding the source of all direct expenses, and mitigating excess risk by developing partnerships with other hospital systems.
Estudo de incidência de eventos adversos hospitalares, Rio de Janeiro, Brasil: avaliação da qualidade do prontuário do paciente Incidence of in-hospital adverse events in the State of Rio de Janeiro, Brazil: Evaluation of patient medical record
Ana Luiza Braz Pavão
Full Text Available OBJETIVO: Avaliar a qualidade da informação dos prontuários de três hospitais de ensino do Estado do Rio de Janeiro, participantes do estudo de base para a estimativa da incidência de eventos adversos (EA. MATERIAL E MÉTODOS: Estudo descritivo, baseado em informações coletadas na revisão de prontuários do estudo de base. Foi aplicado escore de completitude, medido pela proporção de informação ignorada, composto pelos graus de avaliação: excelente (menor que 5%, bom (5% - 10%, regular (11% - 20%, ruim (21% - 50% e muito ruim (mais de 50%. Foram calculados proporções e intervalos de confiança de 95%, para cada informação do prontuário. A análise foi realizada para o conjunto dos pacientes, para os três hospitais e para pacientes com e sem EA. Foram calculadas médias na análise do conjunto de variáveis e, para fins de comparação, foi realizado o teste t de Student. Foi aplicado o teste qui-quadrado e a estatística de Fisher na análise comparativa entre pacientes com e sem EA. RESULTADOS: A qualidade dos prontuários foi considerada ruim, no conjunto dos pacientes. As variáveis que apresentaram maior proporção de ausência de informação foram: "Avaliação inicial da enfermagem" (63,9% e "Avaliação do paciente pelo assistente social" (80%. O hospital 3 apresentou melhor qualidade dos prontuários e o hospital 1 apresentou o pior resultado. Os pacientes com EA apresentaram melhor qualidade dos prontuários do que aqueles sem EA. CONCLUSÕES: Informações indispensáveis ao cuidado apresentaram baixo registro. Ressalta-se a importância da elaboração de medidas que visem melhorias na qualidade do prontuário, que irão refletir na qualidade da assistência ao paciente.OBJECTIVE: To evaluate the quality of information obtained from medical records of three teaching hospitals in the State of Rio de Janeiro, Brazil, which participated in a previous study on the incidence of adverse events (AE. METHODS: Descriptive
Singh, S.S.; Khan, A.R.
The Gandak Project is one of the biggest irrigation projects in India, covering a culturable command area (CCA) of 4.44 lakh ha in U.P., 9.6 lakh ha CCA in Bihar and 0.44 lakh ha in Nepal (Singh and Khan, 2002). The total culturable command areas are 14.44 lakh hectares. The command area is located in between latitude 25 deg 40' to 27 deg 25' and longitude between 83 deg 15' to 85 deg 15'. It is a diversion project through construction of a barrage on the river Gandak. This project area covers up to five districts in the Command of Tirhut Main Canal (TMC) and 3 districts in the Saran Main Canal (SMC) command. The length of main canal is usually long (990 and 650 R.D.'s in eastern and western side, respectively) and the channels are unlined and seepage loss is quite high. (author)
Fleming, R.R.; Hall, R.M.
Two employees inhaled significant amounts of /sup 238/Pu in separate unrelated contamination incidents in 1977. Both acute exposure incidents are described and the urine, feces, and in-vivo chest count data for each employee. Case B (/sup 238/PuNO/sub 3/) received 24 DTPA treatments beginning the day of the incident while, for medical reasons, Case A (/sup 238/PuO/sub 2/) received no therapy.
along with Dick Bartlett and FBI Special Agent Steve Stacy for their strong endorsements for my application. I also wish to thank the Metro ...accessed December 2005. 38 According to Doug Hamilton, Executive Director of Metro Louisville Emergency Management Agency, in personal...VoIP telephony, wireless networking, and an Ethernet switch. That pricing does not include radio interoperability or a satellite terminal. • Cisco
Ekstrand, Jan; And Others
Investigates relationship between ankle sprains and participation time in competitive orienteering. Examined 15,474 competitors in races in the Swedish O-ringen 5-day event in 1987. Injuries requiring medical attention were analyzed, showing 137 (23.9 percent) ankle sprains. Injury incidence was 8.4/10,000 hours. Incidence of ankle sprains was…
Bucey, William H
.... The numerous commands, decentralized command and control, and limited and expensive resources involved in TMD require changes to the joint doctrine in order to provide unity of command and economy of force...
Irizarry, Dan; Tate, Charmaine; Wey, Pierre-Francois; Batjom, Emmanuel; Nicholas, Thomas A; Boedeker, Ben H
Background The Medical Civic Assistance Program (MEDCAP) is a military commander?s tool developed during the Vietnam War to gain access to and positively influence an indigenous population through the provision of direct medical care provided by military medical personnel, particularly in Counter Insurgency Operations (COIN). An alternative to MEDCAPs is the medical seminar (MEDSEM). The MEDSEM uses a Commander?s military medical assets to share culturally appropriate medical information with a defined indigenous population in order to create a sustainable training resource for the local population?s health system. At the heart of the MEDSEM is the ?train the trainer? concept whereby medical information is passed to indigenous trainers who then pass that information to an indigenous population. The MEDSEM achieves the Commander?s objectives of increasing access and influence with the population through a medical training venue rather than direct patient care. Previous MEDSEMS conducted in Afghanistan by military forces focused on improvement of rural healthcare through creation of Village Health Care Workers. This model can also be used to engage host nation (HN) medical personnel and improve medical treatment capabilities in population centers. The authors describe a modification of the MEDSEM, a Medical Mentorship (MM), conducted in November 2010 in Kabul, Afghanistan, at the Afghan National Army (ANA) National Medical Hospital. This training was designed to improve intubation skills in Afghan National Army Hospitals by ANA medical providers, leave residual training capability, and build relationships within the institution that not only assist the institution, but can also be leveraged to foster Commanders? objectives, such as health and reconstruction initiatives and medical partnering for indigenous corps and medical forces described below. Methods We, the authors, developed a culturally appropriate endotracheal intubation training package including a Dari and
Twenty-one Commander robotic arms are on order from INBIS (formerly Ricardo Hitec) and BNFL Engineering Limited (''BEL'', the engineering arm of parent company BNFL). The multi-million pound contract was won amid fierce competition from other well-known names in robotic engineering. The specially designed Commander manipulators will be engaged in remotely handling Intermediate Level Waste (ILW) in a suite of four BNFL ILW plants, which are currently either under construction or planned at Sellafield. The first Commander will delivered to BNFL's Sellafield Silo Emptying Project in January 1998. (Author)
As the number of sensors, platforms, exploitation sites, and command and control nodes continues to grow in response to Joint Vision 2010 information dominance requirements, Commanders and analysts...
Turner, II, Frank L
.... This monograph examined the Intermediate Level Education, the Advanced Military Studies Program, and the Tactical Commanders Development Program curricula at the Command and General Staff College...
communication et renseignement (C3I) du Bison. Les messages ont été présentés en mode silencieux ou en présence d’un bruit de fond qu’on entend dans...commandement, contrôle, communication et renseignement (C3I) du Bison. L’objectif final de la présente recherche est l’atténuation de la surcharge...soit d’un casque d’écoute dans le poste de commandement mobile (MCP) de commandement, contrôle, communication et renseignement (C3I) du Bison. Les
Full Text Available The increasing popularity and improvement in capabilities offered by smartphones caught the attention of botnet developers. Now the threat of botnets is moving towards the mobile environment. This study presents the design of a hybrid command...
Within the past few years, the Naval Air Systems Command (NAVAIR) has undergone several major changes including an engineering reorganization from a matrix organization to an Integrated Program Team/Competency Aligned Organization (IPT/CAO...
.... It asserts that over tine, the defense establishment runs the risk of establishing a cultural identity in the command that limits perspectives to aground-, sea-, or air and space-centric viewpoint...
National Aeronautics and Space Administration — Gestures commands allow a human operator to directly interact with a robot without the use of intermediary hand controllers. There are two main types of hand gesture...
While there will always be a degree of tension in military-media relations, the nature of MOOTW offers the operational commander a new paradigm defined by unprecedented levels of openness and cooperation...
Turner, Kyle H
Commanding Officer's Standing Orders are critical to shipboard watch standing. Written by the captain and used by watch standers, Standing Orders perform many unique and powerful functions aboard ships...
Evans, Thomas P
... and control element at the combatant command level. The military and the Coalition Provisional Authority's ability to establish a national penal system, conduct standardized training and effective prison operations to rebuild the Iraqi penal system...
.... Each Armed Service has begun training and equipping its force using the tenets of Network-Centric Operations, but those forces come together for the first time under the combatant Commander-in-Chief...
National Aeronautics and Space Administration — Command and Control (C2) activities abound in the NAS, and significantly influence daily operations and overall NAS efficiency. Since C2 effects are so prominent,...
... (ITS) for high-level battlefield command reasoning skills. The ultimate goal of this research is to develop new ITS techniques and technology for teaching skills that cannot he taught as simple methods and procedures to he followed...
An analysis of the issues and remedies a Joint Force Commander should be concerned about because of the relationship between the United States and the newly-created International Criminal Court (ICC...
.... Only then will Joint Force Commanders be able to control the battlespace, operate unfettered in littoral areas, and pass freely through critical choke points to execute operational plans. The U.S...
Full Text Available Systems engineering is an established approach to develop systems, including complex sociotechnical systems such as Command and Control (C2) Systems. These systems often occur through introduction of a new technology into an existing system...
Sterling, Bruce S; Lickteig, Carl W
.... This paper examines how participant ratings of command and control planning and observer assessments of teamwork were related in a series of futuristic missions conducted by the Mounted Maneuver...
A relação entre o acompanhamento médico e a incidência de lesões esportivas em atletas jovens de São Paulo Relation between medical clinical monitoring and the incidence of sports injuries in young athletes of São Paulo
Simone Sagres Arena
Full Text Available O objetivo deste estudo foi relacionar a estrutura médica de atendimento de 20 clubes de São Paulo com a incidência de lesões esportivas de atletas jovens praticantes do basquetebol, futsal e voleibol. Para isso, foi utilizado um questionário de lesão com 323 atletas e uma entrevista estruturada com os médicos responsáveis. Foram identificadas 343 lesões esportivas ou 1,7 lesão/atleta/ano. Dos 20 clubes avaliados, apenas oito possuem atendimento médico especializado dentro da instituição. No basquetebol, não houve relação estatística entre a presença ou não do médico dentro do clube com as ocorrências de lesão. No futsal e no voleibol, o número de lesões foi maior com a presença do médico dentro do clube; isso porque nos clubes que não possuem médico, as lesões de menor gravidade não são detectadas. O estudo sugeriu reestruturação no atendimento médico oferecido aos atletas jovens.The objective of this study was to evaluate the relation between medical clinical monitoring and the incidence of the main sports injuries found in young athletes in sports modalities such basketball, indoor soccer and volleyball from 20 clubs located in São Paulo (Brazil. To obtain those data, a questionnaire was applied to 323 athletes and surveys were performed among eight physicians. The results of the study showed a total of 343 injuries or 1,7 injury/athlete/year. In basketball, there was not statistic relation between rates of injury and clinical monitoring in the club. In indoor soccer and volleyball, the rate of injury was bigger with clinical monitoring, because the injuries of less gravity do not are detected in clubs without physician. This study suggest specialized clinical care for young in sports clubs.
fbo . or·~· .wlw:le ~diffetently!OCIDO’fKI-t Att~to••ncon~ Rn .. ntot.....ln ..... ntaf!Mt~om..,....tlom ~-diffffently(loullv)tocO<TeCtmt~Y...J. M. (2011). Display and Interface Design: Subtle Science, Exact Art. CRC Press, Boca Raton, FL. Billings, C. E. (1996). Aviation Automation: The... Aviation Psychology. Fleet Forces Command (2008). Fleet Unmanned Aircraft Systems Concept of Operations. Naval Network Warfare Command, 31 July 2008
units by utilizing predictive analytics and the Person-Environment Fit Theory to aid in selection. Introduction Organizational...most suitable commander candidates with possible units by utilizing predictive analytics and the Person-Environment Fit Theory to better inform the...positive work atmosphere. The commander must keep the long view in mind , not just the short term, first-order effects of a decision. Leading people
holistically. The CJTF staff should include a large number of liaison officers who are trained, equipped and prepared to be embedded with cooperating...procedural recommendations embedded in them. The two are not entirely separable, but others are added here. In order to train commanders and staffs at the...commanders attending multiple orientations. Recognizing that other demands already pull comanders away from their units, we must understand that this
companies and small businesses) the president’s commitment to crisis communication education and unlimited access to training materials were key to...instant communication , it’s essential that Air Force leaders be able to effectively engage the media and tell the Air Force’s story to the public accurately...AU/ACSC/307/1998-04 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY CRISIS COMMUNICATION : A COMMANDERS GUIDE TO EFFECTIVE CRISIS COMMUNICATION by
networks. James Southerland supported U.S. Joint Forces Command as the deputy program manager for the Homeland Security Command and Control...Scrimpsher, Luis Biaggi, Mitchell Gillette, Chew Hom, Michael Gonzales, Randall Smith, Vivian Chu, James Hlava, Eric Rupert, Ellen Ward, Manuel Silveira...force-level ship. 51 Gregory Jaccard delivered a diverse array of specialized sensors as lead mechanical engineer for the 1092/R and the Radioactive
direct support of a specific theatre commander. 17 CONCLUSIONS For the operational commander to minimize risk in all phases of war he must be...Strategic Surprise (London, England: Routledge Taylor and Francis Group, 1982), 190. 22 Patrick Porter, Good Anthropology , Bad History: The Cultural Turn...of Military Deception. London, England: Leo Cooper, 1997. Porter, Patrick. Good Anthropology , Bad History: The Cultural Turn in Studying War
Operations Center DNA Defense Nuclear Agency DoD Department of Defense DRAT Disaster Response Assessment Team ENGR engineer EPOC (United States...USEUCOM Training Transformation in Support of C2 Transformation,” briefing, September 2003, p. 6. Command Concepts 35 Center ( EPOC ).35 Contrary to...most expectations of how the SJFHQ (CE) will work, the EPOC plans to deploy only around 20 of its staff to JTF headquarters. U.S. Pacific Command
This is the first in a series of reports from our audit of the Property, Plant, and Equipment Accounts in the FY 1996 Financial Statements of the...Transportation Command’s $4 billion in expected revenue. In the beginning balance for FY 1996 Defense Business Operations Fund financial statements, the Air...Mobility Command reported $ 1.1 billion of Property, Plant, and Equipment. The objective of this part of the audit was to determine whether the Air
David Be; Cinhtia González; Manuel Escalante; Michel García; Carlos Miranda; Sergio Gonzalez
This paper presents a wireless interface to control a LEGO NXT robot using voice commands through a computer. To perform speech recognition is used CSLU TOOLKIT with a corpus of Mexican Spanish voice, recognized commands are sent via Bluetooth from computer to robot, programming and motion routines to control the motors are done using Java and LeJOS NXJ. The interface consists of two main modules interconnected through the implementation of sockets: the voice recognition module and the wirele...
Billings, Rachel Mae
Modular Integrated Stackable Layers (MISL) is a computer system designed for simple, fast, and cost effective flexible reconfiguration in space environments such as the ISS and Orion projects for various uses. Existing applications include wireless and wired communications, data acquisition and instrumentation, and camera systems, and potential applications include bus protocol converters and subsystem control. MISL is based on Texas Instruments (TI)' MSP430 16-bit ultra-low-power microcontroller device. The purpose of my project was to integrate the MISL system with a liquid crystal display (LCD) touchscreen. The LCD, manufactured by Crystalfontz and part number CFAF320240F-035T-TS, is a 320 by 240 RGB resistive color screen including an optional carrier board. The vast majority of the project was done with Altium Designer, a tool for printed circuit board (PCB) schematic capture, 3D design, and FPGA (Field Programmable Gate Array) development. The new PCB was to allow the LCD to directly stack to the rest of MISL. Research was done with datasheets for the TI microcontroller and touchscreen display in order to meet desired hardware specifications. Documentation on prior MISL projects was also utilized. The initial step was to create a schematic for the LCD, power bus, and data bus connections between components. A layout was then designed with the required physical dimensions, routed traces and vias, power and ground planes, layer stacks, and other specified design rules such as plane clearance and hole size. Multiple consultation sessions were held with Hester Yim, the technical discipline lead for the Command and Data Handling Branch, and Christy Herring, the lead PCB layout designer in the Electronic Design and Manufacturing Branch in order to ensure proper configuration. At the moment, the PCB is awaiting revision by the latter-mentioned branch. Afterwards, the board will begin to undergo the manufacturing and testing process. Throughout the internship at
Mims, Tikiela L.
The purpose of this work is to evaluate the use of SCL in building and monitoring command and control applications in order to determine its fitness for space operations. Approximately 24,325 lines of PCG2 code was converted to SCL yielding a 90% reduction in the number of lines of code as many of the functions and scripts utilized in SCL could be ported and reused. Automated standalone testing, simulating the actual production environment, was performed in order to generalize and gauge the relative time it takes for SCL to update and write a given display. The use of SCL rules, functions, and scripts allowed the creation of several test cases permitting the detection of the amount of time it takes update a given set of measurements given the change in a globally existing CUI or CUI. It took the SCL system an average 926.09 ticks to update the entire display of 323 measurements.
Vivien Arief Wardhany
Full Text Available The purpose of multimedia devices development is controlling through voice. Nowdays voice that can be recognized only in English. To overcome the issue, then recognition using Indonesian language model and accousticc model and dictionary. Automatic Speech Recognizier is build using engine CMU Sphinx with modified english language to Indonesian Language database and XBMC used as the multimedia player. The experiment is using 10 volunteers testing items based on 7 commands. The volunteers is classifiedd by the genders, 5 Male & 5 female. 10 samples is taken in each command, continue with each volunteer perform 10 testing command. Each volunteer also have to try all 7 command that already provided. Based on percentage clarification table, the word “Kanan” had the most recognize with percentage 83% while “pilih” is the lowest one. The word which had the most wrong clarification is “kembali” with percentagee 67%, while the word “kanan” is the lowest one. From the result of Recognition Rate by male there are several command such as “Kembali”, “Utama”, “Atas “ and “Bawah” has the low Recognition Rate. Especially for “kembali” cannot be recognized as the command in the female voices but in male voice that command has 4% of RR this is because the command doesn’t have similar word in english near to “kembali” so the system unrecognize the command. Also for the command “Pilih” using the female voice has 80% of RR but for the male voice has only 4% of RR. This problem is mostly because of the different voice characteristic between adult male and female which male has lower voice frequencies (from 85 to 180 Hz than woman (165 to 255 Hz.The result of the experiment showed that each man had different number of recognition rate caused by the difference tone, pronunciation, and speed of speech. For further work needs to be done in order to improving the accouracy of the Indonesian Automatic Speech Recognition system
Ahn, Y. O.; Koo, H. H.; Park, B. J.; Yoo, K. Y.; Lee, M. S.
This study was undertaken in order to estimate the incidence of leukemia among Koreans. Medical records were studied of patients with diagnoses of either ICD-9 038 (septicemia), or 204-208 (leukemias), or 284 (aplastic anemia), or 289 (other diseases of the blood and blood-forming organs) in the claims sent in by medical care institutions throughout the country to the Korea Medical Insurance Corporation (KMIC) during the period from January 1, 1986 to December 31, 1987. These records were abs...
Ahn, Y. O.; Park, B. J.; Yoo, K. Y.; Kim, N. K.; Heo, D. S.; Lee, J. K.; Ahn, H. S.; Kang, D. H.; Kim, H.; Lee, M. S.
A series of incidence estimation studies of cancers among Koreans through a nationwide survey has been undertaken by authors since 1988. The medical records were studied of inpatients with diagnoses of either ICD-9 151 (malignant neoplasm of the stomach), or 197 (secondary malignant neoplasm of the respiratory and digestive systems), or 211 (benign neoplasm of other parts of the digestive system) in claims sent in by medical care institutions throughout the country to the Korea Medical Insura...
Paulson, G. [University of Medicine and Dentistry of New Jersey, Piscataway, NJ (United States). School of Public Health; Scott, C.H. [Rutgers State Univ. of New Jersey, New Brunswick, NJ (United States)
A survey was conducted in four regions of the state of Kentucky in the early fall of 2002 as part of a counter-terrorism effort. The objective was to find out what responsible professionals think about the current level of preparedness regarding weapons of mass destruction (WMD) incidents, and to ask them what they think is needed to improve the level of preparedness within their organization. Confidential responses were provided by individuals in fire and police departments, emergency medical and emergency management organizations, health agencies, hospitals, private physicians, corporate/university safety and health officials, and others. The four critical areas of emergency response were covered by the survey, namely: communication, incident command, on-scene capability and needs, and off-site capabilities and needs. Needs were found to be high or very high while the level of preparedness was low. Survey respondents emphasized that creating and training well equipped hazardous materials response teams is a major factor in evaluating the level of preparedness. 1 ref., 11 tabs.
... 32 National Defense 5 2010-07-01 2010-07-01 false Administration and discipline: Separate and... OFFICIAL RECORDS Commanders In Chief and Other Commanders Administration and Discipline § 700.723 Administration and discipline: Separate and detached command. Any flag or general officer in command, any officer...
Jokela, Jorma; Rådestad, Monica; Gryth, Dan; Nilsson, Helené; Rüter, Anders; Svensson, Leif; Harkke, Ville; Luoto, Markku; Castrén, Maaret
In mass-casualty situations, communications and information management to improve situational awareness is a major challenge for responders. In this study, the feasibility of a prototype system that utilizes commercially available, low-cost components, including Radio Frequency Identification (RFID) and mobile phone technology, was tested in two simulated mass-casualty incidents. The feasibility and the direct benefits of the system were evaluated in two simulated mass-casualty situations: one in Finland involving a passenger ship accident resulting in multiple drowning/hypothermia patients, and another at a major airport in Sweden using an aircraft crash scenario. Both simulations involved multiple agencies and functioned as test settings for comparing the disaster management's situational awareness with and without using the RFID-based system. Triage documentation was done using both an RFID-based system, which automatically sent the data to the Medical Command, and a traditional method using paper triage tags. The situational awareness was measured by comparing the availability of up-to date information at different points in the care chain using both systems. Information regarding the numbers and status or triage classification of the casualties was available approximately one hour earlier using the RFID system compared to the data obtained using the traditional method. The tested prototype system was quick, stable, and easy to use, and proved to work seamlessly even in harsh field conditions. It surpassed the paper-based system in all respects except simplicity of use. It also improved the general view of the mass-casualty situations, and enhanced medical emergency readiness in a multi-organizational medical setting. The tested technology is feasible in a mass-casualty incident; further development and testing should take place.
Finsterle, S. [Lawrence Berkeley National Lab., CA (United States). Earth Sciences Div.
This report contains a detailed description of all ITOUGH2 commands. It complements the ITOUGH2 User`s Guide and the collection of ITOUGH2 sample problems. ITOUGH2 is a program for parameter estimation, sensitivity analysis, and uncertainty propagation analysis. It is based on the TOUGH2 simulator for non-isothermal multiphase flow in fractured and porous media. Extensive experience in using TOUGH2 is a prerequisite for using ITOUGH2. The preparation of an input file for TOUGH2 or its derivatives is described in separate manuals and is not part of this report. The ITOUGH2 user`s guide summarizes the inverse modeling theory pertaining to ITOUGH2, and describes the program output. Furthermore, information about code architecture and installation are given. In Chapter 2 of this report, a brief summary of inverse modeling theory is given to restate the main concepts implemented in ITOUGH2 and to introduce certain definitions. Chapter 3 introduces the basic concepts of the ITHOUGH2 input language and the main structure of an ITOUGH2 input file. Chapter 4, the main part of this report, provides detailed descriptions of each ITOUGH2 command in alphabetical order. It is complemented by a command index in Appendix B in which the commands are given in logical order. The content of Chapter 4 is also available on-line using command it2help. Chapter 5 describes the usage of the UNIX script files for executing, checking, and terminating ITOUGH2 simulations.
Montgomery County of Maryland — This dataset contains the monthly summary data indicating incident occurred in each fire station response area. The summary data is the incident count broken down by...
Town of Chapel Hill, North Carolina — This table contains incident reports filed with the Chapel Hill Police Department. Multiple incidents may have been reported at the same time. The most serious...
Flaws of\tcurrent incident information management at CMS and CERN\tare discussed. A new data\tmodel for future incident database is\tproposed and briefly described. Recently developed draft version of GIS-‐based tool for incident tracking is presented.
Full Text Available In recent years, there has been a rise in Major Incidents with big impact on the citizens health and the society. Without the possibility of conducting live experiments when it comes to physical and/or toxic trauma, only an accurate in silico reconstruction allows us to identify organizational solutions with the best possible chance of success, in correlation with the limitations on available resources (e.g. medical team, first responders, treatments, transports, and hospitals availability and with the variability of the characteristic of event (e.g. type of incident, severity of the event and type of lesions. Utilizing modelling and simulation techniques, a simplified mathematical model of physiological evolution for patients involved in physical and toxic trauma incident scenarios has been developed and implemented. The model formalizes the dynamics, operating standards and practices of medical response and the main emergency service in the chain of emergency management during a Major Incident.
Meshkat, Leila; Grenander, Sven; Evensen, Ken
center dot In order to reduce commanding errors that are caused by humans, we create an approach and corresponding artifacts for standardizing the command generation process and conducting risk management during the design and assurance of such processes. center dot The literature review conducted during the standardization process revealed that very few atomic level human activities are associated with even a broad set of missions. center dot Applicable human reliability metrics for performing these atomic level tasks are available. center dot The process for building a "Periodic Table" of Command and Control Functions as well as Probabilistic Risk Assessment (PRA) models is demonstrated. center dot The PRA models are executed using data from human reliability data banks. center dot The Periodic Table is related to the PRA models via Fault Links.
Mathiassen, Solvejg K
Betydning af sprøjtetidspunkt, sådybde og nedbør efter sprøjtning for skånsomhed af Command CS i spinat blev undersøgt i potteforsøg. Command CS var mest skånsom ved anvendelse før fremspiring. Typiske skader ved sprøjtning efter fremspiring var klorotiske blade. Risikoen for klorotiske blade blev...... øget med stigende udviklingstrin og ved tankblanding med additiver. Uden nedbør efter sprøjtning påvirkede Command CS i doseringer op til 0,5 L/ha ikke fremspiring af spinat uanset sådybde. Ved regnbehandling kort tid efter sprøjtning blev biomassen af spinat reduceret op til 30% ved en sådybde på 0...
Obuchi, Yasunari; Sumiyoshi, Takashi
In this paper we introduce a new framework of audio processing, which is essential to achieve a trigger-free speech interface for home appliances. If the speech interface works continually in real environments, it must extract occasional voice commands and reject everything else. It is extremely important to reduce the number of false alarms because the number of irrelevant inputs is much larger than the number of voice commands even for heavy users of appliances. The framework, called Intentional Voice Command Detection, is based on voice activity detection, but enhanced by various speech/audio processing techniques such as emotion recognition. The effectiveness of the proposed framework is evaluated using a newly-collected large-scale corpus. The advantages of combining various features were tested and confirmed, and the simple LDA-based classifier demonstrated acceptable performance. The effectiveness of various methods of user adaptation is also discussed.
During the third launch preparations in the Operations and Checkout Building, STS-93 Commander Eileen M. Collins waves while having her launch and entry suit checked. After Space Shuttle Columbia's July 20 and 22 launch attempts were scrubbed, the launch was again rescheduled for Friday, July 23, at 12:24 a.m. EDT. STS-93 is a five-day mission primarily to release the Chandra X-ray Observatory, which will allow scientists from around the world to study some of the most distant, powerful and dynamic objects in the universe. The STS-93 crew numbers five: Commander Collins, Pilot Jeffrey S. Ashby, and Mission Specialists Stephen A. Hawley (Ph.D.), Catherine G. Coleman (Ph.D.) and Michel Tognini of France, with the Centre National d'Etudes Spatiales (CNES). Collins is the first woman to serve as commander of a shuttle mission.
STS-93 Commander Eileen M. Collins waves to her family nearby, a last meeting before launch of mission STS-93 on July 20. Liftoff is scheduled for 12:36 a.m. EDT. The primary mission of STS-93 is the release of the Chandra X-ray Observatory, which will allow scientists from around the world to study some of the most distant, powerful and dynamic objects in the universe. The new telescope is 20 to 50 times more sensitive than any previous X- ray telescope and is expected to unlock the secrets of supernovae, quasars and black holes. The STS-93 crew numbers five: Commander Collins, Pilot Jeffrey S. Ashby, and Mission Specialists Steven A. Hawley (Ph.D.), Catherine G. Coleman (Ph.D.) and Michel Tognini of France, with the Centre National d'Etudes Spatiales (CNES). Collins is the first woman to serve as commander of a shuttle mission.
For the third time, in the Operations and Checkout Building, STS- 93 Commander Eileen M. Collins tries on her helmet with her launch and entry suit. After Space Shuttle Columbia's July 20 and 22 launch attempts were scrubbed, the launch was again rescheduled for Friday, July 23, at 12:24 a.m. EDT. STS-93 is a five-day mission primarily to release the Chandra X-ray Observatory, which will allow scientists from around the world to study some of the most distant, powerful and dynamic objects in the universe. The STS-93 crew numbers five: Commander Collins, Pilot Jeffrey S. Ashby, and Mission Specialists Stephen A. Hawley (Ph.D.), Catherine G. Coleman (Ph.D.) and Michel Tognini of France, with the Centre National d'Etudes Spatiales (CNES). Collins is the first woman to serve as commander of a shuttle mission.
Full Text Available This paper shows connections between command injection attacks, continuations, and the Lambek calculus: certain command injections, such as the tautology attack on SQL, are shown to be a form of control effect that can be typed using the Lambek calculus, generalizing the double-negation typing of continuations. Lambek's syntactic calculus is a logic with two implicational connectives taking their arguments from the left and right, respectively. These connectives describe how strings interact with their left and right contexts when building up syntactic structures. The calculus is a form of propositional logic without structural rules, and so a forerunner of substructural logics like Linear Logic and Separation Logic.
fl.tl 1 S ol co0Mmmnders anld tsLatt vi ith onsis LlI Scope oi sttC I oil itc autLiisit i responsibl Iity. DISTRIBUTioN STATEMENT A 20. DISTRIBUTION...command posts. The remote location of II Corps command post in February 1942 during the * Tunisian campaign was considered a poor commentary on its...briefing began at 0730 in the War Room, housed in two wall tents located in an olive grove near Grosseto about ten miles inland from the coast
The author reports the development of a control-command circuit for the transmission of binary commands related to the safety of nuclear reactors. He presents the main design criteria (operation safety, provided safety level, flexibility, technical adaptation), the definition of the operation principle (inputs, logical outputs), the properties of a logic system. He evokes redundancy issues, and presents the system structure, proposes a possible sketch of the logic circuit. He describes the possible options for intermediate circuits and logic outputs, and tests to be performed
I COMMAND AND CONTROL CAREER LADDER AFSC 274X0 AFPT 90-274-774 APRIL 1987 OCCUPATIONAL ANALYSIS PROGRAM USAF OCCUPATIONAL MEASUREMENT CENTER AIR...3 HQ TAC/TTGT 1 1 HQ USAF/XODRF 1 1 HQ USAF/ MPPT 1 1 HQ USAFE/DPAT 3 3 HQ USAFE/TTGT 1 1 HO USMC (CODE TPI) 1 NODAC 1 3300 TCHTW/TTGX (KEESLER AFB MS...Command and Control career ladder (AFSC 274X0). This survey was requested by the Training Development Services Division of the USAF Occupa- tional
all I’ve got. Good luck to you , and God bless you and your men.23 Upon arrival to Taejon on the morning of July 1, 1950, LTC Smith found BG Church...ABSTRACT On October 31, 2014, the US Anny Training and Doctrine Command published The US Anny Operating Concept: Win in a Complex World (AOC) . The...On October 31, 2014, the US Army Training and Doctrine Command published The US Army Operating Concept: Win in a Complex World (AOC). The purpose of
Van Slambrook, G.A.
Virtual reality concepts are changing the way one thinks about and with computers. The concepts have already proven their potential usefulness in a broad range of applications. This research was concerned with exploring and demonstrating the utility of virtual reality in robotics and satellite command and control applications. The robotics work addressed the need to quickly build accurate graphical models of physical environments by allowing a user to interactively build a model of a remote environment by superimposing stereo graphics onto live stereo video. The satellite work addressed the fusion of multiple data sets or models into one synergistic display for more effective training, design, and command and control of satellite systems
Pot'Vin, Kellyn; Smith, Ray
Oracle Enterprise Manager 12c Command-Line Interface shows how to use Enterprise Manager's powerful scripting language to automate your database administration work and save time by scripting routine tasks, and then executing those scripts across collections of databases and instances in your environment. This book is chock full of ready-made scripting examples contributed by the authors and leading members of the community. For example, you'll find scripts and examples of commands to: Remove an Enterprise Manager agent and its related targetsQuickly create administrator accounts that are ful
early in his life. The sport of football enabled him to practice decision making under the stress of victory or defeat 70 in games filled with...Executive Officer of Combat Command A, 4th Armored Division, during WWII, Mail Interview, 14 October 1992, and BG 49 Albin F. Irzyk (Retired), Commander of...79. Ibid, 149. 80. Weigley, 173. 81. Ibid, 177-178. 82. Ibid, 178. 83. BG Albin F. Irzyk (Retired), "The "Name Enough" Division," Armor Magazine, Vol
Van Slambrook, G.A.
Virtual reality concepts are changing the way one thinks about and with computers. The concepts have already proven their potential usefulness in a broad range of applications. This research was concerned with exploring and demonstrating the utility of virtual reality in robotics and satellite command and control applications. The robotics work addressed the need to quickly build accurate graphical models of physical environments by allowing a user to interactively build a model of a remote environment by superimposing stereo graphics onto live stereo video. The satellite work addressed the fusion of multiple data sets or models into one synergistic display for more effective training, design, and command and control of satellite systems.
Campagna, P.R. [U.S. Environmental Response Team, Office of Superfund Remediation and Technology Innovation, Edison, NJ (United States)
The U.S. Environmental Protection Agency's Environmental Response Team (ERT) was established in October 1978 to provide technical assistance to a variety of governmental agencies in the area of environmental emergency issues such as chemical spills, uncontrolled hazardous waste site and terrorist incidents. This paper describes responses to a biological incident that occurred on July 29 2004, when the United States Department of Agriculture (USDA) received an anonymous e-mail identifying 3 containers on board the M/V Rio Puelo, one of which was said to contain a harmful biological substance. The containers were part of a 5 container shipment of Argentinian lemons bound for Canada. The vessel had a total of 2204 containers, of which 260 were loaded at the same port as the lemons. The containers were to be off-loaded at the Port of Newark and transported via truck to Canada. The federal On-Scene Coordinator (OSC) was responsible for managing this incident, as well as assessing the creditability of the threat. In accordance with federal authorities under the Public Water Safety Act, the Captain of the Port of New York ordered the vessel to anchor off shore. A tactical security operations team was dispatched to assess vessel security. It was determined that none of the crew, who had been exposed to the potential agent 10 days earlier, had shown any symptoms of biological warfare agents. A multi-agency unified command was set up, consisting of state, federal and local agencies. Various options were evaluated, including treatment of the containers on board due to the possibility of a dispersal device which could cause wide-spread contamination; the off loading and disposal of the cargo into the sea; and off loading of containers on shore with subsequent treatment. The following safety precautions were taken: cooling units were shut off 48 hours before sailing; the vents were sealed and closed; and the drains were plugged. At the port, trained dogs were used, and
The purpose of this working session is about the operations in a control system incident. The participants can apply the knowledge acquired in a bus accident exercise where the passengers are in contamination risk by dangerous material. They have to identify the incident commander, the type of response required, the risks of the emergency, the requirements for transporting the victims to the hospital and the actors involved in a radiological emergency
Hobbs, Alan; Cardoza, Colleen; Null, Cynthia
It has been estimated that aviation accidents are typically preceded by numerous minor incidents arising from the same causal factors that ultimately produced the accident. Accident databases provide in-depth information on a relatively small number of occurrences, however incident databases have the potential to provide insights into the human factors of Remotely Piloted Aircraft System (RPAS) operations based on a larger volume of less-detailed reports. Currently, there is a lack of incident data dealing with the human factors of unmanned aircraft systems. An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. During each focus group session, a note taker produced a de-identified written record of the incident narratives. At the end of the session, participants reviewed each written incident report, and made edits and corrections as necessary. The incidents were later analyzed to identify contributing factors, with a focus on design issues that either hindered or assisted the pilot during the events. A total of 90 incidents were reported. This presentation focuses on incidents that involved the management of the command and control (C2) link. The identified issues include loss of link, interference from undesired transmissions, voice latency, accidental control transfer, and the use of the lost link timer, or lost link OK features.
Botnets play an important role in modern Internet-related cybercrime. A botnet consists of a group of infected computers, referred to as bots. The bots are remotely controlled and deployed in malicious activities, such as DDoS attacks, spam, and espionage. Clever design of the botnet C&C (Command
The NET command was defined and supported in order to facilitate file transfer between computers. Among the goals of the implementation were greatest possible ease of use, maximum power (i.e., support of a diversity of equipment and operations), and protection of the operating system
RAPID (Robot Application Programming Interface Delegate) software utilizes highly robust technology to facilitate commanding and monitoring of lunar assets. RAPID provides the ability for intercenter communication, since these assets are developed in multiple NASA centers. RAPID is targeted at the task of lunar operations; specifically, operations that deal with robotic assets, cranes, and astronaut spacesuits, often developed at different NASA centers. RAPID allows for a uniform way to command and monitor these assets. Commands can be issued to take images, and monitoring is done via telemetry data from the asset. There are two unique features to RAPID: First, it allows any operator from any NASA center to control any NASA lunar asset, regardless of location. Second, by abstracting the native language for specific assets to a common set of messages, an operator may control and monitor any NASA lunar asset by being trained only on the use of RAPID, rather than the specific asset. RAPID is easier to use and more powerful than its predecessor, the Astronaut Interface Device (AID). Utilizing the new robust middleware, DDS (Data Distribution System), developing in RAPID has increased significantly over the old middleware. The API is built upon the Java Eclipse Platform, which combined with DDS, provides platform-independent software architecture, simplifying development of RAPID components. As RAPID continues to evolve and new messages are being designed and implemented, operators for future lunar missions will have a rich environment for commanding and monitoring assets.
which threatened the efficient conduct of military operations. The most spectacular and bitter confrontation of this sort was that between the Viceroy of India, Lord Curzon, and the. Commander-in-Chief of the Indian Army, Lord Kitchener, which culminated in Curzon's resignation in August 1905.' The obscure colonies of Natal ...
These features are used as inputs to be classified by the ANN classifier. The performance of this classifier is then evaluated by measuring its accuracy in distinguishing the different interpreted commands. Based on findings from the conducted analysis, we found that PSD is the best feature to be fed as input to the ANN ...
The US decision to establish a unified combatant command (AFRICOM) in African has raised numerous questions, particularly in Africa, regarding its possible security implications for the continent. The article narrows itself to the concern for unraveling the national security implications of Nigeria's opposition to the location of
value in excess of 146 billion dollars. NAVAIR uses the Navy Enterprise Resource Planning ( ERP ) system to process its financial transactions and...resource planning ( ERP ), Naval Air Systems Command (NAVAIR), purchase requests (PR), funding documents, Economy Act Order, intragovernmental transfers...Planning ( ERP ) system to process its financial transactions and, since its implementation, there has been an increase in the overall number of
conclusions expressed herein are those of the student author and do not necessarily represent the views of the U.S. Army Command and General Staff...bombers struck near the Stade de France in Saint-Denis, followed by suicide bombings and mass shootings at cafes , restaurants, and the Bataclan Concert
Carl, C. C.; Couvillon, L. A.; Goldstein, R. M.; Posner, E. C.; Green, R. R.
System, fabricated of highly-reliable digital logic elements, operates on binary pulse-code-modulated signals and derives internal synchronization from data signal. All-digital implementation of detector develops synchronization from data signal by computer cross-correlation of command modulation signal with its expected forms in sequence and adjusts detector phases in accordance with correlation peaks.
Military operations, counter-terrorism operations and emergency response often oblige operators and commanders to operate within distributed organizations and systems for safe and effective mission accomplishment. Tactical commanders and operators frequently encounter violent threats and critical demands on cognitive capacity and reaction time. In the future they will make decisions in situations where operational and system characteristics are highly dynamic and non-linear, i.e. minor events, decisions or actions may have serious and irreversible consequences for the entire mission. Commanders and other decision makers must manage true real time properties at all levels; individual operators, stand-alone technical systems, higher-order integrated human-machine systems and joint operations forces alike. Coping with these conditions in performance assessment, system development and operational testing is a challenge for both practitioners and researchers. This paper reports on research from which the results led to a breakthrough: An integrated approach to information-centered systems analysis to support future command and control systems research development. This approach integrates several areas of research into a coherent framework, Action Control Theory (ACT). It comprises measurement techniques and methodological advances that facilitate a more accurate and deeper understanding of the operational environment, its agents, actors and effectors, generating new and updated models. This in turn generates theoretical advances. Some good examples of successful approaches are found in the research areas of cognitive systems engineering, systems theory, and psychophysiology, and in the fields of dynamic, distributed decision making and naturalistic decision making.
Cliffe, K.A.; Herbert, A.W.
NAMMU is a finite-element program for modelling groundwater flow and transport. The matrix diffusion option models the transport of radionuclides including the effects of rock-matrix diffusion. It uses the free-format structured-input TGIN. This report describes the commands in the TGIN language for running the NAMMU and MATDIF package. (author)
of Staff, Submarine Group TWO; Commander Street, Bureau of Medicine and Surgery; Captain Travis Luz , CO, Naval Health Research Center; Captain...submarine. Both vessels exist in pressure and temperature differentials. Astronauts and submariners live and work in an artificial atmosphere with...cues results in living by an artificial time reference and abnormal sleeping schedules. Crews have limited communications with family, being
A new type of command and control system has been installed at the Chooz B nuclear power plant. A key feature of the system is a man/machine interface designed to provide operators with on-screen assistance more quickly than ever. (Author)
Bakkum, E. L.; Elsenaar, R.J.
A BASIC interpreter is a useful tool for writing small programs in a quick and easy way. For the control of experiments, however, it lacks a number of essential features. A BASIC-like command interpreter BACO has therefore been developed. It runs on PDP-11 computers with the RSX-11M operating
Deborah J. Chavez; Joanne F. Tynon
This is the third in a series of studies to evaluate perceptions of USDA Forest Service law enforcement personnel of the roles, responsibilities, and issues entailed in their jobs. An e-mail survey was administered to the 79 Forest Service patrol captains and patrol commanders (PCs) across the United States. Seventy completed and returned the questionnaire....
... 32 National Defense 2 2010-07-01 2010-07-01 false Checklist for Commanders A Appendix A to Part 192 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS EQUAL OPPORTUNITY IN OFF-BASE HOUSING Pt. 192, App. A Appendix A to Part 192—Checklist for...
200 300 300 Bow Stern 4 2 6 2 6 2 Tor- Mines pedoes 12 22 53 14 28 53 16 28 53 3. Surface Vessels There are more types...subordinate unit and attached unit commanders by way of passing along the mission, or he may pass along the mission in separate chats . When the mission
underestimating an adversary is problematic. Managing the confidence of the unit is a primary task of commanders, and this aspect was a constant...immediate attention. In the ensuring chaos, two helicopters were destroyed while attempting the rescue. A third helicopter finally managed the rescue...States (Boulder, CO: Arms and Armour Press, 1984), 72. 99 Watson, 74. 27
Requirement for Today’s Hgh Itensi Battlefield?, (School of Advanced Mihitary Studies, U.S. Armj Command and General Staff College, Fort Leavenworth...enemy’s main effort and made his decision to concentrate early enough. The emphasis on centralized control was clearly evident: "In fast - moving mounted
...-AA87 Security Zones; Naval Base Point Loma; Naval Mine Anti Submarine Warfare Command; San Diego Bay... establishing a new security zone at the Naval Mine and Anti-Submarine Warfare Command to protect the relocated... Commander of Naval Base Point Loma, the Commander of the Naval Mine Anti Submarine Warfare Command, and the...
Incidents can occur during induction, maintenance and emergence from anaesthesia. The following acute critical incidents are discussed in this article: • Anaphylaxis. • Aspiration ..... Already used in South Africa and Malawi, a scale-up of the technique is under way in Tanzania, Rwanda and Ghana. The report found that.
Neuhalfen, Jon K
.... The analysis uses the PRIDE database, provided by Commander, Navy Recruiting Command. Trend analyses are used to identify significant changes in enlistment and attrition behavior for recruits who joined from fiscal years 1998 through 2005...
Gage, Geoffrey S
.... A single chain of command at the operational level, led by a civilian Joint Executive Commander, is proposed to solve the problems inherent in current doctrinal solutions for interagency coordination...
Avery, L W; Hunt, S T; Savage, S F [Pacific Northwest Lab., Richland, WA (United States); McLaughlin, P D; Shepard, A P; Worl, J C [Battelle Seattle Research Center, Seattle, WA (United States)
The following appendices contain the detailed analysis data for the questionnaires and various FDS-1 after action reports submitted to the Marine Corps Systems Command (MARCORSYSCOM) Marine Tactical Command and Control System (MTACCS) Systems' Engineer.
This monograph asserts that DoD should establish a Unified Combatant Command (COCOM)-level U.S. Logistics Command (USLOGCOM). DoD should begin a deliberate 10-20 year process to establish a USLOGCOM...
...) still in the concept exploration phase. The goal of the present effort was to establish and measure command group behavior observed in such a human-in-the-loop simulation via analysis of the verbal interactions of the command group...
Galazin, Jared J
...), violates the principle of unity of command. Placing components of the BMDS under the control of different combatant commanders creates unnecessary friction in a process where speed of execution is measured in seconds...
... to achieve unity of effort. Based on the tenets of operational command and control by Milan Vego, across all services, the United States helicopter forces fare lacking operational command and control...
... combatant commanders. It can be viewed as infringing upon theater unity of command, a potential avenue for increased national level control and interference, and a competitor for finite warfighting resources...
... management offices to commodity commands. The primary audit objective was to assess whether program management offices were transferring adequate funds and other resources to Military Department commodity commands for missile acquisition...
Full Text Available As terrorists attacks increase in frequency, hospital disaster plans need to be scrutinized to ensure that they take into account issues unique to weapons of mass destruction. This paper reports a review of the literature addressing hospital experiences with such incidents and the planning lessons thus learned. Construction of hospital disaster plans is examined as an ongoing process guided by the disaster planning committee. Hospitals are conceived as one of the components of a larger community disaster planning efforts, with specific attention devoted to defining important linkages among response organizations. This includes the public health authorities, political authorities, prehospital care agencies, and emergency management agencies. A review is completed of six special elements of weapons of mass destruction incidents that should be addressed in hospital disaster plans: incident command, hospital security, patient surge, decontamination, mental health consequences, and communications. The paper closes with a discussion of the importance of training and exercises in maintaining and improving the disaster plan.
Hobzova, L.; Novotny, J.
In many countries a reporting system of radiological incidents to national regulatory body exists and providers of radiotherapy treatment are obliged to report all major and/or in some countries all incidents occurring in institution. State Office for Nuclear Safety (SONS) is providing a systematic guidance for radiotherapy departments from 1997 by requiring inclusion of radiation safety problems into Quality assurance manual, which is the basic document for obtaining a license of SONS for handling with sources of ionizing radiation. For that purpose SONS also issued the recommendation 'Introduction of QA system for important sources in radiotherapy-radiological incidents' in which the radiological incidents are defined and the basic guidance for their classification (category A, B, C, D), investigation and reporting are given. At regular periods the SONS in co-operation with radiotherapy centers is making a survey of all radiological incidents occurring in institutions and it is presenting obtained information in synoptic communication (2003 Motolske dny, 2005 Novy Jicin). This presentation is another summary report of radiological incidents that occurred in our radiotherapy institutions during last 3 years. Emphasis is given not only to survey and statistics, but also to analysis of reasons of the radiological incidents and to their detection and prevention. Analyses of incidents in radiotherapy have led to a much broader understanding of incident causation. Information about the error should be shared as early as possible during or after investigation by all radiotherapy centers. Learning from incidents, errors and near misses should be a part of improvement of the QA system in institutions. Generally, it is recommended that all radiotherapy facilities should participate in the reporting, analyzing and learning system to facilitate the dissemination of knowledge throughout the whole country to prevent errors in radiotherapy.(authors)
United States General Accounting Office GAO Report 1,o, the Commander, Air Force -A0 Systems Command Janar 191FINANCI-AL AUDTFI Financial Reporting ...20332 Dear General Yates: This report presents the results of our review of the Air Force Systems Command’s financial management operations. It addresses...internal control and financial reporting improvements needed within the Air Force Systems Command. The report resulted from our examination of the
Lyhne, Dorte; Lock-Andersen, Jørgen; Dahlstrøm, Karin
Abstract Merkel cell carcinoma (MCC) is a rare, aggressive, skin cancer of obscure histogenesis, the incidence of which is rising. There is no consensus on the optimal treatment. Our aim was to evaluate the staging, investigation, treatment, and follow-up of MCC in eastern Denmark......, and to investigate the incidence. We suggest guidelines for treatment. First we reviewed the medical records of 51 patients diagnosed with MCC from 1995 until 2006 in eastern Denmark. The nation-wide incidence of MCC was extracted from the Danish Cancer Registry for the calculations for the period 1986-2003. We...... reviwed published papers about MCC based on a MEDLINE search. Fourteen of the 51 patients developed recurrence, and 37 (73%) died during the study period. Mean follow-up was 13 months (range 1-122). A total of 153 patients were identified in the Danish Cancer Registry, and showed that incidence rates had...
Huang, Daisie I; Cronk, Quentin C B
Plann automates the process of annotating a plastome sequence in GenBank format for either downstream processing or for GenBank submission by annotating a new plastome based on a similar, well-annotated plastome. Plann is a Perl script to be executed on the command line. Plann compares a new plastome sequence to the features annotated in a reference plastome and then shifts the intervals of any matching features to the locations in the new plastome. Plann's output can be used in the National Center for Biotechnology Information's tbl2asn to create a Sequin file for GenBank submission. Unlike Web-based annotation packages, Plann is a locally executable script that will accurately annotate a plastome sequence to a locally specified reference plastome. Because it executes from the command line, it is ready to use in other software pipelines and can be easily rerun as a draft plastome is improved.
.... national security objectives in Africa and in its surrounding waters. U.S. military involvement on the continent is currently divided among three commands: European Command (EUCOM), Central Command (CENTCOM...
consists of the 15kw, 30kw and 60kw generators and power plants . Understanding how to operate these generators is only a small part of maintaining...equipment when a printer starting printing or a coffee maker was turned on? Understanding how PDISE configurations distribute loads in order to maintain...maintenance of generators is another consideration. Remember that personnel will not only service power plants that are providing power to the command
López Pérez, José Pedro;
Full Text Available The study of natural sciences in the second year of Secondary Education must be complemented with a visit to the laboratory, where experiments should be permormed. The curriculum emphasizes the initial basis of Chemistry and the study of reactions. In this paper we describe a laboratory experience, useful for understanding the concept of chemical change. Also, we present the hypothesis that a chemical reaction was used in the classic movie The Ten Commandments.
Long Beach, 1974 Sutmitted in partial fulfillment of the requirements for the degree of MASTER CF SCIENCI IN INFORMATION SYSTIES from the NAVAL...fundamental management strategy in the Navy is I- centralized policy direction , dezentralized program execu- tion and decentralized control of...centralized ADP command which provided high level policy direction . Additionally, the Services maintained a centralized control of automated data systems (ADS
De Berti Raffaele
Full Text Available Cecil B. DeMille adapted for the screen the biblical text of Exodus twice, and in both cases he devised sophisticated strategies for intersemiotic translation with the aim to create a great show for a popular Christian audience. This is the reason why The Ten Commandments cannot be considered a mere illustration of the biblical story but instead a complex fiction film, which uses the Bible only as a starting point.
REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE Crossing the Streams: Integrating Stovepipes with Command and...ATO for different types of aircraft, making it impossible for pilots to determine which other aircraft will operate in the same area at the same...graduates at the AOC and the air expeditionary task force headquarters can make this happen. They have a successful model but need to open their aper
An Approach To Command and Control Using Emerging Technologies ICCRTS – 044 Dan Carpenter Air Force Research Laboratory / RISA ATTN Dan Carpenter... RISA 525 Brookes Rd Rome, NY 13441 (315) 330-7121 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the...PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Air Force Research Laboratory / RISA ,525
Maritime Tactical Command and Control Analysis of Alternatives Bradley Wilson, Isaac R. Porche III, Mel Eisman, Michael Nixon, Shane Tierney, John ...M. Yurchak, Kim Kendall, James Dryden , Sean Critelli C O R P O R A T I O N Limited Print and Electronic Distribution Rights This document and...missile destroyer USS Ross (U.S. Navy photo by Mass Communication Specialist 2nd Class John Herman/Released). iii Preface This report is about
of the Teradata DBC/1012 -4 database computer to support Command, Control, Communications and Intelligence (C3) functions. The DBC/1012 is an...database machine. The Teradata DBC/1012 has an excellent foreign file capability, good facilities to browse data, and good tools for structured queries...most current C31 systems are tightly coupled. However, when additional functions must be added to current systems, implementing them on a Teradata
of Arab- Islamic theater level forces. Army control was vested in Army Forces Central Command (ARCENT), a reinforced two- corps field army under Lt...RADOC Crisis Actionr Team ... 22)ý,. * Resource Mgt & Plans Dir OC, MITER EV A AUDIT COMIII . COiMMAD HISTORIA OTCINE ATBO-K. Bldg 5 16ý# -MBSATN...0914361 Mr Sullvan Dir ................... 21DCCACDZDMG Hagan DCST.....(83) 5728S800 Mrs Rutledge Del .......p.. 4366 MS Gowe Chi. Ops Or
M.A. thesis, University of Natal, 1985), pp. 47-51; P.B. l30yden and A.J, Guy, 'The British Arrny in Cape Colony and Natal, 1815 - 1877' in. Boyden et ai, 'Ashes and Blood', pp. 44-7; I.F.W. Beckett, 'Military high command in South Africa,. 1854 - 1914' in Boyden et ai, 'Ashes and Blood', pp. 64-5; Dominy, 'Imperial garrison in ...
STS-76 Mission Commander Kevin P. Chilton arrives at KSC's Shuttle Landing Facility in one of the T-38 jets traditionally flown by the astronaut corps. Along with five fellow crew members, Chilton is looking forward to the launch of the Space Shuttle Atlantis around 3:35 a.m. EST, March 21. One of the primary mission objectives is the third docking between the U.S. Shuttle and the Russian Space Station Mir.
STS-87 Commander Kevin Kregel is assisted with his ascent and re- entry flight suit in the white room at Launch Pad 39B by Danny Wyatt, NASA quality assurance specialist. STS-87 is the fourth flight of the United States Microgravity Payload and Spartan-201. A veteran of two space flights (STS-70 and -78), Kregel has logged more than 618 hours in space.
80 Consequently, Frederick‘s army was the first into Silesia in 1740 and first into Saxony 1756.81 Preemption provided Frederick a great advantage in...refinement, of what is developing into a clearer picture of the essence of command. Eisenhower‘s circumstances are again unique; therefore, the analysis...differences, and construct a common picture ,‖ the advantages are unlikely to be that pronounced because understanding is not the same as developing a
deemed to have been earned in the Servicemember’s state of domicile and only that jurisdiction may tax military pay. This does not apply to non...military pay, which may be taxed in the jurisdiction in which the pay was earned , in the state which the Servicemember is currently living and the... infidelity . Waivers are processed through the Defense Finance Accounting Service (DFAS) in accordance with reference (b). COMMAND ACTION UNDER
provide full disclosure, those interviewees are assigned pseudonyms in the interest of privacy and referred to as “Army Colonel A” or “Navy Captain B... pseudonym assigned to an Army O6 well versed in both Global Response Force (GRF) operations, JTF-PO operations, and mission command philosophy, expressed...study will be assigned a pseudonym (e.g. Army Colonel A) associated with their data. Complete confidentiality cannot be promised to subjects
The invention concerns a manual command component designed to be use by a human hand in order to control a slave system, with a tactile and/or kinesthetic feedback. It is composed by a handle and by piece(s) for the feedback. The handle contains a captor to signalize the move and the speed. The signals are transmitted to the slave system. The later send feedbacks which are transformed in a couple for the handle. (TEC)
Adams, Rick A.; Shipp, Stewart; Friston, Karl J.
The descending projections from motor cortex share many features with top-down or backward connections in visual cortex; for example, corticospinal projections originate in infragranular layers, are highly divergent and (along with descending cortico-cortical projections) target cells expressing NMDA receptors. This is somewhat paradoxical because backward modulatory characteristics would not be expected of driving motor command signals. We resolve this apparent paradox using a functional cha...
Six essential elements of leadership. Marine Corps wisdom of a Medal of Honor recipient . Annapolis: Naval Institute Press, 2011. Headquarters...question of command. Counterinsurgency from the Civil War to Iraq. New Haven: Yale University Press, 2009. Nagl, John A. Learning to eat soup with a... recipient (Annapolis: Naval Institute Press, 2011), page 33. 104 “Former Yugoslavia – UNPROFOR,” United Nations Department of Public Information
Les résultats obtenus montrent que la commande floue adaptative directe stable étendue a prouvé une grande efficacité et une bonne robustesse en présence des variations paramétriques et de perturbations. Mots clé: Machine asynchrone- Systèmes flous- Commande par logique floue- Commande adaptative- lois ...
Williams, Tony; LeMire, Steven D.
The authors examined professionally qualified Air Force commanders' barriers to entry into a business doctoral degree program related to the factors of time, financial means, academics, and motivation. Of the 116 present commanders, 63% were interested in pursuing a doctorate in business. For the commanders interested in obtaining a doctorate…
... 32 National Defense 2 2010-07-01 2010-07-01 false DoD Command Newspaper and Magazine Review System... ENTERPRISE PUBLICATIONS Pt. 247, App. E Appendix E to Part 247—DoD Command Newspaper and Magazine Review System A. Purpose. The purpose of the DoD command newspaper and magazine review system is to assist...
of the Commander’s job in facilities management ?, (2) What information sources are available to prepare the new commander for these responsibilities...Commanders say they need to know about facilities management and civil engineering operations?, (5) where can this additional information be found?, (6) How
... 32 National Defense 5 2010-07-01 2010-07-01 false Administration and discipline: Staff unassigned... REGULATIONS AND OFFICIAL RECORDS Commanders In Chief and Other Commanders Administration and Discipline § 700.722 Administration and discipline: Staff unassigned to an administrative command. (a) When it is not...
In the Operations and Checkout Building, STS-93 Commander Eileen M. Collins gets help donning her launch and entry suit. After Space Shuttle Columbia's July 20 launch attempt was scrubbed at the T-7 second mark in the countdown, the launch was rescheduled for Thursday, July 22, at 12:28 a.m. EDT. The target landing date is July 26, 1999, at 11:24 p.m. EDT. STS-93 is a five-day mission primarily to release the Chandra X-ray Observatory, which will allow scientists from around the world to study some of the most distant, powerful and dynamic objects in the universe. The new telescope is 20 to 50 times more sensitive than any previous X- ray telescope and is expected unlock the secrets of supernovae, quasars and black holes. The STS-93 crew numbers five: Commander Collins, Pilot Jeffrey S. Ashby, and Mission Specialists Stephen A. Hawley (Ph.D.), Catherine G. Coleman (Ph.D.) and Michel Tognini of France, with the Centre National d'Etudes Spatiales (CNES). Collins is the first woman to serve as commander of a shuttle mission.
During final launch preparations in the Operations and Checkout Building, STS-93 Commander Eileen M. Collins waves after donning her launch and entry suit. After Space Shuttle Columbia's July 20 launch attempt was scrubbed at the T-7 second mark in the countdown, the launch was rescheduled for Thursday, July 22, at 12:28 a.m. EDT. The target landing date is July 26, 1999, at 11:24 p.m. EDT. STS-93 is a five-day mission primarily to release the Chandra X-ray Observatory, which will allow scientists from around the world to study some of the most distant, powerful and dynamic objects in the universe. The new telescope is 20 to 50 times more sensitive than any previous X-ray telescope and is expected unlock the secrets of supernovae, quasars and black holes. The STS-93 crew numbers five: Commander Collins, Pilot Jeffrey S. Ashby, and Mission Specialists Stephen A. Hawley (Ph.D.), Catherine G. Coleman (Ph.D.) and Michel Tognini of France, with the Centre National d'Etudes Spatiales (CNES). Collins is the first woman to serve as commander of a shuttle mission.
Cooke, Thomas; Chesters, Adam; Grier, Gareth
Since the end of World War II, there has been an emergence of explosives used amongst civilian populations resulting in mass-casualty incidents. The development of pre-hospital medical systems, worldwide, has resulted in an increased response at these incidents. However, information about the pre-hospital medical response is sparse and not collated. This review aimed to collect and appraise the literature on the pre-hospital management of mass-casualty bombing incidents. The primary objective was to identify and discuss the common themes highlighted as problems in the pre-hospital medical response. The secondary objectives reviewed the injury patterns in victims and psychological impacts on pre-hospital responders. A systematic literature search on the PubMed, SCOPUS and Web of Science databases took place. It included literature published from the 1 st of January 2000 to April 3rd 2017, with the last search performed on April 3rd 2017. Literature was included if it offered description, analysis, reflection or review of the bombing incidents.emermed;34/12/A884-a/F1F1F1Figure 1The minimum number of recorded deaths and injuries from 11 deliberate mass casualty bombing incidents (note: two simultaneous marauding terrorist firearm attack and bombing incidents excluded)emermed;34/12/A884-a/F2F2F2Figure 2Percentage of included literature identifying the following themes as problems in the pre-hospitals medical response RESULTS: 1345 articles were found, with 54 included in analysis. 13 mass-casualty bombing incidents were described. Two of these included marauding terrorist firearm attacks (MTFA). In the 11 bombing-only incidents the death of 592-642 people and injury of 3,842-5229 more is described, with a further 301 deaths and 604 injuries from bombings with MTFA attacks. Quality appraisal showed a variation in reporting among incidents and a lack of uniform reporting. Functioning and reliable communication, alongside regular training exercises with other emergency
these components will be presented. 4.17 °°,. CHAPTER III FOOTNOTES 1. Arron Barr and Edward A. Feigenbaum, eds., Te Handbook gf Artificial Inteligence ol...RD-R137 205 ARTIFICIAL INTELLIGENCE APPLIED TO THE COMIMAND CONTROL i/i COMMUNICATIONS RND..(U) ARMY WAR COLL CARLISLE BARRACKS U PA J N ENVART 06...appropriate mlitary servic or *swesmment aency. ARTIFICIAL INTELLIGENCE APPLIED TO THE COMMAND, CONTROL, COMMUNICATIONS, AND INTELLIGENCE OF THE U.S. CENTRAL
Lim, J J; Childs, J; Gonsalves, K
Recent studies have indicated implementation of the CISM Program has impacted and reduced the cost of workers' compensation claims for stress related conditions and the number of lost work days (Ott, 1997; Western Management Consultants, 1996). Occupational health professionals need to be ready to develop and implement a comprehensive critical incident stress management process in anticipation of a major event. The ability to organize, lead, or administer critical incident stress debriefings for affected employees is a key role for the occupational health professional. Familiarity with these concepts and the ability to identify a critical incident enhances value to the business by mitigating the stress and impact to the workplace. Critical Incident Stress Management Systems have the potential for decreasing stress and restoring employees to normal life function--a win/win situation for both the employees and the organization.
National Oceanic and Atmospheric Administration, Department of Commerce — Large whale stranding, death, ship strike and entanglement incidents are all recorded to monitor the health of each population and track anthropogenic factors that...
Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Police Blotter Archive contains crime incident data after it has been validated and processed to meet Uniform Crime Reporting (UCR) standards, published on a...
National Aeronautics and Space Administration — Safety incidents, including injuries, property damage and mission failures, cost NASA and contractors thousands of dollars in direct and indirect costs. This project...
EPA’s RadNet system monitored the environmental radiation levels in the United States and parts of the Pacific following the Japanese Nuclear Incident. Learn about EPA’s response and view historical laboratory data and news releases.
D. I. Persanov
Full Text Available The present report highlights the points of information security incident management in an enterprise. Some aspects of the incident and event classification are given. The author presents his view of the process scheme over the monitoring and processing information security events. Also, the report determines a few critical points of the listed process and gives the practical recommendations over its development and optimization.