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Sample records for mainz emergency evaluation

  1. MAINZ: MAMI microtron

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    Officially inaugurated at the end of January was the new Mainz Microtron - MAMI - which became fully operational last summer after a final three-year construction phase at Johannes Gutenberg University

  2. The research reactor TRIGA Mainz

    International Nuclear Information System (INIS)

    Hampel, G.; Eberhardt, K.; Trautmann, N.

    2006-01-01

    The TRIGA Mark II reactor at the Institut fuer Kernchemie became first critical on August 3 rd , 1965. It can be operated in the steady state mode with a maximum power of 100 kWth and in the pulse mode with a peak power of 250 MWth. A survey of the research programmes performed at the TRIGA Mainz is given covering applications in basic research as well as applied science in nuclear chemistry and nuclear physics. Furthermore, the reactor is used for neutron activation analysis and for education and training of scientists, teachers, students and technical personal. Important projects for the future of the TRIGA Mainz are the UCN (ultra cold neutrons) experiment, fast chemical separation, medical applications and the use of the NAA as well as the use of the reactor facility for the training of students in the fields of nuclear chemistry, nuclear physics and radiation protection. Taking into account the past and future operation schedule and the typically low burn-up of TRIGA fuel elements (∝4 g U-235/a), the reactor can be operated for at least the next decade taking into account the fresh fuel elements on stock and without changing spent fuels. (orig.)

  3. Research activities at the TRIGA Mainz

    International Nuclear Information System (INIS)

    Eberhardt, K.; Trautmann, N.

    2002-01-01

    The TRIGA Mark II reactor of the Mainz University became first critical on August 3, 1965. It can be operated in the steady state mode with a maximum power of 100 kW and in the pulse mode with a peak power of 250 MW. The TRIGA Mainz is mainly used for neutron activation analysis, isotope production, basic research in nuclear chemistry and nuclear physics as well as for education and training

  4. Colon pouch (Mainz III) for continent urinary diversion.

    Science.gov (United States)

    Stolzenburg, Jens-Uwe; Schwalenberg, Thilo; Liatsikos, Evangelos N; Sakelaropoulos, George; Rödder, Kilian; Hohenfellner, Rudolph; Fisch, Margit

    2007-06-01

    To evaluate the use of a continent cutaneous pouch made exclusively of colon (Mainz pouch III), as excellent results with the Mainz pouch III in irradiated patients suggested that the indication for this type of urinary diversion could be extended. The outcome of 24 patients with continent cutaneous urinary diversions using colon segments (Mainz pouch III) was investigated retrospectively. Overall, 22 of the patients had a malignant disease and two a benign disease; 16 had a hysterectomy and pelvic exenteration for gynaecological tumours; two men with a rhabdomyosarcoma of the prostate had a radical cystoprostatectomy; one woman had pelvic exenteration for bladder cancer; one man had a simultaneous rectum resection due to infiltrating rectal cancer, and another a left nephrectomy with cystectomy for concomitant kidney and bladder tumour. Benign indications were hyper-reflexive bladder after polytrauma and two cases of neurogenic bladder dysfunction. Eighteen patients had radiotherapy (32-48 Gy) before the urinary diversion. The mean (range) follow-up was 35 (12-65) months. The mean pouch capacity was 293.8 mL. Three patients died during the follow-up (two from disease progression and one suicide); 20 patients were fully continent, four with reduced pouch capacity (<300 mL) had slight incontinence and are wearing a protective pad (band-aid at the umbilicus). All patients use intermittent self-catheterization (mean catheterization frequency 6.8/day, range 6-12). Complications related to the pouch were one outlet stenosis that required revision. Postoperative pouchograms showed asymptomatic reflux in four patients. None of the patients developed metabolic acidosis or diarrhoea. The Mainz pouch III is an alternative to other types of continent urinary diversion.

  5. Research with Neutrons at the TRIGA Mainz

    International Nuclear Information System (INIS)

    Hampel, Gabriele

    2008-01-01

    The TRIGA Mark II reactor at the Institut fuer Kernchemie of the Johannes Gutenberg-Universitaet in Mainz became first critical on August 3, 1965 and is still intensively used for basic research, applied science and educational purposes. Considering the past and future operation schedule and the low burn-up of the fuel elements (∼4 g 235 U/a), the reactor can be operated for at least the next decade taking into account the fresh fuel elements on stock and without changing spent fuels. The operation of the TRIGA Mainz has been extended very recently until the year 2020. The TRIGA Mainz can be operated in the steady state mode with a maximum power of 100 kWth and in the pulse mode with a peak power of 250 MWth. Until now, more than 16600 pulses have been carried out without any fuel failure. For irradiations the TRIGA Mainz has a central experimental tube, three pneumatic transfer systems and a rotary specimen rack with 40 positions which allows the irradiation of 80 samples at the same time. In addition, the TRIGA Mainz includes four horizontal beam ports penetrating the concrete shielding and extending inside the pool towards the reflector. A graphite thermal column provides a source of well-thermalized neutrons suitable for physical research or biological and medical irradiations. Important projects for the future of the TRIGA Mainz are the production of ultracold neutrons (UCN) and experiments with UCN, high precision mass measurements and laser spectroscopy of short-lived fission products (TRIGA-TRAP), the production of radionuclides for fast chemical separations, medical and radiopharmaceutical applications, and the use of the neutron activation analysis for the application in archeometry, solar energy technique, criminalistics and vine analysis. Furthermore, studies are performed to judge if the Boron Neutron Capture Therapy (BNCT) can be applied at the TRIGA Mainz for cancer treatment of liver metastases. Also, the reactor facility is used for the training

  6. Piscina cubierta en Taubertsberg Mainz, Alemania

    Directory of Open Access Journals (Sweden)

    Apel, O.

    1967-02-01

    Full Text Available The enclosed swimming pool built at Mainz involves two separate levels. The ground level contains the entrance hall, a bar, a gymnasium as well as heating, water renewal, purifying and sterilising installations. On the second level, in addition to the pool, which is 25 x 15 m in area, and a learner's pool, there are changing rooms for men and women, and shower and washing rooms. The building is of compound structure, and the enclosing walls are highly diaphanous, giving the interior much luminosity and a somewhat ethereal quality which characterises it in a very marked manner.El edificio destinado a piscina cubierta, construido en Mainz, consta de dos plantas: La planta baja aloja la zona de ingreso, el bar, un gimnasio, etc., y las instalaciones para: la calefacción, renovación, depuración y esterilización del agua, etc. La planta primera, además de los vestuarios —de señoras y de caballeros—, bloques de duchas y aseos, etc., alberga una piscina de 15 m x 25 m y otra de aprendizaje. El edificio es de estructura mixta y gran diafanidad de cerramientos, lo que proporciona una gran luminosidad y cierto aspecto etéreo que le caracteriza y distingue.

  7. Research activities at the TRIGA Mainz

    International Nuclear Information System (INIS)

    Eberhardt, K.

    1994-01-01

    The experimental programme at the TRIGA Mainz covers a wide range of applications in different fields. Two of the four beam tubes are used for the development of fast and mainly continuous chemical separation procedures. These procedures are applied for the investigation of short-lived nuclides and for studies of the chemical behaviour of the heaviest elements. At the third beam tube an on-line mass-separator facility with a microwave-induced plasma as an ion source is installed. Very recently the fourth beam tube has been modified for the production of polarized neutrons by interaction with optically pumped 3 He atoms. The other irradiation facilities are used for Neutron Activation Analysis (NAA) of different samples, among them geological and environmental ones, tracer production for chemical investigations, neutron irradiations of rat brain tissue to explore the utility of 157 Gd for cancer therapy and γ-ray irradiations for biological purposes. (author)

  8. Research work at the TRIGA Mainz reactor

    International Nuclear Information System (INIS)

    Trautmann, Norbert

    1976-01-01

    In the last two years the research activities at the TRIGA Mark II reactor in Mainz have mainly been concentrated on the investigation of short- lived nuclides of medium mass number produced by thermal-neutron induced fission of 235 U and other fissile materials. For the identification of these nuclides and for detailed studies of their properties rapid chemical separation procedures in combination with high-resolution gamma-ray and neutron spectroscopy as well as mass-separated samples have been used. Fast, discontinuous separation techniques are illustrated by a procedure for technetium. Continuous separation methods from aqueous solutions and in the gas phase, accomplished by combining a gas jet recoil transport system with an on-line operating solvent extraction technique and a thermo- chromatographic method, are presented. The application of such procedures to decay scheme and delayed neutron studies is demonstrated by a few examples. The experimental set-up and the method for nuclear spin - and magnetic moment measurements on alkali isotopes far from the region of beta-stability applying the nuclear radiation detected optical pumping technique to mass- separated samples of neutron-rich alkali nuclides are briefly described. (author)

  9. Status of the TRIGA user facility in Mainz

    Energy Technology Data Exchange (ETDEWEB)

    Kories, Fabian; Heil, Werner; Karch, Jan Peter; Sobolev, Yury [Institut fuer Physik, Johannes Gutenberg Universitaet Mainz (Germany); Eberhardt, Klaus; Hampel, Gabriele; Reich, Tobias; Trautmann, Norbert [Institut fuer Kernchemie, Johannes Gutenberg Universitaet Mainz (Germany)

    2014-07-01

    Ultra-cold neutrons (UCN) offer unique opportunities for investigating the properties of the free neutron with exceptionally high precision such as the measurement of its lifetime. At the pulsed TRIGA reactor in Mainz, a superthermal UCN source using solid deuterium as converter is operational and delivers up to 10 UCN/cm{sup 3} in typical storage volumes of 10 l. Within PRISMA Cluster of excellence, this source will be upgraded to a targeted strength of 100 UCN/cm{sup 3} in order to transform TRIGA Mainz into a world-leading user facility for UCN research. Besides the installation of a He liquefier to sustain long-term experiments, the existing neutron guides have to be replaced by high-quality guides with low surface roughness which are internally coated with Ni-58 to increase the phase space for UCN transport. The poster gives a status report on the activities at the UCN source at TRIGA Mainz.

  10. Institut fuer Kernchemie, Univ. Mainz. Annual report 1983

    International Nuclear Information System (INIS)

    Weber, M.

    1984-01-01

    This annual report contains extended abstracts about the work performed at the named institute together with a list of publications and speeches. The work concern fast chemical separations, the detection of short-lived nuclides, mass separations, nuclear spectroscopy, nuclear fission, heavy ion research, superheavy elements, radionuclide ecology, and the operation of the TRIGA Mainz reactor. (HSI) [de

  11. Outcome of Mainz II pouch urinary diversion after radical cystectomy ...

    African Journals Online (AJOL)

    Outcome of Mainz II pouch urinary diversion after radical cystectomy in patients with muscle-invasive bladder cancer: our experience. ... Nine (82%) had a histological diagnosis of transitional cell carcinoma, and two (18%) were squamous cell carcinoma (SCC). Ten (91%) patients had high‑grade disease, whereas only 1 ...

  12. Five years of operating the TRIGA Mainz reactor

    International Nuclear Information System (INIS)

    Benedict, Georg

    1970-01-01

    Considerable obstacles had to be surmounted before TRIGA MAINZ, first TRIGA reactor built in Germany, reached initial criticality in 1965. Subsequent five years' operation did not raise any major problems. The facility has proven quite reliable and particularly well suited for the purposes of the nuclear chemistry research program pursued at Mainz University. Extensive use is made of the pulse mode of operation. As a result, fuel elements are obviously somewhat overstressed, even though most pulses performed are of the 1.50 dollar size. Maximum licensed steady state power of 100 kW till now has met the requirements of most experiments. However, efforts are in progress to improve irradiation conditions by increasing the reactor power to 300 kW. (author)

  13. Status and perspectives of the Mainz neutrino mass experiment

    International Nuclear Information System (INIS)

    Backe, H.; Barth, H.; Bleile, A.

    1997-01-01

    New data from the decay of molecular tritium studied with the Mainz solenoid retarding spectrometer are presented. From a region close to the end-point we deduce an upper limit for the mass of the electron antineutrino of m ν c 2 ν 2 c 4 = - 22 ± 17 stat ± 14 sys eV 2 . Possible improvements and the perspectives of the experiment are discussed. (orig.)

  14. Operation and maintenance experience at the TRIGA Mainz reactor

    International Nuclear Information System (INIS)

    Menke, Helmut

    1976-01-01

    Oscillations observed in the linear power channel especially at low steady state power with the pulse-rod in down position were found to be due to wear of connections of the pulse-rod. The downstream water from the cooling system caused a swing of the rod, which in turn induced the power oscillations. The wear can be regarded as normal, as more than 10,000 pulses have been performed so far. The repairs of the rod assembly are described. No major problems in operation and maintenance of the TRIGA Mainz were met since 1974. Results of routine inspections as fuel element measurements, power calibrations, etc., are described and discussed. (author)

  15. Searches for dark photons at the Mainz Microtron

    Energy Technology Data Exchange (ETDEWEB)

    Merkel, H.; Achenbach, P.; Gayoso, C. Ayerbe; Beranek, T.; Bernauer, J. C.; Böhm, R.; Correa, L.; Denig, A.; Distler, M. O.; Esser, A.; Gómez, M.; Kegel, S.; Kohl, Y.; Mihovilovič, M.; Middleton, D. G.; Müller, U.; Nungesser, L.; Pochodzalla, J.; Rohrbeck, M.; Majos, S. Sánchez [Institut für Kernphysik, Johannes Gutenberg-Universität, D-55099 Mainz (Germany); and others

    2013-11-07

    The A1 Collaboration at the Mainz Microtron (MAMI) operates high resolution spectrometers at very high luminosities for fixed target electron scattering experiments. The setup is well suited for the search for dark photons in the mass range between 50 MeV and 300 MeV. In these experiments, a possible dark photon would appear as a sharp peak in the mass spectrum of di-lepton electro-production. In this presentation the potential of the setup is presented and the possibilities for future experiments for dark photon searches at MAMI are discussed.

  16. Medical and radiobiological applications at the research reactor TRIGA Mainz

    International Nuclear Information System (INIS)

    Hampel, G.; Grunewald, C.; Kratz, J.-V.; Schmitz, T.; Schutz, C.; Werner, S.; Appelman, K.; Moss, R.; Blaickner, M.; Nawroth, T.; Otto, G.; Schmidberger, H.

    2010-01-01

    At the University of Mainz, Germany, a boron neutron capture therapy (BNCT) project has been started with the aim to expand and advance the research on the basis of the TAOrMINA protocol for the BNCT treatment of liver metastases of colorectal cancer. Irradiations take place at the TRIGA Mark II reactor. Biological and clinical research and surgery take place at the University and its hospital of Mainz. Both are situated in close vicinity to each other, which is an ideal situation for BNCT treatment, as similarly performed in Pavia, in 2001 and 2003. The application of BNCT to auto-transplanted organs requires development in the methodology, as well as regard to the irradiation facility and is part of the complex, interdisciplinary treatment process. The additional high surgical risk of auto-transplantation is only justified when a therapeutic benefit can be achieved. A BNCT protocol including explantation and conservation of the organ, neutron irradiation and re-implantation is logistically a very challenging task. Within the last years, research on all scientific, clinical and logistical aspects for the therapy has been performed. This includes work on computational modelling for the irradiation facility, tissue and blood analysis, radiation biology, dosimetry and surgery. Most recently, a clinical study on boron uptake in both healthy and tumour tissue of the liver and issues regarding dosimetry has been started, as well as a series of cell-biology experiments to obtain concrete results on the relative biological effectiveness (RBE) of ionizing radiation in liver tissue. (author)

  17. The Boron Neutron Capture Therapy (BNCT) Project at the TRIGA Reactor in Mainz, Germany

    DEFF Research Database (Denmark)

    Hampel, G.; Grunewald, C.; Schütz, C.

    2011-01-01

    The thermal column of the TRIGA reactor in Mainz is being used very effectively for medical and biological applications. The BNCT (boron neutron capture therapy) project at the University of Mainz is focussed on the treatment of liver tumours, similar to the work performed at Pavia (Italy) a few ...

  18. Newest results from the Mainz neutrino-mass experiment

    International Nuclear Information System (INIS)

    Bonn, J.; Bornschein, B.; Bornschein, L.; Fickinger, L.; Kraus, Ch.; Otten, E.W.; Ulrich, H.; Weinheimer, Ch.; Kazachenko, O.; Kovalik, A.

    2000-01-01

    The Mainz neutrino-mass experiment investigates the endpoint region of the tritium β-decay spectrum with a MAC-E spectrometer to determine the mass of the electron antineutrino. By the recent upgrade, the former problem of dewetting T 2 films has been solved, and the signal-to-background ratio was improved by a factor of 10. The latest measurement leads to m ν 2 -3.7 ± 5.3(stat.) ± 2.1(syst.) eV 2 /c 4 , from which an upper limit of m ν 2 (95% C.L.) is derived. Some indication for the anomaly, reported by the Troitsk group, was found, but its postulated half-year period is contradicted by our data. To push the sensitivity on the neutrino mass below 1 eV/c 2 , a new larger MAC-E spectrometer is proposed. Besides its integrating mode, it could run in a new nonintegration operation MAC-E-TOF mode

  19. Usability Evaluation in a Digitally Emerging Country

    DEFF Research Database (Denmark)

    Lizano, Fulvio; Sandoval, Maria Marta; Bruun, Anders

    2013-01-01

    Several emerging countries experience increasing software development activities. With the purpose of provide useful feedback on possible courses of action for increasing application of usability evaluation in such countries, this paper explores the status of usability evaluation in a digitally...... emerging country. Our aim is to identifying common characteristics or behavioral patterns that could be compared with digitally advanced countries. We used an online survey answered by 26 software development organizations, which gave a snapshot of the application of usability evaluation...... in these organizations. We found many similarities with advanced countries, several completely new obstacles more connected with software development matters and a relatively positive improvement in the lack of “usability culture”. These findings suggest good conditions to improve conduction of usability evaluations...

  20. Evaluation of Performance Indexes of Emergency Department

    Directory of Open Access Journals (Sweden)

    Alireza Baratloo

    2015-02-01

    Full Text Available Introduction: The importance of evaluating performance indicators in the emergency department, as one of the most important departments of hospital, is obvious to everyone. Therefore, in this study we aimed to appraise the five performance indicators, approved by the ministry of health, in Shohadaye Tajrish hospital, Tehran, Iran. Methods: In a descriptive cross-sectional study based on the profiles of all the patients admitted to the emergency department, performance indicators in the emergency department were evaluated. The study was divided into 2 parts about the establishment of emergency medicine system and training the medical staff: the first 6 months of 1392 and the second. Then these 2 periods were compared using Mann-Whitney U test while P< 0.05 was considered as the level of significance. Results: Of the studied indicators, mean triage time was 6.04 minutes in the first 6 months which was reduced to 1.5 minutes in the second 6 months (p=0.016. In addition, the percentage of patients who moved out of the department in 12 hours was lowered from 97.3% in the first period to 90.4% in the second (p=0.004. While, the percentage of patients who were decided upon in 6 hours (p=0.2, unsuccessful CPR percentage (p=0.34 and patients discharged against medical advice (p=0.42 showed no significant difference. Conclusion: The results of this study showed that the establishment of the emergency medicine system in the emergency department could lead to more efficient triage. Due to the differences made after their establishment including: different pattern of the patients admitted, increased stay of the patients in the department due to their need for prolonged intensive care, a raise in patient referral to the hospital by pre-hospital services and a higher percentage of occupied hospital beds, other indicators have not shown a significant improvement.

  1. The Boron Neutron Capture Therapy (BNCT) Project at the TRIGA Reactor in Mainz, Germany

    Energy Technology Data Exchange (ETDEWEB)

    Hampel, G.; Grunewald, C.; Schutz, C.; Schmitz, T.; Kratz, J.V. [Nuclear Chemistry, University of Mainz, D-55099 Mainz (Germany); Brochhausen, C.; Kirkpatrick, J. [Department of Pathology, University of Mainz, D-55099 Mainz (Germany); Bortulussi, S.; Altieri, S. [Department of Nuclear and Theoretical Physics University of Pavia, Pavia (Italy); National Institute of Nuclear Physics (INFN) Pavia Section, Pavia (Italy); Kudejova, P. [Forschungs-Neutronenquelle Heinz Maier-Leibnitz (FRM II), Technische Universitaet Muenchen, D-85748 Garching (Germany); Appelman, K.; Moss, R. [Joint Research Centre (JRC) of the European Commission, NL-1755 ZG Petten (Netherlands); Bassler, N. [University of Aarhus, Norde Ringade, DK-8000, Aarhus C (Denmark); Blaickner, M.; Ziegner, M. [Molecular Medicine, Health and Environment Department, AIT Austrian Institute of Technology GmbH (Austria); Sharpe, P.; Palmans, H. [National Physical Laboratory, Teddington TW11 0LW, Middlesex (United Kingdom); Otto, G. [Department of Hepatobiliary, Pancreatic and Transplantation Surgery, University of Mainz, D-55099 Mainz (Germany)

    2011-07-01

    The thermal column of the TRIGA reactor in Mainz is being used very effectively for medical and biological applications. The BNCT (boron neutron capture therapy) project at the University of Mainz is focussed on the treatment of liver tumours, similar to the work performed in Pavia (Italy) a few years ago, where patients with liver metastases were treated by combining BNCT with auto-transplantation of the organ. Here, in Mainz, a preclinical trial has been started on patients suffering from liver metastases of colorectal carcinoma. In vitro experiments and the first animal tests have also been initiated to investigate radiobiological effects of radiation generated during BNCT. For both experiments and the treatment, a reliable dosimetry system is necessary. From work elsewhere, the use of alanine detectors appears to be an appropriate dosimetry technique. (author)

  2. Emergency building temperature restrictions. Final evaluation

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-11-01

    On July 5, 1979, DOE promulgated final regulations of the Emergency Building Temperature Restrictions program, placing emergency restrictions on thermostat settings for space heating, space cooling, and hot water in commercial, industrial, and nonresidential public buildings. The final regulations restricted space heating to a maximum of 65/sup 0/F, hot water temperature to a maximum of 105/sup 0/F, and cooling temperature to a minimum of 78/sup 0/F. A comprehensive evaluation of the entire EBTF program for a nine-month period from July 16, 1979 is presented. In Chapter 1, an estimate of the population of buildings covered by EBTR is presented. In Chapter 2, EBTR compliance by building type and region is reported. Exemptions are also discussed. In Chapter 3, the simulations of building energy use are explained and the relative impact of various building characteristics and effectiveness of different control strategies are estimated. Finally, in Chapter 4, the methodology for scaling the individual building energy savings to the national level is described, and estimated national energy savings are presented.

  3. Signal Quality Evaluation of Emerging EEG Devices

    Directory of Open Access Journals (Sweden)

    Thea Radüntz

    2018-02-01

    Full Text Available Electroencephalogram (EEG registration as a direct measure of brain activity has unique potentials. It is one of the most reliable and predicative indicators when studying human cognition, evaluating a subject's health condition, or monitoring their mental state. Unfortunately, standard signal acquisition procedures limit the usability of EEG devices and narrow their application outside the lab. Emerging sensor technology allows gel-free EEG registration and wireless signal transmission. Thus, it enables quick and easy application of EEG devices by users themselves. Although a main requirement for the interpretation of an EEG is good signal quality, there is a lack of research on this topic in relation to new devices. In our work, we compared the signal quality of six very different EEG devices. On six consecutive days, 24 subjects wore each device for 60 min and completed tasks and games on the computer. The registered signals were evaluated in the time and frequency domains. In the time domain, we examined the percentage of artifact-contaminated EEG segments and the signal-to-noise ratios. In the frequency domain, we focused on the band power variation in relation to task demands. The results indicated that the signal quality of a mobile, gel-based EEG system could not be surpassed by that of a gel-free system. However, some of the mobile dry-electrode devices offered signals that were almost comparable and were very promising. This study provided a differentiated view of the signal quality of emerging mobile and gel-free EEG recording technology and allowed an assessment of the functionality of the new devices. Hence, it provided a crucial prerequisite for their general application, while simultaneously supporting their further development.

  4. Evaluating emergency ultrasound training in India

    Directory of Open Access Journals (Sweden)

    Gupta Amit

    2010-01-01

    Full Text Available Background : In countries with fully developed emergency medicine systems, emergency ultrasound (EUS plays an important role in the assessment and treatment of critically ill patients. Methods : The authors sought to introduce EUS to a group of doctors working in the emergency departments (EDs in India through an intensive 4-day adult and pediatric ultrasound course held at the Apex Trauma Center and EM division of the All India Institute of Medical Sciences in New Delhi. The workshop was evaluated with a survey questionnaire and a hands-on practical test. The questionnaire was designed to assess the current state of EUS in India′s EDs, and to identify potential barriers to the incorporation of EUS into current EM practice. The EUS course consisted of a general introductory didactic session followed by pediatric, abdominal and trauma, cardiothoracic, obstetrical and gynecologic, and vascular modules. Each module had a didactic session followed by hands-on applications with live models and/or simulators. A post-course survey questionnaire was given to the participants, and there was a practical test on the final day of the course. The ultrasound images taken by the participants were digitally recorded, and were subsequently graded for their accuracy by independent observers, residency, and/or fellowship trained in EUS. Results : There were a total of 42 participants who completed the workshop and took the practical examination; 32 participants filled in the course evaluation survey. Twenty-four (75% participants had no prior experience with EUS, 5 (16% had some experience, and 3 (9% had significant experience. During the practical examination, 38 of 42 participants (90% were able to identify Morison′s pouch on the focused abdominal sonography for trauma (FAST examination, and 32 (76% were able to obtain a parasternal long axis cardiac view and identify the left ventricle. The inferior vena cava was identified as it crosses the diaphragm into

  5. [The evaluation of academic emergency department design].

    Science.gov (United States)

    Deniz, Turgut; Aydinuraz, Kuzey; Oktay, Cem; Saygun, Meral; Ağalar, Fatih

    2007-01-01

    In our study which was based upon a questionnaire, the inner and outer architectural designs of emergency services of Emergency Medicine Departments were investigated. In this descriptive study, a standard questionnaire was sent to 26 Emergency Medicine Departments which were operating at that time. In the questionnaire, the internal, external architectural and functional features were questioned. Answers of 22 Emergency Medicine Departments were analysed. Two Emergency Medicine Departments that were not operating at that time were not included in the study. The analysis of the replies revealed that only 59% (n=13) of the Emergency Medicine Departments were designed as an emergency service prior to the construction. The ambulance parking areas were not suitable in 77% of the emergency units while only 54.5% (n=12) had protection against adverse weather conditions. In only 59% (n=13) of the emergency units, a triage unit was present and in only one of the in only one (4.5%), a decontamination room was available. It was understood that only 32% (n=8) of the emergency units were appropriate in enlarging their capacity taking the local risk factors into consideration. There was a toilette for disabled patients in only 18% (n=4) of the units as well. Considering a 12-year of history of the Emergency Medicine in Turkey, the presence of a lecture room is still 68% (n=15) in emergency departments which reflects that academic efforts in this field is emerging in challenging physical conditions. The results of our study revealed that emergency service architecture was neglected in Turkey and medical care given was precluded by the insufficient architecture. The design of emergency services has to be accomplished under guidance of scientific data and rules taking advices of architects who have knowledge and experience on this field.

  6. Evaluating emergency risk communications: a dialogue with the experts.

    Science.gov (United States)

    Thomas, Craig W; Vanderford, Marsha L; Crouse Quinn, Sandra

    2008-10-01

    Evaluating emergency risk communications is fraught with challenges since communication can be approached from both a systemic and programmatic level. Therefore, one must consider stakeholders' perspectives, effectiveness issues, standards of evidence and utility, and channels of influence (e.g., mass media and law enforcement). Evaluation issues related to timing, evaluation questions, methods, measures, and accountability are raised in this dialogue with emergency risk communication specialists. Besides the usual evaluation competencies, evaluators in this area need to understand and work collaboratively with stakeholders and be attuned to the dynamic contextual nature of emergency risk communications. Sample resources and measures are provided here to aid in this emerging and exciting field of evaluation.

  7. Production facility for ATLAS new small wheel drift panels at JGU Mainz

    Energy Technology Data Exchange (ETDEWEB)

    Duedder, Andreas; Lin, Tai-Hua; Schott, Matthias [Johannes Gutenberg-Universitaet Mainz (Germany)

    2016-07-01

    The ATLAS Phase-I Upgrade in 2018 includes the replacement of the ATLAS Muon Small Wheel by the so-called New Small Wheel (NSW). Large-scale Micromegas detectors will serve as tracking detectors in the NSW. Parts of these detectors will be constructed at the Johannes Gutenberg University Mainz (JGU). In order to fulfill the requirements of the envisioned detector performance, a high precision detector construction is crucial. Especially the surface planarity of the produced detector panels has to better than 30 μm over an area of 2 m{sup 2}. Methods for the quality control of the raw material and the constructed parts have been developed and implemented. This talk gives an overview of the production facility at JGU Mainz which is used during the mass production of NSW components in coming years.

  8. The identity of new settlements. A new experimental town: Layenhof near Mainz

    Directory of Open Access Journals (Sweden)

    Marco Venturi

    1998-01-01

    Full Text Available Even though at present the attention of European planning agencies is focused on issues of re-use and green areas, a number of events are again raising the need to define proper answers to problems of new urbanization. Following a discussion on the changing definition of the urban phenomenon, the tender for a new settlement in Layenhof near Mainz in Germany and the architectural, urban design solution are presented.

  9. Universitaet Mainz, Institut fuer Kernchemie. Annual report 1998

    International Nuclear Information System (INIS)

    Denschlag, H.O.

    1999-03-01

    The annual report concentrates on three research activities of major interest: (1) Nuclear chemistry in the sense of approaches to fundamental problems which also relate to nuclear physics (nuclear fission, chemistry of the heaviest elements, excitation of giant dipole resonance, Halo nuclei, radiochemical astrophysics (structure of neutron-rich nuclei, prediction of half-lives and P n -values, elemental abundances), metal clusters in vacuum). (2) Radiopharmaceutical chemistry and applications in nuclear medicine (synthesis of radiopharmaceuticals using 3 H and 18 F, in vitro and in vivo evaluation of radiopharmaceuticals, diagnostics using PET, solid-state target systems, development and test of radiopharmaceuticals using isotopes of As, Y, Nb, Nd, and Re). (3) Environmental analysis (humic acid complexes of actinides and lanthanides, disintegration products of cellulose, ultratrace analysis using RIMS, determination of Th and U in the environment and in urine, AOX determination in waste waters, anthropogenic γ emitters in ground level air). (orig./CB) [de

  10. The Dating and Authorship of the Poem Vita Mahumeti, Attributed to Embrico of Mainz

    Directory of Open Access Journals (Sweden)

    Fernando González Muñoz

    2017-12-01

    Full Text Available The aim of this paper is to review the problems with the date of writing and the authorship of one of the first legendary accounts of the Prophet Muhammad written in Central Europe: the Vita Mahumeti, attributed to Embrico of Mainz. After presenting the available evidence and the conjectures of different scholars, a new hypothesis about the identity of the author is put forward, which at the same time enables us to clarify the dating of the work, its possible sources and meaning.

  11. Radiological evaluation of surgical emergencies in neonate

    International Nuclear Information System (INIS)

    Suh, C. O.; Oh, K. K.; Park, C. Y.

    1980-01-01

    Most pathologic conditions requiring emergent operation in neonate are congenital anomalies and delayed diagnosis and associated anomaly are important factors which have contributed to the high mortality rate of congenital anomalies. To prevent this delay, early recognition of the danger signals, adequate roentagenologic examination and accurate diagnosis should be made. Furthermore radiologists should be aware of developing mechanism, clinical manifestations and roentgenographic findings of those neonatal emergencies. 135 cases of neonatal emergencies were analyzed at this point of view, which verified by surgery and pathologic examination at Yonsei University College of Medicine, Severance Hospital since 1968. Embryology and characteristic roentgenographic pictures of each disease were discussed. The conclusions are as follows; 1. Most cases (110/135) presented intestinal obstruction. Imperforate anus (29 cases) was most common disease which followed by infantile hypertrophic pyloric stenosis (25 cases), small bowel atresia and stenosis (18 cases), congenital megacolon (15 cases) and esophageal atresia (14 cases). 2. Clinical Type and time of occurrence of symptoms and signs were so characteristic that these were helpful for differential diagnosis. 3. In infantile hypertrophic pyloric stenosis, confirmative diagnosis could be made in plain abdominal film, when 'Caterpillar sign' was seen. 4. When small bowel obstruction was suspected in plain abdominal film, barium enema examination was more helpful than upper G-I study. When microcolon was found, lower small bowel obstruction was highly suggested. 5. Diagnosis of midgut malrotation was possible in larger cases (4/7). Upper G-I examination was more valuable than barium enema study, because duodenal obstruction due to Ladd's band was common problem in neonate. 6. In neonatal period, diagnosis of aganglionosis could be made with the finding of barium stasis on 24-48 hours delay film, even though no demonstration of

  12. Comparison of EPR response of alanine and Gd₂O₃-alanine dosimeters exposed to TRIGA Mainz reactor.

    Science.gov (United States)

    Marrale, M; Schmitz, T; Gallo, S; Hampel, G; Longo, A; Panzeca, S; Tranchina, L

    2015-12-01

    In this work we report some preliminary results regarding the analysis of electron paramagnetic resonance (EPR) response of alanine pellets and alanine pellets added with gadolinium used for dosimetry at the TRIGA research reactor in Mainz, Germany. Two set-ups were evaluated: irradiation inside PMMA phantom and irradiation inside boric acid phantom. We observed that the presence of Gd2O3 inside alanine pellets increases the EPR signal by a factor of 3.45 and 1.24 in case of PMMA and boric acid phantoms, respectively. We can conclude that in the case of neutron beam with a predominant thermal neutron component the addition of gadolinium oxide can significantly improve neutron sensitivity of alanine pellets. Monte Carlo (MC) simulations of both response of alanine and Gd-added alanine pellets with FLUKA code were performed and a good agreement was achieved for pure alanine dosimeters. For Gd2O3-alanine deviations between MC simulations and experimental data were observed and discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. A psychometric evaluation of the Pediatric Anesthesia Emergence Delirium scale.

    Science.gov (United States)

    Ringblom, Jenny; Wåhlin, Ingrid; Proczkowska, Marie

    2018-04-01

    Emergence delirium and emergence agitation have been a subject of interest since the early 1960s. This behavior has been associated with increased risk of injury in children and dissatisfaction with anesthesia care in their parents. The Pediatric Anesthesia Emergence Delirium Scale is a commonly used instrument for codifying and recording this behavior. The aim of this study was to psychometrically evaluate the Pediatric Anesthesia Emergence Delirium scale, focusing on the factor structure, in a sample of children recovering from anesthesia after surgery or diagnostic procedures. The reliability of the Pediatric Anesthesia Emergence Delirium scale was also tested. One hundred and twenty-two children younger than seven years were observed at postoperative care units during recovery from anesthesia. Two or 3 observers independently assessed the children using the Pediatric Anesthesia Emergence Delirium scale. The factor analysis clearly revealed a one-factor solution, which accounted for 82% of the variation in the data. Internal consistency, calculated with Cronbach's alpha, was good (0.96). The Intraclass Correlation Coefficient, which was used to assess interrater reliability for the Pediatric Anesthesia Emergence Delirium scale sum score, was 0.97 (P Pediatric Anesthesia Emergence Delirium scale for assessing emergence delirium in children recovering from anesthesia after surgery or diagnostic procedures. The kappa statistics for the Pediatric Anesthesia Emergence Delirium scale items essentially indicated good agreement between independent raters, supporting interrater reliability. © 2018 John Wiley & Sons Ltd.

  14. Emergency preparedness exercises for nuclear facilities: Preparation, conduct and evaluation

    International Nuclear Information System (INIS)

    1985-01-01

    This publication offers guidance for operating organizations and public authorities on planning, organizing and conducting exercises, preparing scenarios and evaluating the results of exercises in order to make full use of the experience gained in improving the response planning and preparedness for radiation emergencies. The training aspects associated with achieving an adequate level of emergency preparedness are explored and examples of accident scenarios are presented

  15. Evaluation criteria for emergency response plans in radiological transportation

    International Nuclear Information System (INIS)

    Lindell, M.K.; Perry, R.W.

    1980-01-01

    This paper identifies a set of general criteria which can be used as guides for evaluating emergency response plans prepared in connection with the transportation of radiological materials. The development of criteria takes the form of examining the meaning and role of emergency plans in general, reviewing the process as it is used in connection with natural disasters and other nonnuclear disasters, and explicitly considering unique aspects of the radiological transportation setting. Eight areas of critical importance for such response plans are isolated: notification procedures; accident assessment; public information; protection of the public at risk; other protective responses; radiological exposure control; responsibility for planning and operations; and emergency response training and exercises. (Auth.)

  16. The research reactor TRIGA Mainz. A neutron source for versatile applications in research and education

    International Nuclear Information System (INIS)

    Eberhardt, K.; Kronenberg, A.

    2000-01-01

    Currently, four research reactors with a thermal power ranging from 0.1 to 23 MW th are in operation in Germany and one new reactor (20 MW th ) is under construction. The TRIGA Mark II reactor at the Institut fuer Kernchemie became first critical on August 3, 1965. It can be operated in the steady state mode with a maximum power of 100 kW th and in the pulse mode with a peak power of 250 MW th . A survey of the research programmes carried out at the TRIGA Mainz is given covering a wide range of applications in basic and applied science in nuclear chemistry, nuclear- and particle physics. Furthermore, the reactor is used for neutron activation analysis and for education and training of students and technical personal. (orig.) [de

  17. Irradiation facility at the TRIGA Mainz for treatment of liver metastases

    Energy Technology Data Exchange (ETDEWEB)

    Hampel, G. [Institut fuer Kernchemie, Johannes Gutenberg-Universitaet Mainz, Fritz-Strassmann-Weg 2, D-55128 Mainz (Germany)], E-mail: gabriele.hample@uni-mainz.de; Wortmann, B. [Evonik Energy Services GmbH Essen, Ruettenscheider Str. 1-3, D-45128 Essen (Germany); Blaickner, M. [Austrian Research Centers, 2444 Seibersdorf (Austria); Knorr, J. [TU Dresden, Institut fuer Energietechnik, D-01062 Dresden (Germany); Kratz, J.V. [Institut fuer Kernchemie, Johannes Gutenberg-Universitaet Mainz, Fritz-Strassmann-Weg 2, D-55128 Mainz (Germany); Lizon Aguilar, A. [Evonik Energy Services GmbH Essen, Ruettenscheider Str. 1-3, D-45128 Essen (Germany); Minouchehr, S. [Transplantationschirurgie, Universitaetsklinikum Mainz, D-55131 Mainz (Germany); Nagels, S. [Forschungszentrum Karlsruhe GmbH, Institut fuer Strahlenforschung (ISF), Postfach 3640, D-76021 Karlsruhe (Germany); Otto, G. [Transplantationschirurgie, Universitaetsklinikum Mainz, D-55131 Mainz (Germany); Schmidberger, H. [Klinik und Poliklinik fuer Radioonkologie und Strahlentherapie, Universitaetsklinikum Mainz, D-55131 Mainz (Germany); Schuetz, C.; Vogtlaender, L. [Institut fuer Kernchemie, Johannes Gutenberg-Universitaet Mainz, Fritz-Strassmann-Weg 2, D-55128 Mainz (Germany)

    2009-07-15

    The TRIGA Mark II reactor at University of Mainz provides ideal conditions for duplicating BNCT treatment as performed in Pavia, Italy, in 2001 and 2003 [Pinelli, T., Zonta, A., Altieri, S., Barni, S., Braghieri, A., Pedroni, P., Bruschi, P., Chiari, P., Ferrari, C., Fossati, F., Nano, R., Ngnitejeu Tata, S., Prati, U., Ricevuti, G., Roveda, L., Zonta, C., 2002. TAOrMINA: from the first idea to the application to the human liver. In: Sauerwein et al. (Eds.), Research and Development in Neutron Capture Therapy. Proceedings of the 10th International Congress on Neutron Capture Therapy, Monduzzi editore, Bologna, pp. 1065-1072]. In order to determine the optimal parameters for the planned therapy and therefore for the design of the thermal column, calculations were conducted using the MCNP-code and the transport code ATTILA. The results of the parameter study as well as a possible configuration for the irradiation of the liver are presented.

  18. High-statistics measurement of the η →3 π0 decay at the Mainz Microtron

    Science.gov (United States)

    Prakhov, S.; Abt, S.; Achenbach, P.; Adlarson, P.; Afzal, F.; Aguar-Bartolomé, P.; Ahmed, Z.; Ahrens, J.; Annand, J. R. M.; Arends, H. J.; Bantawa, K.; Bashkanov, M.; Beck, R.; Biroth, M.; Borisov, N. S.; Braghieri, A.; Briscoe, W. J.; Cherepnya, S.; Cividini, F.; Collicott, C.; Costanza, S.; Denig, A.; Dieterle, M.; Downie, E. J.; Drexler, P.; Ferretti Bondy, M. I.; Fil'kov, L. V.; Fix, A.; Gardner, S.; Garni, S.; Glazier, D. I.; Gorodnov, I.; Gradl, W.; Gurevich, G. M.; Hamill, C. B.; Heijkenskjöld, L.; Hornidge, D.; Huber, G. M.; Käser, A.; Kashevarov, V. L.; Kay, S.; Keshelashvili, I.; Kondratiev, R.; Korolija, M.; Krusche, B.; Lazarev, A.; Lisin, V.; Livingston, K.; Lutterer, S.; MacGregor, I. J. D.; Manley, D. M.; Martel, P. P.; McGeorge, J. C.; Middleton, D. G.; Miskimen, R.; Mornacchi, E.; Mushkarenkov, A.; Neganov, A.; Neiser, A.; Oberle, M.; Ostrick, M.; Otte, P. B.; Paudyal, D.; Pedroni, P.; Polonski, A.; Ron, G.; Rostomyan, T.; Sarty, A.; Sfienti, C.; Sokhoyan, V.; Spieker, K.; Steffen, O.; Strakovsky, I. I.; Strandberg, B.; Strub, Th.; Supek, I.; Thiel, A.; Thiel, M.; Thomas, A.; Unverzagt, M.; Usov, Yu. A.; Wagner, S.; Walford, N. K.; Watts, D. P.; Werthmüller, D.; Wettig, J.; Witthauer, L.; Wolfes, M.; Zana, L. A.; A2 Collaboration at MAMI

    2018-06-01

    The largest, at the moment, statistics of 7 ×106η →3 π0 decays, based on 6.2 ×107η mesons produced in the γ p →η p reaction, has been accumulated by the A2 Collaboration at the Mainz Microtron, MAMI. It allowed a detailed study of the η →3 π0 dynamics beyond its conventional parametrization with just the quadratic slope parameter α and enabled, for the first time, a measurement of the second-order term and a better understanding of the cusp structure in the neutral decay. The present data are also compared to recent theoretical calculations that predict a nonlinear dependence along the quadratic distance from the Dalitz-plot center.

  19. Technology and techniques for parity experiments at Mainz: Past, Present and Future

    Science.gov (United States)

    Diefenbach, Juergen

    2016-03-01

    For almost 20 years the Mainz accelerator facility MAMI delivered polarized electron beam to the parity violation experiment A4 that measured the contributions of strange sea quarks to the proton electromagnetic factors. Parity violation asymmetries were of the order of A ~5 ppm. Currently the A1 collaboration carries out single spin asymmetry measurements at MAMI (A ~20 ppm) to prepare for a measurement of neutron skin depth on lead (A ~1 ppm). For such high precision experiments active stabilization and precise determination of beam parameters like current, energy, position, and angle are essential requirements in addition to precision electron beam polarimetry. For the future P2 experiment at the planned superconducting accelerator MESA in Mainz the requirements for beam quality will be even higher. P2 will measure the weak mixing angle with 0.15 percent total uncertainty and, in addition, the neutron skin depth of lead as well as parity violation in electron scattering off 12C. A tiny asymmetry of only -0.03 ppm creates the needs to combine digital feedback with feedforward stabilizations along with new polarimetry developments like a hydro-Moller and a double-Mott polarimeter to meet the goals for systematic uncertainty. This talk gives an overview of our experience with polarimetry, analog feedbacks and compensation techniques for apparative asymmetries at the A4 experiment. It finally leads to the requirements and new techniques for the pioneering P2 experiment at MESA. First results from beam tests currently carried out at the existing MAMI accelerator, employing high speed analog/digital conversion and FPGAs for control of beam parameters, will be presented. Supported by the cluster of excellence PRISMA and the Deutsche Forschungsgemeinschaft in the framework of the SFB1044.

  20. Evaluation of Knowledge of Emergency Healthcare Workers Regarding Approach to Emergency Patients

    Directory of Open Access Journals (Sweden)

    Özgür Tanr›verdi

    2010-09-01

    Full Text Available Aim: Emergency units constitute the most important part of all hospitals. The aim of this study was to evaluate practitioners’ and healthcare providers’ knowledge and experience regarding emergency first aid in a hospital with insufficient facilities. Methods: 17 physicians and 25 assistant staff working at our hospital were evaluated in terms of their knowledge about and experience in “emergency medicine and trauma” by a questionnaire and by observations. Results: The results of observations and questionnaire indicated that knowledge and experience among physicians were inadequate in terms of basic life support and advanced cardiac life support. This lack of knowledge was not associated with age, time of employment, faculty graduated and training on “emergency medicine” in the group of physicians (r=0.301 p>0.05, r=0.317 p>0.06, r=0.228 p>0.05, r=0.284 p>0.05, respectively and in the group of assistant staff (r=0.341 p>0.05, r=0.287 p>0.06, r=0.234 p>0.05, r=0.227 p>0.05, respectively. Conclusion: Considering that the most of the physicians are gathered in certain regions of our country and that there is a lack of emergency medicine specialists in underdeveloped regions, it has been concluded that physicians specialized in other areas and practitioners must attend emergency medicine trainings under the concept of “emergency medicine rotation”. (The Medical Bulletin of Haseki 2010; 48:103-5

  1. The Profile of Neurology Patients Evaluated in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Ufuk Emre

    2009-09-01

    Full Text Available OBJECTIVE: Early, rapid, and multidisciplinary approaches are very important in the diagnosis of neurological disorders in emergency departments. The present study aimed to investigate the features of patients that presented for neurology consultation in the emergency department. METHODS: The present study included 780 patients. Patient demographic features, reasons for emergent treatment and neurological consultation, neurological diagnosis by the neurologist, and laboratory (total blood count, serum glucose level, urea, creatine, erythrocyte sedimentation rate, and D-dimer levels and imaging findings were retrospectively evaluated based on patient charts. RESULTS: Impaired consciousness was the most frequent reason for neurological consultation (19.7%. Among these patients, ischemic stroke was diagnosed in 27.9%, hypoxic encephalopathy in 18.2%, cerebral hemorrhage in 9.1%, and 11% had no neurological diagnosis. Other common reasons for neurological consultation were vertigo, headache, seizure, and stroke. Clinical findings were related to other systemic causes in 43.7% of the study group. Focal neurological findings were present, especially in patients that presented with ischemic and hemorrhagic stroke, epilepsy, and hypoxic encephalopathy. CONCLUSION: In emergency departments, metabolic causes should be ruled out in patients with impaired consciousness and the absence of focal neurological signs. Intracranial structural disorders must be evaluated when focal neurological signs are present. Cautiously prepared algorithms and neurological examination training will help improve the accuracy of emergency department diagnoses

  2. Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia.

    Science.gov (United States)

    Jennings, Natasha; O'Reilly, Gerard; Lee, Geraldine; Cameron, Peter; Free, Belinda; Bailey, Michael

    2008-04-01

    The aim of this study was to evaluate the impact of the introduction of Emergency Nurse Practitioner Candidates (ENPC) on waiting times and length of stay of patients presenting to a major urban Emergency Department (ED) in Melbourne, Australia. As part of a Victorian state funded initiative to improve patient outcomes, the role of the Emergency Nurse Practitioner has been developed. The integration and implementation of this role, is not only new to the Alfred Emergency and Trauma Centre but to EDs in Melbourne, Australia, with aims of providing holistic and comprehensive care for patients. A retrospective case series of all patients with common ED diagnostic subgroups were included. The ENPC group (n = 572) included all patients managed by the ENPC and the Traditional Model (TM) group (n = 2584) included all patients managed by the traditional medical ED model of care. Outcome measures included waiting times and length of stay. Statistically significant differences were evident between the two groups in waiting times and length of stay in the ED. The overall median waiting time for emergency patients to be seen by the ENPC was less than for the TM group [median (IQR): ENPC 12 (5.5-28) minutes; TM 31 (11.5-76) minutes (Wilcoxon p times for ENPC shifts vs. non-ENPC shifts revealed significant differences [median (IQR): ENPC rostered 24 (9-52) minutes; ENPC not rostered 33 (13-80.5) minutes (Wilcoxon p Melbourne, Australia were associated with significantly reduced waiting times and length of stay for emergency patients. Emergency Nurse Practitioners should be considered as a potential long term strategy to manage increased service demands on EDs. Relevance to clinical practice. This study is the first in Australia with a significant sample size to vigorously compare ENPC waiting times and length of stay outcomes with the TM model of care in the ED. The study suggests that ENPCs can have a favourable impact on patient outcomes with regard to waiting times and length

  3. Timing of Emergency Medicine Student Evaluation Does Not Affect Scoring.

    Science.gov (United States)

    Hiller, Katherine M; Waterbrook, Anna; Waters, Kristina

    2016-02-01

    Evaluation of medical students rotating through the emergency department (ED) is an important formative and summative assessment method. Intuitively, delaying evaluation should affect the reliability of this assessment method, however, the effect of evaluation timing on scoring is unknown. A quality-improvement project evaluating the timing of end-of-shift ED evaluations at the University of Arizona was performed to determine whether delay in evaluation affected the score. End-of-shift ED evaluations completed on behalf of fourth-year medical students from July 2012 to March 2013 were reviewed. Forty-seven students were evaluated 547 times by 46 residents and attendings. Evaluation scores were means of anchored Likert scales (1-5) for the domains of energy/interest, fund of knowledge, judgment/problem-solving ability, clinical skills, personal effectiveness, and systems-based practice. Date of shift, date of evaluation, and score were collected. Linear regression was performed to determine whether timing of the evaluation had an effect on evaluation score. Data were complete for 477 of 547 evaluations (87.2%). Mean evaluation score was 4.1 (range 2.3-5, standard deviation 0.62). Evaluations took a mean of 8.5 days (median 4 days, range 0-59 days, standard deviation 9.77 days) to complete. Delay in evaluation had no significant effect on score (p = 0.983). The evaluation score was not affected by timing of the evaluation. Variance in scores was similar for both immediate and delayed evaluations. Considerable amounts of time and energy are expended tracking down delayed evaluations. This activity does not impact a student's final grade. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Exercises for radiological and nuclear emergency response. Planing - performance - evaluation

    International Nuclear Information System (INIS)

    Bayer, A.; Faleschini, J.; Goelling, K.; Stapel, R.; Strobl, C.

    2010-01-01

    The report of the study group emergency response seminar covers the following topics: (A) purpose of exercises and exercise culture: fundamentals and appliances for planning, performance and evaluation; (B) exercises in nuclear facilities; (C) exercises of national authorities and aid organizations on nuclear scenarios; exercises of national authorities and aid organizations on other radiological scenarios; (D) exercises in industrial plants, universities, medical facilities and medical services, and research institutes; (E) transnational exercises, international exercises; (F): exercises on public information.

  5. Upgrade of the ultracold neutron source at the pulsed reactor TRIGA Mainz

    Energy Technology Data Exchange (ETDEWEB)

    Kahlenberg, J.; Ross, K.U.; Beck, M.; Heil, W.; Karch, J.; Kories, F.; Kretschmer, M. [Johannes Gutenberg University, Institute of Physics, Mainz (Germany); Ries, D. [Johannes Gutenberg University, Institute of Nuclear Chemistry, Mainz (Germany); Paul Scherrer Institute (PSI), Laboratory for Particle Physics, Villigen (Switzerland); ETH Zuerich, Institute for Particle Physics, Zuerich (Switzerland); Siemensen, C.; Geppert, C.; Karpuk, S.; Reich, T.; Sobolev, Y.; Trautmann, N. [Johannes Gutenberg University, Institute of Nuclear Chemistry, Mainz (Germany); Hild, N. [Paul Scherrer Institute (PSI), Laboratory for Particle Physics, Villigen (Switzerland); ETH Zuerich, Institute for Particle Physics, Zuerich (Switzerland); Lauss, B. [Paul Scherrer Institute (PSI), Laboratory for Particle Physics, Villigen (Switzerland)

    2017-11-15

    The performance of the upgraded solid deuterium ultracold neutron source at the pulsed reactor TRIGA Mainz is described. The current configuration stage comprises the installation of a He liquefier to run UCN experiments over long-term periods, the use of stainless steel neutron guides with improved transmission as well as sputter-coated non-magnetic {sup 58}NiMo alloy at the inside walls of the thermal bridge and the converter cup. The UCN yield was measured in a ''standard'' UCN storage bottle (stainless steel) with a volume of 32 litres outside the biological shield at the experimental area yielding UCN densities of 8.5/cm{sup 3}; an increase by a factor of 3.5 compared to the former setup. The measured UCN storage curve is in good agreement with the predictions from a Monte Carlo simulation developed to model the source. The growth and formation of the solid deuterium converter during freeze-out are affected by the ortho/para ratio of the H{sub 2} premoderator. (orig.)

  6. Channeling experiments at planar diamond and silicon single crystals with electrons from the Mainz Microtron MAMI

    Science.gov (United States)

    Backe, H.; Lauth, W.; Tran Thi, T. N.

    2018-04-01

    Line structures were observed for (110) planar channeling of electrons in a diamond single crystal even at a beam energy of 180 MeV . This observation motivated us to initiate dechanneling length measurements as function of the beam energy since the occupation of quantum states in the channeling potential is expected to enhance the dechanneling length. High energy loss signals, generated as a result of emission of a bremsstrahlung photon with about half the beam energy at channeling of 450 and 855 MeV electrons, were measured as function of the crystal thickness. The analysis required additional assumptions which were extracted from the numerical solution of the Fokker-Planck equation. Preliminary results for diamond are presented. In addition, we reanalyzed dechanneling length measurements at silicon single crystals performed previously at the Mainz Microtron MAMI at beam energies between 195 and 855 MeV from which we conclude that the quality of our experimental data set is not sufficient to derive definite conclusions on the dechanneling length. Our experimental results are below the predictions of the Fokker-Planck equation and somewhat above the results of simulation calculations of A. V. Korol and A. V. Solov'yov et al. on the basis of the MBN Explorer simulation package. We somehow conservatively conclude that the prediction of the asymptotic dechanneling length on the basis of the Fokker-Planck equation represents an upper limit.

  7. An approach for evaluating expert performance in emergency situations

    International Nuclear Information System (INIS)

    Ujita, Hiroshi; Kawano, Ryutaro; Yoshimura, Sandanori

    1995-01-01

    To understand expert behavior and define what constitutes good performance in emergency situations in huge and complex plants, human performance evaluation should be made from viewpoints of not only error, but also various cognitive, psychological, and behavioral characteristics. Quantitative and qualitative measures of human performance are proposed for both individual operators and crews, based on the operator performance analysis experiment, among which cognitive and behavioral aspects are the most important. Operator performance should be further analyzed experimentally from the cognitive and behavioral viewpoints, using an evaluation based on various gross indexes considering operator's tasks which should be done in response to plant situations

  8. A Conceptual Framework for the Evaluation of Emergency Risk Communications

    Science.gov (United States)

    Lin, Leesa; Gamhewage, Gaya M.

    2017-01-01

    Objectives. To articulate a conceptual framework in support of evaluation activities in emergency risk communications (ERC). Methods. The framework proposed is based on a systematic review of the scientific literature (2001–2016) combined with data derived from a series of semistructured interviews with experts and practitioners in ERC, and it is designed to support local, national, and international public health organizations in implementing evaluation studies in ERC. Results. We identified a list of ERC outcomes from the full-text review of 152 articles and categorized these into 3 groups, depending upon the level at which the outcome was measured: (1) information environment, (2) population, and (3) public health system. We analyzed interviewees’ data from 18 interviews to identify practices and processes related to the effectiveness of ERC and included these as key structural components and processes in the developed evaluation framework. Conclusions. Researchers and public health practitioners interested in the evaluation of ERC can use the conceptual framework described in this article to guide the development of evaluation studies and methods for assessing communication outcomes related to public health emergencies. PMID:28892436

  9. A Conceptual Framework for the Evaluation of Emergency Risk Communications.

    Science.gov (United States)

    Savoia, Elena; Lin, Leesa; Gamhewage, Gaya M

    2017-09-01

    To articulate a conceptual framework in support of evaluation activities in emergency risk communications (ERC). The framework proposed is based on a systematic review of the scientific literature (2001-2016) combined with data derived from a series of semistructured interviews with experts and practitioners in ERC, and it is designed to support local, national, and international public health organizations in implementing evaluation studies in ERC. We identified a list of ERC outcomes from the full-text review of 152 articles and categorized these into 3 groups, depending upon the level at which the outcome was measured: (1) information environment, (2) population, and (3) public health system. We analyzed interviewees' data from 18 interviews to identify practices and processes related to the effectiveness of ERC and included these as key structural components and processes in the developed evaluation framework. Researchers and public health practitioners interested in the evaluation of ERC can use the conceptual framework described in this article to guide the development of evaluation studies and methods for assessing communication outcomes related to public health emergencies.

  10. Evaluating the future of HCI: challenges for the evaluation of emerging applications

    NARCIS (Netherlands)

    Poppe, Ronald Walter; Rienks, R.J.

    2007-01-01

    Current evaluation methods are inappropriate for emerging HCI applications. In this paper, we give three examples of these applications and show that traditional evaluation methods fail. We identify trends in HCI development and discuss the issues that arise with evaluation. We aim at achieving

  11. Evaluating the Future of HCI : Challenges for the Evaluation of Emerging Applications

    NARCIS (Netherlands)

    Poppe, Ronald Walter; Rienks, R.J.; van Dijk, Elisabeth M.A.G.; Huang, T.S; Nijholt, Antinus; Pantic, Maja; Pentland, A.

    2007-01-01

    Current evaluation methods are inappropriate for emerging HCI applications. In this paper, we give three examples of these applications and show that traditional evaluation methods fail. We identify trends in HCI development and discuss the issues that arise with evaluation. We aim at achieving

  12. Ultrasound assisted evaluation of chest pain in the emergency department.

    Science.gov (United States)

    Colony, M Deborah; Edwards, Frank; Kellogg, Dylan

    2018-04-01

    Chest pain is a commonly encountered emergency department complaint, with a broad differential including several life-threatening possible conditions. Ultrasound-assisted evaluation can potentially be used to rapidly and accurately arrive at the correct diagnosis. We propose an organized, ultrasound assisted evaluation of the patient with chest pain using a combination of ultrasound, echocardiography and clinical parameters. Basic echo techniques which can be mastered by residents in a short time are used plus standardized clinical questions and examination. Information is kept on a checklist. We hypothesize that this will result in a quicker, more accurate evaluation of chest pain in the ED leading to timely treatment and disposition of the patient, less provider anxiety, a reduction in the number of diagnostic errors, and the removal of false assumptions from the diagnostic process. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Immersion and contact freezing experiments in the Mainz wind tunnel laboratory

    Science.gov (United States)

    Eppers, Oliver; Mayer, Amelie; Diehl, Karoline; Mitra, Subir; Borrmann, Stephan; Szakáll, Miklós

    2016-04-01

    Immersion and contact freezing are of outmost important ice nucleation processes in mixed phase clouds. Experimental studies are carried out in the Mainz vertical wind tunnel laboratory in order to characterize these nucleation processes for different ice nucleating particles (INP), such as for mineral dust or biological particles. Immersion freezing is investigated in our laboratory with two different experimental techniques, both attaining contact-free levitation of liquid droplets and cooling of the surrounding air down to about -25 °C. In an acoustic levitator placed in the cold room of our laboratory, drops with diameters of 2 mm are investigated. In the vertical air stream of the wind tunnel droplets with diameter of 700 micron are freely floated at their terminal velocities, simulating the flow conditions of the free atmosphere. Furthermore, the wind tunnel offers a unique platform for contact freezing experiments. Supercooled water droplets are floated in the vertical air stream at their terminal velocities and INP are injected into the tunnel air stream upstream of them. As soon as INP collides with the supercooled droplet the contact freezing is initiated. The first results of immersion and contact freezing experiments with cellulose particles both in the acoustic levitator and in the wind tunnel will be presented. Cellulose is considered as typical INP of biological origin and a macrotracer for plant debris. Nucleating properties of cellulose will be provided, mainly focusing on the temperature, INP concentration, and specific surface area dependences of the freezing processes. Direct comparison between the different experimental techniques (acoustic levitator and wind tunnel), as well as between nucleation modes (immersion and contact freezing) will be presented. The work is carried out within the framework of the German research unit INUIT.

  14. Institute for Nuclear Chemistry of the University of Mainz. Annual report 1986

    International Nuclear Information System (INIS)

    Weber, M.

    1987-01-01

    The report summarizes the points of main efforts of the Institute for Nuclear Chemistry during 1986: A. Rapid separations (thermochromatography of platinum elements; ICP source for the HELIOS mass separator; oxidation states of Lr; ionic radii of Lr 3+ and Md 3+ ; heats of hydration). B. Exotic nuclei and nuclear structure (lifetime of the 167 keV level of 97 Sr; description of the K=3/2 + side band in 99 Y with the IBF/PTQ model; pairing-free K π =1 + -rotational bands in deformed odd/odd A ≅ 100 nuclei; proton particle states in 103,105 Rh; β-decay of the 110,112 Rh isomers; β-decay half-life of 130 48 Cd and its importance for astrophysical r-process scenarios; alpha burning of 14 O; β-decay half-lives of nuclei far from stability for astrophysical application; beta delayed neutron energy spectra for application in reactor physics). C. Nuclear fission (charge distribution in the reaction 232 Th(n R ,f); isomeric ratios and decay properties of 96m,g Y, 97m,g Y and 134m,g I). D. Heavy ion reactions (quasi fission in the reaction 40 Ar + 208 Pb near the Coulomb barrier; unusual excitation-energy distribution in quasi-fission reactions; competition of direct reactions with fusion; nucleon transfer in the reaction 40 Ar + 235 U; nuclear reactions and nuclear contact in U+U collisions below the barrier; deflection function and fragmentation in the system 197 Au → 197 Au; search for exotic heavy nuclei using Rutherford backscattering). E. Ecology of radionuclides (preparation of plutonium samples for laser spectroscopy; laser resonance-ionization mass spectrometry on uranium and plutonium; capture of externally produced ions in a high frequency quadrupole trap; Chernobyl fallout in the Mainz area). (orig./RB) [de

  15. Evaluating the success of an emergency response medical information system.

    Science.gov (United States)

    Petter, Stacie; Fruhling, Ann

    2011-07-01

    STATPack™ is an information system used to aid in the diagnosis of pathogens in hospitals and state public health laboratories. STATPack™ is used as a communication and telemedicine diagnosis tool during emergencies. This paper explores the success of this emergency response medical information system (ERMIS) using a well-known framework of information systems success developed by DeLone and McLean. Using an online survey, the entire population of STATPack™ users evaluated the success of the information system by considering system quality, information quality, system use, intention to use, user satisfaction, individual impact, and organizational impact. The results indicate that the overall quality of this ERMIS (i.e., system quality, information quality, and service quality) has a positive impact on both user satisfaction and intention to use the system. However, given the nature of ERMIS, overall quality does not necessarily predict use of the system. Moreover, the user's satisfaction with the information system positively affected the intention to use the system. User satisfaction, intention to use, and system use had a positive influence on the system's impact on the individual. Finally, the organizational impacts of the system were positively influenced by use of the system and the system's individual impact on the user. The results of the study demonstrate how to evaluate the success of an ERMIS as well as introduce potential changes in how one applies the DeLone and McLean success model in an emergency response medical information system context. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  16. Clinic and Emergency Room Evaluation and Testing of Headache.

    Science.gov (United States)

    Nye, Barbara L; Ward, Thomas N

    2015-10-01

    Evaluation of the headache patient in the outpatient clinic and emergency department (ED) has different focuses and goals. The focus of this paper is to review the evaluation of patients in both settings with mention of evaluation in the pediatric and pregnant patient population.  The patient's history should drive the practitioner's decision and evaluation choices. We review recommendations made by the American Board of Internal Medicine and American Headache Society through the Choosing Wisely Campaign, which has an emphasis on choosing the right imaging modality for the clinical situation and elimination/prevention of medication overuse headache, as well as the US Headache Consortium guidelines for migraine headache. We will also review focusing on ED evaluation of the pediatric patient and pregnant patient presenting with headache. At the end of the review we hope to have provided you with a framework to think about the headache patient and what is the appropriate test in the given clinical setting in order to ensure that the patient gets the right diagnosis and is set on a path to the appropriate management plan. © 2015 American Headache Society.

  17. 75 FR 22817 - Emerging Infectious Diseases: Evaluation to Implementation for Transfusion and Transplantation...

    Science.gov (United States)

    2010-04-30

    ...] Emerging Infectious Diseases: Evaluation to Implementation for Transfusion and Transplantation Safety and... public workshops entitled ``Emerging Infectious Diseases: Evaluation to Implementation for Transfusion... Office of Science and Public Health, Centers for Disease Control and Prevention, National Institutes of...

  18. The early emergence of sociomoral evaluation: infants prefer prosocial others.

    Science.gov (United States)

    Van de Vondervoort, Julia W; Hamlin, J Kiley

    2018-04-01

    Humans readily evaluate third-parties' prosocial and antisocial acts. Recent evidence reveals that this tendency emerges early in development-even preverbal infants selectively approach prosocial others and avoid antisocial ones. Rather than reflecting attraction toward or away from low-level characteristics of the displays or simple behavioral rules, infants are sensitive to characteristics of both the agents and recipients of prosocial and antisocial acts. Specifically, infants' preferences require that the recipients of positive and negative acts be social agents with clear unfulfilled goals, who have not previously harmed others. In addition, prosocial and antisocial agents must act intentionally, in the service of positive and negative goals. It is an open question whether these prosocial preferences reflect self-interested and/or moral concerns. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Design evaluation of emergency core cooling systems using Axiomatic Design

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Gyunyoung [Massachusetts Institute of Technology, Department of Mechanical Engineering, 77 Massachusetts Avenue, Cambridge, MA 02139 (United States)]. E-mail: gheo@mit.edu; Lee, Song Kyu [Korea Advanced Institute of Science and Technology, Department of Nuclear and Quantum Engineering, 373-1 Guseong-dong, Yuseong-gu, Daejeon (Korea, Republic of)

    2007-01-15

    In designing nuclear power plants (NPPs), the evaluation of safety is one of the important issues. As a measure for evaluating safety, this paper proposes a methodology to examine the design process of emergency core cooling systems (ECCSs) in NPPs using Axiomatic Design (AD). This is particularly important for identifying vulnerabilities and creating solutions. Korean Advanced Power Reactor 1400 MWe (APR1400) adopted the ECCS, which was improved to meet the stronger safety regulations than that of the current Optimized Power Reactor 1000 MWe (OPR1000). To improve the performance and safety of the ECCS, the various design strategies such as independency or redundancy were implemented, and their effectiveness was confirmed by calculating core damage frequency. We suggest an alternative viewpoint of evaluating the deployment of design strategies in terms of AD methodology. AD suggests two design principles and the visualization tools for organizing design process. The important benefit of AD is that it is capable of providing suitable priorities for deploying design strategies. The reverse engineering driven by AD has been able to show that the design process of the ECCS of APR1400 was improved in comparison to that of OPR1000 from the viewpoint of the coordination of design strategies.

  20. Evaluation of a Tabletop Emergency Preparedness Exercise for Pharmacy Students

    OpenAIRE

    Pate, Adam; Bratberg, Jeffrey P.; Robertson, Courtney; Smith, Gregory

    2016-01-01

    Objective. To describe the implementation and effect of an emergency preparedness laboratory activity on student knowledge, willingness to participate in emergency preparedness training, current level of preparedness, and the importance of a pharmacist’s role in disaster response.

  1. alles – einfach – sofort: Service in Medizinbibliotheken: Jahrestagung der Arbeitsgemeinschaft für Medizinisches Bibliothekswesen (AGMB e.V. vom 27. bis 29.9.2010 in Mainz / all – simply – immediately: service in medical libraries: Annual Meeting 2010 of “Arbeitsgemeinschaft für Medizinisches Bibliothekswesen” (AGMB e.V. 27th to 29th September in Mainz

    Directory of Open Access Journals (Sweden)

    Hentschel, Eike

    2010-12-01

    Full Text Available The annual meeting 2010 of “Arbeitsgemeinschaft für Medizinisches Bibliothekswesen” (AGMB e.V. took place 27th–29th September at Mainz university.During the main event for Advanced training of medical librarianship in Germany, Austria and Switzerland the following topics were presented and discussed:Increasing digitalization of scientific communication and the consequences, innovative services in hybrid libraries (virtual textbook collections and E-Books On-Demand, education (Master degree programm “Informations- und Wissensmanagement” in Hannover, concept and building of the medical library at Düsseldorf university (O.A.S.E., quality management according to ISO 9001, subito (new services based on § 52a+b UrhG, future of the programm “Nationallizenzen” and “Allianz-Initiative der deutschen Wissenschaftsorganisationen”, information literacy (particularly blended-learning, public relation and new strategies for communication and services, future concepts for medical libraries, library services in a UK research institute, reference management, Web 2.0 and other emerging technologies, BibNet.org, Cochrane library, MedPilot, PubMed.All relevant publishers and providers for medical libraries presented new products and services in an accompanying exhibition.

  2. The Profile of Neurology Patients Evaluated in the Emergency Department

    OpenAIRE

    Ufuk Emre; Ayşe Semra Demir; Esra Acıman; Nejla Çabuk; Sibel Kıran; Aysun Ünal

    2009-01-01

    OBJECTIVE: Early, rapid, and multidisciplinary approaches are very important in the diagnosis of neurological disorders in emergency departments. The present study aimed to investigate the features of patients that presented for neurology consultation in the emergency department. METHODS: The present study included 780 patients. Patient demographic features, reasons for emergent treatment and neurological consultation, neurological diagnosis by the neurologist, and laboratory (total blood...

  3. Economic evaluation of emergency obstetric care training: a systematic review.

    Science.gov (United States)

    Banke-Thomas, Aduragbemi; Wilson-Jones, Megan; Madaj, Barbara; van den Broek, Nynke

    2017-12-04

    Training healthcare providers in Emergency Obstetric Care (EmOC) has been shown to be effective in improving their capacity to provide this critical care package for mothers and babies. However, little is known about the costs and cost-effectiveness of such training. Understanding costs and cost-effectiveness is essential in guaranteeing value-for-money in healthcare spending. This study systematically reviewed the available literature on cost and cost-effectiveness of EmOC trainings. Peer-reviewed and grey literature was searched for relevant papers published after 1990. Studies were included if they described an economic evaluation of EmOC training and the training cost data were available. Two reviewers independently searched, screened, and selected studies that met the inclusion criteria, with disagreements resolved by a third reviewer. Quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. For comparability, all costs in local currency were converted to International dollar (I$) equivalents using purchasing power parity conversion factors. The cost per training per participant was calculated. Narrative synthesis was used to summarise the available evidence on cost effectiveness. Fourteen studies (five full and nine partial economic evaluations) met the inclusion criteria. All five and two of the nine partial economic evaluations were of high quality. The majority of studies (13/14) were from low- and middle-income countries. Training equipment, per diems and resource person allowance were the most expensive components. Cost of training per person per day ranged from I$33 to I$90 when accommodation was required and from I$5 to I$21 when training was facility-based. Cost-effectiveness of training was assessed in 5 studies with differing measures of effectiveness (knowledge, skills, procedure cost and lives saved) making comparison difficult. Economic evaluations of EmOC training are limited. There is a

  4. X-ray phase contrast imaging at the Mainz Microtron MAMI

    Energy Technology Data Exchange (ETDEWEB)

    Ghazaly, M. el

    2005-10-15

    Experiments have been performed to explore the potential of the low emittance 855 MeV electron beam of the Mainz Microtron MAMI for imaging with coherent X-rays. Transition radiation from a micro-focused electron beam traversing a foil stack served as X-ray source with good transverse coherence. In a first series of experiments a polychromatic transition radiation X-ray source with typical photon energies in the range of 8-30 keV and a spot size of standard deviation {sigma}{sub h}=(8.6{+-}0.1) {mu}m in horizontal and {sigma}{sub v}=(7.5{+-}0.1) {mu}m in vertical direction was used to record refraction contrast radiographs of low absorbing materials, in particular polymer strings with diameters between 30 and 450 {mu}m. As detectors X-ray films were used. The source-to-detector distance amounted to 13 m. The edge enhancement contrast C{sub ref} = (I{sub max}-I{sub min})/(I{sub max}+I{sub min}) was investigated as a function of the distance between the object and the X-ray film which was varied between 0.5 and 5.5 m. In a second series of experiments holograms of strings were taken with a beam spot size {sigma}{sub v}=(0.50{+-}0.05) {mu}m and a monochromatic X-ray beam of 6 keV energy. The good longitudinal coherence has been obtained by the (111) reflection of a flat silicon single crystal in Bragg geometry. It has been demonstrated that a direct exposure CCD chip with a pixel size of 13 x 13 {mu}m{sup 2} provides a highly efficient on-line detector. The on-line capability allows a minimization of the beam spot size by observing the smallest visible interference fringe spacings or the number of visible fringes. In a third series of experiments it was demonstrated that X-ray films are very useful detectors for the micro-focused and monochromized transition radiation X-ray source at MAMI. The main advantage in comparison with the direct exposure CCD chip is the resolution. For the X-ray film Structurix D3 (Agfa) the standard deviation of the resolution was measured

  5. X-ray phase contrast imaging at the Mainz Microtron MAMI

    International Nuclear Information System (INIS)

    Ghazaly, M. el

    2005-10-01

    Experiments have been performed to explore the potential of the low emittance 855 MeV electron beam of the Mainz Microtron MAMI for imaging with coherent X-rays. Transition radiation from a micro-focused electron beam traversing a foil stack served as X-ray source with good transverse coherence. In a first series of experiments a polychromatic transition radiation X-ray source with typical photon energies in the range of 8-30 keV and a spot size of standard deviation σ h =(8.6±0.1) μm in horizontal and σ v =(7.5±0.1) μm in vertical direction was used to record refraction contrast radiographs of low absorbing materials, in particular polymer strings with diameters between 30 and 450 μm. As detectors X-ray films were used. The source-to-detector distance amounted to 13 m. The edge enhancement contrast C ref = (I max -I min )/(I max +I min ) was investigated as a function of the distance between the object and the X-ray film which was varied between 0.5 and 5.5 m. In a second series of experiments holograms of strings were taken with a beam spot size σ v =(0.50±0.05) μm and a monochromatic X-ray beam of 6 keV energy. The good longitudinal coherence has been obtained by the (111) reflection of a flat silicon single crystal in Bragg geometry. It has been demonstrated that a direct exposure CCD chip with a pixel size of 13 x 13 μm 2 provides a highly efficient on-line detector. The on-line capability allows a minimization of the beam spot size by observing the smallest visible interference fringe spacings or the number of visible fringes. In a third series of experiments it was demonstrated that X-ray films are very useful detectors for the micro-focused and monochromized transition radiation X-ray source at MAMI. The main advantage in comparison with the direct exposure CCD chip is the resolution. For the X-ray film Structurix D3 (Agfa) the standard deviation of the resolution was measured to be σ f =(1.1±0.4) μm, which is about a factor of 6 better as for

  6. Performance Evaluation of Terrestrial Emergency Communication System in NPPs

    International Nuclear Information System (INIS)

    Son, Gwang Sub; Kim, Chang Hwoi; Kang, Hyun Gook

    2014-01-01

    The Fukushima accident induced by the great earthquake and tsunami reveals the vulnerability of I and C System. In the severe environment, the normal I and C system did not work properly and results in false information about the internal situation in NPP. Eventually the accident was not properly handled at the early stage. Therefore advanced emergency response system using a wireless channel is necessary to cope with the severe accident. In this paper, we introduce the ERS consisting of the HMS and MCS the ECS linking the HMS with MCS and the performance requirement of the ECS is analyzed. The ECS satisfying the requirement is designed conceptually and the performance of the ECS is evaluated through analysis and simulator. The terrestrial communication system is designed based on the IEEE 802.11. Analyzed performance results prove that the performance requirement can be sufficiently achieved. But if the scalability of data capacity is considered later, use of the advanced 802.11 standard such as 802.11n and multiple signal paths between the HMS and MCS are necessary

  7. Performance Evaluation of Terrestrial Emergency Communication System in NPPs

    Energy Technology Data Exchange (ETDEWEB)

    Son, Gwang Sub; Kim, Chang Hwoi; Kang, Hyun Gook [KAERI, Daejeon (Korea, Republic of)

    2014-08-15

    The Fukushima accident induced by the great earthquake and tsunami reveals the vulnerability of I and C System. In the severe environment, the normal I and C system did not work properly and results in false information about the internal situation in NPP. Eventually the accident was not properly handled at the early stage. Therefore advanced emergency response system using a wireless channel is necessary to cope with the severe accident. In this paper, we introduce the ERS consisting of the HMS and MCS the ECS linking the HMS with MCS and the performance requirement of the ECS is analyzed. The ECS satisfying the requirement is designed conceptually and the performance of the ECS is evaluated through analysis and simulator. The terrestrial communication system is designed based on the IEEE 802.11. Analyzed performance results prove that the performance requirement can be sufficiently achieved. But if the scalability of data capacity is considered later, use of the advanced 802.11 standard such as 802.11n and multiple signal paths between the HMS and MCS are necessary.

  8. Economic Evaluation of Pediatric Telemedicine Consultations to Rural Emergency Departments.

    Science.gov (United States)

    Yang, Nikki H; Dharmar, Madan; Yoo, Byung-Kwang; Leigh, J Paul; Kuppermann, Nathan; Romano, Patrick S; Nesbitt, Thomas S; Marcin, James P

    2015-08-01

    Comprehensive economic evaluations have not been conducted on telemedicine consultations to children in rural emergency departments (EDs). We conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. We built a decision model with parameters from primary programmatic data, national data, and the literature. We performed a base-case cost-effectiveness analysis (CEA), a probabilistic CEA with Monte Carlo simulation, and ROI estimation when CEA suggested cost-saving. The CEA was based on program effectiveness, derived from transfer decisions following telemedicine and telephone consultations. The average cost for a telemedicine consultation was $3641 per child/ED/year in 2013 US dollars. Telemedicine consultations resulted in 31% fewer patient transfers compared with telephone consultations and a cost reduction of $4662 per child/ED/year. Our probabilistic CEA demonstrated telemedicine consultations were less costly than telephone consultations in 57% of simulation iterations. The ROI was calculated to be 1.28 ($4662/$3641) from the base-case analysis and estimated to be 1.96 from the probabilistic analysis, suggesting a $1.96 return for each dollar invested in telemedicine. Treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. Telephone and telemedicine consultations were not randomly assigned, potentially resulting in biased results. From a health care payer perspective, telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving (base-case and more than half of Monte Carlo simulation iterations) or cost-effective compared with telephone consultations. © The Author(s) 2015.

  9. Quality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review.

    Science.gov (United States)

    Howard, Ian; Cameron, Peter; Wallis, Lee; Castren, Maaret; Lindstrom, Veronica

    2018-02-01

    all, 42.8% were categorized as primarily Clinical, with Out-of-Hospital Cardiac Arrest contributing the highest number within this domain (30.4%). Of the QIs categorized as Non-Clinical (57.2%), Time-Based Intervals contributed the greatest number (28.8%). Population on Whom the Data Collection was Constructed made up the most commonly reported QI component (79.8%), followed by a Descriptive Statement (63.6%). Least reported were Timing of Data Collection (12.1%) and Timing of Reporting (12.1%). Pilot testing of the QIs was reported on 34.7% of QIs identified in the review. Overall, there is considerable interest in the understanding and development of PEC quality measurement. However, closer attention to the details and reporting of QIs is required for research of this type to be more easily extrapolated and generalized. Howard I , Cameron P , Wallis L , Castren M , Lindstrom V . Quality indicators for evaluating prehospital emergency care: a scoping review. Prehosp Disaster Med. 2018;33(1):43-52.

  10. New results from the Mainz neutrino mass experiment and perspective of a new large tritium-β-spectrometer

    International Nuclear Information System (INIS)

    Bonn, J.; Bornschein, B.; Bornschein, L.; Fickinger, L.; Kraus, Ch.; Otten, E.W.; Ulrich, H.; Weinheimer, Ch.; Kazachenko, O.; Kovalik, A.

    2001-01-01

    The Mainz neutrino mass experiment investigates the endpoint region of the tritium β decay spectrum to determine the mass of the electron antineutrino. By the recent upgrade the former problem of de-wetting T 2 films has been solved and the signal-to-background-ratio was improved by a factor of 10. The latest measurement leads to m ν 2 = -1.1 ± 2.6 stat ± 1.8 sys eV 2 /c 4 (preliminary), which corresponds to an upper limit of m ν 2 (95 % C.L.) (preliminary). Some indication for the anomaly, reported by the Troitsk group, was found, but its postulated half year period is contradicted by our data. The perspectives of a new Large Tritium-β-Spectrometer to reach sub eV sensitivity will be presented. (authors)

  11. Detector studies for a high precision determination of the weak mixing angle at the future P2-experiment in Mainz

    Energy Technology Data Exchange (ETDEWEB)

    Gerz, Kathrin; Baunack, Sebastian; Becker, Dominik; Diefenbach, Juergen; Glaeser, Boris; Imai, Yoshio; Jennewein, Thomas [Institut fuer Kernphysik, Johannes-Gutenberg-Universitaet Mainz (Germany); Maas, Frank [Institut fuer Kernphysik, Johannes-Gutenberg-Universitaet Mainz (Germany); Helmholz-Institut Mainz (Germany); PRISMA Cluster of Excellence, Johannes Gutenberg-Universitaet, 55099 Mainz (Germany); Rodriguez, David [Helmholz-Institut Mainz (Germany); Collaboration: A4-Collaboration

    2015-07-01

    The P2 experiment at the upcoming MESA accelerator in Mainz aims for a high precision determination of the electroweak mixing angle: The 2% measurement of the parity violating asymmetry in elastic electron-proton scattering will allow for a determination of sin{sup 2}(θ{sub W}) of 0.15%. The experimental setup is currently being designed and will employ the use of an integrating, large solid angle magnetic solenoid spectrometer with quartz bars for the detection of elastically scattered electrons. The low-energy and high-statistics experiment places high demands on detector performance and radiation hardness of all materials used in the setup. We are going to present the current status of the development of the experiment, feasibility calculations and simulations. We put an emphasis on technology and design of a Cherenkov detector.

  12. Evaluation of the preparedness of the children's emergency rooms ...

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH ... Background: The Children Emergency Room (CHER) is the first point of call for many sick children. ... limitation abounds with regards to personnel, high technology infrastructure, personnel ...

  13. Evaluating nuclear power plant crew performance during emergency response drills

    International Nuclear Information System (INIS)

    Rabin, D.

    1999-01-01

    The Atomic Energy Control Board (AECB) is responsible for the regulation of the health, safety and environmental consequences of nuclear activities in Canada. Recently, the Human Factors Specialists of the AECB have become involved in the assessment of emergency preparedness and emergency response at nuclear facilities. One key contribution to existing AECB methodology is the introduction of Behaviourally Anchored Rating Scales (BARS) to measure crew interaction skills during emergency response drills. This report presents results of an on-going pilot study to determine if the BARS provide a reliable and valid means of rating the key dimensions of communications, openness, task coordination and adaptability under simulated emergency circumstances. To date, the objectivity of the BARS is supported by good inter-rater reliability while the validity of the BARS is supported by the agreement between ratings of crew interaction and qualitative and quantitative observations of crew performance. (author)

  14. Preparation, conduct and evaluation of exercises to test preparedness for a nuclear or radiological emergency. Emergency preparedness and response

    International Nuclear Information System (INIS)

    2005-04-01

    The aim of this publication is to serve as a practical tool for the preparation, conduct and evaluation of exercises to test preparedness for response to a nuclear or radiological emergency. It fulfils in part the functions assigned to the IAEA under Article 5.a(ii) of the Convention on Assistance in Case of a Nuclear Accident or Radiological Emergency (Assistance Convention), namely, to collect and disseminate to States Parties and Member States information concerning the methodologies, techniques and available results of research on such emergencies. To ensure effective response to radiation emergencies when needed, provisions should be made for regular training of emergency response personnel. As stated in Preparedness and Response for a Nuclear or Radiological Emergency (Safety Requirements, Safety Standard Series No. GS-R-2), 'The operator and the response organizations shall make arrangements for the selection of personnel and training to ensure that the personnel have the requisite knowledge, skills, abilities, equipment, procedures and other arrangements to perform their assigned response functions'. A further requirement is that 'Exercise programmes shall be conducted to ensure that all specified functions required to be performed for emergency response and all organizational interfaces for facilities in threat category I, II or III and the national level programmes for threat category IV or V are tested at suitable intervals'. In 2004 the IAEA General Conference, in resolution GC(48)/RES/10 encouraged Member States to 'implement the Safety Requirements for Preparedness and Response to a Nuclear or Radiological Emergency'. This document is published as part of the IAEA Emergency Preparedness and Response Series to assist in meeting these requirements and to fulfil Article 5 of the Assistance Convention. It was developed based on a number of assumptions about national and local capabilities. Therefore, the exercise structure, terms and scenarios must be

  15. Evaluating Emergency Department Asthma Management Practices in Florida Hospitals.

    Science.gov (United States)

    Nowakowski, Alexandra C H; Carretta, Henry J; Dudley, Julie K; Forrest, Jamie R; Folsom, Abbey N

    2016-01-01

    To assess gaps in emergency department (ED) asthma management at Florida hospitals. Survey instrument with open- and closed-ended questions. Topics included availability of specific asthma management modalities, compliance with national guidelines, employment of specialized asthma care personnel, and efforts toward performance improvement. Emergency departments at 10 large hospitals in the state of Florida. Clinical care providers and health administrators from participating hospitals. Compliance with national asthma care guideline standards, provision of specific recommended treatment modalities and resources, employment of specialized asthma care personnel, and engagement in performance improvement efforts. Our results suggest inconsistency among sampled Florida hospitals' adherence to national standards for treatment of asthma in EDs. Several hospitals were refining their emergency care protocols to incorporate guideline recommendations. Despite a lack of formal ED protocols in some hospitals, adherence to national guidelines for emergency care nonetheless remained robust for patient education and medication prescribing, but it was weaker for formal care planning and medical follow-up. Identified deficiencies in emergency asthma care present a number of opportunities for strategic mitigation of identified gaps. We conclude with suggestions to help Florida hospitals achieve success with ED asthma care reform. Team-based learning activities may offer an optimal strategy for sharing and implementing best practices.

  16. Evaluation of the effectiveness of digital radiography in emergency situations

    International Nuclear Information System (INIS)

    Pathi, R.; Langlois, S.

    2002-01-01

    The time differences between digital and conventional radiography for emergency patients were investigated, and clinician satisfaction with the two modalities was compared. Time-motion data was collected daily over 5 weeks for a digital group and a conventional X-ray group. For standardization purposes, only emergency patients requiring chest X-rays were selected for the study. Data were collected from 30 patients in each of the two groups in the time-motion study, and 31 out of 50 Emergency and Intensive Care clinicians responded to the questionnaire. Results were analysed by percentage, and χ 2 analysis was used where appropriate. The time for availability of images to requesting clinicians was 70% less for digital images compared to conventional radiography. The overall satisfaction between digital and conventional radiography was very similar, but most clinicians expressed an opinion that digital radiography offered significant image modification advantages. Copyright (2002) Blackwell Science Pty Ltd

  17. Application and evaluation of training for response to emergency situations

    Energy Technology Data Exchange (ETDEWEB)

    Kidwell, M.D.

    1979-01-01

    At Washington Gas Light Co., a magnetic situation-simulation board has become an effective tool for training field personnel in emergency procedures and decisionmaking. Class participants use magnetic disks - symbolizing physical features and components of the distribution system and service equipment - to visually describe the step-by-step procedures applied to specific emergency scenarios. A manually operated clock keeps a running account of the time estimated for each step, emphasizing the need for quick response. Situation-board programs of typical problems, complete with script and drawings, are available to all training foremen to ensure uniform training throughout the department.

  18. Evaluation of Head Trauma Cases in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Alim Cokuk

    2013-02-01

    Full Text Available Aim: In this study, we aimed to determine the epidemiological characteristics, morbidity and mortality rates of patients admitted to the emergency department with head trauma. Material and Methods: In this study, ambulatory and hospitalized patients over the age of 18 brought to the Emergency Department because of head trauma between 01.12.2009 - 31.12.2010 were analyzed retrospectively. Patient data were recorded to standard data entry form. SPSS 17.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p <0.05. Results: 5200 patients were included in this study. The average age of the patients was 39.97 ± 16.66 years. 4682'si patients (90 % were discharged from the emergency department. The most common reason for admission to the emergency department was falls (41.81 % in the discharged patients. 518 (10 % patients were hospitalized. Gender of these patients was 110 female (21:24% and 408 male (78.76%. 256 patients (48.35% were injured as a result of a traffic accident. 201(38.8% of the cerebral CT were reported as normal and 89 (17.2% of the cerebral CT were reported as traumatic subarachnoid hemorrhage (SAH in hospitalized patients. The fracture of lumbar spine (12 % was detected as an additional pathological disease in patients. 75 patients hospitalized because of head trauma (14.5% had died (1.44 % of all patients. Cervical spine fracture was the most common (14 patients, 18.68 % additional pathology in patients who died. Thoracic trauma was detected as the second most common (13 patients, 17.33 % additional pathology. Conclusion: Most of the patients admitted to the emergency department with head injury had a minor trauma. Patients can be discharged from the emergency department after a thorough physical examination and simple medical intervention. Most of the head injury patients admitted to hospital were male. The most common reason of the patients with head injury admitted to

  19. Handbook for the planning, co-ordination and evaluation of emergency exercises in nuclear power plants

    International Nuclear Information System (INIS)

    Schmidtborn, I.; Bath, N.

    1999-01-01

    The efficiency of the on-site emergency organization in German nuclear power plants is tested regularly through emergency exercises. To achieve federal harmonization on a high level of quality a handbook for the planning, co-ordination and evaluation of such exercises has been developed in the frame of the regulatory investigation programme. In this handbook requirements are set out for emergency training. Key elements are a modular structure, rules to be observed and guidance for post-exercise evaluation. (orig.) [de

  20. Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room

    Directory of Open Access Journals (Sweden)

    VLAUDIMIR DIAS MARQUES

    Full Text Available ABSTRACT Objective: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. Methods: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. Results: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n=187, the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values was performed in greater numbers when compared with cases led by surgeons (n=501. There was a statistically significant relationship (p<0.01 between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28 in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. Conclusion: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.

  1. Evaluation of the preparedness of the children's emergency rooms ...

    African Journals Online (AJOL)

    2017-02-09

    Feb 9, 2017 ... beds per nurse ranges from 3-15, giving a nurse: patient ratio of 1:3-15. (Table 1) .... Emergency Rooms (CHER) in the tertiary health institu- .... vices offered in our tertiary centres must go beyond the mundane ... medical tourism abroad as most often any care beyond the basic ... of general practitioner care.

  2. Evaluating the Emergence of Reverse Intraverbals in Children with Autism

    Science.gov (United States)

    Allan, Alicia C.; Vladescu, Jason C.; Kisamore, April N.; Reeve, Sharon A.; Sidener, Tina M.

    2015-01-01

    Verbal behavior plays a fundamental role in the development of complex social and communication skills. Many children diagnosed with autism spectrum disorder exhibit profound deficiencies in intraverbal repertoires and the development of social relationships. Recent studies that investigated the effects of intraverbal training on the emergence of…

  3. Retrospective evaluation of urological admissions to emergency service of a training and research hospital.

    Science.gov (United States)

    Topaktaş, Ramazan; Altın, Selçuk; Aydın, Cemil; Akkoç, Ali; Yılmaz, Yakup

    2014-12-01

    Many patients consult emergency services with urological complaints. The aim of this study was to investigate the epidemiology, clinical presentation and treatments of urological emergency cases in a training and research hospital. We retrospectively evaluated urological emergency patients referred to the emergency unit between July 2012 and July 2013 according to age, gender, affected organ, radiological imaging techniques and treatment. Among 141.844 emergency cases, 3.113 (2.19%) were urological emergencies and 53.2% of the patients were male (mean age: 49.1), and 46.8% of them were female (median age: 42.8). The most frequent illness was genitourinary infection constituting 41.2% of the cases followed by renal colic (36.9%). Among the urological emergencies 483 (15.5%) patients were hospitalized and 152 surgical operations were performed. The mostly performed procedure was the placement of a suprapubic catheter in 34 patients constituting (22.3%) of the cases. Totally eight patients were referred to another experienced health center due to different reasons. Most of the urological emergency patients do not require emergency surgical interventions however, timely identification and management of urological emergencies with in-depth clinical evaluation are important to prevent late complications. Therefore the doctors working in emergency services must be heedful of urological emergencies.

  4. Emerging technologies in healthcare: navigating risks, evaluating rewards.

    Science.gov (United States)

    McGrady, Elizabeth; Conger, Sue; Blanke, Sandra; Landry, Brett J L

    2010-01-01

    The purpose of this prescriptive research is to help decision makers become better informed about three technologies emerging in the healthcare arena by providing a basic description of the technology and describing their current applications, future healthcare deployment, potential risks, and related managerial issues. Two of the technologies, radio frequency identification (RFID) and global positioning systems (GPS), are currently available to healthcare organizations and appear capable of decreasing cost but may require significant initial investment and have disruptive potential. The third technology, nanotechnology, has limited current use but may revolutionize both the delivery of medicine and hospital infrastructure management. With cautious attention to managerial issues and meticulous attention to implementation details, healthcare organizations that can successfully navigate the coming technologically driven paradigm shifts will emerge more resilient organizations.

  5. Transient global amnesia: emergency department evaluation and management [digest].

    Science.gov (United States)

    Faust, Jeremy Samuel; Nemes, Andreea; Zaurova, Milana

    2016-08-22

    Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. It can last up to 24 hours. The diagnosis is dependent on eliminating other more serious etiologies including toxic ingestions, acute strokes, complex partial seizures, and central nervous system infections. Transient global amnesia confers no known long-term risks; however, when abnormal signs or symptoms are present, they take precedence and guide the formulation of a differential diagnosis and investigation. In witnessed transient global amnesia with classic features, a minimalist approach is reasonable, avoiding overtesting, inappropriate medication, and medical interventions in favor of observation, ensuring patient safety, and reassuring patients and their families. This review provides a detailed framework for distinguishing transient global amnesia from its dangerous mimics and managing its course in the emergency department. [Points & Pearls is a digest of Emergency Medicine Practice].

  6. Evaluating an australian emergency nurse practitioner candidate training program.

    Science.gov (United States)

    Plath, Sharyn J; Wright, Mary; Hocking, Julia

    2017-11-01

    Nurse Practitioners (NPs) receive core clinical training at master's level, with their employer providing the opportunity to upskill in clinical and procedural competencies. It is increasingly recognised that this generic education requires supplementary training for operating effectively within a specific clinical environment. In this paper we describe a pilot program designed to train Australian NP Candidates to work effectively within the Emergency Department Fast Track model of care. The training program consisted of a 12-month period: four hours in-house training per week over two semesters, running concurrently with the NP candidate's University semesters, and 3 months' clinical practice to consolidate. The training team defined milestones for Semesters one and two, and developed a case review form to assess application of the candidate's knowledge in new clinical situations, as well as check for gaps in understanding. A clinical skills guide was developed for the candidate to work toward, and a comprehensive assessment was carried out at two time points in the training program. Feedback was obtained from the mentors and the candidate at the end point of the training program, and has been used to refine the program for 2017. This in-house training program provided specialised, evidence-based training for the emergency department environment, resulting in development of the nurse practitioner candidate as a high functioning team member. Copyright © 2017 College of Emergency Nursing Australasia. All rights reserved.

  7. A protocol for a pragmatic randomized controlled trial evaluating outcomes of emergency nurse practitioner service.

    Science.gov (United States)

    Jennings, Natasha; Gardner, Glenn; O'Reilly, Gerard

    2014-09-01

    To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. Pragmatic randomized controlled trial at one site with 260 participants. This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce. Trial registration details: Australian and New Zealand Clinical Trials Registry dated 18th August 2013, ACTRN12613000933752. © 2014 John Wiley & Sons Ltd.

  8. Evaluating the effect of emergency residency training on productivity in the emergency department.

    Science.gov (United States)

    Henning, Daniel J; McGillicuddy, Daniel C; Sanchez, Leon D

    2013-09-01

    Resident productivity, defined as patients seen per unit time, is one measure that is used to assess the performance and educational progress of residents in the emergency department (ED). One published study suggested that emergency residency training (EM) does not improve productivity compared with that in other specialties, including internal medicine (IM). This study assesses how EM and IM trainees perform in the ED and illustrates how resident productivity changes through the academic year. A retrospective review of attending physicians and residents working 8-h shifts in the higher acuity zone of a large-volume, tertiary, academic health care center was performed for July 2009, October 2009, January 2010, and April 2010. The total number of patients seen primarily and admitted during each shift was recorded. ED volume was approximated by the number of patients seen by the attending physician, and acuity was approximated by admission rate. A mixed model regression assessed the impact of year and type of residency training (e.g., EM1, EM2, IM1, and IM2), ED volume, and acuity on resident productivity (number of patients per shift). The study was granted waiver of informed consent by our institutional review board. We reviewed 936 shifts. After adjusting for acuity and ED volume, the EM1 group had a significant increase in patients per shift over the year, from 6.11 in July to 10.3 in April (p increased productivity significantly. The first EM training year leads to a significant change in productivity that separates EM from IM residents. This contradicts the previous assertion that non-EM residents have the same productivity as EM residents in the ED. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Evaluation of emergency transcatheter arterial embolization in intractable postpartum hemorrhage

    International Nuclear Information System (INIS)

    Qi Weihong; Wang Song; Zhan Ying

    2008-01-01

    Objective: To assess the efficacy and safety of emergency transcatheter arterial embolization in the management of intractable postpartum hemorrhage. Methods: Twenty-five patients with intractable postpartum hemorrhage were undertaken superselective catheterization into the bilateral internal iliac arteries or uterial arteries to find the causes and sites of bleeding through DSA and then followed by arterial embolization with gelfoam particles. Result: All of the 25 patients with obstetrical bleeding were successfully controlled by TAE, the procedure lasted for 25-60 min, (mean 42.5 ± 4.6 min); with both catheterization and bleeding halt successful rates of 100%. Comparison of hemoglobin and heartbeat before and after the procedure showed significance (t=29.49, P<0.01; t=16.51, P<0.01). The uterus showed reintegration on time and menstruation resumed in all patients. Conclusions: Emergency arterial embolization is a safe and effective means for control of intractable postpartum hemorrhage, providing less trauma and no severe complications, especially as an unique management for fetal postpartum hemorrhage. (authors)

  10. Recommended criteria for the evaluation of on-site nuclear power plant emergency exercises

    International Nuclear Information System (INIS)

    Lafortune, J.F.

    1997-01-01

    A review of existing Canadian and International emergency exercise evaluation criteria and approaches has been conducted. Based on the results of the review, criteria are proposed for the evaluation of on-site emergency exercises for Canadian nuclear power stations. The proposed criteria are performance-based. They are comprehensive, yet remain adaptable to all stations and accident scenarios. They are primarily aimed at radiological emergency exercises, but are entirely applicable to fire or other conventional exercises. This report also addresses evaluation preparation and methodology. (author). 21 refs., 6 tabs

  11. An evaluation of emerging vaccines for childhood meningococcal disease

    Directory of Open Access Journals (Sweden)

    Nelson Christopher B

    2011-04-01

    Full Text Available Abstract Background Meningococcal meningitis is a major cause of disease worldwide, with frequent epidemics particularly affecting an area of sub-Saharan Africa known as the “meningitis belt”. Neisseria meningitidis group A (MenA is responsible for major epidemics in Africa. Recently W-135 has emerged as an important pathogen. Currently, the strategy for control of such outbreaks is emergency use of meningococcal (MC polysaccharide vaccines, but these have a limited ability to induce herd immunity and elicit an adequate immune response in infant and young children. In recent times initiatives have been taken to introduce meningococcal conjugate vaccine in these African countries. Currently there are two different types of MC conjugate vaccines at late stages of development covering serogroup A and W-135: a multivalent MC conjugate vaccine against serogroup A,C,Y and W-135; and a monovalent conjugate vaccine against serogroup A. We aimed to perform a structured assessment of these emerging meningococcal vaccines as a means of reducing global meningococal disease burden among children under 5 years of age. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In the first stage we systematically reviewed the literature related to emerging MC vaccines relevant to 12 criteria of interest. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies. They answered questions from CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results For MenA conjugate vaccine the experts showed very high level of optimism (~ 90% or more for 7 out of the 12 criteria. The experts felt that the likelihood of efficacy on meningitis was very high (~ 90%. Deliverability

  12. Psychiatric Evaluation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychiatric Evaluation Workgroup

    OpenAIRE

    Stowell, Keith R; Florence, Peter; Harman, Herbert J; Glick, Rachel L

    2012-01-01

    It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a 2-step process. First, a brief evaluati...

  13. Assessment and Evaluation of National Human Resource Development System Competitiveness in Emerging Countries

    Science.gov (United States)

    Oh, HunSeok; Seo, DongIn; Kim, JuSeuk; Yoo, SangOk; Seong, HeeChang

    2015-01-01

    This study assessed and evaluated the competitiveness of national human resource development (NHRD) systems in emerging countries with potential for growth. The literature on emerging countries and NHRD systems was reviewed. The study developed a model mechanism with forty-one indices and nine sub-components for the NHRD system assessment in…

  14. Evaluation of seed priming and coating on emergence, yield and ...

    African Journals Online (AJOL)

    Bread wheat production is constrained by climate change impacts and diseases in Amhara region. Pre-farming seed treatments are practiced worldwide to avert their effects on wheat. A field experiment was conducted at Adet and Finoteselam research stations in 2014 main cropping season to evaluate the effects of seed ...

  15. EVALUATION OF SUICIDE ATTEMPT CASES ADMITTED TO EMERGENCY DEPARTMENT

    Directory of Open Access Journals (Sweden)

    Hamit Sirri Keten

    2015-06-01

    Material and Methods: A total of 70 attempted suicide cases admitted to Emergency Department of Kahramanmaras Sutcu imam University Medical Faculty Hospital between 01.03.2012 and 01.03.2013 examined retrospectively. Results: Among the 70 patients included in the study, 26 (37.1% were male and 44 (62.9% were female with a mean age of 26.3+/-11.2 years. Of all, 10 (14.3% cases were reported to have one or more previous suicide attempts. Investigation of methods of suicide revealed that 64 (91.4% used medication or toxic substance ingestion, 5 (7.1% stabbing, and 1 (1.4% preferred hanging as suicide method. All of those of preferred stabbing as a means of suicide were males. Conclusion: In order to tackle suicidal attempts author suggests that collective preventive policies should be developed by local governments, non-governmental organizations and health care providers. [J Contemp Med 2015; 5(2.000: 102-105

  16. Performance evaluation of emerging JPEGXR compression standard for medical images

    International Nuclear Information System (INIS)

    Basit, M.A.

    2012-01-01

    Medical images require loss less compression as a small error due to lossy compression may be considered as a diagnostic error. JPEG XR is the latest image compression standard designed for variety of applications and has a support for lossy and loss less modes. This paper provides in-depth performance evaluation of latest JPEGXR with existing image coding standards for medical images using loss less compression. Various medical images are used for evaluation and ten images of each organ are tested. Performance of JPEGXR is compared with JPEG2000 and JPEGLS using mean square error, peak signal to noise ratio, mean absolute error and structural similarity index. JPEGXR shows improvement of 20.73 dB and 5.98 dB over JPEGLS and JPEG2000 respectively for various test images used in experimentation. (author)

  17. Use of field experimental studies to evaluate emergency response models

    International Nuclear Information System (INIS)

    Gudiksen, P.H.; Lange, R.; Rodriguez, D.J.; Nasstrom, J.S.

    1985-01-01

    The three-dimensional diagnostic wind field model (MATHEW) and the particle-in-cell atmospheric transport and diffusion model (ADPIC) are used by the Atmospheric Release Advisory Capability to estimate the environmental consequences of accidental releases of radioactivity into the atmosphere. These models have undergone extensive evaluations against field experiments conducted in a variety of environmental settings ranging from relatively flat to very complex terrain areas. Simulations of tracer experiments conducted in a complex mountain valley setting revealed that 35 to 50% of the comparisons between calculated and measured tracer concentrations were within a factor of 5. This may be compared with a factor of 2 for 50% of the comparisons for relatively flat terrain. This degradation of results in complex terrain is due to a variety of factors such as the limited representativeness of measurements in complex terrain, the limited spatial resolution afforded by the models, and the turbulence parameterization based on sigma/sub theta/ measurements to evaluate the eddy diffusivities. Measurements of sigma/sub theta/ in complex terrain exceed those measured over flat terrain by a factor of 2 to 3 leading to eddy diffusivities that are unrealistically high. The results of model evaluations are very sensitive to the quality and the representativeness of the meteorological data. This is particularly true for measurements near the source. The capability of the models to simulate the dispersion of an instantaneously produced cloud of particulates was illustrated to be generally within a factor of 2 over flat terrain. 19 refs., 16 figs

  18. Preliminary program evaluation of emergency department HIV prevention counseling.

    Science.gov (United States)

    Sitlinger, Andrea P; Lindsell, Christopher J; Ruffner, Andrew H; Wayne, D Beth; Hart, Kimberly W; Trott, Alexander T; Fichtenbaum, Carl J; Lyons, Michael S

    2011-07-01

    Controversy surrounds the linkage of prevention counseling with emergency department (ED)-based HIV testing. Further, the effectiveness and feasibility of prevention counseling in the ED setting is unknown. We investigate these issues by conducting a preliminarily exploration of several related aspects of our ED's HIV prevention counseling and testing program. Our urban, academic ED provides formal client-centered prevention counseling in conjunction with HIV testing. Five descriptive, exploratory observations were conducted, involving surveys and analysis of electronic medical records and programmatic data focused on (1) patient perception and feasibility of prevention counseling in the ED, (2) patient perceptions of the need to link prevention counseling with testing, and (3) potential effectiveness of providing prevention counseling in conjunction with ED-based HIV testing. Of 110 ED patients surveyed after prevention counseling and testing, 98% believed privacy was adequate, and 97% reported that their questions were answered. Patients stated that counseling would lead to improved health (80%), behavioral changes (72%), follow-up testing (77%), and discussion with partners (74%). However, 89% would accept testing without counseling, 32% were willing to seek counseling elsewhere, and 26% preferred not to receive the counseling. Correct responses to a 16-question knowledge quiz increased by 1.6 after counseling (95% confidence interval 1.3 to 12.0). The program completed counseling for 97% of patients tested; however, 6% of patients had difficulty recalling the encounter and 13% denied received testing. Among patients undergoing repeated testing, there was no consistent change in self-reported risk behaviors. Participants in the ED prevention counseling and testing program considered counseling acceptable and useful, though not required. Given adequate resources, prevention counseling can be provided in the ED, but it is unlikely that all patients benefit

  19. System model for evaluation of an emergency response plan for a nuclear power plant based on an assessment of nuclear emergency exercises

    International Nuclear Information System (INIS)

    Silva, Marcos Vinicius C.; Medeiros, Jose A.C.C.

    2011-01-01

    Nuclear power plants are designed and built with systems dedicated to provide a high degree of protection to its workers, the population living in their neighborhoods and the environment. Among the requirements for ensuring safety there are the existence of the nuclear emergency plan. Due to the relationship between the actions contemplated in the emergency plan and the nuclear emergency exercise, it becomes possible to assess the quality of the nuclear emergency plan, by means of emergency exercise evaluation, The techniques used in this work aim at improving the evaluation method of a nuclear emergency exercise through the use of performance indicators in the evaluation of the structures, actions and procedures involved. The proposed model enables comparisons between different moments of an emergency plan directed to a nuclear power plant as well as comparisons between plans dedicated to different facilities. (author)

  20. System model for evaluation of an emergency response plan for a nuclear power plant based on an assessment of nuclear emergency exercises

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Marcos Vinicius C.; Medeiros, Jose A.C.C. [Universidade Federal do Rio de Janeiro (PEN/COPPE/UFRJ), RJ (Brazil). Coordenacao dos Programas de Pos-Graduacao de Engenharia. Programa de Engenharia Nuclear

    2011-07-01

    Nuclear power plants are designed and built with systems dedicated to provide a high degree of protection to its workers, the population living in their neighborhoods and the environment. Among the requirements for ensuring safety there are the existence of the nuclear emergency plan. Due to the relationship between the actions contemplated in the emergency plan and the nuclear emergency exercise, it becomes possible to assess the quality of the nuclear emergency plan, by means of emergency exercise evaluation, The techniques used in this work aim at improving the evaluation method of a nuclear emergency exercise through the use of performance indicators in the evaluation of the structures, actions and procedures involved. The proposed model enables comparisons between different moments of an emergency plan directed to a nuclear power plant as well as comparisons between plans dedicated to different facilities. (author)

  1. An evaluation of emerging vaccines for childhood pneumococcal pneumonia

    Directory of Open Access Journals (Sweden)

    Zhang Jian Shayne F

    2011-04-01

    Full Text Available Abstract Background Pneumonia is the leading cause of child mortality worldwide. Streptococcus pneumoniae (SP or pneumococcus is estimated to cause 821,000 child deaths each year. It has over 90 serotypes, of which 7 to 13 serotypes are included in current formulations of pneumococcal conjugate vaccines that are efficacious in young children. To further reduce the burden from SP pneumonia, a vaccine is required that could protect children from a greater diversity of serotypes. Two different types of vaccines against pneumococcal pneumonia are currently at varying stages of development: a multivalent pneumococcal conjugate vaccine covering additional SP serotypes; and a conserved common pneumococcal protein antigen (PPA vaccine offering protection for all serotypes. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging SP vaccines relevant to several criteria of interest: answerability; efficacy and effectiveness; cost of development, production and implementation; deliverability, affordability and sustainability; maximum potential for disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies. The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to sensitive nature of their involvement in such exercises. They answered questions from CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results The experts expressed very high level of optimism (over 80% that low-cost polysaccharide conjugate SP vaccines would satisfy each of the 9

  2. Evaluation of Cases with Rabies Risk Presenting to Emergency Department

    Directory of Open Access Journals (Sweden)

    Fevzi Yilmaz

    2013-10-01

    Full Text Available Aim: All around the world 10-12 million people/year receive rabies prophylaxis. Rabies is an acute fatal central nervous system viral enfection. The virus can infect all warm-blooded animals and almost in all cases the enfection results with fatal encephalitis. The aim of this study is to determine the demographic characteristics of cases with rabies risk exposures and behind this to emphasise the significance of cooperation between the institutions to perform effective and accurate treatment. Material and Method: This study was performed with retrospective analysis of 1429 cases who attended to Emergency Department of Diyarbakir Goverment Hospital between January 2007-2010 for animal bites and exposures with the risk of rabies. Statistical analysis of data was performed SPSS V16 pocket programme. Data were defined as frequency and %. For statistical analysis Chi-Square and Fischer exact test was used. A value of P<0.05 was accepted statistically significant. Results: A total of 1055 (73.8% were male, 374 (26.2% were female and the mean age was 21.75 ± 16.9 (6 months-87 years. The major group in children was 6-11 years old and 651 (% 45.5 of the cases attended to hospital were under 18 years old. The vast majority (39.3% in adults were between 19-49 years. In our study 808 (56.5% of the cases  were bitten, 597 (41.8% of the cases  were scrabbled by the animal and 24 (1.7%of them  had indirect contact with the animal Both of them were taken into prophylactic vaccination programme (p<0.05. The vast majority of animal bites were dog (67%  and cat (28%. 3 doses of Human diploid cell vaccine-HDCV were administered to 1001 (70% of the patients and 5 doses to 428 (30% of patients. Human rabies immune globulin-HRIG were administered to 475 (33,3% of the patients in addition to vaccine. Discussion:  In our region rabies risk exposure is an important public health problem. Public oriented education should be given about attending to health care

  3. [Evaluation of new and emerging health technologies. Proposal for classification].

    Science.gov (United States)

    Prados-Torres, J D; Vidal-España, F; Barnestein-Fonseca, P; Gallo-García, C; Irastorza-Aldasoro, A; Leiva-Fernández, F

    2011-01-01

    Review and develop a proposal for the classification of health technologies (HT) evaluated by the Health Technology Assessment Agencies (HTAA). Peer review of AETS of the previous proposed classification of HT. Analysis of their input and suggestions for amendments. Construction of a new classification. Pilot study with physicians. Andalusian Public Health System. Spanish HTAA. Experts from HTAA. Tutors of family medicine residents. HT Update classification previously made by the research team. Peer review by Spanish HTAA. Qualitative and quantitative analysis of responses. Construction of a new and pilot study based on 12 evaluation reports of the HTAA. We obtained 11 thematic categories that are classified into 6 major head groups: 1, prevention technology; 2, diagnostic technology; 3, therapeutic technologies; 4, diagnostic and therapeutic technologies; 5, organizational technology, and 6, knowledge management and quality of care. In the pilot there was a good concordance in the classification of 8 of the 12 reports reviewed by physicians. Experts agree on 11 thematic categories of HT. A new classification of HT with double entry (Nature and purpose of HT) is proposed. APPLICABILITY: According to experts, the classification of the work of the HTAA may represent a useful tool to transfer and manage knowledge. Moreover, an adequate classification of the HTAA reports would help clinicians and other potential users to locate them and this can facilitate their dissemination. Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.

  4. Life cycle evaluation of emerging lignocellulosic ethanol conversion technologies.

    Science.gov (United States)

    Spatari, Sabrina; Bagley, David M; MacLean, Heather L

    2010-01-01

    Lignocellulosic ethanol holds promise for addressing climate change and energy security issues associated with personal transportation through lowering the fuel mixes' carbon intensity and petroleum demand. We compare the technological features and life cycle environmental impacts of near- and mid-term ethanol bioconversion technologies in the United States. Key uncertainties in the major processes: pre-treatment, hydrolysis, and fermentation are evaluated. The potential to reduce fossil energy use and greenhouse gas (GHG) emissions varies among bioconversion processes, although all options studied are considerably more attractive than gasoline. Anticipated future performance is found to be considerably more attractive than that published in the literature as being achieved to date. Electricity co-product credits are important in characterizing the GHG impacts of different ethanol production pathways; however, in the absence of near-term liquid transportation fuel alternatives to gasoline, optimizing ethanol facilities to produce ethanol (as opposed to co-products) is important for reducing the carbon intensity of the road transportation sector and for energy security.

  5. Psychiatric evaluation of the agitated patient: consensus statement of the american association for emergency psychiatry project Beta psychiatric evaluation workgroup.

    Science.gov (United States)

    Stowell, Keith R; Florence, Peter; Harman, Herbert J; Glick, Rachel L

    2012-02-01

    It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a 2-step process. First, a brief evaluation must be aimed at determining the most likely cause of agitation, so as to guide preliminary interventions to calm the patient. Once the patient is calmed, more extensive psychiatric assessment can be completed. The goal of the emergency assessment of the psychiatric patient is not necessarily to obtain a definitive diagnosis. Rather, ascertaining a differential diagnosis, determining safety, and developing an appropriate treatment and disposition plan are the goals of the assessment. This article will summarize what components of the psychiatric assessment can and should be done at the time the agitated patient presents to the emergency setting. The complete psychiatric evaluation of the patient whose agitation has been treated successfully is beyond the scope of this article and Project BETA (Best practices in Evaluation and Treatment of Agitation), but will be outlined briefly to give the reader an understanding of what a full psychiatric assessment would entail. Other issues related to the assessment of the agitated patient in the emergency setting will also be discussed.

  6. The Emergence of Contesting Motives for Student Feedback-Based Evaluation in Australian Higher Education

    Science.gov (United States)

    Darwin, Stephen

    2016-01-01

    Student feedback-based evaluation performs a significant social role in framing perceptions of the quality of teaching in contemporary Australian higher education. Yet its emergence is a relatively recent phenomenon, having only been in widespread application since the mid-1980s. The early manifestations of student feedback-based evaluation came…

  7. Experimental Simulation-Based Performance Evaluation of an SMS-Based Emergency Geolocation Notification System

    Directory of Open Access Journals (Sweden)

    Isibor Osebor

    2017-01-01

    Full Text Available In an emergency, a prompt response can save the lives of victims. This statement generates an imperative issue in emergency medical services (EMS. Designing a system that brings simplicity in locating emergency scenes is a step towards improving response time. This paper therefore implemented and evaluated the performance of an SMS-based emergency geolocation notification system with emphasis on its SMS delivery time and the system’s geolocation and dispatch time. Using the RAS metrics recommended by IEEE for evaluation, the designed system was found to be efficient and effective as its reliability stood within 62.7% to 70.0% while its availability stood at 99% with a downtime of 3.65 days/year.

  8. Psychiatric Evaluation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychiatric Evaluation Workgroup

    Directory of Open Access Journals (Sweden)

    Keith R. Stowell

    2012-04-01

    Full Text Available It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency service. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a two-step process. First a brief evaluation must be aimed at determining the most likely cause of agitation, so as to guide preliminary interventions to calm the patient. Once the patient is calmed, more extensive psychiatric assessment can be completed. The goal of the emergency assessment of the psychiatric patient is not necessarily to obtain a definitive diagnosis. Rather, ascertaining a differential diagnosis, determining safety, and developing an appropriate treatment and disposition plan are the goals of the assessment. This article will summarize what components of the psychiatric assessment can and should be done at the time the agitated patient presents. The complete psychiatric evaluation of the patient whose agitation has been treated successfully is beyond the scope of this paper and Project BETA, but will be outlined briefly to give the reader an understanding of what a full psychiatric assessment would entail. Other issues related to the assessment of the agitated patient in the emergency setting will also be discussed. [West J Emerg Med. 2012;13(1:11–16.

  9. Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department.

    Science.gov (United States)

    Southard, Erik P; Neufeld, Jonathan D; Laws, Stephanie

    2014-07-01

    Mentally ill patients in crisis presenting to critical access hospital emergency rooms often face exorbitant wait times to be evaluated by a trained mental health provider. Patients may be discharged from the hospital before receiving an evaluation or boarded in a hospital bed for observation, reducing quality and increasing costs. This study examined the effectiveness of an emergency telemental health evaluation service implemented in a rural hospital emergency room. Retrospective data collection was implemented to consider patients presenting to the emergency room for 212 days prior to telemedicine interventions and for 184 days after. The study compared measures of time to treatment, length of stay (regardless of inpatient or outpatient status), and door-to-consult time. There were 24 patients seen before telemedicine was implemented and 38 seen using telemedicine. All patients had a mental health evaluation ordered by a physician and completed by a mental health specialist. Significant reductions in all three time measures were observed. Mean and median times to consult were reduced from 16.2 h (standard deviation=13.2 h) and 14.2 h, respectively, to 5.4 h (standard deviation =6.4 h) and 2.6 h. Similar reductions in length of stay and door-to-consult times were observed. By t tests, use of telemedicine was associated with a statistically significant reduction in all three outcome measures. Telemedicine appears to be an effective intervention for mentally ill patients by providing more timely access to mental health evaluations in rural hospital emergency departments.

  10. Consumer evaluation of imported organic food products in emerging economies in Asia

    OpenAIRE

    Pedersen, Susanne; Aschemann-Witzel, Jessica; Thøgersen, John

    2017-01-01

    Consumer evaluation of imported organic food products in emerging economies in Asia Introduction Consumers in emerging economies such as Thailand and China have started to demand organic food products – mainly due to food safety reasons (Ortega, Wang, Wu, & Hong, 2015; Roitner-Schobesberger, Darnhofer, Somsook, & Vogl, 2008; C. L. Wang, Li, Barnes, & Ahn, 2012; O. Wang, De Steur, Gellynck, & Verbeke, 2015). However, since the domestic organic markets are still not well-establi...

  11. A Comprehensive Approach for the Ergonomic Evaluation of 13 Emergency and Transport Ventilators.

    Science.gov (United States)

    Marjanovic, Nicolas; L'Her, Erwan

    2016-05-01

    Mechanical ventilation is an important part of emergency medicine and is frequently used for transportation. Human errors during ventilator settings are frequent and may be associated with high morbidity/mortality. The aim of the study was to provide a complete ergonomic evaluation of emergency and transport ventilators, taking into account objective and subjective human-machine interface assessments and individual mental work load. We performed a prospective bench ergonomic evaluation of 13 emergency and transport ventilators, using standardized conditions and a global methodological approach. The study was performed in an evaluation laboratory dedicated to respiratory care, and 12 emergency physicians unfamiliar with the tested devices were included in the evaluation. The ventilators were classified into 3 categories (simple, sophisticated, and ICU-like). Objective chronometric evaluations were conducted considering 9 tasks, and subjective evaluations were performed (ease of use, willingness to use, and user-friendliness of monitoring) using Likert scales. Mental work load evaluation was performed using the NASA Task Load Index scale. Overall task failure rate represented 4% of all attempts. Setting modifications, ventilation mode changes, and powering down durations were different between simple and other emergency and transport ventilator categories (P < .005). There was no difference between ventilator categories for the ease of use and user-friendliness of the monitoring. In contrast, the willingness to use was lower for simple devices, compared with sophisticated and ICU-like emergency and transport ventilators (2.9 ± 1.4 vs 3.9 ± 1.2, P = .002 and 4.3 ± 1, P < .001). No differences were observed between devices regarding the mental work load, except for several specific devices in the sophisticated category. A comprehensive ergonomic evaluation provides valuable information while investigating operational friendliness in emergency and transport

  12. Evaluation of the Emergency Response Command Center. Development of a method for evaluating the performance of the ERCC during exercises

    International Nuclear Information System (INIS)

    Groth, M.

    1997-02-01

    The report describes the development of a structured method for evaluation and analysis of staff performance in the Emergency Response Command Centre (ERCC) during exercises. A comprehensive literature search including current research and theoretical bases in the area of group dynamics has been carried out. To supplement this, ERCC activities during an emergency exercise were observed and responsible staff individuals and others involved were interviewed. From this material, two evaluation instruments were constructed: An Evaluation form for the function of ERCC, which addresses: Activation, information handling, teamwork and overall critique of the exercise; and an Evaluation form for responsible personnel in ERCC, which addresses: Activation, procedures-checklists etc, information handling, teamwork, personnel qualifications, and overall critique of the exercise. The method has been tested in two actual exercises at Ringhals NPP and has been found to effectively fulfill its purpose. 7 refs

  13. Investigation of a superthermal ultracold neutron source based on a solid deuterium converter for the TRIGA Mainz reactor

    International Nuclear Information System (INIS)

    Lauer, Thorsten

    2010-01-01

    Research in fundamental physics with the free neutron is one of the key tools for testing the Standard Model at low energies. Most prominent goals in this field are the search for a neutron electric dipole moment (EDM) and the measurement of the neutron lifetime. Significant improvements of the experimental performance using ultracold neutrons (UCN) require reduction of both systematic and statistical errors.The development and construction of new UCN sources based on the superthermal concept is therefore an important step for the success of future fundamental physics with ultracold neutrons. Significant enhancement of today available UCN densities strongly correlates with an efficient use of an UCN converter material. The UCN converter here is to be understood as a medium which reduces the velocity of cold neutrons (CN, velocity of about 600 m/s) to the velocity of UCN (velocity of about 6 m/s).Several big research centers around the world are presently planning or constructing new superthermal UCN sources, which are mainly based on the use of either solid deuterium or superfluid helium as UCN converter.Thanks to the idea of Yu.Pokotilovsky, there exists the opportunity to build competitive UCN sources also at small research reactors of the TRIGA type. Of course these smaller facilities don't promise high UCN densities of several 1000 UCN/cm 3 , but they are able to provide densities around 100 UCN/cm 3 for experiments.In the context of this thesis, it was possible to demonstrate succesfully the feasibility of a superthermal UCN source at the tangential beamport C of the research reactor TRIGA Mainz. Based on a prototype for the future UCN source at the Forschungs-Neutronenquelle Heinz Maier-Leibnitz (FRMII) in Munich, which was planned and built in collaboration with the Technical University of Munich, further investigations and improvements were done and are presented in this thesis. In parallel, a second UCN source for the radial beamport D was designed and

  14. Investigation of a superthermal ultracold neutron source based on a solid deuterium converter for the TRIGA Mainz reactor

    Energy Technology Data Exchange (ETDEWEB)

    Lauer, Thorsten

    2010-12-22

    Research in fundamental physics with the free neutron is one of the key tools for testing the Standard Model at low energies. Most prominent goals in this field are the search for a neutron electric dipole moment (EDM) and the measurement of the neutron lifetime. Significant improvements of the experimental performance using ultracold neutrons (UCN) require reduction of both systematic and statistical errors.The development and construction of new UCN sources based on the superthermal concept is therefore an important step for the success of future fundamental physics with ultracold neutrons. Significant enhancement of today available UCN densities strongly correlates with an efficient use of an UCN converter material. The UCN converter here is to be understood as a medium which reduces the velocity of cold neutrons (CN, velocity of about 600 m/s) to the velocity of UCN (velocity of about 6 m/s).Several big research centers around the world are presently planning or constructing new superthermal UCN sources, which are mainly based on the use of either solid deuterium or superfluid helium as UCN converter.Thanks to the idea of Yu.Pokotilovsky, there exists the opportunity to build competitive UCN sources also at small research reactors of the TRIGA type. Of course these smaller facilities don't promise high UCN densities of several 1000 UCN/cm{sup 3}, but they are able to provide densities around 100 UCN/cm{sup 3} for experiments.In the context of this thesis, it was possible to demonstrate succesfully the feasibility of a superthermal UCN source at the tangential beamport C of the research reactor TRIGA Mainz. Based on a prototype for the future UCN source at the Forschungs-Neutronenquelle Heinz Maier-Leibnitz (FRMII) in Munich, which was planned and built in collaboration with the Technical University of Munich, further investigations and improvements were done and are presented in this thesis. In parallel, a second UCN source for the radial beamport D was

  15. Nuclear power plant emergency preparedness: results from an evaluation of Michigan's potassium iodide distribution program.

    Science.gov (United States)

    Zwolinski, Laura R; Stanbury, Martha; Manente, Susan

    2012-10-01

    In 2009, the Michigan Department of Community Health (MDCH) made potassium iodide (KI), a nonprescription radio-protective drug, available by mailing vouchers redeemable at local pharmacies for KI tablets, at no cost to residents living within 10 miles of Michigan's 3 nuclear power plants (NPPs). MDCH conducted an evaluation of this program to determine Michigan's KI coverage and to assess general emergency preparedness among residents living near the NPPs. KI coverage was estimated based on redeemed voucher counts and the 2010 Census. Telephone surveys were administered to a random sample (N = 153) of residents living near Michigan's NPPs to evaluate general emergency preparedness, reasons for voucher use or nonuse, and KI knowledge. Only 5.3% of eligible residences redeemed KI vouchers. Most surveyed residents (76.5%) were aware of living near an NPP, yet 42.5% reported doing "nothing" to plan for an emergency. Almost half of surveyed voucher users did not know when to take KI or which body part KI protects. Among voucher nonusers, 48.0% were either unaware of the program or did not remember receiving a voucher. Additional efforts are needed to ensure that all residents are aware of the availability of KI and that recipients of the drug understand when and why it should be taken. Minimal emergency planning among residents living near Michigan's NPPs emphasizes the need for increased emergency preparedness and awareness. Findings are particularly salient given the March 2011 Fukushima Daiichi Nuclear Power Plant emergency in Japan.

  16. Evaluation of a model for predicting Avena fatua and Descurainia sophia seed emergence in winter rapeseed

    Energy Technology Data Exchange (ETDEWEB)

    Aboutalebian, M.A.; Nazari, S.; Gonzalez-Andujar, J.L.

    2017-07-01

    Avena fatua and Descurainia sophia are two important annual weeds throughout winter rapeseed (Brassica napus L.) production systems in the semiarid region of Iran. Timely and more accurate control of both species may be developed if there is a better understanding of its emergence patterns. Non-linear regression techniques are usually unable to accurately predict field emergence under such environmental conditions. The objectives of this research were to evaluate the emergence patterns of A. fatua and D. sophia and determine if emergence could be predicted using cumulative soil thermal time in degree days (CTT). In the present work, cumulative seedling emergence from a winter rapeseed field during 3 years data set was fitted to cumulative soil CTT using Weibull and Gompertz functions. The Weibull model provided a better fit, based on coefficient of determination (R2sqr), root mean square of error (RMSE) and Akaike index (AICd), compared to the Gompertz model between 2013 and 2016 seasons for both species. Maximum emergence of A. fatua occured 70-119 days after sowing or after equals 329-426 °Cd, while in D. sophia it occurred 119-134 days after sowing rapeseed equals 373-470 °Cd. Both models can aid in the future study of A. fatua and D. sophia emergence and assist growers and agricultural professionals with planning timely and more accurate A. fatua and D. sophia control.

  17. Preparation, Conduct and Evaluation of Exercises to Test Preparedness for a Nuclear or Radiological Emergency

    International Nuclear Information System (INIS)

    2010-01-01

    The aim of this publication is to serve as a practical tool for the preparation, conduct and evaluation of exercises to test preparedness for response to a nuclear or radiological emergency. It fulfils in part the functions assigned to the IAEA under Article 5.a(ii) of the Convention on Assistance in Case of a Nuclear Accident or Radiological Emergency (Assistance Convention), namely, to collect and disseminate to States Parties and Member States information concerning the methodologies, techniques and available results of research on such emergencies. To ensure effective response to radiation emergencies when needed, provisions should be made for regular training of emergency response personnel. As stated in Preparedness and Response for a Nuclear or Radiological Emergency (Safety Requirements, Safety Standard Series No. GS-R-2), 'The operator and the response organizations shall make arrangements for the selection of personnel and training to ensure that the personnel have the requisite knowledge, skills, abilities, equipment, procedures and other arrangements to perform their assigned response functions'. A further requirement is that 'Exercise programmes shall be conducted to ensure that all specified functions required to be performed for emergency response and all organizational interfaces for facilities in threat category I, II or III and the national level programmes for threat category IV or V are tested at suitable intervals'. In 2004 the IAEA General Conference, in resolution GC(48)/RES/10 encouraged Member States to 'implement the Safety Requirements for Preparedness and Response to a Nuclear or Radiological Emergency'. This document is published as part of the IAEA Emergency Preparedness and Response Series to assist in meeting these requirements and to fulfil Article 5 of the Assistance Convention. It was developed based on a number of assumptions about national and local capabilities. Therefore, the exercise structure, terms and scenarios must be

  18. Evaluation of Intensive Construction Land Use in the Emerging City Based on PSR-Entropy model

    Science.gov (United States)

    Jia, Yuanyuan; Lei, Guangyu

    2018-01-01

    A comprehensive understanding of emerging city land utilization and the evaluation of intensive land use in the Emerging City will provide the comprehensive and reliable technical basis for the planning and management. It is an important node. According to the Han cheng from 2008 to 2016 years of land use, based on PSR-Entropy model of land use evaluation system, using entropy method to determine the index weight, the introduction of comprehensive index method to evaluate the degree of land use. The results show that the intensive land use comprehensive evaluation index of Han cheng increased from 2008 to 2015, but the land intensive use can not achieve the standards. The potential of further enhancing space is relatively large.

  19. Evaluation of the Emergency Education Response for Syrian Refugee Children and Host Communities in Jordan

    NARCIS (Netherlands)

    Culbertson, S.; Ling, T.; Henham, M.L.; Corbett, J.; Karam, R.; Pankowska, P.K.P.; Saunders, C.L.; Bellasio, J.; Baruch, B.

    2016-01-01

    The Emergency Education Response Programme (EER), launched by UNICEF, the Government of Jordan and partners in 2012, aims to provide free public formal education, as well as safe and appropriate supportive educational services, for Syrian refugee children living in Jordan. RAND's evaluation

  20. Evaluating the effectiveness of burned area emergency response (BAER) efforts after the 2003 wildfires, southern California

    Science.gov (United States)

    Peter M. Wohlgemuth; Ken R. Hubbert; Jan L. Beyers; David R. Weise

    2007-01-01

    Wildfires burned approximately 300,000 hectares (750,000 acres) across southern California in the fall of 2003. Over 10 million dollars were spent on Burned Area Emergency Response (BAER) treatments following these fires. To support the BAER efforts, we designed a comprehensive strategy with standardized protocols to evaluate the effectiveness of various erosion...

  1. Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study

    Directory of Open Access Journals (Sweden)

    Kara H

    2013-12-01

    Full Text Available Hasan Kara,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Necmettin Tufekci,1 Selim Degirmenci,1 Melih Azap21Department of Emergency Medicine, Selçuk University, Konya, Turkey; 2Department of Emergency Medicine, Konya Numune Hospital, Konya, TurkeyPurpose: Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma.Materials and methods: Medical records were retrospectively reviewed for 568 patients (314 women and 254 men aged ≥65 years who were admitted to an emergency department of a tertiary care hospital.Results: Trauma was caused by low-energy fall in 379 patients (67%, traffic accident in 79 patients (14%, high-energy fall in 69 patients (12%, and other causes in 41 patients (7%. The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66% were hospitalized. There were 31 patients (5% who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury.Conclusion: Emergency department admission after trauma in patients aged $65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.Keywords: fall, femur, fracture, injury

  2. Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies

    Directory of Open Access Journals (Sweden)

    Patel NH

    2012-11-01

    Full Text Available Nirali H Patel,1 Sarah K Romero,2 David C Kaelber31Division of Emergency Medicine, Akron Children's Hospital, Akron, OH, USA; 2Division of Emergency Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA; 3Departments of Information Services, Internal Medicine, Pediatrics, and Epidemiology and Biostatistics, The Center for Clinical Informatics Research and Education, The MetroHealth System and School of Medicine, Case Western Reserve University, Cleveland OH, USAAbstract: Hypertension (HTN in the pediatric population is estimated to have a world-wide prevalence of 2%-5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1 safely lower blood pressure, and (2 treat/minimize acute end organ damage, while (3 identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8

  3. A further evaluation of herbicides for post-emergence use in short rotation coppice

    Energy Technology Data Exchange (ETDEWEB)

    Turnbull, D.J.

    2002-07-01

    This report summarises the findings of a project evaluating the safety and efficiency of eleven herbicides for controlling weeds in newly plated willow short rotation coppices, and provides growers with information on post-emergence herbicide options, control of problem weeds, and emergency treatments. Weed germination, crop safety, and the encouraging results obtained using Reflex T and Impuls are discussed. It is suggested that a Technical Register of herbicide applications with contributions by growers and advisers should be considered by the British Biogen trade industry body.

  4. An evaluation of herbicides for post-emergence use in short rotation coppice

    Energy Technology Data Exchange (ETDEWEB)

    Turnbull, D.J.

    2000-07-01

    The objective of the project was to evaluate the safety and efficacy of a range of herbicides and mixtures of herbicides, with both contact and residual activity, for the post-emergence control of weeds in newly planted willow short rotation coppice (SRC). This report provides growers and advisers of short rotation coppice with important (but still limited) information on how to achieve improved weed control of problem weeds increasingly prevalent in SRC fields. This may provide guidance towards often-essential emergency treatments when the crop establishment is under considerable pressure and the potential safety, or otherwise, of certain weed-specific herbicides. (author)

  5. [Evaluation of the vital emergency action plan at the Navarre Hospital (Spain)].

    Science.gov (United States)

    Tirapu, Belén; Rodrigo, Isabel; Gost, Javier; Aranguren, María Isabel; Ezcurra, Paz

    2010-07-01

    Healthcare organizations are placing great emphasis on the care of patients with cardiopulmonary arrest (CPA) since interventions based on the scientific evidence can decrease both the mortality rate and sequelae. Nevertheless, there are limited comprehensive assessments covering all the resources and interventions required when a vital emergency arises. To evaluate the effectiveness of the vital emergency action plan at the Navarre Hospital by analyzing a panel of 70 indicators. Structure and process indicators were assessed in 25 clinical units at the Navarre Hospital from April to June 2008. The structure and review process of CPR carts were analyzed, defibrillators were tested and 40 simulations involving 144 professionals were evaluated. Nonconformities were found in 86% of the indicators evaluated. The percentages of compliance in the indicators of structure ranged from 39.6% to 100%. In the evaluation of process, conformity ranged from 2.5% to 100%. The percentages of simulations meeting time standards varied between 17.5% and 45%. In 37.5% of the simulations, at least 50% of trained staff were present in the unit. In 32.3% of the simulations, the standard for the number of people in the unit who participated in the simulations was achieved. This study identified problems in the structure and process of a vital emergency action plan without, at this stage, evaluating patient outcomes. Copyright © 2010 Elsevier España S.L. All rights reserved.

  6. Nuclear and radiation emergency evaluation and decision-making support system for ministry of environmental protection

    International Nuclear Information System (INIS)

    Yue Huiguo; Lin Quanyi; Zhang Jiangang

    2010-01-01

    This article introduces the design features and main functions of The Nuclear and Radiation Emergency Evaluation and Decision Support System. The Ministry of Environmental Protection will construct a complete set of evaluation and decision-making system at the Nuclear Safety Center of Ministry of Environmental Protection to cope with the sudden event. The system will provide a comprehensive technical support for the consequence evaluation and decision-making of anti-terrorism event according to the responsibility of MEP in the sudden event, with the data provided by the MEP's anti-terrorism information platform. (authors)

  7. Re-evaluation of emergency planning zone for 3 NPPS in Taiwan

    International Nuclear Information System (INIS)

    Chiou, S.-T.; Yin, H.-L.; Chen, C.-S.; Shih, C.-L.

    2004-01-01

    The emergency planning zone for the 3 nuclear power plants in Taiwan are re-evaluated. The analysis is performed by the CRAC2 code and the basic approach follows the NUREG-0396 evaluation procedure. Meteorological data are provided by Taiwan Power Company and reviewed by Taiwan University and Central Weather Bureau. Accident source terms are also provided by Institute of Nuclear Energy Research (INER) by probabilistic risk assessment method with consideration of actual plant system improvement and/or modification. The dose rate distribution, acute and latent cancer fatality are evaluated and compared with proposed EPZ decision criteria including protective action guide dose levels, individual and societal risk safety goal. (author)

  8. Development and use of consolidated criteria for evaluation of emergency preparedness plans for DOE facilities

    International Nuclear Information System (INIS)

    Lerner, K.; Kier, P.H.; Baldwin, T.E.

    1995-01-01

    Emergency preparedness at US Department of Energy (DOE) facilities is promoted by development and quality control of response plans. To promote quality control efforts, DOE has developed a review document that consolidates requirements and guidance pertaining to emergency response planning from various DOE and regulatory sources. The Criteria for Evaluation of Operational Emergency Plans (herein referred to as the Criteria document) has been constructed and arranged to maximize ease of use in reviewing DOE response plans. Although developed as a review instrument, the document also serves as a de facto guide for plan development, and could potentially be useful outside the scope of its original intended DOE clientele. As regulatory and DOE requirements are revised and added in the future, the document will be updated to stay current

  9. Evaluation and management of acute abdominal pain in the emergency department

    Directory of Open Access Journals (Sweden)

    Macaluso CR

    2012-09-01

    Full Text Available Christopher R Macaluso, Robert M McNamaraDepartment of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, USAAbstract: Evaluation of the emergency department patient with acute abdominal pain is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. This article will review general information on abdominal pain and discuss the clinical approach by review of the history and the physical examination. Additionally, this article will discuss the approach to unstable patients with abdominal pain.Keywords: acute abdomen, emergency medicine, peritonitis

  10. Evaluation of the polytrauma victim by the nursing staff in an emergency service of Santa Catarina

    Directory of Open Access Journals (Sweden)

    Leandro Sanceverino Mattos

    2012-06-01

    Full Text Available Objective: To investigate the actions developed by the nursing staff of a private hospital emergency service in the southern Santa Catarina (SC, related to primary and secondary evaluation of polytrauma victims. Methods: Research of a qualitative approach, the type of case study, performed with twelve nurses. Sample has been characterized as non-probabilistic intentional. Data collection has been performed using the techniques of semi-structured interview and participant observation. Data analysis has been developed using the technique of content analysis. Results: Analysis of nurses’ testimonies and the results of observation have showed that most participants comprehend the importance of adopting the ABCDE rule in primary evaluation - A (Air Way - airway permeability with safe administration of cervical collar; B (Breathing; C (Circulation - search for bleeding and control; D (Disability - neurological evaluation; e E (Exposure - patient’s body exposition seeking missed injuries - and the need of meticulous secondary evaluation of polytrauma victim. However, due to demand of urgency and agility in emergencies of this nature, the rule is not followed in a systematic way. Conclusion: It has been demonstrated the nursing staff’s concern over the following aspects: agility of service; immediate performance of examinations; communication between emergency service professionals; adequate perception of the general condition of the victim; and the reception to victim and family.

  11. Introducing PCTRAN as an evaluation tool for nuclear power plant emergency responses

    International Nuclear Information System (INIS)

    Cheng, Yi-Hsiang; Shih, Chunkuan; Chiang, Show-Chyuan; Weng, Tung-Li

    2012-01-01

    Highlights: ► PCTRAN is integrated with an atmospheric dispersion algorithm. ► The improved PCTRAN acts as an accident/incident simulator and a data exchange system. ► The software helps the responsible organizations decide the rescue and protective actions. ► The evaluation results show the nuclear power plant accident and its off-site dose consequences. ► The software can be used for nuclear power plant emergency responses. - Abstract: Protecting the public from radiation exposure is important if a nuclear power plant (NPP) accident occurs. Deciding appropriate protective actions in a timely and effective manner can be fulfilled by using an effective accident evaluation tool. In our earlier work, we have integrated PCTRAN (Personal Computer Transient Analyzer) with the off-site dose calculation model. In this study, we introduce PCTRAN as an evaluation tool for nuclear power plant emergency responses. If abnormal conditions in the plant are monitored or observed, the plant staffs can distinguish accident/incident initiation events. Thus, the responsible personnel can immediately operate PCTRAN and set up those accident/incident initiation events to simulate the nuclear power plant transient or accident in conjunction with off-site dose distributions. The evaluation results consequently help the responsible organizations decide the rescue and protective actions. In this study, we explain and demonstrate the capabilities of PCTRAN for nuclear emergency responses, through applying it to simulate the postulated nuclear power plant accident scenarios.

  12. Evaluation of New-Onset Diabetes in Patients Presenting Emergency Service with a Diabetic Ketoacidosis Attack

    Directory of Open Access Journals (Sweden)

    Yavuz Yiğit

    2013-12-01

    Full Text Available Aim: The aim of this study was to investigate the rate of new-onset diabetes mellitus (DM in patients presenting to our emergency department with diabetic ketoacidosis. Methods: We retrospectively evaluated hospital records of patients who presented to the Emergency Department at Istanbul Goztepe Research and Training Hospital between 01 April 2009 and 01 April 2011 and were diagnosed with diabetic ketoacidosis. 57 patients having complete clinical data were included in the study. Results: 45.6%of patients had type 1 DM, 33.3%- type 2 DM, and 21%of them were with new-onset DM. No statistically significant difference was found between type 1 DM, type 2 DM and new-onset DM patients with respect to arterial blood pH and HCO3 levels and serum sodium, potassium and plasma glucose levels at presentation as well as time of presentation (p>0.05, while HbA1c levels showed statistically significant difference in new-onset DM patients. Conclusion: No statistically significant difference was found between types of DM in patients diagnosed with diabetic ketoacidosis except for precipitating factors, age and HbA1c. Detecting high blood glucose levels in patients presenting to emergency room for reasons other than DM is not a rare condition. Cautious evaluation and recognition of these patients in emergency room for the possibility of undiagnosed DM is important for prevention of future diabetic ketoacidosis episodes. (The Medical Bulletin of Haseki 2013; 51: 168-72

  13. Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival-An evaluation of 548 emergency calls.

    Science.gov (United States)

    Viereck, Søren; Palsgaard Møller, Thea; Kjær Ersbøll, Annette; Folke, Fredrik; Lippert, Freddy

    2017-02-01

    This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPR prior ) versus during the emergency call following dispatcher-assisted CPR (CPR during ) - was associated with return of spontaneous circulation (ROSC) and 30-day survival. The secondary aim was to identify predictors of CPR prior . This observational study evaluated out-of-hospital cardiac arrests (OHCA) occurring in the Capital Region of Denmark from 01.01.2013 to 31.12.2013. OHCAs were linked to emergency medical dispatch centre records and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPR prior . The study included 548 emergency calls for OHCA patients receiving bystander CPR, 34.9% (n=191) in the CPR prior group and 65.1% (n=357) in the CPR during group. Multivariable analyses showed no difference in ROSC (OR=0.88, 95% CI: 0.56-1.38) or 30-day survival (OR=1.14, 95% CI: 0.68-1.92) between CPR prior and CPR during . Predictors positively associated with CPR prior included witnessed OHCA and healthcare professional bystanders. Predictors negatively associated with CPR prior included residential location, solitary bystanders, and bystanders related to the patient. The majority of bystander CPR (65%) was initiated during the emergency call, following dispatcher-assisted CPR instructions. Whether bystander CPR was initiated prior to emergency call versus during the emergency call following dispatcher-assisted CPR was not associated with ROSC or 30-day survival. Dispatcher-assisted CPR was especially beneficial for the initiation of bystander CPR in residential areas. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  14. Evaluation report of the Nordic emergency exercise Odin - November 26, 1993

    International Nuclear Information System (INIS)

    1994-01-01

    An evaluation of the second phase, ODIN, of an emergency exercise which is related to the late phase of a hypothetical nuclear accident outside, but close to the Nordic countries. This phase, in contrast to the first one (NORA) during the course of which it was found that strong national ways of thinking unfluenced decision-making, was carried out on the same day in all five Nordic countries in order to enable contact between them. The main argument in favour of a coordinated approach in the intervention policy in this area is that it is likely that the public in each of these countries would be unable to understand or accept very different levels of ambition with regard to their protection. The main objective of ODIN was to add to the knowledge and increase the capability of those responsible in the Nordic countries for handling a situation of deposition following a nuclear accident to improve provisions for Nordic coordination of the overall decision-making and to reach a joint Nordic view of emergency response. The organization of the evaluation, the methodology of the exercise and the evaluation itself covering, amongst other aspects, responses by emergency organizations to the check lists on actions, the decision-making process, international communication, public information and technical facilities are dealt with. (AB)

  15. Bedside Ultrasound in the Emergency Department to Detect Hydronephrosis for the Evaluation of Suspected Ureteric Colic.

    Science.gov (United States)

    Shrestha, R; Shakya, R M; Khan A, A

    2016-01-01

    Background Renal colic is a common emergency department presentation. Hydronephrosis is indirect sign of urinary obstruction which may be due to obstructing ureteric calculus and can be detected easily by bedside ultrasound with minimal training. Objective To compare the accuracy of detection of hydronephrosis performed by the emergency physician with that of radiologist's in suspected renal colic cases. Method This was a prospective observational study performed over a period of 6 months. Patients >8 years with provisional diagnosis of renal colic with both the bedside ultrasound and the formal ultrasound performed were included. Presence of hydronephrosis in both ultrasounds and size and location of ureteric stone if present in formal ultrasound was recorded. The accuracy of the emergency physician detection of hydronephrosis was determined using the scan reported by the radiologists as the "gold standard" as computed tomography was unavailable. Statistical analysis was executed using SPSS 17.0. Result Among the 111 included patients, 56.7% had ureteric stone detected in formal ultrasound. The overall sensitivity, specificity, positive predictive value and negative predictive value of bedside ultrasound performed by emergency physician for detection of hydronephrosis with that of formal ultrasound performed by radiologist was 90.8%., 78.3%, 85.5% and 85.7% respectively. Bedside ultrasound and formal ultrasound both detected hydronephrosis more often in patients with larger stones and the difference was statistically significant (p=.000). Conclusion Bedside ultrasound can be potentially used as an important tool in detecting clinically significant hydronephrosis in emergency to evaluate suspected ureteric colic. Focused training in ultrasound could greatly improve the emergency management of these patients.

  16. A new measurement of the rare decay eta -> pi^0 gamma gamma with the Crystal Ball/TAPS detectors at the Mainz Microtron

    Energy Technology Data Exchange (ETDEWEB)

    Nefkens, B M; Prakhov, S; Aguar-Bartolom��, P; Annand, J R; Arends, H J; Bantawa, K; Beck, R; Bekrenev, V; Bergh��user, H; Braghieri, A; Briscoe, W J; Brudvik, J; Cherepnya, S; Codling, R F; Collicott, C; Costanza, S; Danilkin, I V; Denig, A; Demissie, B; Dieterle, M; Downie, E J; Drexler, P; Fil' kov, L V; Fix, A; Garni, S; Glazier, D I; Gregor, R; Hamilton, D; Heid, E; Hornidge, D; Howdle, D; Jahn, O; Jude, T C; Kashevarov, V L; K��ser, A; Keshelashvili, I; Kondratiev, R; Korolija, M; Kotulla, M; Koulbardis, A; Kruglov, S; Krusche, B; Lisin, V; Livingston, K; MacGregor, I J; Maghrbi, Y; Mancel, J; Manley, D M; McNicoll, E F; Mekterovic, D; Metag, V; Mushkarenkov, A; Nikolaev, A; Novotny, R; Oberle, M; Ortega, H; Ostrick, M; Ott, P; Otte, P B; Oussena, B; Pedroni, P; Polonski, A; Robinson, J; Rosner, G; Rostomyan, T; Schumann, S; Sikora, M H; Starostin, A; Strakovsky, I I; Strub, T; Suarez, I M; Supek, I; Tarbert, C M; Thiel, M; Thomas, A; Unverzagt, M; Watts, D P; Werthmueller, D; Witthauer, L

    2014-08-01

    A new measurement of the rare, doubly radiative decay eta->pi^0 gamma gamma was conducted with the Crystal Ball and TAPS multiphoton spectrometers together with the photon tagging facility at the Mainz Microtron MAMI. New data on the dependence of the partial decay width, Gamma(eta->pi^0 gamma gamma), on the two-photon invariant mass squared, m^2(gamma gamma), as well as a new, more precise value for the decay width, Gamma(eta->pi^0 gamma gamma) = (0.33+/-0.03_tot) eV, are based on analysis of 1.2 x 10^3 eta->pi^0 gamma gamma decays from a total of 6 x 10^7 eta mesons produced in the gamma p -> eta p reaction. The present results for dGamma(eta->pi^0 gamma gamma)/dm^2(gamma gamma) are in good agreement with previous measurements and recent theoretical calculations for this dependence.

  17. Dose calculation in biological samples in a mixed neutron-gamma field at the TRIGA reactor of the University of Mainz

    DEFF Research Database (Denmark)

    Schmitz, T.; Blaickner, M.; Schütz, C.

    2010-01-01

    and pin-diodes. Material and methods. When L-α-alanine is irradiated with ionizing radiation, it forms a stable radical which can be detected by electron spin resonance (ESR) spectroscopy. The value of the ESR signal correlates to the amount of absorbed dose. The dose for each pellet is calculated using......To establish Boron Neutron Capture Therapy (BNCT) for non-resectable liver metastases and for in vitro experiments at the TRIGA Mark II reactor at the University of Mainz, Germany, it is necessary to have a reliable dose monitoring system. The in vitro experiments are used to determine the relative......-calculations for mixed radiation fields and the Hansen & Olsen alanine detector response model. With the acquired data about the background dose and charged particle spectrum, and with the acquired information of the neutron flux, we are capable of calculating the dose to the tissue. Conclusion. Monte Carlo simulation...

  18. Making sense of the emerging conversation in evaluation about systems thinking and complexity science.

    Science.gov (United States)

    Gates, Emily F

    2016-12-01

    In the last twenty years, a conversation has emerged in the evaluation field about the potential of systems thinking and complexity science (STCS) to transform the practice of evaluating social interventions. Documenting and interpreting this conversation are necessary to advance our understanding of the significance of using STCS in planning, implementing, and evaluating social interventions. Guided by a generic framework for evaluation practice, this paper reports on an inter-disciplinary literature review and argues that STCS raises some new ways of thinking about and carrying out the following six activities: 1) supporting social problem solving; 2) framing interventions and contexts; 3) selecting and using methods; 4) engaging in valuing; 5) producing and justifying knowledge; and 6) facilitating use. Following a discussion of these issues, future directions for research and practice are suggested. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Teaching and evaluating multitasking ability in emergency medicine residents - what is the best practice?

    Science.gov (United States)

    Heng, Kenneth Wj

    2014-01-01

    Multitasking is an essential skill to develop during Emergency Medicine (EM) residency. Residents who struggle to cope in a multitasking environment risk fatigue, stress, and burnout. Improper management of interruption has been causally linked with medical errors. Formal teaching and evaluation of multitasking is often lacking in EM residency programs. This article reviewed the literature on multitasking in EM to identify best practices for teaching and evaluating multitasking amongst EM residents. With the advancement in understanding of what multitasking is, deliberate attempts should be made to teach residents pitfalls and coping strategies. This can be taught through a formal curriculum, role modeling by faculty, and simulation training. The best way to evaluate multitasking ability in residents is by direct observation. The EM Milestone Project provides a framework by which multitasking can be evaluated. EM residents should be deployed in work environments commiserate with their multitasking ability and their progress should be graduated after identified deficiencies are remediated.

  20. Evaluation of Patients Visiting the Dermatology Emergency Unit of a University Dermatology Hospital in Tehran, Iran.

    Science.gov (United States)

    Abedini, Robabeh; Matinfar, Amin; Sasani, Pardis; Salehi, Anahita; Daneshpazhooh, Maryam

    2017-11-01

    Published studies on dermatological emergencies are limited in the literature. To our knowledge, no study has previously explored this subject in Iran. Our aim was to ascertain the characteristics of patients visiting the dermatologic emergency (DE) unit of a university skin hospital in Tehran, Iran. We studied the files of all the patients seen in the DE unit over a 3-month period, collecting data on age, sex, referral mode, duration of consultation, status (true emergency or non-emergency), and diagnosis. A total of 2539 patients were evaluated; 53% of them were female. Infection and infestation (41.9%), urticaria (16.7%), and dermatitis (13.2%) were the most prevalent entities. Almost 1% of the patients were referred by another physician and psoriasis was their most frequent diagnosis. Almost 2.6% of the patients were hospitalized; psoriasis was once again the most frequent cause. The hospitalization rate was significantly higher in referred patients (Pdermatologic disorders. This data could also help in tailoring the educational curriculum for medical students more appropriately in order to increase their knowledge of the most prevalent skin disorders.

  1. Evaluation of 6 and 10 Year-Old Child Human Body Models in Emergency Events.

    Science.gov (United States)

    Gras, Laure-Lise; Stockman, Isabelle; Brolin, Karin

    2017-01-01

    Emergency events can influence a child's kinematics prior to a car-crash, and thus its interaction with the restraint system. Numerical Human Body Models (HBMs) can help understand the behaviour of children in emergency events. The kinematic responses of two child HBMs-MADYMO 6 and 10 year-old models-were evaluated and compared with child volunteers' data during emergency events-braking and steering-with a focus on the forehead and sternum displacements. The response of the 6 year-old HBM was similar to the response of the 10 year-old HBM, however both models had a different response compared with the volunteers. The forward and lateral displacements were within the range of volunteer data up to approximately 0.3 s; but then, the HBMs head and sternum moved significantly downwards, while the volunteers experienced smaller displacement and tended to come back to their initial posture. Therefore, these HBMs, originally intended for crash simulations, are not too stiff and could be able to reproduce properly emergency events thanks, for instance, to postural control.

  2. Evaluation of pharmacists' services for dispensing emergency contraceptive pills in Delhi, India: A mystery shopper study

    Directory of Open Access Journals (Sweden)

    Pikee Saxena

    2016-01-01

    Full Text Available Background: Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI, has not been well documented. Objective: To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique. Material and Methods: This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months. Results: None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57% or with anticipated changes in menstrual flow (78.57%; 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice. Conclusion: There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter.

  3. Human reliability analysis as an evaluation tool of the emergency evacuation process on industrial installation

    International Nuclear Information System (INIS)

    Santos, Isaac J.A.L. dos; Grecco, Claudio H.S.; Mol, Antonio C.A.; Carvalho, Paulo V.R.; Oliveira, Mauro V.; Botelho, Felipe Mury

    2007-01-01

    Human reliability is the probability that a person correctly performs some required activity by the system in a required time period and performs no extraneous activity that can degrade the system. Human reliability analysis (HRA) is the analysis, prediction and evaluation of work-oriented human performance using some indices as human error likelihood and probability of task accomplishment. The human error concept must not have connotation of guilt and punishment, having to be treated as a natural consequence, that emerges due to the not continuity between the human capacity and the system demand. The majority of the human error is a consequence of the work situation and not of the responsibility lack of the worker. The anticipation and the control of potentially adverse impacts of human action or interactions between the humans and the system are integral parts of the process safety, where the factors that influence the human performance must be recognized and managed. The aim of this paper is to propose a methodology to evaluate the emergency evacuation process on industrial installations including SLIM-MAUD, a HRA first-generation method, and using virtual reality and simulation software to build and to simulate the chosen emergency scenes. (author)

  4. Human reliability analysis as an evaluation tool of the emergency evacuation process on industrial installation

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Isaac J.A.L. dos; Grecco, Claudio H.S.; Mol, Antonio C.A.; Carvalho, Paulo V.R.; Oliveira, Mauro V.; Botelho, Felipe Mury [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil)]. E-mail: luquetti@ien.gov.br; grecco@ien.gov.br; mol@ien.gov.br; paulov@ien.gov.br; mvitor@ien.gov.br; felipemury@superig.com.br

    2007-07-01

    Human reliability is the probability that a person correctly performs some required activity by the system in a required time period and performs no extraneous activity that can degrade the system. Human reliability analysis (HRA) is the analysis, prediction and evaluation of work-oriented human performance using some indices as human error likelihood and probability of task accomplishment. The human error concept must not have connotation of guilt and punishment, having to be treated as a natural consequence, that emerges due to the not continuity between the human capacity and the system demand. The majority of the human error is a consequence of the work situation and not of the responsibility lack of the worker. The anticipation and the control of potentially adverse impacts of human action or interactions between the humans and the system are integral parts of the process safety, where the factors that influence the human performance must be recognized and managed. The aim of this paper is to propose a methodology to evaluate the emergency evacuation process on industrial installations including SLIM-MAUD, a HRA first-generation method, and using virtual reality and simulation software to build and to simulate the chosen emergency scenes. (author)

  5. Causes of poisoning in patients evaluated in a hospital emergency department in Konya, Turkey

    International Nuclear Information System (INIS)

    Kara, H.; Bayir, A.; Degirmenci, S.; Akinci, M.; Ak, A.; Azap, M.

    2014-01-01

    Objectives: To evaluate demographic and clinical characteristics of patients with poisoning at a community hospital. Methods: The retrospective study comprised records of patients who were admitted to the emergency department of Konya Numune Hospital, Turkey, because of poisoning between January 1, 2009, and December 31, 2011. Data was evaluated for age, gender, educational status, occupation, arrival time, mechanism of intoxication , body temperature, pulse, respiratory rate, Glasgow Coma Scale score, treatment applied, duration of hospital stay, duration of follow-up, test results, final diagnosis, clinical disposition, and outcome. Agents causing the poisoning were also determined. Results: Records of 1036 patients were evaluated. Of them, 764(74%) were female and 272(26%) were male. The predominant age range was 15-24 years in 617(60%) patients. The median time from substance exposure to admission to the emergency department was 2 hours. The most common cause of poisoning was attempted suicide in 955 (92%) patients and drug intoxication was the agent involved in 932 (90%). In the 15-24 year age range, there were 469(76%) female patients. Of the total female population in the study, 716(94%) attempted suicide. The median hospital stay was 24 hours. There were 908(88%) patients who were advised to seek further evaluation at the psychiatry clinic, and 9 (0.9%) patients were admitted to the psychiatry inpatient units after medical treatment. In patients who were hospitalized and followed up, 1 (0.1%) died because of multiple drug poisoning. Conclusion: Most admissions to the emergency department for poisoning related to young women had used drugs during a suicide attempt. (author)

  6. Preparation, Conduct and Evaluation of Exercises to Test Preparedness for a Nuclear or Radiological Emergency - Training Materials

    International Nuclear Information System (INIS)

    2010-01-01

    Emergency response exercises are a key component of a good program of preparation in emergencies. They can provide a unique insight on the State of preparation of emergency response organizations. They can also be the basis for continuous improvement programs of the infrastructure of response in emergencies. However, to be more useful, the exercises in emergency response need to be well organized, professionally conducted and its assessment should focus on the potential for constructive improvement. The course of the IAEA on preparedness, conduction and evaluation exercises to test the preparation before a nuclear emergency or radiation designed for people and organizations that want to increase their ability to carry out effective and significant emergency exercises. The objectives of this course are: To familiarize participants with concepts, terminology, process of preparation, conduction and evaluation of the exercise to test the preparation before a nuclear emergency or radiation; Provide participants with knowledge practical and the ability to organize, lead and evaluate an exercise to test the preparation for a nuclear emergency or radiation in their own countries; Submit an exercise response model in emergency prepared by the IAEA; and give participants the skill to adapt the proposal of model exercise and organize and lead this exercise model right in your own country. [es

  7. Development of scenarios for emergency exercises and the systematic evaluation of the results

    Energy Technology Data Exchange (ETDEWEB)

    Schmidtborn, I.; Playfair, A. [Colenco Power Consulting AG, Baden (Switzerland)

    2001-07-01

    This paper describes a systematic method for preparing emergency exercises for the training of power station personnel in the establishment of internal and external communications and the initiation of emergency measures in the case of beyond design basis accidents. The exercises are planned over a period of time in such a way that a wide range of scenarios are covered, keeping repetition to a minimum and the work for preparing the individual exercises is reduced as far as possible. To give an idea of the variety of exercises that can be developed using this method, a selection of the exercise titles that have been used by Colenco over the past 10 years is given. A great deal of importance has to be attached to the evaluation of the exercises.

  8. Nurses’ Evaluation of a New Formalized Triage System in the Emergency Department

    DEFF Research Database (Denmark)

    Brehm Johansen, Mette; Forberg, Jakob Lundager

    2011-01-01

    Introduction: Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED. Material and methods: Semi-structured qualitative interviews were conducted with 15 emergency nurses....... The interviews were preceded by observations of the work of the ED nurses in which focus was on the triage process. Results: Formalized triage was experienced to improve the overview of patients and resources at the ED, and the nurses described that they felt more assured when prioritizing between patients....... Communication and coordination were also improved by the triage system. But more time spent on documentation and re-evaluation may cause the nurses to feel professionally inadequate if adequate resources are not provided. Furthermore, the triage system has reduced the focus on the humanistic and psychosocial...

  9. Evaluating cash benefits as real options for a commodity producer in an emerging market

    Directory of Open Access Journals (Sweden)

    Fernando Antonio Lucena Aiube

    2009-07-01

    Full Text Available The amount of cash a firm should maintain is an old problem tackled by finance literature. The recent advances in finance, mainly in the derivatives area, has opened the opportunity to revisit this subject. Cossin and Hricko (2004 studied the benefits of cash holdings using the Real Options approach. We follow their ideas extending the problem to a specific commodity producer firm in an emerging economy. We evaluate the benefits considering that raising capital takes time (timing benefit and also the benefit of avoiding the issue of securities at unfavorable moments (underpricing benefit. We use numerical procedures to solve the problem. Despite the fact that the results are not totally intuitive, we verify that the timing benefit is much more relevant than that of avoiding the underpricing benefit and that firms in emerging economies have greater advantage holding cash than those in developed economies. There is empirical evidence of this last result in the literature.

  10. Development of scenarios for emergency exercises and the systematic evaluation of the results

    International Nuclear Information System (INIS)

    Schmidtborn, I.; Playfair, A.

    2001-01-01

    This paper describes a systematic method for preparing emergency exercises for the training of power station personnel in the establishment of internal and external communications and the initiation of emergency measures in the case of beyond design basis accidents. The exercises are planned over a period of time in such a way that a wide range of scenarios are covered, keeping repetition to a minimum and the work for preparing the individual exercises is reduced as far as possible. To give an idea of the variety of exercises that can be developed using this method, a selection of the exercise titles that have been used by Colenco over the past 10 years is given. A great deal of importance has to be attached to the evaluation of the exercises

  11. Quality Evaluation Scores are no more Reliable than Gestalt in Evaluating the Quality of Emergency Medicine Blogs: A METRIQ Study.

    Science.gov (United States)

    Thoma, Brent; Sebok-Syer, Stefanie S; Colmers-Gray, Isabelle; Sherbino, Jonathan; Ankel, Felix; Trueger, N Seth; Grock, Andrew; Siemens, Marshall; Paddock, Michael; Purdy, Eve; Kenneth Milne, William; Chan, Teresa M

    2018-01-30

    Construct: We investigated the quality of emergency medicine (EM) blogs as educational resources. Online medical education resources such as blogs are increasingly used by EM trainees and clinicians. However, quality evaluations of these resources using gestalt are unreliable. We investigated the reliability of two previously derived quality evaluation instruments for blogs. Sixty English-language EM websites that published clinically oriented blog posts between January 1 and February 24, 2016, were identified. A random number generator selected 10 websites, and the 2 most recent clinically oriented blog posts from each site were evaluated using gestalt, the Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) score, and the Medical Education Translational Resources: Impact and Quality (METRIQ-8) score, by a sample of medical students, EM residents, and EM attendings. Each rater evaluated all 20 blog posts with gestalt and 15 of the 20 blog posts with the ALiEM AIR and METRIQ-8 scores. Pearson's correlations were calculated between the average scores for each metric. Single-measure intraclass correlation coefficients (ICCs) evaluated the reliability of each instrument. Our study included 121 medical students, 88 EM residents, and 100 EM attendings who completed ratings. The average gestalt rating of each blog post correlated strongly with the average scores for ALiEM AIR (r = .94) and METRIQ-8 (r = .91). Single-measure ICCs were fair for gestalt (0.37, IQR 0.25-0.56), ALiEM AIR (0.41, IQR 0.29-0.60) and METRIQ-8 (0.40, IQR 0.28-0.59). The average scores of each blog post correlated strongly with gestalt ratings. However, neither ALiEM AIR nor METRIQ-8 showed higher reliability than gestalt. Improved reliability may be possible through rater training and instrument refinement.

  12. Evaluation of air cleaning system concepts for emergency use in LMFBR plants

    International Nuclear Information System (INIS)

    Hilliard, R.K.; McCormack, J.D.; Postma, A.K.

    1976-12-01

    Nineteen different air cleaning concepts are arranged into twenty-four systems and evaluated for use as accident mitigating systems in LMFBR plants. Both single, low-leakage containment plants and once-through operation applicable to containment/confinement plants are considered. Plant characteristics affecting air cleaning requirements are defined for 1000 MW(e) plants and a sodium and radiological release term is postulated. The accident conditions under which the emergency air cleaning system (EACS) must function is established by use of SOFIRE-II and HAA-3B computer codes. Criteria are developed for evaluating the various systems and for assigning comparative ratings. The numerical ratings are combined with information on cost and development potential to arrive at recommendations for the most promising systems. The conclusion is made that reliable and effective systems are feasible for use as engineered safety features for LMFBR plants, but that development effort is required for all the air cleaning concepts evaluated

  13. Summary of the Fourth International Nuclear Emergency Exercise (INEX-4). Exercise Conduct and Evaluation Questionnaires

    International Nuclear Information System (INIS)

    Auclair, Jean Patrice; Duchesne, David; Caamano, Delphine; Cessac, Bruno; Mehl-auget, Isabelle; Gering, Florian; Macsuga, Geza; Fukumoto, Masahiro; Holo, Eldri Naadland; Ugletveit, Finn; Griffiths, Mike; Breitinger, Mark; Heinrich, Ann; Mcclelland, Vincent; Ahier, Brian; Lazo, Ted; Mcinturff, Sandi; Kawabata, Masanori; Lazo, Ted; Okyar, Halil Burcin

    2013-01-01

    The INEX-4 consequence management exercise, part of the OECD Nuclear Energy Agency's ongoing series of International Nuclear Emergency Exercises (INEX), was developed under the auspices of the NEA/CRPPH Working Party on Nuclear Emergency Matters (WPNEM) in response to members desire to better prepare for the longer-term response to a nuclear or radiological emergency. The INEX-4 exercise was designed to allow participants to investigate the national and, in some cases, international arrangements for responding to widespread radiological contamination of the urban environment from a radiological dispersal devise (or dirty bomb) and the consequence management issues likely to be raised in the medium to longer term after such an event. The experiences of participating countries were gathered through an evaluation questionnaire and are summarised in this report. The INEX-4 series was developed in 2008, and conducted throughout 2010 and 2011 with 17 participating countries using the INEX-4 scenario for an event involving a radiological dispersal device. An INEX-4 evaluation questionnaire was developed to document the process and results of the exercise, which was designed mainly to test emergency responses/actions related to consequence management and transition to recovery. The conclusions drawn from the INEX-4 experiences varied greatly, but this was to be expected given the nature of the scenario and the involvement of organisations outside of the nuclear community. The evaluation questionnaires completed by each participating country provided detailed information on the national approaches taken with respect to each of the exercise objectives and on issues relating to the international interfaces between countries. In collaboration with the NEA Secretariat, staff from the United States Department of Energy (DOE) reviewed each completed questionnaire to identify and summarise the essential information derived from the exercise for consideration by WPNEM members

  14. Early economic evaluation of emerging health technologies: protocol of a systematic review

    Science.gov (United States)

    2014-01-01

    Background The concept of early health technology assessment, discussed well over a decade, has now been collaboratively implemented by industry, government, and academia to select and expedite the development of emerging technologies that may address the needs of patients and health systems. Early economic evaluation is essential to assess the value of emerging technologies, but empirical data to inform the current practice of early evaluation is limited. We propose a systematic review of early economic evaluation studies in order to better understand the current practice. Methods/design This protocol describes a systematic review of economic evaluation studies of regulated health technologies in which the evaluation is conducted prior to regulatory approval and when the technology effectiveness is not well established. Included studies must report an economic evaluation, defined as the comparative analysis of alternatives with respect to their associated costs and health consequences, and must evaluate some regulated health technology such as pharmaceuticals, biologics, high-risk medical devices, or biomarkers. We will conduct the literature search on multiple databases, including MEDLINE, EMBASE, the Centre for Reviews and Dissemination Databases, and EconLit. Additional citations will be identified via scanning reference lists and author searching. We suspect that many early economic evaluation studies are unpublished, especially those conducted for internal use only. Additionally, we use a chain-referral sampling approach to identify authors of unpublished studies who work in technology discovery and development, starting out with our contact lists and authors who published relevant studies. Citation screening and full-text review will be conducted by pairs of reviewers. Abstracted data will include those related to the decision context and decision problem of the early evaluation, evaluation methods (e.g., data sources, methods, and assumptions used to

  15. Technological considerations in emergency instrumentation preparedness. Phase II-D. Evaluation testing and calibration methodology for emergency radiological instrumentation

    International Nuclear Information System (INIS)

    Bramson, P.E.; Andersen, B.V.; Fleming, D.M.; Kathren, R.L.; Mulhern, O.R.; Newton, C.E.; Oscarson, E.E.; Selby, J.M.

    1976-09-01

    In response to recommendations from the Advisory Committee on Reactor Safeguards, the Division of Operational Safety, U.S. ERDA has contracted with Battelle, Pacific Northwest Laboratories to survey the adequacy of existing instrumentation at nuclear fuel cycle facilities to meet emergency requirements and to develop technical criteria for instrumentation systems to be used in assessment of environmental conditions following plant emergencies. This report, the fifth in a series, provides: (1) calibration methods to assure the quality of radiological measurements and (2) testing procedures for determining whether an emergency radiological instrument meets the performance specifications. Three previous reports in this series identified the emergency instrumentation needs for power reactors, mixed oxide fuel plants, and fuel reprocessing facilities. Each of these three reports contains a Section VI, which sets forth applicable radiological instrument performance criteria and calibration requirements. Testing and calibration procedures in this report have been formatted in two parts: IV and V, each divided into three subsections: (1) Power Reactors, (2) Mixed Oxide Fuel Plants, and (3) Fuel Reprocessing Facilities. The three performance criteria subsections directly coincide with the performance criteria sections of the previous reports. These performance criteria sections have been reproduced in this report as Part III with references of ''required action'' added

  16. Multiple performance measures are needed to evaluate triage systems in the emergency department.

    Science.gov (United States)

    Zachariasse, Joany M; Nieboer, Daan; Oostenbrink, Rianne; Moll, Henriëtte A; Steyerberg, Ewout W

    2018-02-01

    Emergency department triage systems can be considered prediction rules with an ordinal outcome, where different directions of misclassification have different clinical consequences. We evaluated strategies to compare the performance of triage systems and aimed to propose a set of performance measures that should be used in future studies. We identified performance measures based on literature review and expert knowledge. Their properties are illustrated in a case study evaluating two triage modifications in a cohort of 14,485 pediatric emergency department visits. Strengths and weaknesses of the performance measures were systematically appraised. Commonly reported performance measures are measures of statistical association (34/60 studies) and diagnostic accuracy (17/60 studies). The case study illustrates that none of the performance measures fulfills all criteria for triage evaluation. Decision curves are the performance measures with the most attractive features but require dichotomization. In addition, paired diagnostic accuracy measures can be recommended for dichotomized analysis, and the triage-weighted kappa and Nagelkerke's R 2 for ordinal analyses. Other performance measures provide limited additional information. When comparing modifications of triage systems, decision curves and diagnostic accuracy measures should be used in a dichotomized analysis, and the triage-weighted kappa and Nagelkerke's R 2 in an ordinal approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Evaluating the Financial Stability of Banking System, Considering the Emergence Property

    Directory of Open Access Journals (Sweden)

    Lesik Vitaliy O.

    2017-03-01

    Full Text Available The article is concerned with analyzing the existing approaches to evaluation of the financial stability of banking system, substantiating the expedience of accounting, and generalizing the characteristics of the emergence property to determine its level. The article considers the interrelation of concepts of «financial stability» and «financial sustainability», the necessity of their correlation, taking account of the time factor, has been substantiated. A critical analysis of the approaches to evaluating the financial stability of banking system has been carried out, their eligibility according to the criteria of accounting of the identification attributes of systemacity and the analytical data aggregation has been examined. To determine the status of banking system as a system phenomenon, the necessity of carrying out an evaluation of its financial stability on the basis of the emergence approach has been substantiated, including the following directions: intensity of credit and financial interaction in the interbank market; functional load of the banking system as to ensuring the macroeconomic development; structural changes and financial disparities in the banking system; scale effects that arise as a consequence of change in the main financial parameters of the system banks.

  18. A systematic review and overview of health economic evaluations of emergency laparotomy

    Directory of Open Access Journals (Sweden)

    Sohail Bampoe

    2017-11-01

    Full Text Available Abstract Background Little is known about the economic impact of emergency laparotomy (EL surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries. Methods MEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015. Quality of studies was assessed using the Consensus on Health Economic Criteria (CHEC checklist. Results Sixteen studies were included from a range of countries. One study was a full economic analysis. Fifteen studies were partial economic evaluations. These studies revealed that emergency abdominal surgery is expensive compared to similar elective surgery when comparing primary resource utilisation costs, with an important societal impact. Most contemporaneous studies indicate that in-hospital costs for EL are in excess of US$10,000 per patient episode, rising substantially when societal costs are considered. Discussion EL is a high-risk and costly procedure with a disproportionate financial burden for healthcare providers, relative to national funding provisions and wider societal cost impact. There is substantial heterogeneity in the methodologies and quality of published economic evaluations of EL; therefore, the true economic costs of EL are yet to be fully defined. Future research should focus on developing strategies to embed health economic evaluations within national programmes aiming to improve EL care, including developing the required measures and infrastructure. Conclusions Emergency laparotomy is expensive, with a significant cost burden to healthcare and systems and society worldwide. Novel strategies for reducing this econmic burden should urgently be explored if greater access to

  19. A systematic review and overview of health economic evaluations of emergency laparotomy.

    Science.gov (United States)

    Bampoe, Sohail; Odor, Peter M; Ramani Moonesinghe, S; Dickinson, Matthew

    2017-01-01

    Little is known about the economic impact of emergency laparotomy (EL) surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries. MEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015. Quality of studies was assessed using the Consensus on Health Economic Criteria (CHEC) checklist. Sixteen studies were included from a range of countries. One study was a full economic analysis. Fifteen studies were partial economic evaluations. These studies revealed that emergency abdominal surgery is expensive compared to similar elective surgery when comparing primary resource utilisation costs, with an important societal impact. Most contemporaneous studies indicate that in-hospital costs for EL are in excess of US$10,000 per patient episode, rising substantially when societal costs are considered. EL is a high-risk and costly procedure with a disproportionate financial burden for healthcare providers, relative to national funding provisions and wider societal cost impact. There is substantial heterogeneity in the methodologies and quality of published economic evaluations of EL; therefore, the true economic costs of EL are yet to be fully defined. Future research should focus on developing strategies to embed health economic evaluations within national programmes aiming to improve EL care, including developing the required measures and infrastructure. Emergency laparotomy is expensive, with a significant cost burden to healthcare and systems and society worldwide. Novel strategies for reducing this econmic burden should urgently be explored if greater access to this type of surgery is to be pursued as a global health target. PROSPERO

  20. Evaluating the Effectiveness of Community and Hospital Medical Record Integration on Management of Behavioral Health in the Emergency Department.

    Science.gov (United States)

    Ngo, Stephanie; Shahsahebi, Mohammad; Schreiber, Sean; Johnson, Fred; Silberberg, Mina

    2017-11-09

    This study evaluated the correlation of an emergency department embedded care coordinator with access to community and medical records in decreasing hospital and emergency department use in patients with behavioral health issues. This retrospective cohort study presents a 6-month pre-post analysis on patients seen by the care coordinator (n=524). Looking at all-cause healthcare utilization, care coordination was associated with a significant median decrease of one emergency department visit per patient (p management of behavioral health patients.

  1. Severe accident modeling and offsite dose consequence evaluations for nuclear power plant emergency planning

    Energy Technology Data Exchange (ETDEWEB)

    Chen, S.H.; Feng, T.S.; Huang, K.C. [National Tsing-Hua Univ., Hsinchu, Taiwan (China); Wang, J.R. [Inst. of Nuclear Energy Research, Longtan, Taiwan (China); Cheng, Y.H. [Industrial Tech. Res. Inst., Hsinchu, Taiwan (China); Shih, C., E-mail: ckshih@ess.nthu.edu.tw [National Tsing-Hua Univ., Hsinchu, Taiwan (China)

    2011-07-01

    We have investigated the roles of Firewater Addition System and Passive Flooder in ABWR severe accidents, such as LOCA and SBO. The results are apparent that Firewater System is vital in the highly unlikely situation where all AC are lost. Also in this paper, we present EPZDose, an effective and faster-than-real time code for offsite dose consequences predictions and evaluations. Illustrations with the release from our severe accident scenario show friendly and informative user's interface for supporting decision makings in nuclear emergency situations. (author)

  2. Evaluation of pre and post-emergence herbicides for weed management in lentil (lens culinaris medik.)

    International Nuclear Information System (INIS)

    Ali, A.; Malik, S.R.; Munawwar, H.; Tahir, M.

    2014-01-01

    The weeds in lentil are one of the major constraints in obtaining maximum yield. The manual weed control is simply not feasible because it is time consuming and costly. The chemical weed control is the effective method of weed management.A field study was conducted to evaluate pre and post-emergence herbicides for weed control in lentil. The experiment comprised eight treatments including three herbicides, manual weeding and check (no weeding). The yield was higher in manual weeding but in herbicide treatments Isoproturon as pre-emergence at the rate 2kg/sup -1/ha produced statistically at par grain yield to that of manual weeding followed by Isoproturon after one month of planting at the rate 2kg ha. Both the treatments showed 193.9% and 109.2% yield increase, respectively, over the check. It indicates that Isoproturon at the rate 2 kg ha can be used pre or post-emergence in lentil fields to control the weeds without causing injury to lentil plants. (author)

  3. Guardian availability in children evaluated in the emergency department for blunt head trauma.

    Science.gov (United States)

    Holmes, James F; Holubkov, Richard; Kuppermann, Nathan

    2009-01-01

    Enrolling children in research studies in the emergency department (ED) is typically dependent on the presence of a guardian to provide written informed consent. The objectives were to determine the rate of guardian availability during the initial ED evaluation of children with nontrivial blunt head trauma, to identify the reasons why a guardian is unavailable, and to compare clinical factors in patients with and without a guardian present during initial ED evaluation. This was a prospective study of children (guardian during the initial ED evaluation. For those children for whom the guardian was not available during the initial ED evaluation, the physicians completing the data forms documented the reasons for the absence. The authors enrolled 602 patients, of whom 271 (45%, 95% confidence interval [CI] = 41% to 49%) did not have a guardian available during the initial ED evaluation. In these 271 patients, 261 had reasons documented for lack of guardian availability, 43 of whom had multiple reasons. The most common of these was that the guardian did not ride in the ambulance (51%). Those patients without a guardian available were more likely to be older (mean age, 11.4 years vs. 7.6 years; p guardian presence. Nearly one-half of children with nontrivial blunt head trauma evaluated in the ED may not have a guardian available during their initial ED evaluation. Patients whose guardians are not available at the time of initial ED evaluation are older and have more severe mechanisms of injury and more serious head trauma. ED research studies of pediatric trauma patients that require written informed consent from a guardian at the time of initial ED evaluation and treatment may have difficulty enrolling targeted sample size numbers and will likely be limited by enrollment bias.

  4. Multidisciplinary evaluation of an emergency department nurse navigator role: A mixed methods study.

    Science.gov (United States)

    Jessup, Melanie; Fulbrook, Paul; Kinnear, Frances B

    2017-09-20

    To utilise multidisciplinary staff feedback to assess their perceptions of a novel emergency department nurse navigator role and to understand the impact of the role on the department. Prolonged emergency department stays impact patients, staff and quality of care, and are linked to increased morbidity and mortality. One innovative strategy to facilitate patient flow is the navigator: a nurse supporting staff in care delivery to enhance efficient, timely movement of patients through the department. However, there is a lack of rigorous research into this emerging role. Sequential exploratory mixed methods. A supernumerary emergency department nurse navigator was implemented week-off-week-on, seven days a week for 20 weeks. Diaries, focus groups, and an online survey (24-item Navigator Role Evaluation tool) were used to collect and synthesise data from the perspectives of multidisciplinary departmental staff. Thematic content analysis of cumulative qualitative data drawn from the navigators' diaries, focus groups and survey revealed iterative processes of the navigators growing into the role and staff incorporating the role into departmental flow, manifested as: Reception of the role and relationships with staff; Defining the role; and Assimilation of the role. Statistical analysis of survey data revealed overall staff satisfaction with the role. Physicians, nurses and others assessed it similarly. However, only 44% felt the role was an overall success, less than half (44%) considered it necessary, and just over a third (38%) thought it positively impacted inter-professional relationships. Investigation of individual items revealed several areas of uncertainty about the role. Within-group differences between nursing grades were noted, junior nurses rating the role significantly higher than more senior nurses. Staff input yielded invaluable insider feedback for ensuing modification and optimal instigation of the navigator role, rendering a sense of departmental

  5. Evolution of gas turbine SGT5-4000F. Experiences at combined cycle plant Mainz-Wiesbaden; Die Evolution der Gasturbine SGT5-4000F. Erfahrungen im GuD-Kraftwerk Mainz-Wiesbaden

    Energy Technology Data Exchange (ETDEWEB)

    Taud, R.; Kreyenberg, O. [Siemens Power Generation, Nuernberg (Germany); Thun, O. [Kraftwerke Mainz-Wiesbaden AG, Mainz (Germany)

    2007-07-01

    Large combined-cycle plants using natural gas emerged as the outstanding trend in electricity production in the 1990s. Pacemaker for this development has been modern gas turbine technology. High efficiency and reliability, low emissions, high operating and fuel flexibility at low investment, together with short construction times, provide extremely attractive features to the customer. (orig.)

  6. Three-year emergency medicine training program in The Netherlands: first evaluation from the residents' perspective.

    Science.gov (United States)

    Koning, Salomon Willem; Gaakeer, Menno Iskander; Veugelers, Rebekka

    2013-07-26

    The Netherlands' 3-year training in Emergency Medicine (EM) was formally approved and introduced in November 2008. To identify areas for improvement, we conducted the first evaluation of this curriculum from the residents' perspective. A questionnaire was composed on ten aspects of the curriculum. It contained multiple-choice, open and opinion questions; answers to the latter were classified using the Likert scale. The questionnaires were mailed to all enrolled residents. We mailed questionnaires to all 189 enrolled residents, and 105 responded (55.6%). Although they were satisfied with their training overall, 96.2% thought it was currently too short: 18.3% desired extension to 4 years, 76.0% to 5 and 1.9% to 6 years. Nevertheless, residents expected that they would function effectively as emergency physicians (EPs) after finishing their 3-year training program. Bedside teaching was assessed positively by 35.2%. All rotations were assessed positively, with the general practice rotation seen as contributing the least to the program. According to 43.7%, supervising EPs were available for consultation; 40.7% thought that, in a clinical capacity, the EP was sufficiently present during residents' shifts. When EPs were present, 82.5% found them to be easily accessible, and 66.6% viewed them as role models. In the Emergency Medicine Departments (EDs) with a higher number of EPs employed, residents tended to perceive better supervision and were more likely to see their EPs as role models. While residents were stimulated to do research, actual support and assistance needed to be improved. Although overall, the current training program was evaluated positively, the residents identified four areas for improvement: (1) in training hospitals, trained EPs should be present more continuously for clinical supervision; (2) bedside teaching should be improved, (3) scientific research should be facilitated more and (4) the training program should be extended.

  7. Evaluation Framework for Non-Emergency Medical Transportation Services for Patients with End-Stage Renal Disease

    Science.gov (United States)

    2014-12-01

    The objective of this project is to design a framework that could be used to evaluate the effectiveness and efficiency of non-emergency transportation services (NEMT) for better livability. In addition to the development of the framework, this projec...

  8. Application of quality improvement analytic methodology in emergency medicine research: A comparative evaluation.

    Science.gov (United States)

    Harries, Bruce; Filiatrault, Lyne; Abu-Laban, Riyad B

    2018-05-30

    Quality improvement (QI) analytic methodology is rarely encountered in the emergency medicine literature. We sought to comparatively apply QI design and analysis techniques to an existing data set, and discuss these techniques as an alternative to standard research methodology for evaluating a change in a process of care. We used data from a previously published randomized controlled trial on triage-nurse initiated radiography using the Ottawa ankle rules (OAR). QI analytic tools were applied to the data set from this study and evaluated comparatively against the original standard research methodology. The original study concluded that triage nurse-initiated radiographs led to a statistically significant decrease in mean emergency department length of stay. Using QI analytic methodology, we applied control charts and interpreted the results using established methods that preserved the time sequence of the data. This analysis found a compelling signal of a positive treatment effect that would have been identified after the enrolment of 58% of the original study sample, and in the 6th month of this 11-month study. Our comparative analysis demonstrates some of the potential benefits of QI analytic methodology. We found that had this approach been used in the original study, insights regarding the benefits of nurse-initiated radiography using the OAR would have been achieved earlier, and thus potentially at a lower cost. In situations where the overarching aim is to accelerate implementation of practice improvement to benefit future patients, we believe that increased consideration should be given to the use of QI analytic methodology.

  9. Evaluating oversight systems for emerging technologies: a case study of genetically engineered organisms.

    Science.gov (United States)

    Kuzma, Jennifer; Najmaie, Pouya; Larson, Joel

    2009-01-01

    The U.S. oversight system for genetically engineered organisms (GEOs) was evaluated to develop hypotheses and derive lessons for oversight of other emerging technologies, such as nanotechnology. Evaluation was based upon quantitative expert elicitation, semi-standardized interviews, and historical literature analysis. Through an interdisciplinary policy analysis approach, blending legal, ethical, risk analysis, and policy sciences viewpoints, criteria were used to identify strengths and weaknesses of GEOs oversight and explore correlations among its attributes and outcomes. From the three sources of data, hypotheses and broader conclusions for oversight were developed. Our analysis suggests several lessons for oversight of emerging technologies: the importance of reducing complexity and uncertainty in oversight for minimizing financial burdens on small product developers; consolidating multi-agency jurisdictions to avoid gaps and redundancies in safety reviews; consumer benefits for advancing acceptance of GEO products; rigorous and independent pre- and post-market assessment for environmental safety; early public input and transparency for ensuring public confidence; and the positive role of public input in system development, informed consent, capacity, compliance, incentives, and data requirements and stringency in promoting health and environmental safety outcomes, as well as the equitable distribution of health impacts. Our integrated approach is instructive for more comprehensive analyses of oversight systems, developing hypotheses for how features of oversight systems affect outcomes, and formulating policy options for oversight of future technological products, especially nanotechnology products.

  10. Evaluation of diffusion-perfusion mismatch for determining indication for emergency endovascular revascularization

    International Nuclear Information System (INIS)

    Masuda, Atsushi; Miki, Takanori; Matsumoto, Hiroaki

    2010-01-01

    We evaluated the usefulness of assessing by diffusion-perfusion mismatch (D/P mismatch) whether there is adaptation of neuroendovascular revascularization for acute ischemic stroke out of intravenous tissue plasminogen activator (IV t-PA). We retrospectively analyzed 24 patients who underwent D/P mismatch and endovascular treatment between October 2005 and September 2008. This investigation included stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score less than 4. Sixteen acute ischemic stroke patients had an NIHSS score greater than 5. Eight patients (50%) had a favorable neurological outcome (modified Rankin Scale 0 to 2). Eight acute ischemic stroke patients had an NIHSS score equal to or less than 4. Four patients who underwent emergency endovascular treatment on admission had a favorable neurological outcome, but 3 patients treated for progressive stroke after admission all had a poor prognosis. Evaluating D/P mismatch was useful for determining the adaptation of emergency neuroendovascular revascularization for acute ischemic stroke out of IV t-PA. Acute ischemic stroke patients with an NIHSS score equal to or less than 4 and diffusion/perfusion mismatch need careful observation to enable endovascular treatment immediately after progressive stroke. (author)

  11. Example of emergency response model evaluation of studies using the Mathew/Adpic models

    International Nuclear Information System (INIS)

    Dickerson, M.H.; Lange, R.

    1986-04-01

    This report summarizes model evaluation studies conducted for the MATHEW/ADPIC transport and diffusion models during the past ten years. These models support the US Department of Energy Atmospheric Release Advisory Capability, an emergency response service for atmospheric releases of nuclear material. Field studies involving tracer releases used in these studies cover a broad range of meteorology, terrain and tracer release heights, the three most important aspects of estimating air concentration values resulting from airborne releases of toxic material. Results of these studies show that these models can estimate air concentration values within a factor of 2 20% to 50% of the time and a factor of 5 40% to 80% of the time. As the meterology and terrain become more complex and the release height of the tracer is increased, the accuracy of the model calculations degrades. This band of uncertainty appears to correctly represent the capability of these models at this time. A method for estimating angular uncertainty in the model calculations is described and used to suggest alternative methods for evaluating emergency response models

  12. [Evaluation of hospital admissions: admission guidelines implementation in a pediatric emergency department].

    Science.gov (United States)

    Katz, Manuel; Warshawsky, Sheila S; Rosen, Shirley; Barak, Nurit; Press, Joseph

    2004-10-01

    To develop and implement locally tailored pediatric admission guidelines for use in a pediatric emergency department and evaluate the appropriateness of admissions based on these guidelines. Our Study was based on the development of admission guidelines by senior physicians, using the Delphi Consensus Process, for use in the Pediatric Emergency Department (PED) at Soroka University Medical Center (Soroka). We evaluated the appropriateness of admissions to the pediatric departments of Soroka on 33 randomly selected days in 1999 and 2000 prior to guideline implementation and 30 randomly selected days in 2001, after guideline implementation. A total of 1037 files were evaluated. A rate of 12.4% inappropriate admissions to the pediatric departments was found based on locally tailored admission guidelines. There was no change in the rate of inappropriate admissions after implementation of admission guidelines in PED. Inappropriate admissions were associated with age above 3 years, hospital stay of two days or less and the season. The main reasons for evaluating an admission as inappropriate were that the admission did not comply with the guidelines and that the case could be managed in an ambulatory setting. There were distinctive differences in the characteristics of the Bedouin and Jewish populations admitted to the pediatric departments, although no difference was found in the rate of inappropriate admissions between these populations. Patient management in Soroka PED is tailored to the conditions of this medical center and to the characteristics of the population it serves. The admission guidelines developed reflect these special conditions. Lack of change in the rate of inappropriate admissions following implementation of the guidelines indicates that the guidelines reflect the physicians' approach to patient management that existed in Soroka PED prior to guideline implementation. Hospital admission guidelines have a role in the health management system; however

  13. Neurology Concepts: Young Women and Ischemic Stroke-Evaluation and Management in the Emergency Department.

    Science.gov (United States)

    Chang, Bernard P; Wira, Charles; Miller, Joseph; Akhter, Murtaza; Barth, Bradley E; Willey, Joshua; Nentwich, Lauren; Madsen, Tracy

    2018-01-01

    Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g., premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting. A panel of six board-certified emergency physicians, one with fellowship training in stroke and one with training in sex- and sex-based medicine, along with one vascular neurologist were coauthors involved in the paper. Each author used various search strategies (e.g., PubMed, PsycINFO, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors. Estimates on the incidence of ischemic stroke in premenopausal women range from 3.65 to 8.9 per 100,000 in the United States. Several risk factors for ischemic stroke exist for young women including oral contraceptive (OCP) use and migraine with aura. Pregnancy and the postpartum period (up to 12 weeks) is also an important transient state during which risks for both ischemic stroke and cerebral hemorrhage are elevated, accounting for 18% of strokes in women under 35. Current evidence regarding the management of acute ischemic stroke in young women is also summarized including use of thrombolytic agents (e.g., tissue plasminogen activator) in both pregnant and nonpregnant individuals. Unique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment

  14. Comparison of visual analogue and Likert scales in evaluation of an emergency department bedside teaching programme.

    Science.gov (United States)

    Celenza, Antonio; Rogers, Ian R

    2011-02-01

    The present study compares visual analogue scale (VAS) to Likert-type scale (LTS) instruments in evaluating perceptions of an ED bedside clinical teaching programme. A prospective study was conducted in the ED of an urban, adult tertiary hospital. Prospective pairing occurred of a teaching consultant and registrar who were relatively quarantined from normal clinical duties. Registrars received 3 months of the teaching intervention, and 3 months without the intervention in a cross-over fashion. Evaluation questionnaires were completed using both the LTS and 100 mm horizontal VAS for each question. Correlation between VAS and LTS gave a measure of validity, and test-retest stability and internal consistency gave measures of reliability. Registrar perceptions of the teaching programme were positive, but no differences were found between the pre- and post-intervention groups. The test-retest reliabilities (intraclass correlation coefficient) for the questionnaires were 0.51 and 0.54 for the VAS, and 0.58 and 0.58 for the LTS. Cronbach's alpha varied between 0.79 and 0.91 for the VAS, and 0.79 and 0.81 for the LTS. Correlations between the two methods varied from 0.35 to 0.94 for each question. A linear regression equation describing the relationship approximated VAS = 19.5 × LTS-9 with overall r= 0.89. An ED bedside teaching programme is perceived to be a beneficial educational intervention. The VAS is a reliable and valid alternative to the LTS for educational evaluation and might provide advantages in educational measurement. Further research into the significance of extreme values and educationally important changes in scores is required. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. Emergency and backup power supplies at Department of Energy facilities: Augmented Evaluation Team -- Final report

    Energy Technology Data Exchange (ETDEWEB)

    1993-11-01

    This report documents the results of the Defense Programs (DP) Augmented Evaluation Team (AET) review of emergency and backup power supplies (i.e., generator, uninterruptible power supply, and battery systems) at DP facilities. The review was conducted in response to concerns expressed by former Secretary of Energy James D. Watkins over the number of incidents where backup power sources failed to provide electrical power during tests or actual demands. The AET conducted a series of on-site reviews for the purpose of understanding the design, operation, maintenance, and safety significance of emergency and backup power (E&BP) supplies. The AET found that the quality of programs related to maintenance of backup power systems varies greatly among the sites visited, and often among facilities at the same site. No major safety issues were identified. However, there are areas where the AET believes the reliability of emergency and backup power systems can and should be improved. Recommendations for improving the performance of E&BP systems are provided in this report. The report also discusses progress made by Management and Operating (M&O) contractors to improve the reliability of backup sources used in safety significant applications. One area that requires further attention is the analysis and understanding of the safety implications of backup power equipment. This understanding is needed for proper graded-approach implementation of Department of Energy (DOE) Orders, and to help ensure that equipment important to the safety of DOE workers, the public, and the environment is identified, classified, recognized, and treated as such by designers, users, and maintainers. Another area considered important for improving E&BP system performance is the assignment of overall ownership responsibility and authority for ensuring that E&BP equipment performs adequately and that reliability and availability are maintained at acceptable levels.

  16. Evaluation of emergency medical text processor, a system for cleaning chief complaint text data.

    Science.gov (United States)

    Travers, Debbie A; Haas, Stephanie W

    2004-11-01

    Emergency Medical Text Processor (EMT-P) version 1, a natural language processing system that cleans emergency department text (e.g., chst pn, chest pai), was developed to maximize extraction of standard terms (e.g., chest pain). The authors compared the number of standard terms extracted from raw chief complaint (CC) data with that for CC data cleaned with EMT-P and evaluated the accuracy of EMT-P. This cross-sectional observation study included CC text entries for all emergency department visits to three tertiary care centers in 2001. Terms were extracted from CC entries before and after cleaning with EMT-P. Descriptive statistics included number and percentage of all entries (tokens) and all unique entries (types) that matched a standard term from the Unified Medical Language System (UMLS). An expert panel rated the accuracy of the CC-UMLS term matches; inter-rater reliability was measured with kappa. The authors collected 203,509 CC entry tokens, of which 63,946 were unique entry types. For the raw data, 89,337 tokens (44%) and 5,081 types (8%) matched a standard term. After EMT-P cleaning, 168,050 tokens (83%) and 44,430 types (69%) matched a standard term. The expert panel reached consensus on 201 of the 222 CC-UMLS term matches reviewed (kappa=0.69-0.72). Ninety-six percent of the 201 matches were rated equivalent or related. Thirty-eight percent of the nonmatches were found to match UMLS concepts. EMT-P version 1 is relatively accurate, and cleaning with EMT-P improved the CC-UMLS term match rate over raw data. The authors identified areas for improvement in future EMT-P versions and issues to be resolved in developing a standard CC terminology.

  17. Operative characteristics of rest myocardial perfusion in emergency thoracic pain evaluation

    International Nuclear Information System (INIS)

    Merlano G, Sonia; Murgueitio C, Ramon; Rodriguez F, Edgard; Carvajal C, Andres; Suarez R, Martin

    2000-01-01

    Study objective: Conventional emergency department testing strategies for patients with chest pain often provide equivocal diagnosis of coronary artery disease. This study was conducted to determine the sensibility, specificity , positive predictive value (PPV), negative predictive value (NPV) and Likelihood ratio LR(-) of the myocardial perfusion imaging with single photon emission computed tomography (SPECT) imaging at rest. Methods: We design a diagnostic imaging protocol to evaluate clinical usefulness of SPECT Technetium sestamibi imaging at rest in patients with typical and atypical chest pain and normal or non diagnostic electrocardiogram. Coronary angiogram was the gold standard for positive studies and six month follow up after completing the exercise test for negatives. Nuclear Medicine physicians were unaware of the angiograms results. The inter observers variability was measure with a Kappa coefficient. Results: We enrolled 107 patients 78 males (72.8%) and 29 females (27.2%). We found sensitivity 95.45% (IC 95% 95.41-95.48), specificity 92.94%(IC 95% 92.9- 92.98) Negative predictive value 98.75% LR(-) 0.092 . The study adequately classified 93% of the patients. Kappa coefficient for concordance between observer was 0.95 Conclusion: Myocardial perfusion imaging with SPECT at rest, has a high negative predictive value and a very good ability to classify normal patients as such and therefore may be use for the assessment of patients with chest pain and normal or non diagnostic electrocardiograms at the emergency room (Au)

  18. Retrospective evaluation of patients with elevated digoxin levels at an emergency department

    Directory of Open Access Journals (Sweden)

    Gulsum Limon

    2016-03-01

    Full Text Available Objectives: We investigated the demographic characteristics, clinical and laboratory findings, treatment strategies and clinical outcomes of patients presenting at emergency department (ED with digoxin levels at or above 1.2 ng/ml. Materials and methods: The demographic and clinical characteristics of patients with serum digoxin levels at or above 1.2 ng/ml admitted to an ED between January 2010 and July 2011 were investigated in this cross-sectional descriptive study. Patients with ECG and clinical findings consistent with digoxin toxicity and no additional explanation of their symptoms were evaluated for digoxin toxicity. Results: In this study 137 patients were included, and 68.6% of patients were women with mean age 76.1 ± 12.2. There was no significant difference between gender and digoxin intoxication. The mean age of intoxicated group was significantly higher than the non-intoxicated group (P = 0.03. The most common comorbidities were congestive heart failure (n = 91 and atrial fibrillation (n = 74. The most common symptoms were nausea, vomiting and abdominal pain. The levels of hospitalization and mortality in this group were significantly higher. Conclusion: Digoxin intoxication must be suspected in patients present in the ED, particularly those with complaints that include nausea and vomiting, as well as new ECG changes; serum digoxin levels must be determined. Keywords: Digoxin, Digoxin level, Intoxication, Emergency department

  19. Evaluation of Pediatric Forensic Cases in Emergency Department: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Tanzer Korkmaz

    2014-12-01

    Full Text Available Aim: Our aim was to evaluate the properties of pediatric forensic cases and to discuss the precautions in order to prevent the occurrence of these forensic events. Methods: The patient files and forensic reports of pediatric (age 0-18 years forensic cases, who were referred to the emergency department in our hospital between January 01, 2009 and December 31, 2011 were retrospectively investigated. Results: A total of 421 forensic pediatric cases with a median age of 9.9±5.5 years were included in the study. Off the cases, 61% (n=257 were male and 47.3% were in 5-14 age group. The type of the events were traffic accident (50.4%, fall (18.3%, stab injuries (10.9%, intoxication (5.9%, pounding (5.0% and other incidents (9.5%. There were nine cases of suicide attempt (all of them were above 14 years of age and four cases of physical abuse (three of them were under 15 years of age. After the observation period, 79.8% of the cases were discharged from the emergency department, whilst 20.2% of cases were hospitalized in one of the clinics. Conclusion: Because most of the cases were traffic accident, this situation show us that these injuries are preventable. Prevention and intervention strategies should be developed for providing a safe environment for children.

  20. UAV Deployment Exercise for Mapping Purposes: Evaluation of Emergency Response Applications.

    Science.gov (United States)

    Boccardo, Piero; Chiabrando, Filiberto; Dutto, Furio; Tonolo, Fabio Giulio; Lingua, Andrea

    2015-07-02

    Exploiting the decrease of costs related to UAV technology, the humanitarian community started piloting the use of similar systems in humanitarian crises several years ago in different application fields, i.e., disaster mapping and information gathering, community capacity building, logistics and even transportation of goods. Part of the author's group, composed of researchers in the field of applied geomatics, has been piloting the use of UAVs since 2006, with a specific focus on disaster management application. In the framework of such activities, a UAV deployment exercise was jointly organized with the Regional Civil Protection authority, mainly aimed at assessing the operational procedures to deploy UAVs for mapping purposes and the usability of the acquired data in an emergency response context. In the paper the technical features of the UAV platforms will be described, comparing the main advantages/disadvantages of fixed-wing versus rotor platforms. The main phases of the adopted operational procedure will be discussed and assessed especially in terms of time required to carry out each step, highlighting potential bottlenecks and in view of the national regulation framework, which is rapidly evolving. Different methodologies for the processing of the acquired data will be described and discussed, evaluating the fitness for emergency response applications.

  1. Implementation and evaluation of health passport communication tools in emergency departments.

    Science.gov (United States)

    Heifetz, Marina; Lunsky, Yona

    2018-01-01

    People with IDD (intellectual or developmental disabilities) and their families consistently report dissatisfaction with their emergency department experience. Clear care plans and communication tools may not only improve the quality of patient care, but also can prevent unnecessary visits and reduce the likelihood of return visits. To evaluate communication tools to be used by people with IDD in psychiatric and general emergency departments in three different regions of Ontario. Health passport communication tools were locally tailored and implemented in each of the three regions. A total of 28 questionnaires and 18 interviews with stakeholders (e.g., hospital staff, community agency representatives, families) were completed across the regions to obtain feedback on the implementation of health passports with people with IDD. Participants felt that the health passport tools provided helpful information, improved communication between patients with IDD and hospital staff, and were user friendly. Continued efforts are needed to work with communities on maintenance of this tool, ensuring all hospital staff are utilizing the information. These findings emphasize the merits of health passport tools being implemented in the health system to support communication between patients with IDD and health care practitioners and the importance of tailoring tools to local settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. UAV Deployment Exercise for Mapping Purposes: Evaluation of Emergency Response Applications

    Directory of Open Access Journals (Sweden)

    Piero Boccardo

    2015-07-01

    Full Text Available Exploiting the decrease of costs related to UAV technology, the humanitarian community started piloting the use of similar systems in humanitarian crises several years ago in different application fields, i.e., disaster mapping and information gathering, community capacity building, logistics and even transportation of goods. Part of the author’s group, composed of researchers in the field of applied geomatics, has been piloting the use of UAVs since 2006, with a specific focus on disaster management application. In the framework of such activities, a UAV deployment exercise was jointly organized with the Regional Civil Protection authority, mainly aimed at assessing the operational procedures to deploy UAVs for mapping purposes and the usability of the acquired data in an emergency response context. In the paper the technical features of the UAV platforms will be described, comparing the main advantages/disadvantages of fixed-wing versus rotor platforms. The main phases of the adopted operational procedure will be discussed and assessed especially in terms of time required to carry out each step, highlighting potential bottlenecks and in view of the national regulation framework, which is rapidly evolving. Different methodologies for the processing of the acquired data will be described and discussed, evaluating the fitness for emergency response applications.

  3. Users' experiences of an emergency department patient admission predictive tool: A qualitative evaluation.

    Science.gov (United States)

    Jessup, Melanie; Crilly, Julia; Boyle, Justin; Wallis, Marianne; Lind, James; Green, David; Fitzgerald, Gerard

    2016-09-01

    Emergency department overcrowding is an increasing issue impacting patients, staff and quality of care, resulting in poor patient and system outcomes. In order to facilitate better management of emergency department resources, a patient admission predictive tool was developed and implemented. Evaluation of the tool's accuracy and efficacy was complemented with a qualitative component that explicated the experiences of users and its impact upon their management strategies, and is the focus of this article. Semi-structured interviews were conducted with 15 pertinent users, including bed managers, after-hours managers, specialty department heads, nurse unit managers and hospital executives. Analysis realised dynamics of accuracy, facilitating communication and enabling group decision-making Users generally welcomed the enhanced potential to predict and plan following the incorporation of the patient admission predictive tool into their daily and weekly decision-making processes. They offered astute feedback with regard to their responses when faced with issues of capacity and communication. Participants reported an growing confidence in making informed decisions in a cultural context that is continually moving from reactive to proactive. This information will inform further patient admission predictive tool development specifically and implementation processes generally. © The Author(s) 2015.

  4. Evaluating the performance of the ORTECR DetectiveTM for emergency urine bioassay

    International Nuclear Information System (INIS)

    Li, C.; Ko, R.; Moodie, G.; Kramer, G. H.

    2011-01-01

    The performance of the ORTEC R Detective TM as a field deployable tool for emergency urine bioassay of 137 Cs, 60 Co, 192 Ir, 169 Yb and 75 Se was evaluated against ANSI N13.30. The tested activity levels represent 10 % RL (reference level) and 1 % RL defined by [Li C., Vlahovich S., Dai X., Richardson R. B., Daka J. N. and Kramer G. H. Requirements for radiation emergency urine bioassay techniques for the public and first responders. Health Phys (in press, 99(5), 702-707 (2010)]. The tests were conducted for both single radionuclide and mixed radionuclides at two geometries, one conventional geometry (CG) and one improved geometry (IG) which improved the MDAs (minimum detectable amounts) by a factor of 1.6-2.7. The most challenging radionuclide was 169 Yb. The measurement of the mixture radionuclides for 169 Yb at the CG did not satisfy the ANSI N13.30 requirements even at 10 % RL. At 1 % RL, 169 Yb and 192 Ir were not detectable at either geometry, while the measurement of 60 Co in the mixed radionuclides satisfied the ANSI N13.30 requirements only at the IG. (authors)

  5. Simulator Evaluation of Simplified Propulsion-Only Emergency Flight Control Systems on Transport Aircraft

    Science.gov (United States)

    Burcham, Frank W., Jr.; Kaneshige, John; Bull, John; Maine, Trindel A.

    1999-01-01

    With the advent of digital engine control systems, considering the use of engine thrust for emergency flight control has become feasible. Many incidents have occurred in which engine thrust supplemented or replaced normal aircraft flight controls. In most of these cases, a crash has resulted, and more than 1100 lives have been lost. The NASA Dryden Flight Research Center has developed a propulsion-controlled aircraft (PCA) system in which computer-controlled engine thrust provides emergency flight control capability. Using this PCA system, an F-15 and an MD-11 airplane have been landed without using any flight controls. In simulations, C-17, B-757, and B-747 PCA systems have also been evaluated successfully. These tests used full-authority digital electronic control systems on the engines. Developing simpler PCA systems that can operate without full-authority engine control, thus allowing PCA technology to be installed on less capable airplanes or at lower cost, is also a desire. Studies have examined simplified ?PCA Ultralite? concepts in which thrust control is provided using an autothrottle system supplemented by manual differential throttle control. Some of these concepts have worked well. The PCA Ultralite study results are presented for simulation tests of MD-11, B-757, C-17, and B-747 aircraft.

  6. Final evaluation of the 2005 to 2007 National Pediatric Emergency Medicine Fellows' Conferences.

    Science.gov (United States)

    Jaffe, David M; Knapp, Jane F; Jeffe, Donna B

    2009-05-01

    Evaluate the effectiveness of the 2005 to 2007 National Pediatric Emergency Medicine (PEM) Fellows Conference series in achieving predefined objectives in the domains of scholarship, leadership, and partnership. Conference attendees included fellows in the existing PEM fellowship programs. Self-administered preconference and postconference questionnaires measured knowledge, research-related confidence, beliefs about institutional support for Emergency Medical Services for Children (EMSC) research, and intentions to engage in 7 specific behaviors relating to scholarship, leadership, and partnership. Pearson product-moment correlations measured relationships among continuous variables. Repeated-measures analysis of variance measured change between preconference and postconference measures. Hierarchical multiple linear regression models identified predictors of postconference intentions to engage in each of the 7 specific behaviors, controlling for preconference intention. Approximately one third of all PEM fellows attended the conference each year. Preconference and postconference questionnaires were completed by at least 70% of attendees each year. Because several fellows attended more than one conference, data were analyzed from the first conference that a fellow attended. In each year, we observed significant increases in attendees' conference-specific knowledge, confidence, and intentions to continue in EMSC research, join national collaborative research networks, and establish national mentoring relationships. The National PEM Fellows' Conference is an effective means to increasing fellows' knowledge about scholarship, leadership, and partnership in EMSC and increasing their confidence and intentions to conduct research in EMSC.

  7. Emergency response guide-B ECCS guideline evaluation analyses for N reactor

    International Nuclear Information System (INIS)

    Chapman, J.C.; Callow, R.A.

    1989-07-01

    INEL conducted two ECCS analyses for Westinghouse Hanford. Both analyses will assist in the evaluation of proposed changes to the N Reactor Emergency Response Guide-B (ERG-B) Emergency Core System (ECCS) guideline. The analyses were a sensitivity study for reduced-ECCS flow rates and a mechanistically determined confinement steam source for a delayed-ECCS LOCA sequence. The reduced-ECCS sensitivity study established the maximum allowable reduction in ECCS flow as a function of time after core refill for a large break loss-of-coolant accident (LOCA) sequence in the N Reactor. The maximum allowable ECCS flow reduction is defined as the maximum flow reduction for which ECCS continues to provide adequate core cooling. The delayed-ECCS analysis established the liquid and steam break flows and enthalpies during the reflood of a hot core following a delayed ECCS injection LOCA sequence. A simulation of a large, hot leg manifold break with a seven-minute ECCS injection delay was used as a representative LOCA sequence. Both analyses were perform using the RELAP5/MOD2.5 transient computer code. 13 refs., 17 figs., 3 tabs

  8. Population-based evaluation of the effectiveness of two regimens for emergency contraception.

    Science.gov (United States)

    Leung, Vivian W Y; Soon, Judith A; Lynd, Larry D; Marra, Carlo A; Levine, Marc

    2016-06-01

    To estimate and compare the effectiveness of the levonorgestrel and Yuzpe regimens for hormonal emergency contraception in routine clinical practice. A retrospective population-based study included women who accessed emergency contraceptives for immediate use prescribed by community pharmacists in British Columbia, Canada, between December 2000 and December 2002. Linked administrative healthcare data were used to discern the timings of menses, unprotected intercourse, and any pregnancy-related health services. A panel of experts evaluated the compatibility of observed pregnancies with the timing of events. The two regimens were compared with statistical adjustments for potential confounding. Among 7493 women in the cohort, 4470 (59.7%) received levonorgestrel and 3023 (40.3%) the Yuzpe regimen. There were 99 (2.2%) compatible pregnancies in the levonorgestrel group and 94 (3.1%) in the Yuzpe group (P=0.017). The estimated odds ratio for levonorgestrel compared with the Yuzpe regimen after adjusting for potential confounders was 0.64 (95% confidence interval 0.47-0.87). Against an expected pregnancy rate of approximately 5%, the relative and absolute risk reductions were 56.0% and 2.8%, respectively, for levonorgestrel and 36.7% and 1.8% for the Yuzpe regimen. The levonorgestrel regimen is more effective than the Yuzpe regimen in routine use. The data suggest that both regimens are less effective than has been observed in randomized trials. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  9. Evaluation of preparedness for medical emergencies among dental practitioners in Khammam town: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    L Surya Chandra Varma

    2015-01-01

    Full Text Available Introduction: Medical emergencies can occur frequently in the dental setting. Effective management of an emergency situation in the dental office is ultimately the dentist responsibility. The assessment of preparedness of dental practitioners would help to bring about required changes in the teaching aspects of dental institutions, which would ultimately help dental graduates to improve knowledge regarding management of medical emergencies. This would also make dental offices available with required emergency drugs. Aim: To evaluate the preparedness for medical emergencies among the dental practitioners in Khammam town. Materials and Methods: A cross-sectional questionnaire-based study with a sample of 301 was conducted among dental clinicians at Khammam to evaluate their knowledge regarding medical emergencies. The questionnaire consisted of nineteen questions. First nine questions are objective questions, requiring a simple yes or no reply. Next ten questions are multiple choice questions regarding Emergency Medical Services and basic life support. Chi-square test was used to analyze the data. A P < 0.05 is considered significant. Results: The results of this study showed that almost all the participants (94.02% enquired about medical and drug history, but only 67.11% of them obtained a complete health history proforma of the patient. About 83.06% record vital signs, 74.09% of members report about attending workshops on emergency training and management, and 50.5% of members were either not sure or not in a position to handle the emergency condition. Conclusion: The results of this study reflect an alarming situation of the capability of dentists to deal with medical emergencies at dental offices and make available all the emergency drugs at their offices.

  10. Development and evaluation of a leadership training program for public health emergency response: results from a Chinese study

    Directory of Open Access Journals (Sweden)

    Xu Yihua

    2008-10-01

    Full Text Available Abstract Background Since the 9/11 attack and severe acute respiratory syndrome (SARS, the development of qualified and able public health leaders has become a new urgency in building the infrastructure needed to address public health emergencies. Although previous studies have reported that the training of individual leaders is an important approach, the systemic and scientific training model need further improvement and development. The purpose of this study was to develop, deliver, and evaluate a participatory leadership training program for emergency response. Methods Forty-one public health leaders (N = 41 from five provinces completed the entire emergency preparedness training program in China. The program was evaluated by anonymous questionnaires and semi-structured interviews held prior to training, immediately post-training and 12-month after training (Follow-up. Results The emergency preparedness training resulted in positive shifts in knowledge, self-assessment of skills for public health leaders. More than ninety-five percent of participants reported that the training model was scientific and feasible. Moreover, the response of participants in the program to the avian influenza outbreak, as well as the planned evaluations for this leadership training program, further demonstrated both the successful approaches and methods and the positive impact of this integrated leadership training initiative. Conclusion The emergency preparedness training program met its aims and objectives satisfactorily, and improved the emergency capability of public health leaders. This suggests that the leadership training model was effective and feasible in improving the emergency preparedness capability.

  11. A reactor core/containment status evaluation flowchart for determining protective actions in emergencies

    International Nuclear Information System (INIS)

    Glissman, M.A.

    1988-01-01

    In the event of an emergency at a power reactor station, there might not be adequate time or sufficient data to fully assess radiological implications and make protective action recommendations based on projected population exposures. Thus, decision-making guidance is needed that is based on readily available plant indicators, not just on time-consuming dose calculations. In the United States, this guidance must be compatible with the recommended by the Nuclear Regulatory Commission and the Environmental Protection Agency, and it must include predetermined, measurable, site-specific parameters for assessing conditions in the reactor core and containment. The preparation of this real time guidance calls for the selection of suitable parameters and the determination of the values for these parameters that will correspond to different levels of protective action. This process is illustrated in this paper by selecting parameters and determining appropriate values for constructing a Core/Containment Status Evaluation Flowchart for an example power plant

  12. Fracture evaluation of a crack in the service water piping system to an emergency diesel generator

    International Nuclear Information System (INIS)

    Rudland, D.; Scott, P.; Rahman, S.; Wilkowski, G.

    1995-01-01

    A pipe fracture experiment was conducted on a section of 6-inch nominal diameter pipe which was degraded by microbiologically induced corrosion (MIC) at a circumferential girth weld. The pipe was a section of one of the service water piping system to one of the emergency diesel generators at the Haddam Neck (Connecticut Yankee) plant. The experimental results will help validate future ASME Section XI pipe flaw evaluation criteria for other than Class 1 piping. A critical aspect of this experiment was an assessment of the degree of conservatism embodied in the ASME definition of flaw size. The ASME flaw size definition assumes a rectangular shaped, constant depth flaw with a depth equal to its maximum depth for its entire length. Since most service flaws are very irregular in shape, this definition can be very conservative. Alternative equivalent flaw size definitions for irregular shaped flaws are explored in this paper. (author). 7 refs., 2 figs., 4 tabs

  13. Evaluating the effectiveness of warning systems for nuclear power plant emergencies: criteria and application

    International Nuclear Information System (INIS)

    Sorensen, J.H.

    1984-01-01

    The accident at Three Mile Island Nuclear Power Plant in 1979 was an emergency management disaster. Chief among the problems was ineffective public warning and communications. While it is difficult to assign blame for that condition to any given party or determine if it was due to unique situational factors, the failure led to fairly significant regulatory changes in the arena of public warning and notification. These changes are intended to avoid the problems that arose during the TMI accident. This chapter reviews these regulations and suggests an alternative set of criteria for evaluating warning systems. The criteria are used to assess the effectiveness of the warning system at the Ft. St. Vrain nuclear power plant in Colorado. The paper concludes with some discussion of the lessons learned from the TMI experience as they apply to warning systems for all nuclear generating stations

  14. Flight Simulator Evaluation of Enhanced Propulsion Control Modes for Emergency Operation

    Science.gov (United States)

    Litt, Jonathan, S; Sowers, T.; Owen, A., Karl; Fulton, Christopher, E.; Chicatelli, Amy, K.

    2012-01-01

    This paper describes piloted evaluation of enhanced propulsion control modes for emergency operation of aircraft. Fast Response and Overthrust modes were implemented to assess their ability to help avoid or mitigate potentially catastrophic situations, both on the ground and in flight. Tests were conducted to determine the reduction in takeoff distance achievable using the Overthrust mode. Also, improvements in Dutch roll damping, enabled by using yaw rate feedback to the engines to replace the function of a stuck rudder, were investigated. Finally, pilot workload and ability to handle the impaired aircraft on approach and landing were studied. The results showed that improvement in all aspects is possible with these enhanced propulsion control modes, but the way in which they are initiated and incorporated is important for pilot comfort and perceived benefit.

  15. Evaluation of Savannah River Plant emergency response models using standard and nonstandard meteorological data

    International Nuclear Information System (INIS)

    Hoel, D.D.

    1984-01-01

    Two computer codes have been developed for operational use in performing real time evaluations of atmospheric releases from the Savannah River Plant (SRP) in South Carolina. These codes, based on mathematical models, are part of the SRP WIND (Weather Information and Display) automated emergency response system. Accuracy of ground level concentrations from a Gaussian puff-plume model and a two-dimensional sequential puff model are being evaluated with data from a series of short range diffusion experiments using sulfur hexafluoride as a tracer. The models use meteorological data collected from 7 towers on SRP and at the 300 m WJBF-TV tower about 15 km northwest of SRP. The winds and the stability, which is based on turbulence measurements, are measured at the 60 m stack heights. These results are compared to downwind concentrations using only standard meteorological data, i.e., adjusted 10 m winds and stability determined by the Pasquill-Turner stability classification method. Scattergrams and simple statistics were used for model evaluations. Results indicate predictions within accepted limits for the puff-plume code and a bias in the sequential puff model predictions using the meteorologist-adjusted nonstandard data. 5 references, 4 figures, 2 tables

  16. The prehospital emergency care system in Mexico City: a system's performance evaluation.

    Science.gov (United States)

    Peralta, Luis Mauricio Pinet

    2006-01-01

    Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1-44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design. The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems. This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the soc ial, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The p aper includesdata obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers. The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow

  17. Using the /phi/resund experimental data to evaluate the ARAC emergency response models

    International Nuclear Information System (INIS)

    Gudiksen, P.H.; Gryning, S.E.

    1988-07-01

    A series of meteorological and tracer experiments, was conducted during May and June 1984 over the 20-km wide /O/resund strait between Denmark and Sweden for the purpose of studying atmospheric dispersion processes over cold water and warm land surfaces and providing the data needed to evaluate meso-scale models in a coastal environment. In concert with these objectives the data from these experiments have been used as part of a continuing effort to evaluate the capability of the three-dimensional MATHEW/ADPIC (M/A) atmospheric dispersion models to simulate pollutant transport and diffusion characteristics of the atmospheric during a wide variety of meteorological conditions. Since previous studies have focused primarily on M/A model evaluations over rolling and complex terrain at inland sites, the /O/resund experiments provide a unique opportunity to evaluate the models in a coastal environment. The M/A models are used by the Atmospheric Release Advisory Capability (ARAC), developed by the Lawrence Livermore National Laboratory, for performing real-time assessments of the environmental consequences of potential or actual releases of radioactivity into the atmosphere. These assessments include estimation of radiation doses to nearby population centers and of the extent of surface contamination. Model evaluations, using field experimental data such as those generated by the /O/resund experiments, serve as a basis for providing emergency response managers with estimated of the uncertainties associated with accident consequence assessments. This report provides a brief description of the /O/resund experiments, the current understanding of the meteorological processes governing pollutant dispersion over the /O/resund strait, and the results of the M/A model simulations of these experiments. 11 refs., 7 figs., 1 tab

  18. Evaluation of substrates on the emergence of "araticum-de-terra-fria" (Annona emarginata (Schltdl. H. Rainer Seedlings

    Directory of Open Access Journals (Sweden)

    Daniel Baron

    2011-06-01

    Full Text Available Choosing a substrate is the determinant factor for the seedling producer; thus, the aim of this study was to evaluate the effect of different types of substrates on the emergence of "araticum-de-terra-fria" (Annona emarginata (Schltdl. H. Rainer seedlings. The experiment was carried out in a greenhouse and the experimental design was in randomized blocks, with three treatments and five replicates of 72 seeds per plot. The treatments consisted of the following substrates: coconut fiber, vermiculite and Plantmax® Citrus. The number of emerged seedlings was weekly counted for 105 days. Data regarding seedling height were obtained, and the emergence velocity index and mean time, besides total emergence percentage and that over time were calculated. Results from total mean emergence percentage, seedling height, emergence velocity index (EVI, and mean emergence time (MET were subjected to analysis of variance and means were compared by the Tukey's test at 5% significance. The curves concerning the emergence percentage over time were fit by the logistic growth equation for each treatment and the means of each parameter (A, B, C were compared by the Duncan's test at 5% significance. The substrates vermiculite led to the highest values of emergence percentage differing from the PlantMax® Citrus, but not of the coconut fiber, however the vermiculite promoted seedling height in a shorter time; therefore, this substrate is recommended for the initial development of "araticum-de-terra-fria" (Annona emarginata (Schltdl. H. Rainer seedlings.

  19. Critical evaluation of emergency stockpile ventilators in an in vitro model of pediatric lung injury.

    Science.gov (United States)

    Custer, Jason W; Watson, Christopher M; Dwyer, Joe; Kaczka, David W; Simon, Brett A; Easley, R Blaine

    2011-11-01

    Modern health care systems may be inadequately prepared for mass casualty respiratory failure requiring mechanical ventilation. Current health policy has focused on the "stockpiling" of emergency ventilators, though little is known about the performance of these ventilators under conditions of respiratory failure in adults and children. In this study, we seek to compare emergency ventilator performance characteristics using a test lung simulating pediatric lung injury. Evaluation of ventilator performance using a test lung. Laboratory. None. Six transport/emergency ventilators capable of adult/child application were chosen on the basis of manufacturer specifications, Autovent 3000, Eagle Univent 754, EPV 100, LP-10, LTV 1200, and Parapac 200D. Manufacturer specifications for each ventilator were reviewed and compared with known standards for alarms and functionality for surge capacity ventilators. The delivered tidal volume, gas flow characteristics, and airway pressure waveforms were evaluated in vitro using a mechanical test lung to model pediatric lung injury and integrated software. Test lung and flow meter recordings were analyzed over a range of ventilator settings. Of the six ventilators assessed, only two had the minimum recommended alarm capability. Four of the six ventilators tested were capable of being set to deliver a tidal volume of less than 200 mL. The delivered tidal volume for all ventilators was within 8% of the nominal setting at a positive end expiratory pressure of zero but was reduced significantly with the addition of positive end expiratory pressure (range, ±10% to 30%; p ventilators tested performed comparably at higher set tidal volumes; however, only three of the ventilators tested delivered a tidal volume across the range of ventilator settings that was comparable to that of a standard intensive care unit ventilator. Multiple ventilators are available for the provision of ventilation to children with respiratory failure in a mass

  20. Supporting Sustainable Markets Through Life Cycle Assessment: Evaluating emerging technologies, incorporating uncertainty and the consumer perspective

    Science.gov (United States)

    Merugula, Laura

    As civilization's collective knowledge grows, we are met with the realization that human-induced physical and biological transformations influenced by exogenous psychosocial and economic factors affect virtually every ecosystem on the planet. Despite improvements in energy generation and efficiencies, demand of material goods and energy services increases with no sign of a slowing pace. Sustainable development requires a multi-prong approach that involves reshaping demand, consumer education, sustainability-oriented policy, and supply chain management that does not serve the expansionist mentality. Thus, decision support tools are needed that inform developers, consumers, and policy-makers for short-term and long-term planning. These tools should incorporate uncertainty through quantitative methods as well as qualitatively informing the nature of the model as imperfect but necessary and adequate. A case study is presented of the manufacture and deployment of utility-scale wind turbines evaluated for a proposed change in blade manufacturing. It provides the first life cycle assessment (LCA) evaluating impact of carbon nanofibers, an emerging material, proposed for integration to wind power generation systems as blade reinforcement. Few LCAs of nanoproducts are available in scientific literature due to research and development (R&D) for applications that continues to outpace R&D for environmental, health, and safety (EHS) and life cycle impacts. LCAs of emerging technologies are crucial for informing developers of potential impacts, especially where market growth is swift and dissipative. A second case study is presented that evaluates consumer choice between disposable and reusable beverage cups. While there are a few studies that attempt to make the comparison using LCA, none adequately address uncertainty, nor are they representative for the typical American consumer. By disaggregating U.S. power generation into 26 subregional grid production mixes and evaluating

  1. Evaluation of food emergency response laboratories' capability for 210Po analysis using proficiency test material with verifiable traceability

    International Nuclear Information System (INIS)

    Zhongyu Wu; Zhichao Lin; Mackill, P.; Cong Wei; Noonan, J.; Cherniack, J.; Gillis-Landrum, D.

    2009-01-01

    Measurement capability and data comparability are essential for emergency response when analytical data from cooperative laboratories are used for risk assessment and post incident decision making. In this study, the current capability of food emergency response laboratories for the analysis of 210 Po in water was evaluated using a proficiency test scheme in compliance with ISO-43 and ILAC G13 guidelines, which comprises a test sample preparation and verification protocol and an insightful statistical data evaluation. The results of performance evaluations on relative bias, value trueness, precision, false positive detection, minimum detection limit, and limit of quantification, are presented. (author)

  2. Outcomes of allergy/immunology follow-up after an emergency department evaluation for anaphylaxis.

    Science.gov (United States)

    Campbell, Ronna L; Park, Miguel A; Kueber, Michael A; Lee, Sangil; Hagan, John B

    2015-01-01

    Anaphylaxis guidelines currently recommend referring patients with anaphylaxis seen in the emergency department (ED) to an allergist for follow up. The objective of our study was to evaluate outcomes of allergy/immunology follow-up after an ED visit for anaphylaxis. A retrospective health records review was conducted from April 2008 to August 2012. Charts were reviewed independently by 2 allergists to determine outcomes. Descriptive statistics with corresponding 95% CIs were calculated. Among 573 patients seen in the ED who met anaphylaxis diagnostic criteria, 217 (38%) had a documented allergy/immunology follow-up. After allergy/immunology evaluation, 16 patients (7% [95% CI, 5%-12%]) had anaphylaxis ruled out. Among those with an unknown ED trigger (n = 74), 24 (32% [95% CI, 23%-44%]) had a trigger identified; and, among those who had a specific suspected ED trigger (n = 143), 9 (6% [95% CI, 3%-12%]) had a trigger identified in a category other than the one suspected in the ED, and 28 (20% [95% CI, 14%-27%]) had an unknown trigger. Thus, there were a total of 77 patients (35% [95% CI, 29%-42%]) who had an alteration in the diagnosis of anaphylaxis or trigger after allergy/immunology evaluation. Four patients (2% [95% CI, 0.7%-4.6%]) were diagnosed with a mast cell activation disorder, and 13 patients (6% [95% CI, 4%-10%]) underwent immunotherapy or desensitization. Overall, 35% of the patients with suspected anaphylaxis in the ED had an alteration in the diagnosis or suspected trigger after allergy/immunology evaluation. These results underscore the importance of allergy/immunology follow-up after an ED visit for anaphylaxis. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  3. Future enhanced clinical role of pharmacists in emergency departments in England:multi-site observational evaluation

    OpenAIRE

    Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony

    2017-01-01

    Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at thei...

  4. Standard review plan for the review and evaluation of emergency plans for research and test reactors

    International Nuclear Information System (INIS)

    1983-10-01

    This document provides a Standard Review Plan to assure that complete and uniform reviews are made of research and test reactor radiological emergency plans. The report is organized under ten planning standards which correspond to the guidance criteria in American National Standard ANSI/ANS 15.16 - 1982 as endorsed by Revision 1 to Regulatory Guide 2.6. The applicability of the items under each planning standard is indicated by subdivisions of the steady-state thermal power levels at which the reactors are licensed to operate. Standard emergency classes and example action levels for research and test reactors which should initiate these classes are given in an Appendix. The content of the emergency plan is as follows: the emergency plan addresses the necessary provisions for coping with radiological emergencies. Activation of the emergency plan is in response to the emergency action levels. In addition to addressing those severe emergencies that will fall within one of the standard emergency classes, the plan also discusses the necessary provisions to deal with radiological emergencies of lesser severity that can occur within the operations boundary. The emergency plan allows for emergency personnel to deviate from actions described in the plan for unusual or unanticipated conditions

  5. [Triage evaluation making in a pediatric emergency department of a tertiary hospital].

    Science.gov (United States)

    Pascual-Fernández, Ma Cristina; Ignacio-Cerro, Ma Carmen; Jiménez-Carrascosa, Ma Amalia

    2014-03-01

    Evaluation triage level assignments depending level of the professionals' education and experience in the unit. This was a retrospective and observational study to triages making from January to March 2012 in Pediatric Emergency Department of tertiary hospital in Madrid. The collection data included variables from Pediatric Canadian Triage with five levels, triage tool using in the unit. 6443 triages were evaluated. The most common mistakes was: not to register pain level, 1445 (22.4%); not to register hydration level, 377 (5.9%); principal symptoms inappropriate, 232 (3.6%). Didn't indicate pain level 140 (5.6%) nurses with 12 hour formal training on triage; 492 (14.5%) with training in the unit, and 92 (16.3%) without training in the last year (p hydration level 296 (7.7%). The triage education favors better adaptation in the triage assignment. The most common errors are: not to register level pain and hydration when it's needed for the principal symptoms.

  6. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

    Directory of Open Access Journals (Sweden)

    Yuwares Sittichanbuncha

    2015-01-01

    Full Text Available Background. To differentiate acute coronary syndrome (ACS from other causes in patients presenting with chest pain at the emergency department (ED is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0% were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval were 4.220 (1.445, 12.327, 3.333 (1.040, 10.684, and 12.539 (3.876, 40.567, respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  7. A comparative evaluation of the process of developing and implementing an emergency department HIV testing program

    Directory of Open Access Journals (Sweden)

    Weiser Sheri

    2011-03-01

    Full Text Available Abstract Background The 2006 Centers for Disease Control and Prevention (CDC HIV testing guidelines recommend screening for HIV infection in all healthcare settings, including the emergency department (ED. In urban areas with a high background prevalence of HIV, the ED has become an increasingly important site for identifying HIV infection. However, this public health policy has been operationalized using different models. We sought to describe the development and implementation of HIV testing programs in three EDs, assess factors shaping the adoption and evolution of specific program elements, and identify barriers and facilitators to testing. Methods We performed a qualitative evaluation using in-depth interviews with fifteen 'key informants' involved in the development and implementation of HIV testing in three urban EDs serving sizable racial/ethnic minority and socioeconomically disadvantaged populations. Testing program HIV prevalence ranged from 0.4% to 3.0%. Results Three testing models were identified, reflecting differences in the use of existing ED staff to offer and perform the test and disclose results. Factors influencing the adoption of a particular model included: whether program developers were ED providers, HIV providers, or both; whether programs took a targeted or non-targeted approach to patient selection; and the extent to which linkage to care was viewed as the responsibility of the ED. A common barrier was discomfort among ED providers about disclosing a positive HIV test result. Common facilitators were a commitment to underserved populations, the perception that testing was an opportunity to re-engage previously HIV-infected patients in care, and the support and resources offered by the medical setting for HIV-infected patients. Conclusions ED HIV testing is occurring under a range of models that emerge from local realities and are tailored to institutional strengths to optimize implementation and overcome provider

  8. Evaluating the effect of clinical decision units on patient flow in seven Canadian emergency departments.

    Science.gov (United States)

    Schull, Michael J; Vermeulen, Marian J; Stukel, Therese A; Guttmann, Astrid; Leaver, Chad A; Rowe, Brian H; Sales, Anne

    2012-07-01

    To evaluate the effect of emergency department (ED) clinical decision units (CDUs) on overall ED patient flow in a pilot project funded in 2008 by the Ontario Ministry of Health and Long-Term Care (MOHLTC). A retrospective analysis of unscheduled ED visits at seven CDU pilot and nine control sites was conducted using administrative data. The authors examined trends in CDU utilization and compared outcomes between pilot-CDU and control sites 1 year prior to implementation, with the first 18 months of CDU operation. Sites that were unsuccessful in their applications for CDU program funding served as controls. Outcomes included ED length of stay (LOS), admission rates, and ED revisit rates. At CDU sites, roughly 4% of ED patients were admitted to CDUs. The presence of a pilot-CDU was independently associated with a small reduction in ED LOS for all low-acuity patients (-0.14 hour, 95% confidence interval [CI]=-0.22 to -0.07) and nonadmitted patients (-0.11 hour, 95% CI=-0.16 to -0.07). A small independent effect on absolute hospital admission rate for all high-acuity patients (-0.8%, 95% CI=-1.5% to -0.03%) and moderate-acuity patients (-0.6%, 95% CI=-1.1% to -0.2%) was also observed. Pilot-CDUs were not associated with changes in ED revisit rates. With only 4% of ED patients admitted to CDUs, the potential for efficiency gains in these EDs was limited. Nonetheless, these findings suggest small improvements in the operation of the ED through CDU implementation. Although marginal, the observed effects of CDU operation were in the desired direction of reduced ED LOS, reduced admission rate, and no increase in ED revisit rate. © 2012 by the Society for Academic Emergency Medicine.

  9. An Evaluation of Complications in Ultrasound-Guided Central Venous Catheter Insertion in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Engin OZAKIN

    2014-06-01

    Full Text Available SUMMARY: Objectives: In emergency departments, emergency physicians frequently have to perform central venous access. In cases where peripheral venous access is not possible, central venous access is required for dialysis, fulfillment of urgent fluid need, or central venous pressure measurement. This study was carried out to evaluate the emergence of complications in the process of and in the 15 days following the insertion of central venous catheter under ultrasound guidance in the emergency department. Methods: For this study, patients who presented to the emergency department over a period of eight months with an urgent need for central catheter were examined prospectively. Age, gender, and accompanying diseases of patients as well as the type, time, duration, and indication of the venous access were recorded. Furthermore, the amount of experience of the physician was taken into consideration. Results: In the emergency department, physicians performed ultrasound-guided central venous catheter insertion for 74 patients (40 men and 34 women. For access, internal jugular vein was used in 65 (87.8% patients, and femoral vein was used in 9 (12.2% patients. The reason for access was urgent dialysis need in 55 (74.3%, CVP measurement in 3 (4.1%, fluid support due to severe hypovolemia in 6 (8.1%, and difficulty of peripheral venous access in 10 (13.5% patients. None of the patients developed complications in the process of or after the insertion. Patients did not have infections related to the catheter in 15 days following the insertion. Conclusions: Central venous access is frequently required in emergency departments. The risk of complication is little if any in ultrasonographyguided access carried out under appropriate conditions. ÖZET: Amaç: Acil servislerde acil tıp hekimlerince santral damar yolu işlemi sık uygulanır. Periferik damar yolu açılamadığı hallerde, diyaliz, acil sıvı ihtiyacı veya santral venöz basınç

  10. 1992 update of US EPA's Superfund Innovative Technology Evaluation (SITE) Emerging Technology Program

    International Nuclear Information System (INIS)

    Lewis, N.M.; Barkley, N.P.; Williams, T.

    1992-01-01

    The Superfund Innovative Technology Evaluation (SITE) Emerging Technology Program (ETP) has financially supported further development of bench- and pilot-scale testing and evaluation of innovative technologies for use at hazardous waste sites for five years. The ETP was established under the Superfund Amendments and Reauthorization Act (SARA) of 1986. The ETP complies with the goal of the SITE Program to promote, accelerate and make commercially available the development of alternative/innovative treatment technologies for use at Superfund sites. Technologies are submitted to the ETP through yearly solicitations for Preproposals. Applicants are asked to submit a detailed project proposal and a cooperative agreement application that requires Developer/EPA cost sharing. EPA co-funds selected Developers for one to two years. Second-year funding requires documentation of significant progress during the first year. Facilities, equipment, data collection, performance and development are monitored throughout the project. The US Department of Energy (DOE) and the US Air Force (USAF) are participants in the ETP. DOE has co-funded ETP projects since 1990 and the USAF since 1991. A goal of the ETP is to move developed technologies to the field-demonstration stage. A developer may be considered for participation in the SITE Demonstration Program if performance in the ETP indicates the technology is field-ready for evaluation. Six technology categories: biological, chemical, materials handling, physical, solidification/stabilization and thermal, are presently in the ETP. Technologies of primary interest to EPA are those that can treat complex mixtures of hazardous organic and inorganic contaminants and provide improved solids handling and/or pretreatment. An account of the background and progress of the ETP's first five years is presented in this paper. Technologies currently in the ETP are noted, and developers and EPA Project Managers, are listed. 4 refs., 11 figs., 6 tabs

  11. Systematic preparation, execution and evaluation of emergency exercises at the Beznau nuclear power plant

    International Nuclear Information System (INIS)

    Tenschert, J.

    2011-01-01

    Based on federal acts and a specific guideline of the nuclear authority ENSI, strict requirements are imposed on emergency exercises at Swiss NPPs. The Beznau NPP has conducted emergency exercises for more than 30 years. Systematic exercise planning assures that all emergency cases defined in the plant-specific emergency plan are considered in the exercise scenarios. Technically oriented scenarios cover all groups of initiating events and all safety levels of the defense in depth principle. The exercise results are an important input for optimization measures in the areas of emergency organization, documentation and infrastructure. Due to the goal-oriented enforcement of laws and guidelines by the nuclear authority ENSI, emergency exercises serve as a motor of further optimization of emergency preparedness. (orig.)

  12. Emergent Expertise?

    Science.gov (United States)

    McGivern, Patrick

    2014-01-01

    The concept of emergence appears in various places within the literature on expertise and expert practice. Here, I examine some of these applications of emergence in the light of two prominent accounts of emergence from the philosophy of science and philosophy of mind. I evaluate these accounts with respect to several specific contexts in which…

  13. An Independent Human Factors Analysis and Evaluation of the Emergency Medical Protocol Checklist for the International Space Station

    Science.gov (United States)

    Marshburn, Thomas; Whitmore, Mihriban; Ortiz, Rosie; Segal, Michele; Smart, Kieran; Hughes, Catherine

    2003-01-01

    Emergency medical capabilities aboard the ISS include a Crew Medical Officer (CMO) (not necessarily a physician), and back-up, resuscitation equipment, and a medical checklist. It is essential that CMOs have reliable, usable and informative medical protocols that can be carried out independently in flight. The study evaluates the existing ISS Medical Checklist layout against a checklist updated to reflect a human factors approach to structure and organization. Method: The ISS Medical checklist was divided into non-emergency and emergency sections, and re-organized based on alphabetical and a body systems approach. A desk-top evaluation examined the ability of subjects to navigate to specific medical problems identified as representative of likely non-emergency events. A second evaluation aims to focus on the emergency section of the Medical Checklist, based on the preliminary findings of the first. The final evaluation will use Astronaut CMOs as subjects comparing the original checklist against the updated layout in the task of caring for a "downed crewmember" using a Human Patient Simulator [Medical Education Technologies, Inc.]. Results: Initial results have demonstrated a clear improvement of the re-organized sections to determine the solution to the medical problems. There was no distinct advantage for either alternative, although subjects stated having a preference for the body systems approach. In the second evaluation, subjects will be asked to identify emergency medical conditions, with measures including correct diagnosis, time to completion and solution strategy. The third evaluation will compare the original and fully updated checklists in clinical situations. Conclusions: Initial findings indicate that the ISS Medical Checklist will benefit from a reorganization. The present structure of the checklist has evolved over recent years without systematic testing of crewmember ability to diagnose medical problems. The improvements are expected to enable ISS

  14. Short communication: Evaluation of a model for predicting Avena fatua and Descurainia sophia seed emergence in winter rapeseed

    Directory of Open Access Journals (Sweden)

    Mohammad A. Aboutalebian

    2017-07-01

    Full Text Available Avena fatua and Descurainia sophia are two important annual weeds throughout winter rapeseed (Brassica napus L. production systems in the semiarid region of Iran. Timely and more accurate control of both species may be developed if there is a better understanding of its emergence patterns. Non-linear regression techniques are usually unable to accurately predict field emergence under such environmental conditions. The objectives of this research were to evaluate the emergence patterns of A. fatua and D. sophia and determine if emergence could be predicted using cumulative soil thermal time in degree days (CTT. In the present work, cumulative seedling emergence from a winter rapeseed field during 3 years data set was fitted to cumulative soil CTT using Weibull and Gompertz functions. The Weibull model provided a better fit, based on coefficient of determination (R2sqr, root mean square of error (RMSE and Akaike index (AICd, compared to the Gompertz model between 2013 and 2016 seasons for both species. Maximum emergence of A. fatua occured 70-119 days after sowing or after equals 329-426 °Cd, while in D. sophia it occurred 119-134 days after sowing rapeseed equals 373-470 °Cd. Both models can aid in the future study of A. fatua and D. sophia emergence and assist growers and agricultural professionals with planning timely and more accurate A. fatua and D. sophia control.

  15. Evaluation of response capacity to patient attention demand in an Emergency Department

    OpenAIRE

    Bruballa Vilas, Eva

    2017-01-01

    The progressive growth of aging, increased life expectancy and a greater number of chronic diseases contribute significantly to the growing demand of emergency medical care, and thus, on saturation of Emergency Departments. This is one of the most important current problems in healthcare systems worldwide. This work proposes an analytical model to calculate the theoretical throughput of a particular sanitary staff configuration in a Hospital Emergency Department, which is, the number of patie...

  16. Predicting pneumococcal community-acquired pneumonia in the emergency department: evaluation of clinical parameters.

    Science.gov (United States)

    Huijts, S M; Boersma, W G; Grobbee, D E; Gruber, W C; Jansen, K U; Kluytmans, J A J W; Kuipers, B A F; Palmen, F; Pride, M W; Webber, C; Bonten, M J M

    2014-12-01

    The aim of this study was to quantify the value of clinical predictors available in the emergency department (ED) in predicting Streptococcus pneumoniae as the cause of community-acquired pneumonia (CAP). A prospective, observational, cohort study of patients with CAP presenting in the ED was performed. Pneumococcal aetiology of CAP was based on either bacteraemia, or S. pneumoniae being cultured from sputum, or urinary immunochromatographic assay positivity, or positivity of a novel serotype-specific urinary antigen detection test. Multivariate logistic regression was used to identify independent predictors and various cut-off values of probability scores were used to evaluate the usefulness of the model. Three hundred and twenty-eight (31.0%) of 1057 patients with CAP had pneumococcal CAP. Nine independent predictors for pneumococcal pneumonia were identified, but the clinical utility of this prediction model was disappointing, because of low positive predictive values or a small yield. Clinical criteria have insufficient diagnostic capacity to predict pneumococcal CAP. Rapid antigen detection tests are needed to diagnose S. pneumoniae at the time of hospital admission. © 2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases.

  17. Evaluation of a curriculum for intimate partner violence screening in a pediatric emergency department.

    Science.gov (United States)

    Knapp, Jane F; Dowd, M Denise; Kennedy, Christopher S; Stallbaumer-Rouyer, Jennifer; Henderson, Deborah P

    2006-01-01

    We sought to describe the assessment of course participant changes in attitudes, self-efficacy, and behaviors after completion of the Its Time to Ask training curriculum for screening for intimate partner violence (IPV) in a pediatric emergency department (PED). A 22-item Likert scale questionnaire was administered at baseline (before training), after training, and at 6-month follow-up to PED employee participants in a 2-hour IPV education program. Mean participant responses were compared between baseline/posttraining and baseline/6-month follow-up. Participants also completed a course-satisfaction survey. A total of 79 PED staff completed the baseline questionnaire before the training. Eighty-seven participants completed the posttraining questionnaire, and 48 completed the 6-month follow-up questionnaire. Participants had consistent, positive changes in attitudes after training that persisted at the 6-month follow-up for 5 items on the questionnaire. Attitudes that did not change showed baseline means already in disagreement with questionnaire statements. Participants reported significant, positive changes for all 7 self-efficacy statements at 1 or both of the posttraining evaluations. The only changes in behavior were observed at 6 months. The majority of participants were satisfied with the training and would recommend it to colleagues. Significant, self-reported changes in attitudes, self-efficacy, and behaviors/clinical practice regarding screening for IPV in a PED can be achieved through participation in a brief training curriculum.

  18. Evaluation of emerging contaminants in a drinking water treatment plant using electrodialysis reversal technology.

    Science.gov (United States)

    Gabarrón, S; Gernjak, W; Valero, F; Barceló, A; Petrovic, M; Rodríguez-Roda, I

    2016-05-15

    Emerging contaminants (EC) have gained much attention with globally increasing consumption and detection in aquatic ecosystems during the last two decades from ng/L to lower ug/L. The aim of this study was to evaluate the occurrence and removal of pharmaceutically active compounds (PhACs), endocrine disrupting chemicals (EDCs) and related compounds in a Drinking Water Treatment Plant (DWTP) treating raw water from the Mediterranean Llobregat River. The DWTP combined conventional treatment steps with the world's largest electrodialysis reversal (EDR) facility. 49 different PhACs, EDCs and related compounds were found above their limit of quantification in the influent of the DWTP, summing up to a total concentration of ECs between 1600-4200 ng/L. As expected, oxidation using chlorine dioxide and granular activated carbon filters were the most efficient technologies for EC removal. However, despite the low concentration detected in the influent of the EDR process, it was also possible to demonstrate that this process partially removed ionized compounds, thereby constituting an additional barrier against EC pollution in the product. In the product of the EDR system, only 18 out of 49 compounds were quantifiable in at least one of the four experimental campaigns, showing in all cases removals higher than 65% and often beyond 90% for the overall DWTP process. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Current and Emerging Uses of Insertable Cardiac Monitors: Evaluation of Syncope and Monitoring for Atrial Fibrillation.

    Science.gov (United States)

    Tomson, Todd T; Passman, Rod

    Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost-effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Recent trials have demonstrated that a substantial proportion of patients with cryptogenic stroke have AF detected only by the prolonged monitoring provided by ICMs. A particularly promising and emerging use for ICMs is in the management of anticoagulation in patients with known paroxysmal AF. The introduction in recent years of ICMs with automatic AF detection algorithms and continuous remote monitoring in combination with novel oral anticoagulants have opened the door for targeted anticoagulation guided by remote monitoring, a strategy that has recently shown promise in pilot studies of this technique. While further research is needed before official recommendations can be given, this use of ICMs opens exciting new possibilities for personalized medicine that could potentially reduce bleeding risk and improve quality of life in patients with atrial fibrillation.

  20. [Security material for venous peripheral..catheterization evaluation in an emergency ward].

    Science.gov (United States)

    Romero Ruiz, Adolfo; Jiménez Ruiz, Manuel; Rodríguez Navarro, Luis Miguel; Muñoz Pascual, José Carlos; Ramos Rueda, M del Carmen; Torres Pérez, Luis

    2007-06-01

    Venous canalization can be one of the most frequent causes of accidents due to an accidental puncture. To carry out activities which serve to lessen these misfortunes, bearing high biological risk, should become a priority for sanitary institutions and for their professionals. Inside a global strategy which deals with this aspect and with the objective of evaluating the convenience these instruments have in our center the authors made a practical evaluation on a series of them to discover their technical viability and their subjective consideration by professionals who employ them. For motives related to the practices of the ward in which this research took place, an emergency ward, the authors intentionally chose two passive instruments, available on the market, and three nurses who received 120 sample security catheters, 60 each for products A and B, to carry out habitual clinical practices, alongside a pad of paper on which to record any incidents. Regarding instrument A, 30 incidents, 52.6%, were detected while 37 sample procedures occurred. Regarding instrument B, 4 incidents, 7.01%, were detected while 47 sample procedures occurred. In absolute terms, neither of the two instruments demonstrated problems of an insecure manner; which is to say neither produced a situation related to the appearance of mis fortunate incidents associated to accidental punctures. The lower number of incidents with instrument B appears to be related to the habitual use of a conventional cathetec not a security one, produced by the same manufacturer in our center This research project was subsidized by the Sanitary Research Fund, PI 051265.

  1. Role of presepsin for the evaluation of sepsis in the emergency department.

    Science.gov (United States)

    Pizzolato, Elisa; Ulla, Marco; Galluzzo, Claudia; Lucchiari, Manuela; Manetta, Tilde; Lupia, Enrico; Mengozzi, Giulio; Battista, Stefania

    2014-10-01

    Sepsis, severe sepsis and septic shock are among the most common conditions handled in the emergency department (ED). According to new Sepsis Guidelines, early diagnosis and treatment are the keys to improve survival. Plasma C-reactive protein (CRP) and procalcitonin (PCT) levels, when associated with documented or suspected infection, are now part of the definitions of sepsis. Blood culture is the gold standard method for detecting microorganisms but it requires too much time for results to be known. Sensitive biomarkers are required for early diagnosis and as indexes of prognosis sepsis. CRP is one of the acute phase proteins synthesized by the liver: it has a great sensitivity but a very poor specificity for bacterial infections. Moreover, the evolution of sepsis does not correlate with CRP plasma changes. In recent years PCT has been widely used for sepsis differential diagnosis, because of its close correlation with infections, but it still retains some limitations and false positivity (such as in multiple trauma and burns). Soluble CD14 subtype (sCD14-ST), also known as presepsin, is a novel and promising biomarker that has been shown to increase significantly in patients with sepsis, in comparison to the healthy population. Studies pointed out the capability of this biomarker for diagnosing sepsis, assessing the severity of the disease and providing a prognostic evaluation of patient outcome. In this mini review we mainly focused on presepsin: we evaluate its diagnostic and prognostic roles in patients presenting to the ED with systemic inflammatory response syndrome (SIRS), suspected sepsis or septic shock.

  2. Novel effects-based monitoring approaches to evaluate chemicals of emerging concern in the St. Louis River estuary

    Science.gov (United States)

    As part of an on-going program of research in support of the Great Lakes Restoration Initiative, the US EPA MED laboratory has been developing effects-based biomonitoring tools to evaluate the occurrence and potential hazards associated with Chemicals of Emerging Concern (CECs). ...

  3. Novel effects-based monitoring approaches to evaluate chemicals of emerging concern in Great Lakes areas of concern

    Science.gov (United States)

    As part of an on-going program of research in support of the Great Lakes Restoration Initiative, we have been developing effects-based biomonitoring tools to evaluate the occurrence and potential hazards associated with Chemicals of Emerging Concern (CECs). Over three field seaso...

  4. Evaluation of semi-generic PBTK modeling for emergency risk assessment after acute inhalation exposure to volatile hazardous chemicals

    NARCIS (Netherlands)

    Olie, J Daniël N; Bessems, Jos G; Clewell, Harvey J; Meulenbelt, Jan; Hunault, Claudine C

    BACKGROUND: Physiologically Based Toxicokinetic Models (PBTK) may facilitate emergency risk assessment after chemical incidents with inhalation exposure, but they are rarely used due to their relative complexity and skill requirements. We aimed to tackle this problem by evaluating a semi-generic

  5. Evaluation of semi-generic PBTK modeling for emergency risk assessment after acute inhalation exposure to volatile hazardous chemicals

    NARCIS (Netherlands)

    Olie, J. Daniël N; Bessems, Jos G.; Clewell, Harvey J.; Meulenbelt, Jan; Hunault, Claudine C.

    2015-01-01

    BACKGROUND: Physiologically Based Toxicokinetic Models (PBTK) may facilitate emergency risk assessment after chemical incidents with inhalation exposure, but they are rarely used due to their relative complexity and skill requirements. We aimed to tackle this problem by evaluating a semi-generic

  6. Using artificial intelligence and web media data to evaluate the growth potential of companies in emerging industry sectors

    DEFF Research Database (Denmark)

    Tanev, Stoyan; Droll, Andrew; Khan, Shahzad

    2017-01-01

    In this article, we describe our efforts to adapt and validate a web search and analytics tool – the Gnowit Cognitive Insight Engine – to evaluate the growth and competitive potential of new technology startups and existing firms in the newly emerging precision medicine sector. The results are ba...

  7. Evaluation of three physiologically based pharmacokinetic (PBPK) modeling tools for emergency risk assessment after acute dichloromethane exposure

    NARCIS (Netherlands)

    Boerleider, R. Z.; Olie, J. D N; van Eijkeren, J. C H; Bos, P. M J; Hof, B. G H; de Vries, I.; Bessems, J. G M; Meulenbelt, J.; Hunault, C. C.

    2015-01-01

    Introduction: Physiologically based pharmacokinetic (PBPK) models may be useful in emergency risk assessment, after acute exposure to chemicals, such as dichloromethane (DCM). We evaluated the applicability of three PBPK models for human risk assessment following a single exposure to DCM: one model

  8. Developing and evaluating the success of a family activated medical emergency team: a quality improvement report.

    Science.gov (United States)

    Brady, Patrick W; Zix, Julie; Brilli, Richard; Wheeler, Derek S; Griffith, Kristie; Giaccone, Mary Jo; Dressman, Kathy; Kotagal, Uma; Muething, Stephen; Tegtmeyer, Ken

    2015-03-01

    Family-activated medical emergency teams (MET) have the potential to improve the timely recognition of clinical deterioration and reduce preventable adverse events. Adoption of family-activated METs is hindered by concerns that the calls may substantially increase MET workload. We aimed to develop a reliable process for family activated METs and to evaluate its effect on MET call rate and subsequent transfer to the intensive care unit (ICU). The setting was our free-standing children's hospital. We partnered with families to develop and test an educational intervention for clinicians and families, an informational poster in each patient room and a redesigned process with hospital operators who handle MET calls. We tracked our primary outcome of count of family-activated MET calls on a statistical process control chart. Additionally, we determined the association between family-activated versus clinician-activated MET and transfer to the ICU. Finally, we compared the reason for MET activation between family calls and a 2:1 matched sample of clinician calls. Over our 6-year study period, we had a total of 83 family-activated MET calls. Families made an average of 1.2 calls per month, which represented 2.9% of all MET calls. Children with family-activated METs were transferred to the ICU less commonly than those with clinician MET calls (24% vs 60%, pFamilies, like clinicians, most commonly called MET for concerns of clinical deterioration. Families also identified lack of response from clinicians and a dismissive interaction between team and family as reasons. Family MET activations were uncommon and not a burden on responders. These calls recognised clinical deterioration and communication failures. Family activated METs should be tested and implemented in hospitals that care for children. 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.

  9. Utility of the CORD ECG Database in Evaluating ECG Interpretation by Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Wong, Hubert E

    2002-10-01

    Full Text Available OBJECTIVES: Electrocardiograph (ECG interpretation is a vital component of Emergency Medicine (EM resident education, but few studies have formally examined ECG teaching methods used in residency training. Recently, the Council of EM Residency Directors (CORD developed an Internet database of 395 ECGs that have been extensively peer-reviewed to incorporate all findings and abnormalities. We examined the efficacy of this database in assessing EM residents' skills in ECG interpretation. METHODS: We used the CORD ECG database to evaluate residents at our academic three-year EM residency. Thirteen residents participated, including four first-year, four second-year, and five third-year residents. Twenty ECGs were selected using 14 search criteria representing a broad range of abnormalities, including infarction, rhythm, and conduction abnormalities. Exams were scored based on all abnormalities and findings listed in the teaching points accompanying each ECG. We assigned points to each abnormal finding based on clinical relevance. RESULTS: Out of a total of 183 points in our clinically weighted scoring system, first-year residents scored an average of 99 points (54.1% [9 1- 1191, second-year residents 11 1 points (60.4% [97-1261, and third-year residents 130 points (7 1.0% [94- 1501, p = 0.12. Clinically relevant abnormalities, including anterior and inferior myocardial infarctions, were most frequently diagnosed correctly, while posterior infarction was more frequently missed. Rhythm abnormalities including ventricular and supraventricular tachycardias were most frequently diagnosed correctly, while conduction abnormalities including left bundle branch block and atrioventricular (AV block were more frequently missed. CONCLUSION: The CORD database represents a valuable resource in the assessment and teaching of ECG skills, allowing more precise identification of areas upon which instruction should be further focused or individually tailored. Our

  10. Evaluation of management of communication in the actions of preparedness and response to nuclear and radiological emergencies

    Energy Technology Data Exchange (ETDEWEB)

    Mello Filho, Mauro Otto de Cavalcanti; Beserra, Marcela Tatiana Fernandes, E-mail: maurootto@cefet-rj.br, E-mail: maurootto@gmail.com, E-mail: mbeserra@cefet-rj.br [Centro Federal de Educacao Celso Sucknow da Fonseca (CEFET-RJ), Rio de Janeiro, RJ (Brazil); Wasserman, Maria Angelica Vergara, E-mail: mwasserman@ien.gov.br [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Wasserman, Julio Cesar de Faria Alvim, E-mail: geowass@vm.uff.br [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil)

    2013-07-01

    The use of practices involving the use of ionizing radiation in diverse areas of knowledge increases every day. This growth warning about the increased probability of accidents, radiological and nuclear emergencies, with possible consequences for the public, workers and the environment. Within this scenario, it is clear that studies and reassessments of the emergency response actions, receive proposals for continuous improvement. The achievement of the objectives of the response must be sustained by tactical, operation and logistics optimized processes. The articulation through communication between the teams involved in the response must be adaptable to each accident or emergency, respecting its size. The objectives of this study is to perform an assessment on the management of communication in the actions of Preparedness and Response to Nuclear and Radiological Emergencies. This assessment is supported by best practices of the Incident Command System (ICS) and the Institute of Project Management (Project Management Institute-PMI). For this purpose, based on models referred were established performance indicators supported by the BSC (Balanced Scorecard). These indicators allowed to evaluate more objectively the performance of the communication processes associated with each phase of the response. The study resulted in the proposed model documents aiming to assist planning of communications exercises in preparation and response actions, supported and adapted the best practices of PMI. These methodologies were evaluated by real cases selected from radiological and nuclear emergencies published by the International Atomic Energy Agency (IAEA). (author)

  11. Evaluation of management of communication in the actions of preparedness and response to nuclear and radiological emergencies

    International Nuclear Information System (INIS)

    Mello Filho, Mauro Otto de Cavalcanti; Beserra, Marcela Tatiana Fernandes; Wasserman, Maria Angelica Vergara; Wasserman, Julio Cesar de Faria Alvim

    2013-01-01

    The use of practices involving the use of ionizing radiation in diverse areas of knowledge increases every day. This growth warning about the increased probability of accidents, radiological and nuclear emergencies, with possible consequences for the public, workers and the environment. Within this scenario, it is clear that studies and reassessments of the emergency response actions, receive proposals for continuous improvement. The achievement of the objectives of the response must be sustained by tactical, operation and logistics optimized processes. The articulation through communication between the teams involved in the response must be adaptable to each accident or emergency, respecting its size. The objectives of this study is to perform an assessment on the management of communication in the actions of Preparedness and Response to Nuclear and Radiological Emergencies. This assessment is supported by best practices of the Incident Command System (ICS) and the Institute of Project Management (Project Management Institute-PMI). For this purpose, based on models referred were established performance indicators supported by the BSC (Balanced Scorecard). These indicators allowed to evaluate more objectively the performance of the communication processes associated with each phase of the response. The study resulted in the proposed model documents aiming to assist planning of communications exercises in preparation and response actions, supported and adapted the best practices of PMI. These methodologies were evaluated by real cases selected from radiological and nuclear emergencies published by the International Atomic Energy Agency (IAEA). (author)

  12. [Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission].

    Science.gov (United States)

    Bartiaux, M; Mols, P

    2017-01-01

    patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.

  13. Consensus Guidelines on Evaluation and Management of the Febrile Child Presenting to the Emergency Department in India.

    Science.gov (United States)

    Mahajan, Prashant; Batra, Prerna; Thakur, Neha; Patel, Reena; Rai, Narendra; Trivedi, Nitin; Fassl, Bernhard; Shah, Binita; Lozon, Marie; Oteng, Rockerfeller A; Saha, Abhijeet; Shah, Dheeraj; Galwankar, Sagar

    2017-08-15

    India, home to almost 1.5 billion people, is in need of a country-specific, evidence-based, consensus approach for the emergency department (ED) evaluation and management of the febrile child. We held two consensus meetings, performed an exhaustive literature review, and held ongoing web-based discussions to arrive at a formal consensus on the proposed evaluation and management algorithm. The first meeting was held in Delhi in October 2015, under the auspices of Pediatric Emergency Medicine (PEM) Section of Academic College of Emergency Experts in India (ACEE-INDIA); and the second meeting was conducted at Pune during Emergency Medical Pediatrics and Recent Trends (EMPART 2016) in March 2016. The second meeting was followed with futher e-mail-based discussions to arrive at a formal consensus on the proposed algorithm. To develop an algorithmic approach for the evaluation and management of the febrile child that can be easily applied in the context of emergency care and modified based on local epidemiology and practice standards. We created an algorithm that can assist the clinician in the evaluation and management of the febrile child presenting to the ED, contextualized to health care in India. This guideline includes the following key components: triage and the timely assessment; evaluation; and patient disposition from the ED. We urge the development and creation of a robust data repository of minimal standard data elements. This would provide a systematic measurement of the care processes and patient outcomes, and a better understanding of various etiologies of febrile illnesses in India; both of which can be used to further modify the proposed approach and algorithm.

  14. [Evaluation of the activity of a urological emergency unit in university hospital].

    Science.gov (United States)

    Martin, L; Pillot, P; Bardonnaud, N; Lillaz, J; Chabannes, E; Bernardini, S; Guichard, G; Bittard, H; Kleinclauss, F

    2014-01-01

    To determine the epidemiology of urological emergencies in a university hospital and the interest of a dedicated urological emergency unit. In 2008, a dedicated urological emergency unit was individualized in our department of urology. We conducted a retrospective study including all patients consulting in this unit in 2009 with epidemiological, clinical and therapeutic data. During 2009, 1257 patients consulted in this unit. Main diagnoses were acute urinary retention (303, 24.11%), renal colic (219, 17.42%), urinary infections (278, 22.11%), postoperative complications (141, 11.22%), symptomatic benign prostate hyperplasia (65, 5.17%), genitourinary cancers (61, 4.85%), trauma of urinary apparel (41, 3.26%), and spermatic cords torsion (10, 0.8%). In 99 cases (7.88%) diagnosis did not involved the urinary system. The treatment was surgical in 213 (17.7%) cases, technical procedure under local anesthesia in 368 (29.3%) and a medical treatment in 675 (53.7%) cases. Six hundred and sixty (52.5%) patients were managed ambulatory whereas 596 (47.5%) needed hospitalization. The opening of a dedicated urological emergency unit lead to 1257 emergency consultations. Frequent etiologies were acute urinary retention, renal colic and urinary infection. The creation of this unit allowed to register and to valorize this emergency activity through the ATU emergency amount. Copyright © 2013. Published by Elsevier Masson SAS.

  15. Evaluating psychiatric nursing competencies applied to emergency settings: A pilot role delineation study.

    Science.gov (United States)

    Mello, Joanna J; Bell, Janice F; Siegel, Elena O; Ward, Deborah H

    2016-03-01

    Despite increasing emergency department (ED) use for psychiatric emergencies, limited evidence exists to clearly identify the competencies necessary of emergency nurses to care for this population. 1. To define the specialized skill and knowledge of emergency nurses by examining the frequency with which recommended psychiatric nursing competencies are performed in the ED setting. 2. To assess emergency nurses' rankings of importance and self-efficacy related to recommended psychiatric nursing competencies in order to explore their relevance to emergency nursing. Emergency nurses (n = 75) completed a survey ranking the frequency, importance and self-efficacy of 15 psychiatric nursing competencies. Data analysis revealed competency relevance and regression analysis demonstrated factors that may contribute to self-efficacy. Nurses reported performing psychiatric competencies frequently (mean scores of 0.64 to 3.04). Importance rankings were highest (mean scores of 1.81 to 3.67). Self-efficacy mean scores ranged from 0.89 to 3.47. Frequency and importance of activities predicted higher self-efficacy scores. Younger age and competencies often, and existing competencies appear applicable. As frequency and importance of competencies influence self-efficacy, practice and interventions to underscore the importance of competencies may improve self-efficacy. Younger and less experienced nurses might require more support. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Evaluation of emergency department nursing services and patient satisfaction of services.

    Science.gov (United States)

    Mollaoğlu, Mukadder; Çelik, Pelin

    2016-10-01

    To identify nursing services and assess patient satisfaction in patients who present to the emergency department. Emergency nursing care is a significant determinant of patient satisfaction. Patient satisfaction is often regarded as a reliable indicator of the quality of services provided in the emergency department. This is a descriptive study. Eighty-four patients who presented to the university emergency department were included in the study. The study data were collected by the Patient Information Form and the Satisfaction Level Form. Emergency nursing services, including history taking, assessing vital signs, preparing the patient for an emergency intervention, oxygen therapy, drug delivery and blood-serum infusion were shown to be more commonly provided compared with other services such as counselling the patients and the relatives about their care or delivering educational and psychosocial services. However, 78·6% of the patients were satisfied with their nursing services. The highest satisfaction rates were observed in the following sub-dimensions of the Satisfaction Level Form: availability of the nurse (82·1%), behaviour of the nurse towards the patient (78·6%) and the frequency of nursing rounds (77·4%). The most common practices performed by nurses in the emergency department were physical nursing services. Patient satisfaction was mostly associated with the availability of nurses when they were needed. Our results suggest that in addition to the physical care, patients should also receive education and psychosocial care in the emergency department. We believe that this study will contribute to the awareness and understanding of principles and concepts of emergency nursing, extend the limits of nursing knowledge and abilities, and improve and maintain the quality of clinical nursing education and practice to train specialist nurses with high levels of understanding in ethical, intellectual, administrative, investigative and professional issues.

  17. Evaluation of Ventricle Size Measurements in Infants by Pediatric Emergency Medicine Physicians.

    Science.gov (United States)

    Halm, Brunhild M; Leone, Tina A; Chaudoin, Lindsey T; McKinley, Kenneth W; Ruzal-Shapiro, Carrie; Franke, Adrian A; Tsze, Daniel S

    2018-06-05

    The identification of hydrocephalus in infants by pediatric emergency medicine (PEM) physicians using cranial point-of-care ultrasound (POCUS) has not been evaluated. We aimed to conduct a pilot/proof-of-concept study to evaluate whether PEM physicians can identify hydrocephalus (anterior horn width >5 mm) in 15 infants (mean 69 ± 42 days old) from the neonatal intensive care unit using POCUS. Our exploratory aims were to determine the test characteristics of cranial POCUS performed by PEM physicians for diagnosing hydrocephalus and the interrater reliability between measurements made by the PEM physicians and the radiologist. Depending on the availability, 1 or 2 PEM physicians performed a cranial POCUS through the open anterior fontanel for each infant after a 30-minute didactic lecture to determine the size of the left and right ventricles by measuring the anterior horn width at the foramen of Monroe in coronal view. Within 1 week, an ultrasound (US) technologist performed a cranial US and a radiologist determined the ventricle sizes from the US images; these measurements were the criterion standard. A radiologist determined 12 of the 30 ventricles as hydrocephalic. The sensitivity and specificity of the PEM physicians performed cranial POCUS was 66.7% (95% confidence interval [CI], 34.9%-90.1%) and 94.4% (95% CI, 72.7%-99.9%), whereas the positive and negative predictive values were 88.9% (95% CI, 53.3%-98.2%) and 81.0% (95% CI, 65.5%-90.5%), respectively. The interrater reliability between the PEM physician's and radiologist's measurements was r = 0.91. The entire POCUS examinations performed by the PEM physicians took an average of 1.5 minutes. The time between the cranial POCUS and the radiology US was, on average, 4 days. While the PEM physicians in our study were able to determine the absence of hydrocephalus in infants with high specificity using cranial POCUS, there was insufficient evidence to support the use of this modality for identifying

  18. Systems approach to detect and evaluate contaminants of emerging concern in the Great Lakes

    Science.gov (United States)

    The release of chemicals of emerging concern threatens near shore health in the Great Lakes, particularly in regions already suffering from degradation of water and environmental quality due to past and present anthropogenic activities. Critical issues remain in delisting Areas ...

  19. Reliability evaluation of emergency AC power systems based on operating experience at U.S. nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Baranowsky, P. W. [U.S. Nuclear Regulatory Commission, Washington, DC (United States)

    1986-02-15

    The reliability of emergency AC power Systems has been under study at the U.S. Nuclear Regulatory Commission and by its contractors for several years. This paper provides the results of work recently performed to evaluate past U.S. nuclear power plant emergency AC power System reliability performance using system level data. Operating experience involving multiple diesel generator failures, unavailabilities, and simultaneous occurrences of failures and out of service diesel generators were used to evaluate reliability performance at individual nuclear power plants covering a 9 year period from 1976 through 1984. The number and nature of failures and distributions of reliability evaluation results are provided. The results show that plant specific performance varied considerably during the period with a large number achieving high reliability performance and a smaller number accounting for lower levels of reliability performance. (author)

  20. Emergency Preparedness Hazards Assessment for solid waste management facilities in E-area not previously evaluated

    International Nuclear Information System (INIS)

    Hadlock, D.J.

    1999-01-01

    This report documents the facility Emergency Preparedness Hazards Assessment (EPHA) for the Solid Waste Management Department (SWMD) activities located on the Department of Energy (DOE) Savannah River Site (SRS) within E Area that are not described in the EPHAs for Mixed Hazardous Waste storage, the TRU Waste Storage Pads or the E-Area Vaults. The hazards assessment is intended to identify and analyze those hazards that are significant enough to warrant consideration in the SWMD operational emergency management program

  1. Bedside Ultrasonography as an Adjunct to Routine Evaluation of Acute Appendicitis in the Emergency Department

    OpenAIRE

    Lam, Samuel H.F.; Grippo, Anthony; Kerwin, Chistopher; Konicki, P. John; Goodwine, Diana; Lambert, Michael J.

    2014-01-01

    Introduction: Appendicitis is a common condition presenting to the emergency department (ED). Increasingly emergency physicians (EP) are using bedside ultrasound (BUS) as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis. Methods: Patients four years of age and older presenting to the ED with suspect...

  2. Emergency contraception: why can't you give it away? Qualitative findings from an evaluation of advance provision of emergency contraception.

    Science.gov (United States)

    Fairhurst, Karen; Ziebland, Sue; Wyke, Sally; Seaman, Peter; Glasier, Anna

    2004-07-01

    The Lothian Emergency Contraception Project (LECP)--a primary care-based intervention to offer advance supplies of emergency contraception (EC) to women aged 16-29 was not associated with a reduction in abortion rates. We undertook case studies, utilizing qualitative and quantitative methods, to evaluate the intervention. In this article we present findings from qualitative interviews with 44 primary care professionals working at case study sites and 22 women who had received advance supplies to explain this failure. Professionals reported that women rarely asked for advance supplies of EC and they were reluctant to offer supplies to women because of concerns about contradictory sexual health messages implied by the offer, a perceived association of EC use with chaotic behavior by women, views about the sort of women suitable for advance supplies and practical difficulties making the offer. Women were reluctant to ask for advance supplies because of misgivings about the appropriateness of offering advance supplies to everybody and concerns about being judged by health professionals as morally inadequate. If advance provision of EC is to be successful in reducing abortion rates, professionals must address their concerns about EC and develop imaginative ways of encouraging women most at risk of unwanted pregnancy to take supplies home.

  3. Thallium myocardial scanning in the emergency department evaluation of chest pain

    International Nuclear Information System (INIS)

    Mace, S.E.

    1989-01-01

    Chest pain is a common complaint of patients seen in the emergency department. The causes are legion, and range from the non-life threatening to the potentially catastrophic. Thallium heart scanning was done prospectively in 20 patients with a ''classic'' history for myocardial infarction (eight patients) or atypical chest pain and/or associated symptoms plus an abnormal ECG (12 patients) to discern a subset of patients from whom thallium scintography may be indicated in the emergency department. Although further investigation is needed, our preliminary study suggests that myocardial scanning with thallium can be a safe, fairly rapid, and useful objective parameter in the emergency department detection of suspected myocardial infarction, and in differential diagnosis of chest pain when other data such as the history, physical examination, ECG, or enzymes are inconclusive

  4. Non-traumatic limping in Paediatric Emergencies: Epidemiology, evaluation and results.

    Science.gov (United States)

    Lázaro Carreño, M I; Fraile Currius, R; García Clemente, A

    Non-traumatic limping is a common reason for consultation in paediatric emergencies. Although transient synovitis of the hip (TS) is the most frequent diagnosis, there are cases of limping secondary to serious pathologies. The aim of this review is to describe the variables related to non-traumatic limp that come to the paediatric emergency department to establish the best management protocol, making the most of resources and speeding up emergency care. A prospective study was conducted, selecting all children less than 15 years old who consulted aspaediatric emergencies for non-traumatic limping during the 2014. Clinical variables, complementary examinations and diagnoses were collected in the emergency room consultation and 6 months after the consultation RESULTS: During 2014, 146 patients (0.69% of the emergencies) were included in the non-traumatic limping study. Four cases of severe limping were diagnosed: 2 leukaemias, 1 septic arthritis and 1 acetabular bone tumour. The most frequent diagnosis was TS (53.16%). At 6 months, 135 children (92.4%) had resolved lameness. The diagnosis was changed in 9 children (6.1%). Children with TS had fewer days of evolution, and 77% were between 3 and 10 years old. Children with a final diagnosis of severe pathology had a limp for longer, fever and did not weight bear on ambulation. In limping of probable hip origin, at the ages of between 3 and 10, without fever or systemic symptoms and of less than one week's onset, it is possible to make a clinical diagnosis of TS limiting the use of complementary examinations. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. The Mainz Neutrino Mass Experiment

    Czech Academy of Sciences Publication Activity Database

    Kraus, C.; Bornschein, L.; Bonn, J.; Bornschein, B.; Flatt, B.; Kovalík, Alojz; Müller, B.; Otten, EW; Schall, JP.; Thummler, T.; Weinheimer, C.

    2005-01-01

    Roč. 143, - (2005), s. 143 ISSN 0920-5632. [International Conference on Neutrino Physics and Astrophysics /21./. Paříž, 14.06.2004-19.06.2004] R&D Projects: GA MŠk 1P04LA213 Institutional research plan: CEZ:AV0Z10480505 Keywords : neutrino mass * tritium beta decay Subject RIV: BG - Nuclear, Atomic and Molecular Physics, Colliders Impact factor: 0.875, year: 2005

  6. Thermal-hydraulic evaluation study of the effectiveness of emergency core cooling system for light water reactors

    International Nuclear Information System (INIS)

    Sobajima, Makoto

    1985-08-01

    In order to evaluate the core cooling capability of the emergeny core cooling system, which is a safety guard system of light water reactors for a loss-of-coolant accident, a variety of large scale test were performed. Through the results, many phenomena were investigated and the predictabity of analytical codes were examined. The tests conducted were a single-vessel blowdown test, emergency core cooling test in a PWR simulation facility, spray cooling test for a BWR, large scale reflood test and a separate effect test on countercurrent flow. These test results were examined to clarify thermal-hydraulic phenomena and the effect of various test parameters and were utilized to improve predictability of the analytical codes. Some models for flow behavior in the upper core were also developed. By evaluating the effectiveness of various emergency core cooling system configurations, more effective cooling system than the current one was proposed and demonstrated. (author)

  7. Use of standardized multidimensional evaluation tools and the emergence of the case manager's professional identity in France.

    Science.gov (United States)

    Nugue, Mathilde; De Stampa, Matthieu; Couturier, Yves; Somme, Dominique

    2012-01-01

    In France, the national public health plan proposes a group of innovations including the initiation of case management for older adults in complex situations, particularly those with cognitive disorders. In this context, public authorities asked case managers to use a standardized multidimensional evaluation tool. The results of a qualitative study on the pertinence of such a tool relative to the emergence of this new professional field are described. Early use of an evaluation tool seems to be linked to the emergence of a new professional identity for recently recruited case managers. Factors determining the strength of this link are training tool standardization, computerization, and local structure's involvement. Our results contribute to identifying one of the ways by which professional identity can be changed to become a case manager.

  8. A framework for evaluating the effectiveness of flood emergency management systems in Europe

    NARCIS (Netherlands)

    Gilissen, H.K.|info:eu-repo/dai/nl/314838732; Alexander, Meghan; Matczak, Piotr; Pettersson, Maria; Bruzzone, Silvia

    2016-01-01

    Society is faced with a range of contemporary threats to everyday life, from natural and technological hazards, to accidents and terrorism. These are embodied within integrated emergency management arrangements, designed to enhance preparedness and response to such incidents, and in turn facilitate

  9. Improving evaluation criteria for monitoring networks of weak radioactive plumes after nuclear emergencies

    DEFF Research Database (Denmark)

    Urso, L.; Astrup, Poul; Helle, K.B.

    2012-01-01

    Networks of monitoring stations have been set up in many European countries to detect the passage of a radioactive cloud in the event of a large-scale nuclear emergency. The layout and spatial density of these networks differs according to the needs and criteria defined by national authorities...

  10. An Assessment of an Oral Examination Format for Evaluating Clinical Competence in Emergency Medicine.

    Science.gov (United States)

    Solomon, David J.; And Others

    1990-01-01

    In July 1989 the American Board of Emergency Medicine conducted a field test of the oral recertification examination process. Sixteen examiners and 25 examinees participated in the field test. The examination included 3 chart-stimulated recall and 3 simulated-patient encounter cases. (MLW)

  11. Role of computed tomography in emergency evaluation of the nervous system

    International Nuclear Information System (INIS)

    Pelletier, J.; Martini, P.

    1994-01-01

    Computed tomography is the essential examination in patients with severe manifestations of neurological disorders. We discuss emergency situations involving the central nervous system due to vascular and infections lesions. Trauma and acute complications of brain tumours, usually seen within a neurosurgical context, are not discussed here. (authors). 11 refs., 19 figs

  12. Adapting protocols of CT imaging in a pediatric emergency department. Evaluation of image quality and dose

    International Nuclear Information System (INIS)

    Batista Arce, A.; Gonzalez Lopez, S.; Catalan Acosta, A.; Casares Magaz, O.; Hernandez Armas, O.; Hernandez Armas, J.

    2011-01-01

    The purpose of this study was to assess qualitatively the picture quality in relation to the radiation dose delivered in CT studies of computer tomograph Pediatric Emergency Department of Hospital Universitario de Canarias (HUC) in order to optimize the technical parameters used these radiological examinations so as to obtain optimal image quality at the lowest possible dose.

  13. The significance of a usability evaluation of an emerging laboratory order entry system

    NARCIS (Netherlands)

    Peute, Linda W. P.; Jaspers, Monique W. M.

    2007-01-01

    OBJECTIVES: To assess the usability of an emerging POE system, OM/Lab, for the computer-supported ordering of laboratory tests. We were more specifically interested in the relation of the usability problems detected in the user testing sessions with the order behaviour in terms of efficiency and

  14. Emergency Contraception Education for Health and Human Service Professionals: An Evaluation of Knowledge and Attitudes

    Science.gov (United States)

    Colarossi, Lisa; Billowitz, Marissa; Breitbart, Vicki

    2010-01-01

    Objective: To assess the knowledge and attitudes of health care providers, health educators, and social service providers before and after a training session on emergency contraceptive pills. Design: A survey study using pre-post training measurements. Setting: Two hundred and twenty-three medical, social service, and health education providers in…

  15. Future enhanced clinical role of pharmacists in Emergency Departments in England: multi-site observational evaluation.

    Science.gov (United States)

    Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony

    2017-08-01

    Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists.

  16. [Evaluation of a Legionella outbreak emerged in a recently opening hotel].

    Science.gov (United States)

    Erdoğan, Haluk; Arslan, Hande

    2013-04-01

    Legionnaires' disease (LD) is a systemic infection caused by Legionella species especially colonized in the water systems. Hotels are common locations in which waterwork-associated sporadic or epidemic legionellosis can be detected. The aim of this study was to evaluate a small Legionella outbreak emerged in a recently opened 600-bed hotel in Alanya, a touristic county in Mediterranean part of Turkey. A 66 years old male patient who stayed in this hotel opened on May 15th, 2009, was admitted to our hospital on May 21st, 2009 with the complaints of high fever, headache and diarrhea lasting for three days. Since chest X-ray revealed non-homogenous density increase in left middle and inferior zone, the patient was diagnosed as atypical pneumoniae and LD was confirmed by positive urinary Legionella antigen test (Card test, BinaxNOW®Legionella Urinary Antigen Test; Alere Co, USA) result. Following the identification of the index case, the records of our hospital were reviewed and revealed another case being treated with the diagnosis of community acquired pneumonia who was also the guest of the same hotel. This patient was then diagnosed as LD by positive urinary antigen test. Since new cases were identified during the following days (May 22, 25 and 26) the Antalya County Health Department and hotel management were informed about a cluster of LD. In addition subsequent investigation for environmental surveillance and water sampling were conducted. The LD diagnosis and environmental inspections were performed according to the procedure described in the guideline from "Turkish Ministry of Health Travel-Associated Legionnaires' Disease Control Programme". Five definitive cases and one presumptive case of LD were identified during the outbreak period (May 20-26, 2009). All of the cases were successfully treated (intravenous ciprofloxacin or levofloxacin or clarithromycin), however one patient died due to sudden death during sleep after being discharged. Since sputum

  17. The emergence of government evaluation systems in Africa: The case of Benin, Uganda and South Africa

    Directory of Open Access Journals (Sweden)

    Ian Goldman

    2018-03-01

    Results and conclusions: Initial lessons include the importance of a central unit to drive the evaluation system, developing a national evaluation policy, prioritising evaluations through an evaluation agenda or plan and taking evaluation to subnational levels. The countries are exploring the role of non-state actors, and there are increasing moves to involve Parliament. Key challenges include difficulty of getting a learning approach in government, capacity issues and ensuring follow-up. These lessons are being used to support other countries seeking to establish national evaluation systems, such as Ghana, Kenya and Niger.

  18. Retrospective Evaluation of Patients Admitted to the Pediatric Emergency Department with Intoxication

    Directory of Open Access Journals (Sweden)

    Alaaddin Yorulmaz

    2017-12-01

    Full Text Available Introduction: In this study, we aimed to retrospectively analyze the demographic and epidemiologic features, clinical course, laboratory results and prognoses of the patients admitted to the department of pediatric emergency due to poisoning. Methods: This trial enrolled a total of 430 patients aged 1 month to 18 years. The medical data of the patients were reviewed retrospectively according to patient's medical record. Demographic data such as age, sex, time of occurrence, time of patient presentation to the emergency department, time to first medical intervention after taking the drug, cause of poisoning, received active substances, ways of taking, number of active substances received, and symptoms at admission to the hospital were analyzed. Results: The study population consisted of 0.74% of all patients who were admitted to the department of pediatric emergency. 243 (56.5% patients were female and 187 (43.5% were male. The age of the patients ranged from 4 months to 220 months (72.89±66.38. One hundred-thirteen (26.3% of our patients were referred to our hospital in the summer, 111 (25.8% in the spring, 110 (25.6% in the autumn and 96 (22.3% in the winter. Eighteen patients were admitted to our emergency department with poisoning in 2014, 193 in 2015, 178 in 2016 and 41 in 2017. 12.3% of our patients were referred to our emergency department between hours 00:00 and 08:00, 35.1% between 08:00 and 16:00 and 52.6% between 16:00 and 24:00. Ninety-six of the patients were admitted to our emergency department due to suicidal poisoning and 334 due to accidental poisoning. Nausea was present at the time of presentation in 142 (33.02% of our patients, vomiting in 122 (28.37% and dizziness in 102 (23.72%. Conclusion: We believe that determination of the epidemiological features of the poisonings in our country by large scale studies and public consciousness will contribute significantly to the prevention of childhood poisoning.

  19. Qualitative evaluation of a deferred consent process in paediatric emergency research: a PREDICT study.

    Science.gov (United States)

    Furyk, Jeremy; McBain-Rigg, Kristin; Watt, Kerrianne; Emeto, Theophilus I; Franklin, Richard C; Franklin, Donna; Schibler, Andreas; Dalziel, Stuart R; Babl, Franz E; Wilson, Catherine; Phillips, Natalie; Ray, Robin

    2017-11-15

    A challenge of conducting research in critically ill children is that the therapeutic window for the intervention may be too short to seek informed consent prior to enrolment. In specific circumstances, most international ethical guidelines allow for children to be enrolled in research with informed consent obtained later, termed deferred consent (DC) or retrospective consent. There is a paucity of data on the attitudes of parents to this method of enrolment in paediatric emergency research. To explore the attitudes of parents to the concept of DC and to expand the knowledge of the limitations to informed consent and DC in these situations. Children presenting with uncomplicated febrile seizures or bronchiolitis were identified from three separate hospital emergency department databases. Parents were invited to participate in a semistructured telephone interview exploring themes of limitations of prospective informed consent, acceptability of the DC process and the most appropriate time to seek DC. Transcripts underwent inductive thematic analysis with intercoder agreement, using Nvivo 11 software. A total of 39 interviews were conducted. Participants comprehended the limitations of informed consent under emergency circumstances and were generally supportive of DC. However, they frequently confused concepts of clinical care and research, and support for participation was commonly linked to their belief of personal benefit. Participants acknowledged the requirement for alternatives to prospective informed consent in emergency research, and were supportive of the concept of DC. Our results suggest that current research practice seems to align with community expectations. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Qualitative evaluation of a deferred consent process in paediatric emergency research: a PREDICT study

    OpenAIRE

    Furyk, Jeremy; McBain-Rigg, Kristin; Watt, Kerrianne; Emeto, Theophilus I; Franklin, Richard C; Franklin, Donna; Schibler, Andreas; Dalziel, Stuart R; Babl, Franz E; Wilson, Catherine; Phillips, Natalie; Ray, Robin

    2017-01-01

    Background A challenge of conducting research in critically ill children is that the therapeutic window for the intervention may be too short to seek informed consent prior to enrolment. In specific circumstances, most international ethical guidelines allow for children to be enrolled in research with informed consent obtained later, termed deferred consent (DC) or retrospective consent. There is a paucity of data on the attitudes of parents to this method of enrolment in paediatric emergency...

  1. Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Wolfe Rory

    2006-06-01

    Full Text Available Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002 were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million.

  2. Evaluation of the effectiveness of peer pressure to change disposition decisions and patient throughput by emergency physician.

    Science.gov (United States)

    Wu, Kuan-Han; Cheng, Fu-Jen; Li, Chao-Jui; Cheng, Hsien-Hung; Lee, Wen-Huei; Lee, Chi-Wei

    2013-03-01

    The aim of this study was to develop a strategy for imposing peer pressure on emergency physicians to discharge patients and to evaluate patient throughput before and after intervention. A before-and-after study was conducted in a medical center with more than 120 000 annual emergency department (ED) visits. All nontraumatic adult patients who presented to the ED between 7:30 and 11:30 am Wednesday to Sunday were reviewed. We created a "team norm" imposed peer-pressure effect by announcing the patient discharge rate of each emergency physician through monthly e-mail reminders. Emergency department length of stay (LOS) and 8-hour (the end of shift) and final disposition of patients before (June 1, 2011-September 30, 2011) and after (October 1, 2011-January 30, 2012) intervention were compared. Patients enrolled before and after intervention totaled 3305 and 2945. No differences existed for age, sex, or average number of patient visits per shift. The 8-hour discharge rate increased significantly for all patients (53.5% vs 48.2%, P peer pressure to enhance patient flow and throughput. More patients were discharged at the end of shifts, particularly triage level III patients. The ED LOS for patients whose final disposition was discharge decreased significantly. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Evaluation report of the Nordic emergency exercise Nora - January 14, 1993

    International Nuclear Information System (INIS)

    Salo, A.; Singer, K.; Aakesson, T.; Valfells, A.; Backe, S.; Kallhagen, B.

    1993-01-01

    Nordic countries are signatories to the Convention on Early Notification of a Nuclear Accident and to the Convention on Assistance in Case of a Nuclear Accident or Radiological Emergency. In addition to these international conventions the states, except Iceland, have bilateral agreements on early notification and exchange of information with each other and with neighbouring countries. The bilateral agreements also require notification if levels of radionuclide contamination are observed which prompt information to the public or activation of the emergency organization or part of it. The main objective of the exercise NORA was to test and harmonize the overall decision making in the responsible Nordic approach to the emergency response, to improve co-operation in assessing rumour-, threat- and accident-situations, to improve co-operation in making decisions on intervention levels and on interventions in a Nordic perspective, to enhance harmony in information policy concerning information to the public in order to avoid ''double messages'', to improve information exchange between the Nordic countries and internationally. The objectives of the exercise were considered to have been met satisfactorily and the exercise made a valuable contribution to further develop the Nordic co-operation. (EG)

  4. Evaluation of the Use of Ultra Low Sulfur Diesel Oil for an Emergency Diesel Generator

    International Nuclear Information System (INIS)

    Yun, Young-Chul; Chung, Woo-Geun

    2016-01-01

    The aim of this study is to assess the compatibility and effect on driving an emergency diesel generator using ULSD examining the specific gravity and lubricity of the oil. Because generators at NPPs use ULSD which is not mostly used for medium-large diesel generator engines, this study seeks to provide effective precautions for the driving stability of emergency diesel generators. One of the major fuel oils used in medium-large diesel engines for the normal driving of vessels and the generation of emergency power at power plants is heavy fuel oil. There are no vessels and power generation engines known to use high-quality diesel oil which is widely used in cars. The findings of this study suggest that when driving a diesel generator, there will be increased fuel consumption by 3.6% [m 3 /hr.]. Furthermore, the mechanical fuel limiter on the engine needs an upward adjustment because the system is set for 110% load operations for the former LSD fuel. Both LSD and ULSD retain lubricity with a WSD around 330~350μm. These results clearly show that bad lubricity problems are not expected to occur. We had presumed an increased amount of foreign particulates because of the increased additives for high lubricity and oxidative stability

  5. Evaluation of the Use of Ultra Low Sulfur Diesel Oil for an Emergency Diesel Generator

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Young-Chul; Chung, Woo-Geun [KHNP CRI, Daejeon (Korea, Republic of)

    2016-10-15

    The aim of this study is to assess the compatibility and effect on driving an emergency diesel generator using ULSD examining the specific gravity and lubricity of the oil. Because generators at NPPs use ULSD which is not mostly used for medium-large diesel generator engines, this study seeks to provide effective precautions for the driving stability of emergency diesel generators. One of the major fuel oils used in medium-large diesel engines for the normal driving of vessels and the generation of emergency power at power plants is heavy fuel oil. There are no vessels and power generation engines known to use high-quality diesel oil which is widely used in cars. The findings of this study suggest that when driving a diesel generator, there will be increased fuel consumption by 3.6% [m{sup 3}/hr.]. Furthermore, the mechanical fuel limiter on the engine needs an upward adjustment because the system is set for 110% load operations for the former LSD fuel. Both LSD and ULSD retain lubricity with a WSD around 330~350μm. These results clearly show that bad lubricity problems are not expected to occur. We had presumed an increased amount of foreign particulates because of the increased additives for high lubricity and oxidative stability.

  6. A Virtual Emergency Telemedicine Serious Game in Medical Training: A Quantitative, Professional Feedback-Informed Evaluation Study.

    Science.gov (United States)

    Nicolaidou, Iolie; Antoniades, Athos; Constantinou, Riana; Marangos, Charis; Kyriacou, Efthyvoulos; Bamidis, Panagiotis; Dafli, Eleni; Pattichis, Constantinos S

    2015-06-17

    Serious games involving virtual patients in medical education can provide a controlled setting within which players can learn in an engaging way, while avoiding the risks associated with real patients. Moreover, serious games align with medical students' preferred learning styles. The Virtual Emergency TeleMedicine (VETM) game is a simulation-based game that was developed in collaboration with the mEducator Best Practice network in response to calls to integrate serious games in medical education and training. The VETM game makes use of data from an electrocardiogram to train practicing doctors, nurses, or medical students for problem-solving in real-life clinical scenarios through a telemedicine system and virtual patients. The study responds to two gaps: the limited number of games in emergency cardiology and the lack of evaluations by professionals. The objective of this study is a quantitative, professional feedback-informed evaluation of one scenario of VETM, involving cardiovascular complications. The study has the following research question: "What are professionals' perceptions of the potential of the Virtual Emergency Telemedicine game for training people involved in the assessment and management of emergency cases?" The evaluation of the VETM game was conducted with 90 professional ambulance crew nursing personnel specializing in the assessment and management of emergency cases. After collaboratively trying out one VETM scenario, participants individually completed an evaluation of the game (36 questions on a 5-point Likert scale) and provided written and verbal comments. The instrument assessed six dimensions of the game: (1) user interface, (2) difficulty level, (3) feedback, (4) educational value, (5) user engagement, and (6) terminology. Data sources of the study were 90 questionnaires, including written comments from 51 participants, 24 interviews with 55 participants, and 379 log files of their interaction with the game. Overall, the results were

  7. The Evaluation and Management of Rocky Mountain Spotted Fever in the Emergency Department: a Review of the Literature.

    Science.gov (United States)

    Gottlieb, Michael; Long, Brit; Koyfman, Alex

    2018-07-01

    Rocky Mountain spotted fever (RMSF) is potentially deadly and can present subtly with signs and symptoms overlapping with other clinical conditions. Delayed diagnosis can be fatal. This review provides an evidence-based summary of the current data for the evaluation and management of RMSF in the emergency department. RMSF occurs through transmission of Rickettsia rickettsii by an infected tick. Exposure in the United States occurs most commonly from April to September, and high-risk locations include wooded, shrubby, or grassy areas. Approximately half of patients with infection do not recall tick exposure. Symptoms can include fever, headache, photophobia, malaise, myalgias, and a petechial rash that begins on the wrists and ankles and spreads to the trunk. Rash may not occur in ≤15% of patients, and the classic triad of fever, headache, and rash is also not definitive. Laboratory evaluation may demonstrate hyponatremia, anemia, thrombocytopenia, abnormal liver enzymes, and elevated coagulation tests. Antibody testing can be helpful, but these results are not typically available to the emergency clinician. Doxycycline is the treatment of choice in adults, children, and pregnant patients. Patients should be advised about prevention strategies and effective techniques for removing ticks. RMSF is a potentially deadly disease that requires prompt recognition and management. Focused history, physical examination, and testing are important in the diagnosis of this disease. Understanding the clinical features, diagnostic tools, and proper treatment can assist emergency clinicians in the management of RMSF. Published by Elsevier Inc.

  8. Too much ‘Dreaming’: Evaluations of the Northern Territory National Emergency Response Intervention 2007–2012

    Directory of Open Access Journals (Sweden)

    Jon Altman

    2012-12-01

    Full Text Available The Northern Territory National Emergency Response Intervention (the Intervention of 2007 was a bold experiment by the Howard Government. The Intervention was developed quickly without comprehensive policy development based on evidence or consultation. During its five-year statutory life (ending August 2012, the absence of coherent policy logic has seen the Intervention fundamentally reframed by the Rudd and Gillard Governments. The unprecedented and controversial nature of the Intervention has seen extraordinary levels of monitoring, review and evaluation, but the absence of an overarching evaluation strategy has resulted in a fragmented and confused approach. In this article, we do not seek to critique the Intervention itself or to assess whether these multiple monitoring and evaluation exercises have been successes or failures. Indeed, our review illustrates that in highly contested policy areas, notions of success, failure and the evaluations themselves become politically charged. Instead we make a series of critical observations regarding this contradictory messiness of evaluations, using political science and anthropological frameworks to draw wider conclusions about the nature and logic of evaluation fetishism. We conclude that evaluations of the Intervention have not led to greater transparency, accountability and monitoring of outcomes and outputs. The Intervention evaluations instead are consistent with the view that they are both obfuscating mechanisms and techniques of governance designed to allay public concern and normalise the governance of marginalised Indigenous Australian spaces.

  9. Prospect Evaluation as an Emerging Pre-Evaluation Technique in the Case of Great Plains Wheat Producers’ Use of Web 2.0

    Directory of Open Access Journals (Sweden)

    Nicholas R. Brown

    2016-06-01

    Full Text Available We introduce a pre-evaluation technique, prospect evaluation, in the case of Great Plains wheat producers’ practices with Web 2.0. We emerged prospect evaluation as a pre-evaluation technique, expanding the role of evaluative logic and reasoning into the ideation phase of project and product development to close the risk gap between project idea and implementation. Prospect evaluation serves as a prequel to the well-established developmental, formative, and summative evaluation models. We implemented the prospect evaluation technique in the context of iWheat, a USDA-funded Web 2.0 project (currently known as myFields, http://myfields.info/dashboard. Wheat producers were comfortable using computers; however, they conceptualized the Internet with a Web 1.0 mindset that depends on a centralized model of development and delivery of content. Wheat producers were not comfortable actively co-creating useful information for the betterment of community, a fundamental underpinning of Web 2.0 advancement. Extension specialists and educators should focus on the rewards of contributing to Web 2.0 sites and proceed in diffusing Web 2.0 tools to the wheat producers. Prospect evaluation was sufficient for helping project leaders bridge the risk gap and move forward with the project.

  10. Emergency evacuation/transportation plan update: Traffic model development and evaluation of early closure procedures. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-10-28

    Prolonged delays in traffic experienced by Laboratory personnel during a recent early dismissal in inclement weather, coupled with reconstruction efforts along NM 502 east of the White Rock Wye for the next 1 to 2 years, has prompted Los Alamos National Laboratory (LANL) to re-evaluate and improve the present transportation plan and its integration with contingency plans maintained in other organizations. Facilities planners and emergency operations staff need to evaluate the transportation system`s capability to inefficiently and safely evacuate LANL under different low-level emergency conditions. A variety of potential procedures governing the release of employees from the different technical areas (TAs) requires evaluation, perhaps with regard to multiple emergency-condition scenarios, with one or more optimal procedures ultimately presented for adoption by Lab Management. The work undertaken in this project will hopefully lay a foundation for an on-going, progressive transportation system analysis capability. It utilizes microscale simulation techniques to affirm, reassess and validate the Laboratory`s Early Dismissal/Closure/Delayed Opening Plan. The Laboratory is required by Federal guidelines, and compelled by prudent practice and conscientious regard for the welfare of employees and nearby residents, to maintain plans and operating procedures for evacuation if the need arises. The tools developed during this process can be used outside of contingency planning. It is anticipated that the traffic models developed will allow site planners to evaluate changes to the traffic network which could better serve the normal traffic levels. Changes in roadway configuration, control strategies (signalization and signing), response strategies to traffic accidents, and patterns of demand can be modelled using the analysis tools developed during this project. Such scenarios typically are important considerations in master planning and facilities programming.

  11. Evaluating acute medical admissions through emergency departments in Hong Kong: can one adjust for case-mix variation?

    Science.gov (United States)

    Rainer, T H; Sollich, P; Piotrowski, T; Coolen, A C C; Cheng, B; Graham, C A

    2012-12-01

    Healthcare systems are under pressure to efficiently and safely reduce acute care admissions to hospital. There is a need to develop a standardised system for assessing emergency department performance which takes into account case-mix variation. The objective of this study was to derive and validate a standardised tool for assessing variations in medical admissions through emergency departments in Hong Kong. Retrospective study of patients attending emergency departments of 14 acute hospitals in Hong Kong. Data were retrieved from a centralised administrative database. Of 2,531,225 patients who attended emergency departments between 1 January 2001 and 31 December 2003, 780,444 (30.8%) were admitted to medical wards. A model derived from 2001 data shows well-calibrated admission probabilities, with an area under the receiver operating characteristic curve for probability of admission of 90.3 (95% CI ±0.11). The areas under the receiver operating characteristic curves for 2002 and 2003 validation sets were 89.9 (95% CI ±0.11) and 89.0 (95% CI ±0.12), respectively. With an averaged benchmark, reductions in medical admissions of up to 19% could be achieved, while under the most optimistic assumption, reductions of up 36% could be achieved. A tool for benchmarking hospital medical admissions and minimising case-mix variation has been derived and validated in Hong Kong, but it requires further validation in other healthcare systems given the wide variations in admission thresholds internationally. This may be used as one potential method to evaluate the performance of emergency departments against a common standard.

  12. Interface between marketing, policy and development in emerging economies. An exploratory study and evaluation

    Directory of Open Access Journals (Sweden)

    Rodney Oudan

    2017-11-01

    Full Text Available This paper explores the role of marketing, policy, and development for emerging economies moving toward a market-driven economic environment. A historical review provides a foundation, then deductive analyses from theoretical reviews and transcripts reveal that such marketing is still in the developmental stages and has become necessary for the future direction of these economies. Following the findings, the paper provides managerial marketing implications and highlights how a market orientation and market-driven approach is necessary for the greater social good in a global economy.

  13. Evaluating an emergent behaviour algorithm in JCSP for energy conservation in lighting systems

    DEFF Research Database (Denmark)

    Kosek, Anna Magdalena; Syed, Aly; Kerridge, J.

    2011-01-01

    Since the invention of the light bulb, artificial light is accompanying people all around the world every day and night. As the light bulb itself evolved a lot through years, light control systems are still switch-based and require users to make most of the decisions about its behaviour. This pap...... presents an algorithm for emergent behaviour in a lighting system to achieve stable, user defined light level, while saving energy. The algorithm employs a parallel design and was tested using JCSP. © 2011 The authors and IOS Press. All rights reserved....

  14. A further evaluation of herbicides for post-emergence use in short rotation coppice

    Energy Technology Data Exchange (ETDEWEB)

    Turnbull, D.J.

    2002-07-01

    This report describes a study of the safety and efficacy of a range of herbicides and mixtures of herbicides (with both contact and residual activity) for the post-emergence control of weeds in newly planted willow short rotation coppice (SRC). Severe competition from weeds that have not been controlled adequately by pre-emergence herbicide application is one of the commonest causes of SRC crop failure. In the study, the effects of 11 herbicide treatments currently recommendation for weed control with cereals, legumes or potatoes were compared with an untreated control. There was minimal crop death from any treatment, though most of the treatments caused varying degrees of phytotoxicity. Two commercial products, Reflex T and Impuls, gave the best overall crop safety and weed control results. The report provides growers of SRC and their advisors with some information on how to achieve improved weed control in SRC fields, and recommends that British Biogen (the trade industry body) should consider the compilation of a technical register of herbicide applications based on information supplied by growers and advisers, including field treatment details.

  15. Evaluation of Social Media Use by Emergency Medicine Residents and Faculty.

    Science.gov (United States)

    Pearson, David; Bond, Michael C; Kegg, Jason; Pillow, Tyson; Hopson, Laura; Cooney, Robert; Garg, Manish; Khadpe, Jay; Runyon, Michael; Patterson, Leigh

    2015-09-01

    Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty. In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher's exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses. We received 1,314 responses: 63% of respondents were male, 40% were respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [psocial media. Awareness of these utilization patterns could benefit future educational endeavors.

  16. Evaluation of knowledge and attitude of school teachers about emergency management of traumatic dental injury.

    Science.gov (United States)

    Singh, Mala; Ingle, Navin Anand; Kaur, Navpreet; Yadav, Pramod

    2015-01-01

    Traumatic dental injuries (TDIs) are widespread in the population and are a serious dental public health problem among children. Dental trauma may cause both functional and esthetic problems, with possible impacts on the patient's quality of life. To investigate teacher's knowledge and attitudes of Mathura city about emergency management of TDIs in children. A total of 352 teachers from total 23 schools of Mathura city were included in the study. Data were collected through a survey, which included a self-administered questionnaire. The questionnaire consisted of three major parts containing multiple-choice questions. Among the teachers 51.1% were males and 48.9% were females. Majority of the respondents, that is, 33.5% were between 31 and 40 years of age. Most respondents (34%) had more than 10 years of teaching experience. Majority of the teachers (39.2%) had educational qualification other than B.Ed. and M.Ed. degrees. Physical education teachers comprised the largest group of school teachers. Regarding knowledge and attitude, the teachers with 10-20 years of teaching experience, physical education teachers, and the teachers other than B.Ed. and M.Ed. qualifications had given more correct answers to the questions when compared with other groups. For the teachers having a low level of knowledge, there is a need for greater awareness to improve teachers' knowledge and attitudes related to the emergency management of TDIs in children by organizing educative and motivational programs.

  17. Threshold Evaluation of Emergency Risk Communication for Health Risks Related to Hazardous Ambient Temperature.

    Science.gov (United States)

    Liu, Yang; Hoppe, Brenda O; Convertino, Matteo

    2018-04-10

    Emergency risk communication (ERC) programs that activate when the ambient temperature is expected to cross certain extreme thresholds are widely used to manage relevant public health risks. In practice, however, the effectiveness of these thresholds has rarely been examined. The goal of this study is to test if the activation criteria based on extreme temperature thresholds, both cold and heat, capture elevated health risks for all-cause and cause-specific mortality and morbidity in the Minneapolis-St. Paul Metropolitan Area. A distributed lag nonlinear model (DLNM) combined with a quasi-Poisson generalized linear model is used to derive the exposure-response functions between daily maximum heat index and mortality (1998-2014) and morbidity (emergency department visits; 2007-2014). Specific causes considered include cardiovascular, respiratory, renal diseases, and diabetes. Six extreme temperature thresholds, corresponding to 1st-3rd and 97th-99th percentiles of local exposure history, are examined. All six extreme temperature thresholds capture significantly increased relative risks for all-cause mortality and morbidity. However, the cause-specific analyses reveal heterogeneity. Extreme cold thresholds capture increased mortality and morbidity risks for cardiovascular and respiratory diseases and extreme heat thresholds for renal disease. Percentile-based extreme temperature thresholds are appropriate for initiating ERC targeting the general population. Tailoring ERC by specific causes may protect some but not all individuals with health conditions exacerbated by hazardous ambient temperature exposure. © 2018 Society for Risk Analysis.

  18. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 2. Equipment, Safe Driving Practices, Legal Aspects, Controlling the Situation, Action Evaluation Conference. Revised.

    Science.gov (United States)

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the second in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains five sections that cover the following course content: ambulance equipment, safe driving practices for emergency vehicle drivers, legal aspects of the EMT's job, how to maintain control at an accident scene…

  19. Application of GRA method, dynamic analysis and fuzzy set theory in evaluation and selection of emergency treatment technology for large scale phenol spill incidents

    Science.gov (United States)

    Zhao, Jingjing; Yu, Lean; Li, Lian

    2017-05-01

    Select an appropriate technology in an emergency response is a very important issue with various kinds of chemical contingency spills frequently taking place. Due to the complexity, fuzziness and uncertainties of the chemical contingency spills, the theory of GRA method, dynamic analysis combined with fuzzy set theory will be appropriately applied to selection and evaluation of emergency treatment technology. Finally, a emergency phenol spill accidence occurred in highway is provided to illustrate the applicability and feasibility of the proposed methods.

  20. Bedside Ultrasonography as an Adjunct to Routine Evaluation of Acute Appendicitis in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Samuel H.F. Lam

    2014-11-01

    Full Text Available Introduction: Appendicitis is a common condition presenting to the emergency department (ED. Increasingly emergency physicians (EP are using bedside ultrasound (BUS as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis. Methods: Patients four years of age and older presenting to the ED with suspected appendicitis were eligible for enrollment. After informed consent was obtained, BUS was performed on the subjects by trained EPs who had undergone a minimum of one-hour didactic training on the use of BUS to diagnose appendicitis.They then recorded elements of clinical history, physical examination, white blood cell count (WBC with polymophonuclear percentage (PMN, and BUS findings on a data form. We ascertained subject outcomes by a combination of medical record review and telephone follow-up. Results: A total of 125 subjects consented for the study, and 116 had adequate image data for final analysis. Prevalence of appendicitis was 40%. Mean age of the subjects was 20.2 years, and 51% were male. BUS was 100% sensitive (95% CI 87-100% and 32% specific (95% CI 14-57% for detection of appendicitis, with a positive predictive value of 72% (95% CI 56-84%, and a negative predictive value of 100% (95% CI 52-100%. Assuming all non-diagnostic studies were negative would yield a sensitivity of 72% and specificity of 81%. Subjects with appendicitis had a significantly higher occurrence of anorexia, nausea, vomiting, and a higher WBC and PMN count when compared to those without appendicitis. Their BUS studies were significantly more likely to result in visualization of the appendix, appendix diameter >6mm, appendix wall thickness >2mm, periappendiceal fluid, visualization of the appendix tip, and sonographic Mcburney’s sign (p6mm, appendix wall thickness >2mm, periappendiceal fluid were

  1. Analysis of search and rescue emergency evaluation in ship accidents in Indonesia

    Directory of Open Access Journals (Sweden)

    Arleiny

    2018-01-01

    Full Text Available The objectives og this research is to describe the factors causing ship accident in Indonesia and know the effectiveness of SAR emergency in ship accident in Indonesia. The research method used in this research is qualitative research. Techniques Collection of literature study data and documents. Data validity method using triangulation. Data analysis uses interactive data analysis. The conclusions of this study are Factors that cause the occurrence of ship accidents in Indonesia, among others, the resources of the crew, the eligibility of ships, supporting facilities for shipping, operators, lack of supervision of apparatus, service users and other factors. The high number of ship accidents in Indonesia shows the ineffective implementation of SAR in ship accident in Indonesia.

  2. Characterization and Monitoring Data for Evaluating Constructed Emergent Sandbar Habitat in the Missouri River Mainstem

    Energy Technology Data Exchange (ETDEWEB)

    Duberstein, Corey A.; Downs, Janelle L.

    2008-11-06

    Emergent sandbar habitat (ESH) in the Missouri River Mainstem System is a critical habitat element for several federally listed bird species: the endangered interior least tern (Sterna antillarum) and the threatened Northern Great Plains piping plover (Charadrius melodus). The Army Corps of Engineers (Corps) provides the primary operational management of the Missouri River and is responsible under the Endangered Species Act (ESA) to take actions within its authorities to conserve listed species. To comply with the 2000 USFWS BiOp and the 2003 amended USFWS BiOp, the Corps has created habitats below Gavins Point Dam using mechanical means. Initial monitoring indicates that constructed sandbars provide suitable habitat features for nesting and foraging least terns and piping plovers. Terns and plovers are using constructed sandbars and successfully reproducing at or above levels stipulated in the BiOp. However, whether such positive impacts will persist cannot yet be adequately assessed at this time.

  3. Evaluation of Stress Experienced by Emergency Telecommunications Personnel Employed in a Large Metropolitan Police Department.

    Science.gov (United States)

    Ramey, Sandra L; Perkhounkova, Yelena; Hein, Maria; Chung, Sophia J; Anderson, Amanda A

    2017-07-01

    Emergency telecommunications personnel (ETCP) form the hub of police agencies and persistently deal with distressing situations on a daily basis, making them highly susceptible to psychological and physiological ailments. To date, few studies have examined the necessity or feasibility of implementing a resilience training intervention for ETCP. In this study, the authors assessed baseline psychological data from the ETCP of a large police department to determine the differences in baseline measures for ETCP and police officers. Participants included ETCP ages 29 to 64 years ( n = 19). Results showed that ETCP self-reported greater levels of psychological stress compared with police officers ( p < .05) for the majority of measures; ETCP experience excessive levels of stress and greater prevalence of chronic disease. Consideration should be given to piloting resilience interventions within this group to manage stress; improve health, performance, and decision making; and decrease the prevalence of chronic disease.

  4. Consumer evaluation of imported organic food products in emerging economies in Asia

    DEFF Research Database (Denmark)

    Pedersen, Susanne; Aschemann-Witzel, Jessica; Thøgersen, John

    , product image and consumer purchase intention: Evidence from an emerging economy. International Business Review, 21(6), 1041-1051. doi:http://dx.doi.org/10.1016/j.ibusrev.2011.11.010 Wang, O., De Steur, H., Gellynck, X., & Verbeke, W. (2015). Motives for consumer choice of traditional food and European......-country combinations in every product category (Pappu, Quester, & Cooksey, 2006, 2007). A country-of-origin-effect strong enough to drive purchasing decisions appears when a country’s equity is high and there is a good product-country match (S. A. Ahmed, d'Astous, & Petersen, 2011; Herz & Diamantopoulos, 2013; Roth......, preferences and purchase behaviour (Newman, Turri, Howlett, & Stokes, 2014). A wide range of contingencies and moderators of COO effects has been identified (Pharr, 2005; Verlegh & Steenkamp, 1999) – also for food products (Z. U. Ahmed et al., 2004; Chryssochoidis, Krystallis, & Perreas, 2007; Hoffmann, 2000...

  5. Evaluation of secondary exposure doses to transportation and medical personnel in the radiation emergency medicine

    International Nuclear Information System (INIS)

    Kato, Hideki; Suzuki, Shoichi; Koga, Sukehiko; Mukoyama, Takashi; Tomatsu, Hirotaka; Suzuki, Yusuke

    2009-01-01

    Radionuclide contamination is one of the accidents that might occur while carrying out a periodical inspection of nuclear power stations during normal reactor operation. When such an accident occurs, rescue and medical personnel, involved in transporting and treating affected workers run the risk of exposure to secondary radiation. In this study, the ambient dose equivalent rate at a certain distance from the surface of the human body contaminated with typical radioactive corrosion products was calculated. Further, the relationships among the adhesion area, contamination density, and secondary exposure dose were clarified. The secondary exposure dose and permissible working hours in a radiation emergency medicine were estimated by presenting these relationships in the form of a chart and by specifying the contamination levels. (author)

  6. Feelings of nurses in the reception and risk classification evaluation in the emergency room

    Directory of Open Access Journals (Sweden)

    Andressa Midori Sakai

    2016-05-01

    Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

  7. Feelings of nurses in the reception and risk classification evaluation in the emergency room

    Directory of Open Access Journals (Sweden)

    Andressa Midori Sakai

    2016-01-01

    Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

  8. Evaluation of emerging parallel optical link technology for high energy physics

    International Nuclear Information System (INIS)

    Chramowicz, J; Kwan, S; Prosser, A; Winchell, M

    2012-01-01

    Modern particle detectors utilize optical fiber links to deliver event data to upstream trigger and data processing systems. Future detector systems can benefit from the development of dense arrangements of high speed optical links emerging from industry advancements in transceiver technology. Supporting data transfers of up to 120 Gbps in each direction, optical engines permit assembly of the optical transceivers in close proximity to ASICs and FPGAs. Test results of some of these parallel components will be presented including the development of pluggable FPGA Mezzanine Cards equipped with optical engines to provide to collaborators on the Versatile Link Common Project for the HI-LHC at CERN. This work was supported by the U.S. Department of Energy, operated by Fermi Research Alliance, LLC under contract No. DE-AC02-07CH11359 with the United States Department of Energy.

  9. Diagnostic evaluation of the MRP-8/14 for the emergency assessment of chest pain.

    Science.gov (United States)

    Vora, Amit N; Bonaca, Marc P; Ruff, Christian T; Jarolim, Petr; Murphy, Sabina; Croce, Kevin; Sabatine, Marc S; Simon, Daniel I; Morrow, David A

    2012-08-01

    Elevated levels of myeloid-related protein (MRP)-8/14 (S100A8/A9) are associated with first cardiovascular events in healthy individuals and worse prognosis in patients with acute coronary syndrome (ACS). The diagnostic utility of MRP-8/14 in patients presenting to the emergency room with symptoms concerning for ACS is uncertain. MRP-8/14 was measured in serial serum and plasma samples in a single center prospective cohort-study of patients presenting to the emergency room with non-traumatic chest pain concerning for ACS. Final diagnosis was adjudicated by an endpoint committee. Of patients with baseline MRP-8/14 results (n = 411), the median concentration in serum was 1.57 μg/ml (25th, 75th: 0.87, 2.68) and in plasma was 0.41 μg/ml (MRP-8/14 was higher in patients presenting with MI (p MRP-8/14 was poor: sensitivity 28% (95% CI 20-38), specificity 82% (78-86), positive predictive value 36% (26-47), and negative predictive value 77% (72-81). The area under the ROC curve for diagnosis of MI with MRP-8/14 was 0.55 (95% CI 0.51-0.60) compared with 0.95 for cTnI. The diagnostic performance was not improved in early-presenters, patients with negative initial cTnI, or using later MRP-8/14 samples. Patients presenting with MI had elevated levels of serum MRP-8/14 compared to patients with non-cardiac chest pain. However, overall diagnostic performance of MRP-8/14 was poor and neither plasma nor serum MRP-8/14 offered diagnostic utility comparable to cardiac troponin.

  10. Collaborative Audit of Risk Evaluation in Medical Emergency Treatment (CARE-MET I) - an international pilot.

    Science.gov (United States)

    Subbe, C P; Gauntlett, W; Kellett, J G

    2010-06-01

    The absence of an accepted model for risk-adjustment of acute medical admissions leads to suboptimal clinical triage and serves as a disincentive to compare outcomes in different hospitals. The Simple Clinical Score (SCS) is a model based on 16 clinical parameters affecting hospital mortality. We undertook a feasibility pilot in 21 hospitals in Europe and New Zealand each collecting data for 12 or more consecutive medical emergency admissions. Data from 281 patients was analysed. Severity of illness as estimated by SCS was related to risk of admission to the Intensive Care Unit (pRisk group to 22% in the Very High Risk Group (p<0.0001). Very low scores were associated with earlier discharge as opposed to very high scores (mean length of stay of 2.4 days vs 5.6 days, p<0.001). There were differences in the pattern of discharges in different hospitals with comparable SCS data. Clinicians reported no significant problems with the collection of data for the score in a number of different health care settings. The SCS appears to be a feasible tool to assist clinical triage of medical emergency admissions. The ability to view the profile of the SCS for different clinical centres opens up the possibility of accurate comparison of outcomes across clinical centres without distortion by different regional standards of health care. This pilot study demonstrates that the adoption of the SCS is practical across an international range of hospitals. Copyright 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  11. Emergency department evaluation of ischemic stroke and TIA: the BASIC Project.

    Science.gov (United States)

    Brown, D L; Lisabeth, L D; Garcia, N M; Smith, M A; Morgenstern, L B

    2004-12-28

    To identify demographic and clinical variables of emergency department (ED) practices in a community-based acute stroke study. By both active and passive surveillance, the authors identified cerebrovascular disease cases in Nueces County, TX, as part of the Brain Attack Surveillance in Corpus Christi (BASIC) Project, a population-based stroke surveillance study, between January 1, 2000, and December 31, 2002. With use of multivariable logistic regression, variables independently associated with three separate outcomes were sought: hospital admission, brain imaging in the ED, and neurologist consultation in the ED. Prespecified variables included age, sex, ethnicity, insurance status, NIH Stroke Scale score, type of stroke (ischemic stroke or TIA), vascular risk factors, and symptom presentation variables. Percentage use of recombinant tissue plasminogen activator (rt-PA) was calculated. A total of 941 Mexican Americans (MAs) and 855 non-Hispanic whites (NHWs) were seen for ischemic stroke (66%) or TIA (34%). Only 8% of patients received an in-person neurology consultation in the ED, and 12% did not receive any head imaging. TIA was negatively associated with neurology consultations compared with completed stroke (odds ratio [OR] 0.35 [95% CI 0.21 to 0.57]). TIA (OR 0.14 [0.10 to 0.19]) and sensory symptoms (OR 0.59 [0.44 to 0.81]) were also negatively associated with hospital admission. MAs (OR 0.58 [0.35 to 0.98]) were less likely to have neurology consultations in the ED than NHWs. Only 1.7% of patients were treated with rt-PA. Neurologists are seldom involved with acute cerebrovascular care in the emergency department (ED), especially in patients with TIA. Greater neurologist involvement may improve acute stroke diagnosis and treatment efforts in the ED.

  12. Evaluation of the certificate in emerging infectious disease research and the certificate in one health training programs, University of Florida

    Directory of Open Access Journals (Sweden)

    Marissa A. Valentine

    2015-03-01

    Full Text Available In developing countries, public health professionals and scientists need targeted training and practical skills to respond to global emerging infectious disease threats. The Certificate in Emerging Infectious Disease Research was developed in 2008 to aid such professionals to respond to complex emerging disease problems. The short-course was modified slightly in 2013 and renamed the Certificate in One Health. To evaluate the immediate impact of the short-course, an online survey of 176 past participants from both the courses was conducted. The survey tool assessed the program’s process, impact, and outcome measures respectively via assessing the courses’ perceived strengths and weaknesses, perceived skills gained, and the participants’ current position, publication status, funding status, and educational attainment; 85 (48.3% participants completed the survey. Reported program strengths included the curriculum, expertise of lecturers, and diversity of the training cohort. The principal reported weakness was the compressed academic schedule. The most frequently reported benefits included: epidemiological and biostatistical skills, followed by One-Health knowledge, and research skills. Twenty-eight percent of the survey respondents reported publishing one or more manuscripts since completing the course and 21% reported receiving research funding. The course appears to have had a positive, immediate impact on the students’ self-perceived knowledge and capabilities.

  13. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

    Directory of Open Access Journals (Sweden)

    Tan-Hsu Tan

    2017-01-01

    Full Text Available This study presents a new ubiquitous emergency medical service system (UEMS that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients’ biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient’s biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.

  14. Evaluation of the crash mitigation effect of low-speed automated emergency braking systems based on insurance claims data.

    Science.gov (United States)

    Isaksson-Hellman, Irene; Lindman, Magdalena

    2016-09-01

    The aim of the present study was to evaluate the crash mitigation performance of low-speed automated emergency braking collision avoidance technologies by examining crash rates, car damage, and personal injuries. Insurance claims data were used to identify rear-end frontal collisions, the specific situations where the low-speed automated emergency braking system intervenes. We compared cars of the same model (Volvo V70) with and without the low-speed automated emergency braking system (AEB and no AEB, respectively). Distributions of spare parts required for car repair were analyzed to identify car damage, and crash severity was estimated by comparing the results with laboratory crash tests. Repair costs and occupant injuries were investigated for both the striking and the struck vehicle. Rear-end frontal collisions were reduced by 27% for cars with low-speed AEB compared to cars without the system. Those of low severity were reduced by 37%, though more severe crashes were not reduced. Accordingly, the number of injured occupants in vehicles struck by low-speed AEB cars was reduced in low-severity crashes. In offset crash configurations, the system was found to be less effective. This study adds important information about the safety performance of collision avoidance technologies, beyond the number of crashes avoided. By combining insurance claims data and information from spare parts used, the study demonstrates a mitigating effect of low-speed AEB in real-world traffic.

  15. Recommended criteria for the evaluation of on-site nuclear power plant emergency plans, volume II: criteria

    International Nuclear Information System (INIS)

    1997-01-01

    A critical review of existing Canadian and international nuclear power plant (NPP) emergency plans, evaluation criteria, and approaches has been conducted to provide AECB staff with information which can be used to assess the adequacy of NPP on-site emergency response plans. The results of this work are published in two volumes. Volume I, Basis Document, provides the reasons why certain requirements are in place. It also gives comprehensive references to various standards.Volume II, Criteria, contains the criteria which relate to on-site actions and their integration with control room activities and the roles of off-site responsible organizations. The recommended criteria provide information on what is required, and not on how to accomplish the requirements. The licensees are given the latitude to decide on the methods and processes needed to meet the requirements. The documents do not address NPP off-site plans and response capability, or the control room emergency operating procedures and response capability. This report contains only Volume II: Criteria. 55 refs., 2 tabs., 1 fig

  16. Evaluation of staff cultural awareness before and after attending cultural awareness training in an Australian emergency department.

    Science.gov (United States)

    Chapman, Rose; Martin, Catherine; Smith, Tammy

    2014-10-01

    Cultural awareness of emergency department staff is important to ensure delivery of appropriate health care to people from all ethnic groups. Cultural awareness training has been found to increase knowledge about other cultures and is widely used as a means of educating staff, however, debate continues as to the effectiveness of these programs. To determine if an accredited cultural awareness training program affected emergency department staff knowledge, familiarity, attitude of and perception towards Australian Aboriginal and Torres Strait Islander people. One group pre-test and post-test intervention study compared the cultural awareness of 44 emergency department staff towards Aboriginal and Torres Strait Islander people before and after training. The cultural awareness training was delivered in six hours over three sessions and was taught by an accredited cultural awareness trainer. The cultural awareness training changed perception but did not affect attitude towards Aboriginal and Torres Strait Islander people in this group. Future strategies to improve staff cultural awareness need to be investigated, developed, implemented and evaluated. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. The BWR [Boiling Water Reactor] Emergency Operating Procedures Tracking System (EOPTS): Evaluation by control-room operating crews

    International Nuclear Information System (INIS)

    Spurgin, A.J.; Orvis, D.D.; Spurgin, J.P.; Luna, C.J.

    1990-05-01

    This report presents the results of a project sponsored by the Electric Power Research Institute (EPRI) and Taiwan Power Company (TPC) and conducted by APG and TPC to perform evaluation of the Emergency Operating Procedures Tracking System (EOPTS). The EOPTS is an expert system employing artificial intelligence techniques developed by EPRI for Boiling Water Reactor (BWR) plants based on emergency operating procedures (EOPs). EOPTS is a computerized decision aid used to assist plant operators in efficient and reliable use of EOPs. The main objective of this project was to evaluate the EOPTS and determine how an operator aid of this type could noticeably improve the response time and the reliability of control room crews to multi-failure scenarios. A secondary objective was to collect data on how crew performance was affected. Experiments results indicate that the EOPTS measurably improves crew performance over crews using the EOP flow charts. Time-comparison measurements indicate that crews using the EOPTS perform required actions more quickly than do those using the flowcharts. The results indicate that crews using the EOPTS are not only faster and more consistent in their actions but make fewer errors. In addition, they have a higher likelihood of recovering from the errors that they do make. Use of the EOPTS in the control room should result in faster termination and mitigation of accidents and reduced risk of power plant operations. Recommendations are made towards possible applications of the EOPTS to operator training and evaluation, and for the applicability of the evaluation methodology developed for this project to the evaluation of similar operator aides. 17 refs., 14 figs., 14 tabs

  18. Evaluation of the Effect of a Preoperative Single Dose of Gabapentin on Emergence Agitation in Patients Undergoing Breast Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Simin Azemati

    2013-10-01

    Full Text Available Background: Emergence agitation is a transient confusional state that usuallyoccurs within 10 to 30 minutes of recovery from general anesthesia. It may lead to seriousconsequences and increasing hospital costs. This study evaluates the effect of gabapentinon emergence agitation in patients undergoing breast cancer surgery.Methods: This randomized, double blind controlled trial enrolled 100 femalepatients with American Society of Anesthesiologists' classifications I and II who werecandidates for breast cancer surgery. Patients were randomly assigned into two groups(n=50 that received either oral gabapentin 600 mg or placebo. Induction andmaintenance of anesthesia were similar in both groups. At the end of surgery, patient'sagitation score, pain score, and presence of nausea or vomiting were reported. In theward, the presence of headache or dizziness was checked during the first 8 h. Mann-Whitney test was used for comparison of agitation and pain scores between two groups.Chi-square test was used for comparing occurrence of nausea, vomiting and qualitative.The qualitative demographic variable and t-test compared quantitative demographicvariables.Results: There was a significantly lower incidence of emergence agitation in thegabapentin group before (P<0.001 and after (P=0.029 extubation. There weresignificantly lower mean agitation scores before (P<001 and after (P=0.006 extubationand in the pain score (P=0.005 in the gabapentin group. The need for remifentanilinfusion (P<0.05 during surgery was significantly lower in the gabapentin groupcompared with the placebo group. Occurrence of nausea and vomiting and gabapentinside effects that included headache or dizziness did not significantly differ between twogroups (P=0.126, P=1, P=0.629 respectively.Conclusion: Gabapentin not only decreased postoperative pain but also effectivelyreduced emergence agitation without any significant side effects in patients undergoingbreast cancer surgery.

  19. Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit

    Directory of Open Access Journals (Sweden)

    Fernando Nobre

    2002-02-01

    Full Text Available OBJECTIVE: To evaluate the characteristics of the patients receiving medical care in the Ambulatory of Hypertension of the Emergency Department, Division of Cardiology, and in the Emergency Unit of the Clinical Hospital of the Ribeirão Preto Medical School. METHODS: Using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. The characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between January 1996 and December 1997. RESULTS: The care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. Thus, in the Emergency Unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. In 50% of the cases, nifedipine SL was the elected medication. Patients who applied to the Ambulatory of Hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. CONCLUSION: The therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. In the Emergency Unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the Ambulatory of Hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. These results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.

  20. Evaluation of the quality of nursing records in the emergency department of a teaching hospital

    Directory of Open Access Journals (Sweden)

    Beatriz Araújo Seignemartin

    2014-01-01

    Full Text Available Nursing records are all systematized registers made by the nursing team, with legal and ethical implications on research, patient´s safety and communication among health professionals. This quantitative and retrospective cross-sectional study was conducted in a school hospital dedicated to the woman’s care, aiming at evaluating by auditing the quality of the nursing records. The 168 medical records were evaluated according to the standard established by the literature and the legislation of the Professional Council from January to June 2011. The importance of early contact with the patient, incomplete records or lack of information on the assistance rendered, besides nonconformities related to what is expected, were identified. The conclusion is that there is the need of periodic evaluations of the quality of the records and discussions on the results with the nursing team, on its importance regarding legislation, literature and the safety of patients.

  1. Design and evaluation of a patient website to reduce crowding in emergency departments: a preliminary study.

    Science.gov (United States)

    Schiro, Jessica; Marcilly, Romaric; Leroy, Nicolas; Wawrzyniak, Clément; Martinot, Alain; Pelayo, Sylvia

    2015-01-01

    The study aims to identify the information useful to support a patients' EDs' choice in order to design a patient Web-based system. For that purpose, a focus group and a formative user test have been performed. The results show that five types of information can be relevant. The spontaneous favored information is the "distance" to EDs. The "Wait time", that is sanctified in literature, is only used in a second time. A larger summative evaluation should be planned to evaluate and validate the befits of this kind of tool.

  2. Evaluation of Social Media Use by Emergency Medicine Residents and Faculty

    Directory of Open Access Journals (Sweden)

    David Pearson

    2015-10-01

    Full Text Available Introduction: Clinicians and residency programs are increasing their use of social media (SM websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM residents and faculty. Methods: In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK was used for all analyses. Results: We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001], entertainment (61% vs 47% [p<0.0001], and videos (42% vs 23% [p=0.0006]. Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01], whereas residents used Twitter™ (19% vs 26% [p=0.005] and LinkedIn™ (15% vs 32% [p<0.0001] less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]. For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001] and videos (33% vs 26% [p=0.005] and less interested than faculty with award postings (22% vs 33% [p<0.0001] or publications (30

  3. Evaluation of California's Alcohol and Drug Screening and Brief Intervention Project for Emergency Department Patients

    Directory of Open Access Journals (Sweden)

    Susan I Woodruff

    2013-05-01

    Full Text Available Introduction: Visits to settings such as emergency departments (EDs may present a “teachable moment” in that a patient may be more open to feedback and suggestions regarding their risky alcohol and illicit drug-use behaviors. Screening, Brief Intervention, and Referral to Treatment (SBIRT is an ’opportunistic’ public health approach that targets low-risk users, in addition to those already dependent on alcohol and/or drugs. SBIRT programs provide patients with comprehensive screening and assessments, and deliver interventions of appropriate intensity to reduce risks related to alcohol and drug use. Methods: This study used a single group pre-post test design to assess the effect of the California SBIRT service program (i.e., CASBIRT on 6 substance-use outcomes (past-month prevalence and number of days of binge drinking, illegal drug use, and marijuana use. Trained bilingual/bicultural Health Educators attempted to screen all adult patients in 12 EDs/trauma centers (regardless of the reason for the patient’s visit using a short instrument, and then delivered a brief motivational intervention matched to the patient’s risk level. A total of 2,436 randomly selected patients who screened positive for alcohol and/or drug use consented to be in a 6-month telephone follow-up interview. Because of the high loss to follow-up rate, we used an intention-to-treat approach for the data analysis. Results: Results of generalized linear mixed models showed modest reductions in all 6 drug- and alcohol-use outcomes. Men (versus women, those at relatively higher risk status (versus lower risk, and those with only one substance of misuse (versus both alcohol and illicit drug misuse tended to show more positive change. Conclusion: These results suggest that SBIRT services provided in acute care settings are associated with modest changes in self-reported recent alcohol and illicit drug use. [West J Emerg Med. 2013;14(3:263–270.

  4. Evaluation of performance quality of an advanced scope physiotherapy role in a hospital emergency department

    Directory of Open Access Journals (Sweden)

    Morris J

    2015-07-01

    Full Text Available J Morris,1 K Vine,1 K Grimmer21Physiotherapy Department, The Canberra Hospital, Cnr Hindmarsh Dr & Yamba Dr, Garran, ACT, 2International Centre for Allied Health Evidence, University of South Australia, City East Campus, Adelaide, SA, AustraliaBackground: Physiotherapists working in advanced and extended scope roles internationally make a difference to workflow, performance targets, and patient satisfaction in areas traditionally served by medicine and nursingAim: To assess the impact of an advanced scope of practice physiotherapist (ASoP-PT service in a large Australian hospital emergency department (ED by measuring national service and triage category indicators, patient and staff satisfactionMethods: Consecutive patients consulting the ASoP-PT were recruited over 53 weeks following service inception. Descriptions of ASoP-PT activities and patients were collected. Performance was assessed against national ED indicators for length of stay and wait. Patient and staff perspectives were assessed independently by semi-structured interviews. The physiotherapist was formally trained to extended scope of practice including competency in medicines, prescription and application. The legislation prevented him from applying these skills, therefore he worked in an ASoP-PT role in EDResults: The ASoP-PT treated on average, 72 patients per month in ten shifts per fortnight, consulting patients aged from 1 to 88 years. Patients largely presented with musculoskeletal problems in triage Categories 4 and 5. There were shorter length of wait and length of stay, when the ASoP-PT was on shift. However overall compliance with national performance targets was similar with and without the ASoP-PT. Staff and patient satisfaction was high, particularly valuing the ASoP-PT's expertise in musculoskeletal injuries.Conclusion: The ASoP-PT performed at least as well as other ED health care providers in meeting national triage targets. Had the legislation permitted his

  5. Bedside Ultrasonography as an Adjunct to Routine Evaluation of Acute Appendicitis in the Emergency Department

    Science.gov (United States)

    Lam, Samuel H.F.; Grippo, Anthony; Kerwin, Chistopher; Konicki, P. John; Goodwine, Diana; Lambert, Michael J.

    2014-01-01

    Introduction Appendicitis is a common condition presenting to the emergency department (ED). Increasingly emergency physicians (EP) are using bedside ultrasound (BUS) as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis. Methods Patients four years of age and older presenting to the ED with suspected appendicitis were eligible for enrollment. After informed consent was obtained, BUS was performed on the subjects by trained EPs who had undergone a minimum of one-hour didactic training on the use of BUS to diagnose appendicitis. They then recorded elements of clinical history, physical examination, white blood cell count (WBC) with polymophonuclear percentage (PMN), and BUS findings on a data form. We ascertained subject outcomes by a combination of medical record review and telephone follow-up. Results A total of 125 subjects consented for the study, and 116 had adequate image data for final analysis. Prevalence of appendicitis was 40%. Mean age of the subjects was 20.2 years, and 51% were male. BUS was 100% sensitive (95% CI 87–100%) and 32% specific (95% CI 14–57%) for detection of appendicitis, with a positive predictive value of 72% (95% CI 56–84%), and a negative predictive value of 100% (95% CI 52–100%). Assuming all non-diagnostic studies were negative would yield a sensitivity of 72% and specificity of 81%. Subjects with appendicitis had a significantly higher occurrence of anorexia, nausea, vomiting, and a higher WBC and PMN count when compared to those without appendicitis. Their BUS studies were significantly more likely to result in visualization of the appendix, appendix diameter >6mm, appendix wall thickness >2mm, periappendiceal fluid, visualization of the appendix tip, and sonographic Mcburney’s sign (p6mm, appendix wall thickness >2mm, periappendiceal fluid were found

  6. A Sample of Crisis Management in the Emergency Department and Evaluation of Patients; Reyhanli-Hatay-Turkey Experience

    Directory of Open Access Journals (Sweden)

    Ali Karakus

    2014-04-01

    Full Text Available Aim: Natural disasters, terrorist bombings, transportation and industrial accidents can lead to many deaths and injuries. The number of deaths and injuries in these situations are closely related to cooperation among police, fire fighters, ambulances and hospital staff. Practice and organized positioning can improve such cooperation and experiences. In this study, we aimed to investigate the medical situation of the patients admitted to our hospital emergency service after the terrorist bombing attack occurred on Saturday May 11th, 2013 at about 14:00 pm in the Reyhanli province and to evaluate our hospital applications. Material and Method: Data including gender, age, Glascow Coma Scale score, Injury Severity Score-ISS , K-Revise Trauma Score(RTS, type of transportation and injury, duration of treatment and prognosis of the patients injured after the explosion were collected retrospectively from the hospital records. Results: The terrorist bombing attack was the bloodiest event in the history of the Republic of Turkey. After the explosion, 51 people died. 27 of the 146 injured patients were admitted to our hospital. 20 of them were male and 7 were female. The mean age of the patients was 31,85 (1-63. Glascow Coma Scale scores were 3-8 for 3 patients, 9-13 for 6 patients and 14-15 for 18 patients. The most frequent injuries were observed in the extremities and soft tissues. 15 patients were discharged after their treatment and 9 patients were hospitalized by different services related to their medical conditions. Three patients died in the emergency department. The size of the event and the number of injured patients were evaluated by the doctors in charge in emergency service and the 112 paramedics. Then, other relevant doctors, administrative officers and health care staffs were instructed and called to the hospital. Appropriately triaged, monitored and treated patients were resulted after evaluating their conditions. Discussion: The soft

  7. Development and Flight Evaluation of an Emergency Digital Flight Control System Using Only Engine Thrust on an F-15 Airplane

    Science.gov (United States)

    Burcham, Frank W., Jr.; Maine, Trindel A.; Fullerton, C. Gordon; Webb, Lannie Dean

    1996-01-01

    A propulsion-controlled aircraft (PCA) system for emergency flight control of aircraft with no flight controls was developed and flight tested on an F-15 aircraft at the NASA Dryden Flight Research Center. The airplane has been flown in a throttles-only manual mode and with an augmented system called PCA in which pilot thumbwheel commands and aircraft feedback parameters were used to drive the throttles. Results from a 36-flight evaluation showed that the PCA system can be used to safety land an airplane that has suffered a major flight control system failure. The PCA system was used to recover from a severe upset condition, descend, and land. Guest pilots have also evaluated the PCA system. This paper describes the principles of throttles-only flight control; a history of loss-of-control accidents; a description of the F-15 aircraft; the PCA system operation, simulation, and flight testing; and the pilot comments.

  8. Twinning "Practices of Change" with "Theory of Change": Room for Emergence in Advocacy Evaluation

    Science.gov (United States)

    Arensman, Bodille; van Waegeningh, Cornelie; van Wessel, Margit

    2018-01-01

    Theory of change (ToC) is currently "the" approach for the evaluation and planning of international development programs. This approach is considered especially suitable for complex interventions. We question this assumption and argue that ToC's focus on cause-effect logic and intended outcomes does not do justice to the recursive nature…

  9. 76 FR 72431 - Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness...

    Science.gov (United States)

    2011-11-23

    ... national preparedness terms and concepts found in the National Incident Management System (NIMS)/ Incident... many of the REP Program's operative guidance and policy documents into one location, and [[Page 72432... for alert and notification systems. In addition, Supplement 4 revises and adds evaluation criteria and...

  10. Emergency procedures

    International Nuclear Information System (INIS)

    Abd Nasir Ibrahim; Azali Muhammad; Ab Razak Hamzah; Abd Aziz Mohamed; Mohammad Pauzi Ismail

    2004-01-01

    The following subjects are discussed - Emergency Procedures: emergency equipment, emergency procedures; emergency procedure involving X-Ray equipment; emergency procedure involving radioactive sources

  11. The role of perceived threat during emergency department cardiac evaluation and the age-posttraumatic stress disorder link.

    Science.gov (United States)

    Meli, Laura; Kautz, Marin; Julian, Jacob; Edmondson, Donald; Sumner, Jennifer A

    2018-06-01

    Evaluation for acute coronary syndrome (ACS) can trigger posttraumatic stress symptoms (PSS). Research suggests that younger, versus older, individuals may be at elevated risk for PSS after ACS evaluation. It has been proposed that younger individuals may be at greater risk because they perceive the suspected ACS event as more threatening than their older counterparts; however, this has yet to be tested. We examined whether perceived threat during ACS evaluation mediated the association between age and PSS after ACS evaluation in an observational cohort study of patients presenting to the emergency department (ED) with suspected ACS. Demographics and perceived threat were assessed in the ED. PSS were measured upon inpatient transfer or by phone 3 days later. The analytic sample comprised 871 adult participants. Multiple linear regression was used to examine (1) associations of age and perceived threat with PSS and (2) whether perceived threat mediated the association. Bootstrapping with percentile-based confidence intervals (CIs) was used to test the indirect effect. Each year of age was associated with lower PSS (b = - 0.12, p age was associated with lower perceived threat during ACS evaluation (b = - 0.05, p age differences in PSS development risk and the potential impact of age on threat perceptions may help inform ED treatment.

  12. Identification and evaluation of competencies of health professionals in the hospital emergency management of the radiation accident victim

    International Nuclear Information System (INIS)

    Berger, M.E.

    1982-01-01

    A preliminary list of ten competency and forty-six sub-competency statements derived from literature and consultation with experts and based on the general areas of clinical performance defined by the National Board of Medical Examiners were the concern of Phase I of this study. Forty-eight experts in nuclear medicine, radiology, radiotherapy, health physics, medical physics, radiation biology, public and occupational health, surgery, and emergency medicine and nursing considered this preliminary list of competencies and sub-competencies to determine which were essential for health professionals who may be caring for radiation accident victims in hospital emergency departments. Eight competencies and thirty-three sub-competencies were rated as Essential competencies. Competencies dealing with establishing priorities in patient care and initiating treatment, assessment, contamination control, and decontamination were highly rated. In the second part of this study, the Essential competencies were utilized in the development of an original evaluation instrument designed to identify deficiencies and continuing education needs during radiation accident drills or exercises. The instrument was designed for use in sixteen possible patient care situations in which the radiation accident victims have varying medical and radiological conditions. Development of the evaluation instrument was described

  13. Emergency department knowledge management in the age of Web 2.0: evaluation of a new concept.

    Science.gov (United States)

    Dinh, Michael; Tan, Timothy; Bein, Kendall; Hayman, Jon; Wong, Yuk Kuen; Dinh, David

    2011-02-01

    The objective of the present study was to describe the implementation of an organizational learning model and evaluate the effectiveness and usability of an application used to facilitate it in an ED setting. This was an implementation case study and technology evaluation. The organizational learning model was implemented using an online Web 2.0 collaborative learning application developed by the investigating team. Online use was tracked over a 9-month period. At the end of the study period, a usability assessment was conducted as well as a semistructured interview of participants to assess perceptions of usefulness and effect on learning capacity in the ED. Over a period of 9 months, a total of 54 individual sites from 74 eligible staff members were created within a specific web domain. There were 251 registered users including users outside the ED, who accessed learning materials within these sites 7494 times. The majority of staff members interviewed agreed or strongly agreed that the collaborative learning application had improved learning capacity within this ED (88%, 95% CI 74-94%). We demonstrate the implementation of an organizational learning model based on independent online sites networking together within an organization. This appears to be both usable and acceptable to staff members working in a large ED as a means of knowledge management. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  14. A survey on evaluation function for contaminations and doses in the primary and the secondary radiation emergency hospitals

    International Nuclear Information System (INIS)

    Yamada, Yuji; Akashi, Makoto; Shiraishi, Kunio; Suzuki, Toshikazu; Ishigure, Nobuhito; Endo, Akira; Sanada, Tetsuya; Nakayama, Kazushige; Shizuma, Kiyoshi; Takada, Chie; Momose, Takumaro; Hoshi, Masaharu; Yamaguchi, Takenori

    2009-01-01

    The questionnaire on evaluation function for contaminations and doses was sent to the primary and the secondary radiation emergency hospitals in Japan by the network council for physical dosimetry in National Institute of Radiological Sciences (NIRS) designated as the tertiary hospital. The recovery percentage from the 88 hospitals was 70%. It turned out that six primary hospitals in 37 hospitals did not have even the basic instruments on radiation measurement such as GM counter and personal dosimeter. 64% of the secondary hospitals have the whole body counter, but its operation frequency including exercise was considerably low. It is thought that the main cause originates in a chronic manpower shortage and the budget shortfall seen by all the primary and the secondary hospitals. And also peculiar difficulty of correspondence to the radiation emergency medical treatment and the few experience might promote the problem. Thus the anxiety of the site staff had been appeared to the result of the questionnaire survey in shape like the opinion and the demand, etc. It will be necessary to advance the enhancement of training and to make the manual for the contaminations and the doses evaluation in the hospitals. (author)

  15. Clinical pharmacist evaluation of medication inappropriateness in the emergency department of a teaching hospital in Malta

    Directory of Open Access Journals (Sweden)

    West LM

    2012-12-01

    Full Text Available Appropriate prescribing remains an important priority in all medical areas of practice. Objective: The objective of this study was to apply a Medication Appropriateness Index (MAI to identify issues of inappropriate prescribing amongst patients admitted from the Emergency Department (ED.Method: This study was carried out at Malta’s general hospital on 125 patients following a two-week pilot period on 10 patients. Patients aged 18 years and over and on medication therapy were included. Medication treatment for inappropriateness was assessed by using the MAI. Under-prescribing was also screened for. Results: Treatment charts of 125 patients, including 697 medications, were assessed using a MAI. Overall, 115 (92% patients had one or more medications with one or more MAI criteria rated as inappropriate, giving a total of 384 (55.1% medications prescribed inappropriately. The mean SD MAI score per drug was 1.78 (SD=2.19. The most common medication classes with appropriateness problems were supplements (20.1%, antibiotics (20.0% and steroids (19.8%. The most common problems involved incorrect directions (26% and incorrect dosages (18.5%. There were 36 omitted medications with untreated indications. Conclusion: There is considerable inappropriate prescribing which could have significant negative effects regarding patient care.

  16. Prospective, randomized evaluation of a personal digital assistant-based research tool in the emergency department

    Directory of Open Access Journals (Sweden)

    Dinizio Anthony

    2008-01-01

    Full Text Available Abstract Background Personal digital assistants (PDA offer putative advantages over paper for collecting research data. However, there are no data prospectively comparing PDA and paper in the emergency department. The aim of this study was to prospectively compare the performance of PDA and paper enrollment instruments with respect to time required and errors generated. Methods We randomized consecutive patients enrolled in an ongoing prospective study to having their data recorded either on a PDA or a paper data collection instrument. For each method, we recorded the total time required for enrollment, and the time required for manual transcription (paper onto a computer database. We compared data error rates by examining missing data, nonsensical data, and errors made during the transcription of paper forms. Statistical comparisons were performed by Kruskal-Wallis and Poisson regression analyses for time and errors, respectively. Results We enrolled 68 patients (37 PDA, 31 paper. Two of 31 paper forms were not available for analysis. Total data gathering times, inclusive of transcription, were significantly less for PDA (6:13 min per patient compared to paper (9:12 min per patient; p Conclusion Using a PDA-based data collection instrument for clinical research reduces the time required for data gathering and significantly improves data integrity.

  17. Spatio-temporal evaluation of emerging contaminants and their partitioning along a Brazilian watershed.

    Science.gov (United States)

    de Sousa, Diana Nara Ribeiro; Mozeto, Antonio Aparecido; Carneiro, Renato Lajarim; Fadini, Pedro Sergio

    2018-02-01

    The occurrence, partitioning, and spatio-temporal distribution of seven pharmaceuticals for human use, three steroid hormones and one personal care product were determined in surface water, suspended particulate matter (SPM), and sediment of Piraí Creek and Jundiaí River (Jundiaí River Basin, São Paulo, Brazil). The maximum average detected concentrations of the compounds in the Piraí River samples were contaminants most frequently detected in sediment and SPM samples. Triclosan had the highest average proportion of SPM as opposed to in the aqueous phase (> 75%). Contaminants with acid functional groups showed, in general, a lower tendency to bind to particulate matter and sediments. In addition, hydrophobicity had an important effect on their environmental partitioning. The spatial distribution of contaminants along the Jundiaí River was mainly affected by the higher concentration of contaminants in water samples collected downstream from a sewage treatment plant (STP). The results obtained here clearly showed the importance of the analysis of some contaminants in the whole water, meaning both dissolved and particulate compartments in the water, and that the partitioning is ruled by a set of parameters associated to the physicochemical characteristics of contaminants and the matrix properties of the studied, which need be considered in an integrated approach to understand the fate of emerging chemical contaminants in aquatic environments.

  18. Encountering Anger in the Emergency Department: Identification, Evaluations and Responses of Staff Members to Anger Displays

    Directory of Open Access Journals (Sweden)

    Cheshin Arik

    2012-01-01

    Full Text Available Background. Anger manifestations in emergency departments (EDs occur daily, interrupting workflow and exposing staff to risk. Objectives. How staff assess and recognize patients’ angry outbursts in EDs and elucidate responses to anger expressions, while considering effects of institution guidelines. Methods. Observations of staff patient interaction in EDs and personal interviews of staff (n=38 were conducted. Two questionnaires were administered (n=80 & n=144. Assessment was based mainly on regression statistic tests. Results. Staff recognizes two types of anger displays. Magnitude of anger expressions were correlated with staff’s fear level. Staff’s responses ranged from ignoring incidents, giving in to patients’ requests or immediately calling security. When staff felt fear and became angry they tended to call security. Staff was more likely to ignore anger when incident responsibility was assigned to patients. Discussion. Anger encounters are differentiated according to intensity level, which influences interpretations and response. Organizational policy has an effect on staff’s response. Conclusions. Staff recognizes anger at varying levels and responds accordingly. The level of danger staff feels is a catalyst in giving in or calling security. Call security is influenced by fear, and anger. Permanent guidelines can help staff in responding to anger encounters.

  19. An Evaluation Of Advertising Models In Emergent Countries – The Case Of Albania

    Directory of Open Access Journals (Sweden)

    Elenica Pjero

    2012-10-01

    Full Text Available The market today is confronted with cornucopia of challenges and opportunities. The unfolding scenario is being closely watched by marketers across the globe and they are competing with each other to grasp the market share. In order to win over the consumers, marketers are constantly evolving strategies.The western firms based and operating from market-based economies are progressively being confronted with the growing challenge of creating brand awareness amongst the perspective consumers. As a result, advertising has become an essential marketing tool for these foreign firms in establishing their relatively less or unknown brands and products. The study aims to report the results of a survey about changing attitudes towards advertising in Albania. It examines the questionnaire - based response of a sample population of consumers from the city of Vlora, in their general attitudes towards advertising. Findings will contribute to the understanding of theoretical explanations for advertising in emerging markets, and of western firms using advertising marketing tool to penetrate these markets.

  20. Scalable Emergency Response System for Oceangoing Assets Report on Brainstorming Concept Evaluations

    Science.gov (United States)

    2007-04-11

    biological agents is of Report on Brainstorming Concept Evaluations 19 great importance to Navy. For example, isolating and testing Bacillus anthracis at...cleanup involved sensitive government areas a warren of tight spaces, HVAC systems, and enclosed areas including the tunnels USPS Trenton facility 1...Ekaterinaberg, Russia Suspected Anthrax spores released by bioweapons lab in the city affecting at least 94 killing 64 of them biological weapon

  1. Ensemble Genetic Fuzzy Neuro Model Applied for the Emergency Medical Service via Unbalanced Data Evaluation

    Directory of Open Access Journals (Sweden)

    Muammar Sadrawi

    2018-03-01

    Full Text Available Equally partitioned data are essential for prediction. However, in some important cases, the data distribution is severely unbalanced. In this study, several algorithms are utilized to maximize the learning accuracy when dealing with a highly unbalanced dataset. A linguistic algorithm is applied to evaluate the input and output relationship, namely Fuzzy c-Means (FCM, which is applied as a clustering algorithm for the majority class to balance the minority class data from about 3 million cases. Each cluster is used to train several artificial neural network (ANN models. Different techniques are applied to generate an ensemble genetic fuzzy neuro model (EGFNM in order to select the models. The first ensemble technique, the intra-cluster EGFNM, works by evaluating the best combination from all the models generated by each cluster. Another ensemble technique is the inter-cluster model EGFNM, which is based on selecting the best model from each cluster. The accuracy of these techniques is evaluated using the receiver operating characteristic (ROC via its area under the curve (AUC. Results show that the AUC of the unbalanced data is 0.67974. The random cluster and best ANN single model have AUCs of 0.7177 and 0.72806, respectively. For the ensemble evaluations, the intra-cluster and the inter-cluster EGFNMs produce 0.7293 and 0.73038, respectively. In conclusion, this study achieved improved results by performing the EGFNM method compared with the unbalanced training. This study concludes that selecting several best models will produce a better result compared with all models combined.

  2. Evaluation of coping strategies in established rheumatoid arthritis patients: emergence of concealment in an Asian cohort.

    Science.gov (United States)

    Chew, Elizabeth; Griva, Konstadina; Cheung, Peter P

    2016-11-01

    To evaluate coping strategies of Asian RA patients and their associations with health-related quality of life (HRQoL). A cross-sectional sample of patients with established RA was evaluated using measures of coping (Coping in Rheumatoid Arthritis Questionnaire [C-RAQ]; appraisal of coping effectiveness and helplessness), HRQoL (Mental and Physical Components [MCS/PCS] of the Short Form 12v2; Rheumatoid Arthritis Impact of Disease score [RAID]) and clinical/laboratory assessments. Principal component analysis was conducted to identify coping strategies. Multiple linear regression analyses were performed to evaluate the associations between coping strategies and HRQoL outcomes. The study sample comprised 101 patients, 81% female, 72.3% Chinese, mean age 54.2 ± 12.6 years. Five coping strategies were identified: Active problem solving (E = 5.36), Distancing (E = 2.30), Concealment (E = 1.89), Cognitive reframing (E = 1.55) and Emotional expression (E = 1.26). Concealment was consistently associated with PCS (r s = -0.23, P = 0.049), MCS (r s = -0.24, P = 0.04) and RAID (r s = 0.39, P culture-specific. Interventions should tailor psychosocial support needs to address not only coping strategies, but patients' perception of their coping. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  3. An evaluation of the emerging vaccines and immunotherapy against staphylococcal pneumonia in children

    Directory of Open Access Journals (Sweden)

    Rubens Craig

    2011-04-01

    Full Text Available Abstract Background Staphylococcus aureus is a commensal of human skin and nares. It is also one of the leading nosocomial pathogens in both developed and developing countries and is responsible for a wide range of life threatening infections, especially in patients who are immunocompromised, post-surgery, undergoing haemodialysis and those who are treated with catheters and ventilators. Over the past two decades, the incidence of nosocomial staphylococcal infections has increased dramatically. Currently there are at least seven vaccine and immunotherapy candidates against S. aureus in the developmental phase targeting both active and passive immunization. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging vaccines against Staphylococcus aureus relevant to several criteria of interest: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies to participate. The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to sensitive nature of their involvement in such exercises. They answered questions from CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results The panel of experts expressed low levels of optimism (score around or below 50% on the criteria of answerability, efficacy, maximum disease burden reduction potential, low cost of production, low cost

  4. An evaluation of the emerging vaccines and immunotherapy against staphylococcal pneumonia in children.

    Science.gov (United States)

    Huda, Tanvir; Nair, Harish; Theodoratou, Evropi; Zgaga, Lina; Fattom, Ali; El Arifeen, Shams; Rubens, Craig; Campbell, Harry; Rudan, Igor

    2011-04-13

    Staphylococcus aureus is a commensal of human skin and nares. It is also one of the leading nosocomial pathogens in both developed and developing countries and is responsible for a wide range of life threatening infections, especially in patients who are immunocompromised, post-surgery, undergoing haemodialysis and those who are treated with catheters and ventilators. Over the past two decades, the incidence of nosocomial staphylococcal infections has increased dramatically. Currently there are at least seven vaccine and immunotherapy candidates against S. aureus in the developmental phase targeting both active and passive immunization. We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging vaccines against Staphylococcus aureus relevant to several criteria of interest: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies) to participate. The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to sensitive nature of their involvement in such exercises. They answered questions from CHNRI framework and their "collective optimism" towards each criterion was documented on a scale from 0 to 100%. The panel of experts expressed low levels of optimism (score around or below 50%) on the criteria of answerability, efficacy, maximum disease burden reduction potential, low cost of production, low cost of implementation and affordability; moderate levels of

  5. [Evaluation and improvement of the management of informed consent in the emergency department].

    Science.gov (United States)

    del Pozo, P; García, J A; Escribano, M; Soria, V; Campillo-Soto, A; Aguayo-Albasini, J L

    2009-01-01

    To assess the preoperative management in our emergency surgical service and to improve the quality of the care provided to patients. In order to find the causes of non-compliance, the Ishikawa Fishbone diagram was used and eight assessment criteria were chosen. The first assessment includes 120 patients operated on from January to April 2007. Corrective measures were implemented, which consisted of meetings and conferences with doctors and nurses, insisting on the importance of the informed consent as a legal document which must be signed by patients, and the obligation of giving a copy to patients or relatives. The second assessment includes the period from July to October 2007 (n=120). We observed a high non-compliance of C1 signing of surgical consent (CRITERION 1: all patients or relatives have to sign the surgical informed consent for the operation to be performed [27.5%]) and C2 giving a copy of the surgical consent (CRITERION 2: all patients or relatives must have received a copy of the surgical informed consent for the Surgery to be performed [72.5%]) and C4 anaesthetic consent copy (CRITERION 4: all patients or relatives must have received a copy of the Anaesthesia informed consent corresponding to the operation performed [90%]). After implementing corrective measures a significant improvement was observed in the compliance of C2 and C4. In C1 there was an improvement without statistical significance. The carrying out of an improvement cycle enabled the main objective of this paper to be achieved: to improve the management of informed consent and the quality of the care and information provided to our patients.

  6. Evaluating the effects of increasing surgical volume on emergency department patient access.

    Science.gov (United States)

    Levin, S; Dittus, R; Aronsky, D; Weinger, M; France, D

    2011-02-01

    To determine how increases in surgical patient volume will affect emergency department (ED) access to inpatient cardiac services. To compare how strategies to increase cardiology inpatient throughput can either accommodate increases in surgical volume or improve ED patient access. A stochastic discrete event simulation was created to model patient flow through a cardiology inpatient system within a US, urban, academic hospital. The simulation used survival analysis to examine the relationship between anticipated increases in surgical volume and ED patient boarding time (ie, time interval from cardiology admission request to inpatient bed placement). ED patients boarded for a telemetry and cardiovascular intensive care unit (CVICU) bed had a mean boarding time of 5.3 (median 3.1, interquartile range 1.5-6.9) h and 2.7 (median 1.7, interquartile range 0.8-3.0) h, respectively. Each 10% incremental increase in surgical volume resulted in a 37 and 33 min increase in mean boarding time to the telemetry unit and CVICU, respectively. Strategies to increase cardiology inpatient throughput by increasing capacity and decreasing length of stay for specific inpatients was compared. Increasing cardiology capacity by one telemetry and CVICU bed or decreasing length of stay by 1 h resulted in a 7-9 min decrease in average boarding time or an 11-19% increase in surgical patient volume accommodation. Simulating competition dynamics for hospital admissions provides prospective planning (ie, decision making) information and demonstrates how interventions to increase inpatient throughput will have a much greater effect on higher priority surgical admissions compared with ED admissions.

  7. Development of an integrated system for evaluation of environmental radiologic impact during emergency situations

    International Nuclear Information System (INIS)

    Conti, Luiz Fernando de Carvalho

    2002-03-01

    An integrated system for performing environmental dose assessment after nuclear or radiological emergencies has been developed, as a tool for decision making process. The system includes databases such as those describing radionuclide decay, dose conversion factors for several environmental geometries and radionuclides with emitted radiation and energies. It includes several models for predicting environmental behaviour at the short,medium and long terms, for both rural and urban environments and is flexible enough for simulating the exposure of members of the public due to small accidents involving individual sources up to large scale nuclear accidents with complex source terms to the environment. The model has been built in a way that can perform assessment of actual exposures or make forecasts for future exposure based on dynamic simulation of the fate of radionuclides in environmental and potential exposure pathways to members of the public, taking into account he kind of contaminated environment and the age groups of exposed persons. Input data may come from a predicted source term or information on environmental concentration based on dispersion models or on environmental measurements, including on line monitoring systems, environmental surveys, direct measurements by in situ gamma spectrometry or analysis of environmental samples. Outputs of the model are dose estimates to members of the public as a function of the exposure pathway, time after the contamination and age group, for different groups of members of the public and kind of use of the environment. Time dependent kerma rates in air and concentrations in environmental compartments such as soil and foodstuff are also available, including the simulation of the effect of protective measures, to support the decision making process. (author)

  8. Evaluating the benefits of coordinated emerging flexible resources in electricity markets

    International Nuclear Information System (INIS)

    Heydarian-Forushani, E.; Golshan, M.E.H.; Siano, Pierluigi

    2017-01-01

    Highlights: •Variable renewable energy sources create a flexibility gap in power system operation. •BESs, PEV PLs and DR are modeled as flexible options. •DR programs have remarkable impacts in terms of cost and emission reduction. •PEV PL is not a favorable flexible option by its own due to uncertain behavior of PEV owners. •Coordinated operation of PEV PLs and BESs under TOU program is the most effective generation mixture. -- Abstract: Increasing share of variable renewable energy sources (VRESs) with the aim of tackling climate changes impose several techno-economic challenges to power system operation. VRESs reduce the available flexibility by displacing existing flexible units due to their priority in dispatch and simultaneously enhance the need for additional flexibility due to their uncertain nature. In this light, the system is faced with a flexibility gap. One way to cover the created flexibility gap is the incorporation of emerging flexible resources into power systems operation. On this basis, this paper proposes a comprehensive flexible generation portfolio including bulk energy storages (BESs), plug-in electric vehicle parking lots (PEV PLs), and demand response (DR) programs. A stochastic market-based model is proposed to coordinate the interactions among these flexibility providers considering different sets of uncertainty, such as wind power generation and PEV owner’s behavior. Finally, various generation mixtures are prioritized based on the system operator’s economic, technical, and environmental desires to provide a guideline to opt the most effective generation mixture in the context of flexibility promotion.

  9. Multidisciplinary Delphi Development of a Scale to Evaluate Team Function in Obstetric Emergencies: The PETRA Scale.

    Science.gov (United States)

    Balki, Mrinalini; Hoppe, David; Monks, David; Cooke, Mary Ellen; Sharples, Lynn; Windrim, Rory

    2017-06-01

    The objective of this study was to develop a new interdisciplinary teamwork scale, the Perinatal Emergency: Team Response Assessment (PETRA), for the management of obstetric crises, through consensus agreement of obstetric caregivers. This prospective study was performed using expert consensus, based on a Delphi method. The study investigators developed a new PETRA tool, specifically related to obstetric crisis management, based on the existing literature and discussions among themselves. The scale was distributed to a selected panel of experts in the field for the Delphi process. After each round of Delphi, every component of the scale was analyzed quantitatively by the percentage of agreement ratings and each comment reviewed by the blinded investigators. The assessment scale was then modified, with components of less than 80% agreement removed from the scale. The process was repeated on three occasions to reach a consensus and final PETRA scale. Fourteen of 24 invited experts participated in the Delphi process. The original PETRA scale included six categories and 48 items, one global scale item, and a 3-point rubric for rating. The overall percentage agreement by experts in the first, second, and third rounds was 95.0%, 93.2%, and 98.5%, respectively. The final scale after the third round of Delphi consisted of the following seven categories: shared mental model, communication, situational awareness, leadership, followership, workload management, and positive/effective behaviours and attitudes. There were 34 individual items within these categories, each with a 5-point rating rubric (1 = unacceptable to 5 = perfect). Using a structured Delphi method, we established the face and content validity of this assessment scale that focuses on important aspects of interdisciplinary teamwork in the management of obstetric crises. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada

  10. Evaluation of effective dose in an anthropomorphic phantom in radiological emergencies situations

    International Nuclear Information System (INIS)

    Silva, Livia K. da; Ribeiro, Rosane M.; Santos, Denison de S.

    2013-01-01

    This work aims to implement the code of Monte Carlo Geant4 in a male and female phantom, ADAM and EVA, to be able to evaluate the dose in individuals who have been exposed externally to ionizing radiation sources so that in the future be made a review within the limits of validity of the terms contained in TECDOC-1162, published by the International Atomic Energy Agency (IAEA), which recommends formulas for the effective dose assessment in individuals who have been exposed to external radiation sources in various geometric configurations and for various radionuclides

  11. Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Michael M. Neeki

    2017-05-01

    Full Text Available Introduction: Necrotizing fasciitis (NF is an uncommon but rapidly progressive infection that results in gross morbidity and mortality if not treated in its early stages. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC score is used to distinguish NF from other soft tissue infections such as cellulitis or abscess. This study analyzed the ability of the LRINEC score to accurately rule out NF in patients who were confirmed to have cellulitis, as well as the capability to differentiate cellulitis from NF. Methods: This was a 10-year retrospective chart-review study that included emergency department (ED patients ≥18 years old with a diagnosis of cellulitis or NF. We calculated a LRINEC score ranging from 0–13 for each patient with all pertinent laboratory values. Three categories were developed per the original LRINEC score guidelines denoting NF risk stratification: high risk (LRINEC score ≥8, moderate risk (LRINEC score 6–7, and low risk (LRINEC score ≤5. All cases missing laboratory values were due to the absence of a C-reactive protein (CRP value. Since the score for a negative or positive CRP value for the LRINEC score was 0 or 4 respectively, a LRINEC score of 0 or 1 without a CRP value would have placed the patient in the “low risk” group and a LRINEC score of 8 or greater without CRP value would have placed the patient in the “high risk” group. These patients missing CRP values were added to these respective groups. Results: Among the 948 ED patients with cellulitis, more than one-tenth (10.7%, n=102 of 948 were moderate or high risk for NF based on LRINEC score. Of the 135 ED patients with a diagnosis of NF, 22 patients had valid CRP laboratory values and LRINEC scores were calculated. Among the other 113 patients without CRP values, six patients had a LRINEC score ≥ 8, and 19 patients had a LRINEC score ≤ 1. Thus, a total of 47 patients were further classified based on LRINEC score without a CRP value

  12. Identification and Evaluation of Human Factors Issues Associated with Emerging Nuclear Plant Technology

    International Nuclear Information System (INIS)

    O'Hara, J.M.; Higgins, J.; Brown, William S.

    2009-01-01

    This study has identified human performance research issues associated with the implementation of new technology in nuclear power plants (NPPs). To identify the research issues, current industry developments and trends were evaluated in the areas of reactor technology, instrumentation and control technology, human-system integration technology, and human factors engineering (HFE) methods and tools. The issues were prioritized into four categories based on evaluations provided by 14 independent subject matter experts representing vendors, utilities, research organizations and regulators. Twenty issues were categorized into the top priority category. The study also identifies the priority of each issue and the rationale for those in the top priority category. The top priority issues were then organized into research program areas of: New Concepts of Operation using Multi-agent Teams, Human-system Interface Design, Complexity Issues in Advanced Systems, Operating Experience of New and Modernized Plants, and HFE Methods and Tools. The results can serve as input to the development of a long-term strategy and plan for addressing human performance in these areas to support the safe operation of new NPPs.

  13. Emergency Food Assistance in Northern Syria: An Evaluation of Transfer Programs in Idleb Governorate.

    Science.gov (United States)

    Doocy, Shannon; Tappis, Hannah; Lyles, Emily; Witiw, Joseph; Aken, Vicki

    2017-06-01

    The war in Syria has left millions struggling to survive amidst violent conflict, pervasive unemployment, and food insecurity. Although international assistance funding is also at an all-time high, it is insufficient to meet the needs of conflict-affected populations, and there is increasing pressure on humanitarian stakeholders to find more efficient, effective ways to provide assistance. To evaluate 3 different assistance programs (in-kind food commodities, food vouchers, and unrestricted vouchers) in Idleb Governorate of Syria from December 2014 and March 2015. The evaluation used repeated survey data from beneficiary households to determine whether assistance was successful in maintaining food security at the household level. Shopkeeper surveys and program monitoring data were used to assess the impact on markets at the district/governorate levels and compare the cost-efficiency and cost-effectiveness of transfer modalities. Both in-kind food assistance and voucher programs showed positive effects on household food security and economic measures in Idleb; however, no intervention was successful in improving all outcomes measured. Food transfers were more likely to improve food access and food security than vouchers and unrestricted vouchers. Voucher programs were found to be more cost-efficient than in-kind food assistance, and more cost-effective for increasing household food consumption. Continuation of multiple types of transfer programs, including both in-kind assistance and vouchers, will allow humanitarian actors to remain responsive to evolving access and security considerations, local needs, and market dynamics.

  14. Differences between orthopaedic evaluation and radiological reports of conventional radiographs in patients with minor trauma admitted to the emergency department.

    Science.gov (United States)

    Catapano, Michele; Albano, Domenico; Pozzi, Grazia; Accetta, Riccardo; Memoria, Sergio; Pregliasco, Fabrizio; Messina, Carmelo; Sconfienza, Luca Maria

    2017-11-01

    During night and on weekends, in our emergency department there is no radiologist on duty or on call: thus, X-ray examinations (XR) are evaluated by the orthopaedic surgeon on duty and reported the following morning/monday by radiologists. The aim of our study was to examine the discrepancy rate between orthopaedists and radiologists in the interpretation of imaging examinations performed on patients in our tertiary level orthopaedic institution and the consequences of delayed diagnosis in terms of patient management and therapeutic strategy. We retrospectively reviewed all cases of discrepancy between orthopaedists and radiologists, which were categorized according to anatomical location of injury, initial diagnosis and treatment, change in diagnosis and treatment. We used the Chi square test to compare the frequencies of discrepancies between patients ≤14 and >14years of age. From January to December 2016, 19,512 patients admitted to our emergency department performed at least an imaging examination; among these patients, 13,561 underwent XR in absence of an attending radiologist. A discrepant diagnosis was found in 337/13,561 (2.5%; 184 males; mean age: 36.7±23.7, range 2-95); 151/337 (45%) discrepancies were encountered in the lower limbs, with ankle being the most common site of misdiagnosis (64/151), and 103/337 (30%) in the upper limbs, with the elbow being the most frequent site in this district (35/103). We found 293/337 false negatives (87%) and 44/337 false positives (13%), with 134 and 13 patients needing treatment change, respectively. We found 85/337 discrepancies (25%) in patients ≤14 years of age, and 252/337 (75%) in those >14years. The distribution of discrepancies per anatomic district was significantly different (P<0.001) in these two groups of patients. A low rate of discrepancy between orthopaedists and radiologists in evaluating images of patients admitted to our emergency department was found, although treatment change occurred in about

  15. MBRRACE in simulation: an evaluation of a multi-disciplinary simulation training for medical emergencies in obstetrics (MEmO).

    Science.gov (United States)

    Lavelle, Mary; Abthorpe, Jennifer; Simpson, Thomas; Reedy, Gabriel; Little, Fiona; Banerjee, Anita

    2018-03-21

    The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions, known as 'indirect deaths'. The MBRRACE report identified serious gaps in clinicians' human factors skills, including communication, leadership and teamwork, which contributed to maternal death. In response, we developed the first multi-disciplinary simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Employing a mixed methods design, this study evaluated the educational impact of this training programme on the healthcare staff (n = 140), including the medical doctors (n = 91) and the midwives (n = 49). The training improved participants' clinical management of medical deterioration in pregnancy (p=.003) alongside improving their human factors skills (p=.004). Furthermore, participants reported the translation of these skills to their routine clinical practice. This flexible training is responsive to the changing national needs and contextualises the MBRRACE findings for healthcare staff. It is a promising avenue for reducing the rates of in-direct death in pregnancy. Impact statement What is already known on this subject? The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions. The management of medical conditions in pregnancy relies on a multi-professional approach. However, serious gaps in clinicians' human factors skills, highlighted by the MBRRACE report, may contribute to maternal death. What do the results of this study add? This study evaluated the first multi-disciplinary, simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Training significantly improved participants' management of medical deterioration in pregnancy and human factors skills, particularly in the areas of leadership, communication and teamwork. Moreover, the participants learning translated into their clinical practice. What are the implications of

  16. Integrating care for frequent users of emergency departments: implementation evaluation of a brief multi-organizational intensive case management intervention.

    Science.gov (United States)

    Kahan, Deborah; Leszcz, Molyn; O'Campo, Patricia; Hwang, Stephen W; Wasylenki, Donald A; Kurdyak, Paul; Wise Harris, Deborah; Gozdzik, Agnes; Stergiopoulos, Vicky

    2016-04-27

    Addressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre. Coordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions. To examine barriers and facilitators to early implementation of this multi-organizational intervention, between July and October 2012, 47 stakeholders, including direct service providers, managers and administrators participated in 32 semi-structured qualitative interviews and one focus group exploring their experience with the intervention and factors that helped or hindered successful early implementation. Qualitative data were analyzed using thematic analysis. Stakeholders valued the intervention and its potential to support continuity of care for this population. Service delivery system factors, including organizational capacity and a history of collaborative relationships across the healthcare continuum, and support system factors, such as training and supervision, emerged as key facilitators of program implementation. Operational challenges included early low program referral rates, management of a multi-organizational initiative, variable adherence to the model among participating organizations, and scant access to specialty psychiatric resources. Factors contributing to these challenges included lack of dedicated staff in the ED and limited local system capacity to support this population, and insufficient training and technical assistance available to participating organizations. A multi

  17. The consumer quality index (CQ-index in an accident and emergency department: development and first evaluation

    Directory of Open Access Journals (Sweden)

    Bos Nanne

    2012-08-01

    Full Text Available Abstract Background Assessment of patients’ views are essential to provide a patient-centred health service and to evaluating quality of care. As no standardized and validated system for measuring patients’ experiences in accident and emergency departments existed, we have developed the Consumer Quality index for the accident and emergency department (CQI A&E. Methods Qualitative research has been undertaken to determine the content validity of the CQI A&E. In order to assess psychometric characteristics an 84-item questionnaire was sent to 653 patients who had attended a large A&E in the Netherlands. Also, fifty importance questions were added to determine relevance of the questions and for future calculations of improvement scores. Exploratory factor analysis was applied to detect the domains of the questionnaire. Results Survey data of 304 (47% patients were used for the analysis. The first exploratory factor analysis resulted in three domains based on 13 items: ‘Attitude of the healthcare professionals’, ‘Environment and impression of the A&E’ and ‘Respect for and explanation to the patient’. The first two had an acceptable internal consistency. The second analysis, included 24 items grouped into 5 domains: ‘Attitude of the healthcare professionals’, ‘Information and explanation’, ‘Environment of the A&E’,’Leaving the A&E’ and ‘General information and rapidity of care’. All factors were internal consistent. According to the patients, the three most important aspects in healthcare performance in the A&E were: trust in the competence of the healthcare professionals, hygiene in the A&E and patients’ health care expectations. In general, the highest improvement scores concerned patient information. Conclusions The Consumer Quality index for the accident and emergency department measures patients’ experiences of A&E healthcare performance. Preliminary psychometric characteristics are sufficient to justify

  18. The Usage of Authority in Management Process and Evaluation of Emerged Problems: A Critical Approach

    Directory of Open Access Journals (Sweden)

    Salih ARSLAN

    2018-01-01

    Full Text Available This study aims to discuss the role, effect and the problems of ‘authority’ in the management process from a critical perspective. Firstly, the concept of authority is evaluated as a term in social science, then the role and effect of authority in management process is emphasized. The concept of authority is discussed not only in terms of its practical issues in management discipline but also the psychological, political and philosophical aspects of the term are included in discussion. Therefore, it is underlined that the usage of authority causes not only managerial problems but also some humane issues. So, the study professes that a moral authority is required besides other types of authority in management process. In this context, the study aims to test the accordance between theory and practice by comparing the results of the survey, which is implemented on public officers about their perception of authority, with the theoretical discussions.

  19. Model Selection and Evaluation Based on Emerging Infectious Disease Data Sets including A/H1N1 and Ebola

    Directory of Open Access Journals (Sweden)

    Wendi Liu

    2015-01-01

    Full Text Available The aim of the present study is to apply simple ODE models in the area of modeling the spread of emerging infectious diseases and show the importance of model selection in estimating parameters, the basic reproduction number, turning point, and final size. To quantify the plausibility of each model, given the data and the set of four models including Logistic, Gompertz, Rosenzweg, and Richards models, the Bayes factors are calculated and the precise estimates of the best fitted model parameters and key epidemic characteristics have been obtained. In particular, for Ebola the basic reproduction numbers are 1.3522 (95% CI (1.3506, 1.3537, 1.2101 (95% CI (1.2084, 1.2119, 3.0234 (95% CI (2.6063, 3.4881, and 1.9018 (95% CI (1.8565, 1.9478, the turning points are November 7,November 17, October 2, and November 3, 2014, and the final sizes until December 2015 are 25794 (95% CI (25630, 25958, 3916 (95% CI (3865, 3967, 9886 (95% CI (9740, 10031, and 12633 (95% CI (12515, 12750 for West Africa, Guinea, Liberia, and Sierra Leone, respectively. The main results confirm that model selection is crucial in evaluating and predicting the important quantities describing the emerging infectious diseases, and arbitrarily picking a model without any consideration of alternatives is problematic.

  20. A multicentre observational study to evaluate a new tool to assess emergency physicians' non-technical skills.

    Science.gov (United States)

    Flowerdew, Lynsey; Gaunt, Arran; Spedding, Jessica; Bhargava, Ajay; Brown, Ruth; Vincent, Charles; Woloshynowych, Maria

    2013-06-01

    To evaluate a new tool to assess emergency physicians' non-technical skills. This was a multicentre observational study using data collected at four emergency departments in England. A proportion of observations used paired observers to obtain data for inter-rater reliability. Data were also collected for test-retest reliability, observability of skills, mean ratings and dispersion of ratings for each skill, as well as a comparison of skill level between hospitals. Qualitative data described the range of non-technical skills exhibited by trainees and identified sources of rater error. 96 assessments of 43 senior trainees were completed. At a scale level, intra-class coefficients were 0.575, 0.532 and 0.419 and using mean scores were 0.824, 0.702 and 0.519. Spearman's ρ for calculating test-retest reliability was 0.70 using mean scores. All skills were observed more than 60% of the time. The skill Maintenance of Standards received the lowest mean rating (4.8 on a nine-point scale) and the highest mean was calculated for Team Building (6.0). Two skills, Supervision & Feedback and Situational Awareness-Gathering Information, had significantly different distributions of ratings across the four hospitals (ptechnical skills, especially in relation to leadership. The framework of skills may be used to identify areas for development in individual trainees, as well as guide other patient safety interventions.

  1. Evaluation and improvement of doctor–patient communication competence for emergency neurosurgeons: a standardized family model

    Directory of Open Access Journals (Sweden)

    Wu X

    2014-06-01

    Full Text Available Xi Wu,1 Zhinong Wang,2 Bo Hong,1 Shengjuan Shen,3 Yan Guo,4 Qinghai Huang,1 Jianmin Liu1 1Department of Neurosurgery, Changhai Hospital, Shanghai, People’s Republic of China; 2Department of Surgical Education, Changhai Hospital, Changzheng Hospital, Shanghai, People’s Republic of China; 3Department of Medical Education, The Second Military Medical University, Shanghai, People’s Republic of China; 4Department of Internal Medicine, Changhai Hospital, Shanghai, People’s Republic of China Abstract: Disease treatments have been significantly influenced by the communications between patients, their families, and doctors the lack of which may lead to malpractice allegations and complaints. In particular, inadequate communication may delay diagnosis and treatment. Therefore, for doctors communication and interpersonal skills, are as important as clinical skills and medical knowledge. In this study we intended to develop two detailed communication content checklists and a modified interpersonal skills inventory, aiming to evaluate their integrity in the midst of communication skills assessments, to provide feedback for some participants, and to observe their communication competence in both aspects Keywords: standardized patient, communication skill, training, medical education, neurosurgeon

  2. THE EVALUATION OF PSYCHOSOCIAL RISKS: AN EMERGING ISSUE? AND ITS PREVENTION... A POSTPONED ISSUE?

    Directory of Open Access Journals (Sweden)

    Liliana Cunha

    2018-03-01

    Full Text Available Psychosocial risks, its diagnosis and better understanding, have, in recent years, occupied a central place in the societal debates, setting new demanding to the ones involved in the field of occupational safety and health. In line with this, the concerns of evaluation and diagnosis of psychosocial risk factors boosted the development of several questionnaires, their widespread dissemination, and even their “exportation”, not always sensitive to the specificities of local realities. The purpose of this paper is to discuss the methods of “diagnosis” and the type of prevention practices, taking into account the comparison of two surveys in this area and the theoretical and epistemological approaches that underlie them: (i the Copenhagen Psychosocial Questionnaire (COPSOQ and (ii the Health and Work Survey (INSAT. The results reinforce the importance of a contextualized approach in work situations, as well as in the perspective of the workers themselves about the risks to which they are exposed to - beyond what is, or not, significant from the statistical point of view, or what can be normatively defined as an “acceptable risk”.

  3. Evaluation of an accident management strategy of emergency water injection using fire engines in a typical pressurized water reactor

    International Nuclear Information System (INIS)

    Park, Soo Yong; Ahn, Kwang Il

    2015-01-01

    Following the Fukushima accident, a special safety inspection was conducted in Korea. The inspection results show that Korean nuclear power plants have no imminent risk for expected maximum potential earthquake or coastal flooding. However long- and short-term safety improvements do need to be implemented. One of the measures to increase the mitigation capability during a prolonged station blackout (SBO) accident is installing injection flow paths to provide emergency cooling water of external sources using fire engines to the steam generators or reactor cooling systems. This paper illustrates an evaluation of the effectiveness of external cooling water injection strategies using fire trucks during a potential extended SBO accident in a 1,000 MWe pressurized water reactor. With regard to the effectiveness of external cooling water injection strategies using fire engines, the strategies are judged to be very feasible for a long-term SBO, but are not likely to be effective for a short-term SBO

  4. Epidemiological evaluation of cats rescued at a secondary emergency animal shelter in Miharu, Fukushima, after the Great East Japan Earthquakes.

    Science.gov (United States)

    Tanaka, Aki; Martinez-Lopez, Beatriz; Kass, Philip

    2017-03-01

    The aims of this research were to report characteristics of rescued cats at a secondary emergency animal shelter in Fukushima prefecture, Japan, and evaluate how adoptability, stress level, upper respiratory infection (URI) syndrome incidence, and URI pathogen prevalence were associated with the cat's shelter intake source and shelter characteristics. All cats admitted to the Miharu shelter, Fukushima Prefecture from 2012 to 2014 were included in the study. The results demonstrate that in situ corticosteroid and antibiotic use were associated with cats subsequently developing upper respiratory infections (URI). Disease and cat behavior were unassociated with adoption. Cats in group housing had lower stress metrics than cats individually housed. Prevalences of URI pathogens exceeded 80%, but symptomatic cats were uncommon. Environmental enrichment and stress reduction strategies are important in controlling URI and reducing the need for corticosteroids and antibiotics in shelters. Preemptive protocols are important in preventing shelter admission of cats during disasters. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Evaluation of an accident management strategy of emergency water injection using fire engines in a typical pressurized water reactor

    Energy Technology Data Exchange (ETDEWEB)

    Park, Soo Yong; Ahn, Kwang Il [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2015-10-15

    Following the Fukushima accident, a special safety inspection was conducted in Korea. The inspection results show that Korean nuclear power plants have no imminent risk for expected maximum potential earthquake or coastal flooding. However long- and short-term safety improvements do need to be implemented. One of the measures to increase the mitigation capability during a prolonged station blackout (SBO) accident is installing injection flow paths to provide emergency cooling water of external sources using fire engines to the steam generators or reactor cooling systems. This paper illustrates an evaluation of the effectiveness of external cooling water injection strategies using fire trucks during a potential extended SBO accident in a 1,000 MWe pressurized water reactor. With regard to the effectiveness of external cooling water injection strategies using fire engines, the strategies are judged to be very feasible for a long-term SBO, but are not likely to be effective for a short-term SBO.

  6. Veterans Health Administration's Disaster Emergency Medical Personnel System (DEMPS) Training Evaluation: Potential Implications for Disaster Health Care Volunteers.

    Science.gov (United States)

    Schmitz, Susan; Radcliff, Tiffany A; Chu, Karen; Smith, Robert E; Dobalian, Aram

    2018-02-20

    The US Veterans Health Administration's Disaster Emergency Medical Personnel System (DEMPS) is a team of employee disaster response volunteers who provide clinical and non-clinical staffing assistance when local systems are overwhelmed. This study evaluated attitudes and recommendations of the DEMPS program to understand the impact of multi-modal training on volunteer perceptions. DEMPS volunteers completed an electronic survey in 2012 (n=2120). Three training modes were evaluated: online, field exercise, and face-to-face. Measures included: "Training Satisfaction," "Attitudes about Training," "Continued Engagement in DEMPS." Data were analyzed using χ2 and logistic regression. Open-ended questions were evaluated in a manner consistent with grounded theory methodology. Most respondents participated in DEMPS training (80%). Volunteers with multi-modal training who completed all 3 modes (14%) were significantly more likely to have positive attitudes about training, plan to continue as volunteers, and would recommend DEMPS to others (P-valuevolunteer engagement. A blended learning environment using multi-modal training methods, could enhance satisfaction and attitudes and possibly encourage continued engagement in DEMPS or similar programs. DEMPS training program modifications in 2015 expanded this blended learning approach through new interactive online learning opportunities. (Disaster Med Public Health Preparedness. 2018; page 1 of 8).

  7. Evaluation of semi-generic PBTK modeling for emergency risk assessment after acute inhalation exposure to volatile hazardous chemicals.

    Science.gov (United States)

    Olie, J Daniël N; Bessems, Jos G; Clewell, Harvey J; Meulenbelt, Jan; Hunault, Claudine C

    2015-08-01

    Physiologically Based Toxicokinetic Models (PBTK) may facilitate emergency risk assessment after chemical incidents with inhalation exposure, but they are rarely used due to their relative complexity and skill requirements. We aimed to tackle this problem by evaluating a semi-generic PBTK model built in MS Excel for nine chemicals that are widely-used and often released in a chemical incident. The semi-generic PBTK model was used to predict blood concentration-time curves using inhalation exposure scenarios from human volunteer studies, case reports and hypothetical exposures at Emergency Response Planning Guideline, Level 3 (ERPG-3) levels.(2) Predictions using this model were compared with measured blood concentrations from volunteer studies or case reports, as well as blood concentrations predicted by chemical-specific models. The performances of the semi-generic model were evaluated on biological rationale, accuracy, and ease of use and range of application. Our results indicate that the semi-generic model can be easily used to predict blood levels for eight out of nine parent chemicals (dichloromethane, benzene, xylene, styrene, toluene, isopropanol trichloroethylene and tetrachloroethylene). However, for methanol, 2-propanol and dichloromethane the semi-generic model could not cope with the endogenous production of methanol and of acetone (being a metabolite of 2-propanol) nor could it simulate the formation of HbCO, which is one of the toxic end-points of dichloromethane. The model is easy and intuitive to use by people who are not so familiar with toxicokinetic models. A semi-generic PBTK modeling approach can be used as a 'quick-and-dirty' method to get a crude estimate of the exposure dose. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. The risk stratification and prognostic evaluation of soluble programmed death-1 on patients with sepsis in emergency department.

    Science.gov (United States)

    Zhao, Yongzhen; Jia, Yumei; Li, Chunsheng; Fang, Yingying; Shao, Rui

    2018-01-01

    To evaluate the efficacy of soluble programmed death-1 (sPD-1) for risk stratification and prediction of 28-day mortality in patients with sepsis, we compared serum sPD-1 with procalcitonin (PCT), C-reactive protein (CRP), and the Mortality in Emergency Department Sepsis (MEDS) score. A total of 60 healthy volunteers and 595 emergency department (ED) patients were recruited for this prospective cohort study. According to the severity of their condition on ED arrival, the patients were allocated to the systemic inflammatory response syndrome group (130 cases), sepsis group (276 cases), severe sepsis group (121 cases), and septic shock group (68 cases). In addition, all patients with sepsis were also divided into the survivor group (349 cases) and nonsurvivor group (116 cases) according to the 28-day outcomes. When the severity of sepsis increased, the levels of sPD-1 gradually increased. The levels of sPD-1, PCT, CRP and the MEDS score were also higher in the nonsurvivor group compared to the survivor group. Logistic regression suggested that sPD-1, PCT, and the MEDS score were independent risk factors for 28-day mortality of patients with sepsis. Area under the curve (AUC) of sPD-1, PCT and the MEDS score for 28-day mortality was 0.725, 0.693, and 0.767, respectively, and the AUC was improved when all 3 factors were combined (0.843). Serum sPD-1 is positively correlated with the severity of sepsis, and it is valuable for risk stratification of patients and prediction of 28-day mortality. Combining sPD-1 with PCT and the MEDS score improves the prognostic evaluation. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Emergence delirium

    DEFF Research Database (Denmark)

    Munk, Louise; Andersen, Lars Peter Holst; Gögenur, Ismail

    2013-01-01

    Emergence delirium (ED) is a well-known phenomenon in the postoperative period. However, the literature concerning this clinical problem is limited. This review evaluates the literature with respect to epidemiology and risk factors. Treatment strategies are discussed. The review concludes...

  10. Technical evaluation of the proposed changes in the technical specifications for emergency power sources for the Big Rock Point nuclear power plant

    International Nuclear Information System (INIS)

    Latorre, V.R.

    1979-12-01

    The technical evaluation is presented for the proposed changes to the Technical Specifications for emergency power sources for the Big Rock Point nuclear power plant. The criteria used to evaluate the acceptability of the changes include those delineated in IEEE Std-308-1974, and IEEE Std-450-1975 as endorsed by US NRC Regulatory Guide 1.129

  11. The Quebec emergency department guide: A cross-sectional study to evaluate its use, perceived usefulness, and implementation in rural emergency departments.

    Science.gov (United States)

    Fleet, Richard; Hegg-Deloye, Sandrine; Maltais-Giguère, Julie; Légaré, France; Ouimet, Mathieu; Poitras, Julien; Tanguay, Alain; Archambault, Patrick; Levesque, Jean-Frédéric; Simard-Racine, Geneviève; Dupuis, Gilles

    2017-12-07

    The Quebec Emergency Department Management Guide (QEDMG) is a unique document with 78 recommendations designed to improve the organization of emergency departments (EDs) in the province of Quebec. However, no study has examined how this guide is perceived or used by rural health care management. We invited all directors of professional services (DPS), directors of nursing services (DNS), head nurses (HN), and emergency department directors (EDD) working in Quebec's rural hospitals to complete an online survey (144 questions). Simple frequency analyses (percentage [%] and 95% confidence interval) were conducted to establish general familiarity and use of the QEDMG, as well as perceived usefulness and implementation of its recommendations. Seventy-three percent (19/26) of Quebec's rural EDs participated in the study. A total of 82% (62/76) of the targeted stakeholders participated. Sixty-one percent of respondents reported being "moderately or a lot" familiar with the QEDMG, whereas 77% reported "almost never or sometimes" refer to this guide. Physician management (DPS, EDD) were more likely than nursing management (DNS and especially HN) to report "not at all" or "little" familiarity on use of the guide. Finally, 98% of the QEDMG recommendations were considered useful. Although the QEDMG is considered a useful guide for rural EDs, it is not optimally known or used in rural EDs, especially by physician management. Stakeholders should consider these findings before implementing the revised versions of the QEDMG.

  12. Organization, execution and evaluation of the 2014 Academic Emergency Medicine consensus conference on Gender-Specific Research in Emergency Care - an executive summary.

    Science.gov (United States)

    Safdar, Basmah; Greenberg, Marna R

    2014-12-01

    With the goal of reducing inequalities in patient care, the 2014 Academic Emergency Medicine (AEM) consensus conference, "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," convened a diverse group of researchers, clinicians, health care providers, patients, and representatives of federal agencies and policy-makers in Dallas, Texas, in May 2014. The executive and steering committees identified seven clinical domains as key to gender-specific emergency care: cardiovascular, neurological, trauma/injury, substance abuse, pain, mental health, and diagnostic imaging. The main aims of the conference were to: 1) summarize and consolidate current data related to sex- and gender-specific research for acute care and identify critical gender-related gaps in knowledge to inform an EM research agenda; 2) create a consensus-driven research agenda that advances sex- and gender-specific research in the prevention, diagnosis, and management of acute diseases and identify strategies to investigate them; and 3) build a multinational interdisciplinary consortium to disseminate and study the sex and gender medicine of acute conditions. Over a 2-year period, this collaborative network of stakeholders identified key areas where sex- and gender-specific research is most likely to improve clinical care and ultimately patient outcomes. The iterative consensus process culminated in a daylong conference on May 13, 2014, with a total of 133 registrants, with the majority being between ages 31 and 50 years (57%), females (71%), and whites (79%). Content experts led the consensus-building workshops at the conference and used the nominal group technique to consolidate consensus recommendations for priority research. In addition, panel sessions addressed funding mechanisms for gender-specific research as well as gender-specific regulatory challenges to product development and approval. This special issue of AEM reports the

  13. Criteria for preparation and evaluation of radiological emergency response plans and preparedness in support of nuclear power plants: Criteria for utility offsite planning and preparedness: Final report

    International Nuclear Information System (INIS)

    Podolak, E.M. Jr.; Sanders, M.E.; Wingert, V.L.; Donovan, R.W.

    1988-09-01

    The Nuclear Regulatory Commission (NRC) and the Federal Emergency Management Agency (FEMA) have added a supplement to NUREG-0654/FEMA-REP-1, Rev. 1 that provides guidance for the development, review, and evaluation of utility offsite radiological emergency response planning and preparedness for those situations in which state and/or local governments decline to participate in emergency planning. While this guidance primarily applies to plants that do not have full-power operating licenses, it does have relevance to operating nuclear power plants

  14. Improving mental health care transitions for children and youth: a protocol to implement and evaluate an emergency department clinical pathway.

    Science.gov (United States)

    Jabbour, Mona; Reid, S; Polihronis, C; Cloutier, P; Gardner, W; Kennedy, A; Gray, C; Zemek, R; Pajer, K; Barrowman, N; Cappelli, M

    2016-07-07

    While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication among these groups is often poor, resulting in gaps, particularly in transitions of care, for this vulnerable population. The evidence-based Emergency Department Mental Health Clinical Pathway (EDMHCP) was created with two main goals: (1) to guide risk assessment and disposition decision-making for children and youth presenting to the ED with MH concerns and (2) to provide a streamlined transition to follow-up services with community MH agencies (CMHAs) and other providers. The purpose of this paper is to describe our study protocol to implement and evaluate the EDMHCP. This mixed methods health services research project will involve implementation and evaluation of the EDMHCP in four exemplar ED-CMHA dyads. The Theoretical Domains Framework will be used to develop a tailored intervention strategy to implement the EDMHCP. A multiple baseline study design and interrupted time-series analysis will be used to determine if the EDMHCP has improved health care utilization, medical management of the MH problems, and health sector coordination. The primary process outcome will be the proportion of patients with MH-specific recommendations documented in the health record. The primary service outcome will be the proportion of patients receiving the EDMHCP-recommended follow-up at 24-h or at 7 days. Data sources will include qualitative interviews, health record audits, administrative databases, and patient surveys. A concurrent process evaluation will be conducted to assess the degree of variability and fidelity in implementation across the sites. This paper presents a novel model for measuring the effects of the EDMHCP. Our development process will identify how the EDMHCP

  15. Sensory evaluation of a highly nutritive bread, formulated for populations suffering food emergencies, preserved with ionizing radiation

    International Nuclear Information System (INIS)

    Gonzalez, G.S.; Gómez, B.; Cova, M.C.; Narvaiz, Patricia

    2011-01-01

    The aim of this work was to evaluate with sensorial analysis, the feasibility of extending the shelf life at room temperature of highly nutritive bread, specially formulated for people suffering alimentary emergencies such as floods, earthquakes, geographical isolation or malnourishment, by means of ionizing radiation. The shelf life of any bread is limited by microbial growth, so the food industry uses chemicals and /or refrigeration to control it. Twenty one breads were formulated and manufactured employing wheat and soybean flours, dehydrated whey, skim milk and egg, vegetal oil, water, and some commercial food additives as emulsifiers and water retention substances. A final formulation was chosen by means of a preliminary sensory evaluation. Bibliographic estimations were made on its nutritional quality as compared to that of a regular wheat bread; improvements were found on vitamins, minerals, proteins, lipids and fibre. Forty 450 g breads were manufactured, oven cooked at 220°C for 20 minutes, packaged with polyethylene film, 100 microns thickness, and irradiated at the semi industrial cobalt-60 facility of the Ezeiza Atomic Centre, about 600,000 Ci of activity, with doses of 0, 6 and 10 kilo Grays, dose rate: 10 kGy/h, dose uniformity: 1.1. Control and irradiated samples were stored at room temperature and relative humidity for 43 days. Sensory analysis was performed with a panel of about 50 consumers on days 3, 29 and 43, evaluating aroma, aspect, colour, flavour, texture and general acceptability with hedonic scores ranging from 1 to 9. No significant differences between control and irradiated samples were found, being the latter afforded scores close to 7 even at the end of the storage period. Control samples had to be discarded on day 6 due to visible mould growth. So this bread formulation, suitable to fulfill most of the nutritional requirements of a population under alimentary emergency, attained at least a 7 fold shelf life increase when treated

  16. An application of the learning curve-cumulative summation test to evaluate training for endotracheal intubation in emergency medicine.

    Science.gov (United States)

    Je, Sangmo; Cho, Youngsuk; Choi, Hyuk Joong; Kang, Boseung; Lim, Taeho; Kang, Hyunggoo

    2015-04-01

    The learning curve-cumulative summation (LC-CUSUM) test allows for quantitative and individual assessments of the learning process. In this study, we evaluated the process of skill acquisition for performing endotracheal intubation (ETI) in three emergency medicine (EM) residents over a 2 year period in their first 2 years of their EM residency. We evaluated 342 ETI cases performed by three EM residents using the LC-CUSUM test according to their rate of success or failure of ETI. A 90% success rate (SR) was chosen to define adequate performance and an SR of 80% was considered inadequate. After the learning phase, the standard CUSUM test was applied to ensure that performance was maintained. The mean number of ETI cases required to reach the predefined level of performance was 74.7 (95% CI 62.0 to 87.3). CUSUM tests confirmed that performance was maintained after the learning phase. By using the LC-CUSUM test, we were able to quantitatively monitor the acquisition of the skill of ETI by EM residents. The LC-CUSUM could be useful for monitoring the learning process for the training of airway management in the practice of EM. 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.

  17. Syncope: Assessment of risk and an approach to evaluation in the emergency department and urgent care clinic

    Directory of Open Access Journals (Sweden)

    Baris Akdemir

    2015-03-01

    Full Text Available Syncope is among the most frequent forms of transient loss of consciousness (TLOC, and is characterized by a relatively brief and self-limited loss of consciousness that by definition is triggered by transient cerebral hypoperfusion. Most often, syncope is caused by a temporary drop of systemic arterial pressure below that required to maintain cerebral function, but brief enough not to cause permanent structural brain injury. Currently, approximately one-third of syncope/collapse patients seen in the emergency department (ED or urgent care clinic are admitted to hospital for evaluation. The primary objective of developing syncope/TLOC risk stratification schemes is to provide guidance regarding the immediate prognostic risk of syncope patients presenting to the ED or clinic; thereafter, based on that risk assessment physicians may be better equipped to determine which patients can be safely evaluated as outpatients, and which require hospital care. In general, the need for hospitalization is determined by several key issues: i the patient's immediate (usually considered 1 week to 1 month mortality risk and risk for physical injury (e.g., falls risk, ii the patient's ability to care for him/herself, and iii whether certain treatments inherently require in-hospital initiation (e.g., pacemaker implantation. However, at present no single risk assessment protocol appears to be satisfactory for universal application, and development of a consensus recommendation is an essential next step.

  18. Evaluating legacy contaminants and emerging chemicals in marine environments using adverse outcome pathways and biological effects-directed analysis

    International Nuclear Information System (INIS)

    Hutchinson, Thomas H.; Lyons, Brett P.; Thain, John E.; Law, Robin J.

    2013-01-01

    Natural and synthetic chemicals are essential to our daily lives, food supplies, health care, industries and safe sanitation. At the same time protecting marine ecosystems and seafood resources from the adverse effects of chemical contaminants remains an important issue. Since the 1970s, monitoring of persistent, bioaccumulative and toxic (PBT) chemicals using analytical chemistry has provided important spatial and temporal trend data in three important contexts; relating to human health protection from seafood contamination, addressing threats to marine top predators and finally providing essential evidence to better protect the biodiversity of commercial and non-commercial marine species. A number of regional conventions have led to controls on certain PBT chemicals over several years (termed ‘legacy contaminants’; e.g. cadmium, lindane, polycyclic aromatic hydrocarbons [PAHs] and polychlorinated biphenyls [PCBs]). Analytical chemistry plays a key role in evaluating to what extent such regulatory steps have been effective in leading to reduced emissions of these legacy contaminants into marine environments. In parallel, the application of biomarkers (e.g. DNA adducts, CYP1A-EROD, vitellogenin) and bioassays integrated with analytical chemistry has strengthened the evidence base to support an ecosystem approach to manage marine pollution problems. In recent years, however, the increased sensitivity of analytical chemistry, toxicity alerts and wider environmental awareness has led to a focus on emerging chemical contaminants (defined as chemicals that have been detected in the environment, but which are currently not included in regulatory monitoring programmes and whose fate and biological impacts are poorly understood). It is also known that natural chemicals (e.g. algal biotoxins) may also pose a threat to marine species and seafood quality. Hence complex mixtures of legacy contaminants, emerging chemicals and natural biotoxins in marine ecosystems represent

  19. Evaluating legacy contaminants and emerging chemicals in marine environments using adverse outcome pathways and biological effects-directed analysis.

    Science.gov (United States)

    Hutchinson, Thomas H; Lyons, Brett P; Thain, John E; Law, Robin J

    2013-09-30

    Natural and synthetic chemicals are essential to our daily lives, food supplies, health care, industries and safe sanitation. At the same time protecting marine ecosystems and seafood resources from the adverse effects of chemical contaminants remains an important issue. Since the 1970s, monitoring of persistent, bioaccumulative and toxic (PBT) chemicals using analytical chemistry has provided important spatial and temporal trend data in three important contexts; relating to human health protection from seafood contamination, addressing threats to marine top predators and finally providing essential evidence to better protect the biodiversity of commercial and non-commercial marine species. A number of regional conventions have led to controls on certain PBT chemicals over several years (termed 'legacy contaminants'; e.g. cadmium, lindane, polycyclic aromatic hydrocarbons [PAHs] and polychlorinated biphenyls [PCBs]). Analytical chemistry plays a key role in evaluating to what extent such regulatory steps have been effective in leading to reduced emissions of these legacy contaminants into marine environments. In parallel, the application of biomarkers (e.g. DNA adducts, CYP1A-EROD, vitellogenin) and bioassays integrated with analytical chemistry has strengthened the evidence base to support an ecosystem approach to manage marine pollution problems. In recent years, however,the increased sensitivity of analytical chemistry, toxicity alerts and wider environmental awareness has led to a focus on emerging chemical contaminants (defined as chemicals that have been detected in the environment, but which are currently not included in regulatory monitoring programmes and whose fate and biological impacts are poorly understood). It is also known that natural chemicals (e.g. algal biotoxins) may also pose a threat to marine species and seafood quality. Hence complex mixtures of legacy contaminants, emerging chemicals and natural biotoxins in marine ecosystems represent

  20. Emergency Medicine Evaluation of Community-Acquired Pneumonia: History, Examination, Imaging and Laboratory Assessment, and Risk Scores.

    Science.gov (United States)

    Long, Brit; Long, Drew; Koyfman, Alex

    2017-11-01

    Pneumonia is a common infection, accounting for approximately one million hospitalizations in the United States annually. This potentially life-threatening disease is commonly diagnosed based on history, physical examination, and chest radiograph. To investigate emergency medicine evaluation of community-acquired pneumonia including history, physical examination, imaging, and the use of risk scores in patient assessment. Pneumonia is the number one cause of death from infectious disease. The condition is broken into several categories, the most common being community-acquired pneumonia. Diagnosis centers on history, physical examination, and chest radiograph. However, all are unreliable when used alone, and misdiagnosis occurs in up to one-third of patients. Chest radiograph has a sensitivity of 46-77%, and biomarkers including white blood cell count, procalcitonin, and C-reactive protein provide little benefit in diagnosis. Biomarkers may assist admitting teams, but require further study for use in the emergency department. Ultrasound has shown utility in correctly identifying pneumonia. Clinical gestalt demonstrates greater ability to diagnose pneumonia. Clinical scores including Pneumonia Severity Index (PSI); Confusion, blood Urea nitrogen, Respiratory rate, Blood pressure, age 65 score (CURB-65); and several others may be helpful for disposition, but should supplement, not replace, clinical judgment. Patient socioeconomic status must be considered in disposition decisions. The diagnosis of pneumonia requires clinical gestalt using a combination of history and physical examination. Chest radiograph may be negative, particularly in patients presenting early in disease course and elderly patients. Clinical scores can supplement clinical gestalt and assist in disposition when used appropriately. Published by Elsevier Inc.

  1. Above, Beyond, and Over the Side rails: Evaluating the New Memorial Emergency Department Fall-Risk-Assessment Tool.

    Science.gov (United States)

    Scott, Robin A; Oman, Kathleen S; Flarity, Kathleen; Comer, Jennifer L

    2018-03-06

    Patient falls are a significant issue in hospitalized patients and financially costly to hospitals. The Joint Commission requires that patients be assessed for fall risk and interventions in place to mitigate the risk of falls. It is imperative to have a patient population/setting specific fall risk assessment tool to identify patients at risk for falling. The purpose of this study was to evaluate the reliability and validity of the 2013 Memorial ED Fall Risk Assessment tool (MEDFRAT) specifically designed for the ED population. A two-phase prospective design was used for this study. Phase one determined the interrater reliability of the MEDFRAT. Phase two assessed the validity of the MEDFRAT in an emergency department (ED) within a 600-bed academic/teaching institution; Level II Trauma Center with >100,000 annual patient visits. The Memorial ED Fall Risk Assessment Tool was validated in this ED setting. The tool demonstrated positive interrater reliability (k=0.701) and when implemented with a falls prevention strategy and staff education demonstrated a 48% decrease in ED fall rate (0.57 falls/1000 patient visits) post implementation during the study period. The MEDFRAT, an evidenced based ED-specific fall risk tool was implemented on the basis of the risk factors consistently identified in the literature: prior fall history, impaired mobility, altered mental status, altered elimination, and the use of sedative medication. The Memorial ED Fall Risk Assessment Tool demonstrated to be a valid tool for this hospital system. Copyright © 2018 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  2. Evaluation of publicly financed and privately delivered model of emergency referral services for maternal and child health care in India.

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    Full Text Available BACKGROUND: Emergency referral services (ERS are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. METHODS: Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. RESULTS: On an average, an ambulance transported 3-4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7 per patient transported or INR 21 (USD 0.35 per km travelled. CONCLUSION: Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system.

  3. Conceptual design of emergency communication system to cope with severe accidents in NPPs and its performance evaluation

    International Nuclear Information System (INIS)

    Son, Kwang Seop; Kim, Chang Hwoi; Kang, Hyun Gook

    2015-01-01

    Highlights: • The emergency communication system requires the performances of the throughput of 1 Mbps, BER of 10 −6 and network configuration of 1:12 communication. • The emergency communication system consists of the terrestrial communication and satellite communication system. • In the terrestrial communication system, at least two wireless repeaters are needed to secure LOS and the throughput and delay time are 16 Mbps and 16 ms, respectively. • In the satellite communication system, DSSS and FDMA are used and the fade margin range is from 1.3 to 16 dB. - Abstract: The Fukushima accident induced by the great earthquake and tsunami reveals the vulnerability of I and C System. In the severe environment, the normal I and C system did not work properly and results in false information about the internal situation in NPP. Eventually the accident was not properly handled at the early stage. Therefore advanced emergency response system using a wireless channel is necessary to cope with the severe accident. In this paper, we introduce the ERS consisting of the HMS and MCS the ECS linking the HMS with MCS and the performance requirement of the ECS is analyzed. The ECS satisfying the requirement is designed conceptually and the performance of the ECS is evaluated through analysis and simulator. To secure a reliable and diverse configuration, the ECS is configured as the dual system which consists of the terrestrial communication and satellite communication. The terrestrial communication system is designed based on the IEEE 802.11. Analyzed performance results prove that the performance requirement can be sufficiently achieved. But if the scalability of data capacity is considered later, use of the advanced 802.11 standard such as 802.11n and multiple signal paths between the HMS and MCS are necessary. In the satellite communication system, the FDMA is used in the status link and the DSSS is used in the control link. The network supporting various data rates is

  4. Breast imaging after dark: patient outcomes following evaluation for breast abscess in the emergency department after hours.

    Science.gov (United States)

    Bosma, Melissa S; Morden, Kasey L; Klein, Katherine A; Neal, Colleen H; Knoepp, Ursula S; Patterson, Stephanie K

    2016-02-01

    In our study, we sought to report the management, clinical outcomes, and follow-up rates of patients who presented for evaluation of breast abscess in the Emergency Department (ED) after hours. A retrospective search of ultrasound reports at our institution identified all patients from January 1, 2009 to June 30, 2013 who were scanned in the ED after hours to evaluate for breast abscess. Patient demographics, clinical information, imaging findings, follow-up rates, and outcomes were reviewed. One hundred eighty-five patients were included in the study. Forty-four percent (86/185) of the patients were diagnosed with abscess based on ultrasound findings in the ED. Twenty-seven percent (23/86) were recently post-operative, and 12 % (10/86) were postpartum/breastfeeding. Mastitis was the diagnosis in the remaining 54 % (99/185). Only 1/86 cases were associated with breast cancer. Seventy-seven percent (66/86) of patients were treated with an invasive procedure; 39 % (26/66) had surgical evacuation, 30 % (20/66) image-guided drainage, 23 % (15/66) bedside or clinic incision and drainage, and 8 % (5/66) palpation-guided fine needle aspiration (FNA). Seventy-seven percent (143/185) of patients had clinical and/or imaging follow-up. Forty-four percent (63/143) had long-term follow-up (≥ 3 months). Almost 50 % of the patients who presented to the ED for evaluation of abscess were diagnosed with abscess while the remaining patients were diagnosed with mastitis. Appropriate clinical and/or imaging follow-up occurred in 77 %. Long-term follow-up (≥ 3 months) occurred more frequently in patients older than 30 years of age. Appropriate follow-up does not occur in approximately one fourth of cases, suggesting that additional clinician and patient education is warranted.

  5. Diabetic Emergencies

    Science.gov (United States)

    ... Campaigns Share this! EmergencyCareForYou » Emergency 101 » Diabetic Emergencies Diabetic Emergencies It is estimated that more than 20 ... they have it. The best way to prevent diabetic emergencies is to effectively manage the disease through ...

  6. How and when do expert emergency physicians generate and evaluate diagnostic hypotheses? A qualitative study using head-mounted video cued-recall interviews.

    Science.gov (United States)

    Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Ammirati, Christine; Bertrand, Catherine; Dory, Valérie; Charlin, Bernard

    2014-12-01

    The ability to make a diagnosis is a crucial skill in emergency medicine. Little is known about the way emergency physicians reach a diagnosis. This study aims to identify how and when, during the initial patient examination, emergency physicians generate and evaluate diagnostic hypotheses. We carried out a qualitative research project based on semistructured interviews with emergency physicians. The interviews concerned management of an emergency situation during routine medical practice. They were associated with viewing the video recording of emergency situations filmed in an "own-point-of-view" perspective. The emergency physicians generated an average of 5 diagnostic hypotheses. Most of these hypotheses were generated before meeting the patient or within the first 5 minutes of the meeting. The hypotheses were then rank ordered within the context of a verification procedure based on identifying key information. These tasks were usually accomplished without conscious effort. No hypothesis was completely confirmed or refuted until the results of investigations were available. The generation and rank ordering of diagnostic hypotheses is based on the activation of cognitive processes, enabling expert emergency physicians to process environmental information and link it to past experiences. The physicians seemed to strive to avoid the risk of error by remaining aware of the possibility of alternative hypotheses as long as they did not have the results of investigations. Understanding the diagnostic process used by emergency physicians provides interesting ideas for training residents in a specialty in which the prevalence of reasoning errors leading to incorrect diagnoses is high. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  7. A randomized controlled evaluation of specialist nurse education following accident and emergency department attendance for acute asthma.

    Science.gov (United States)

    Levy, M L; Robb, M; Allen, J; Doherty, C; Bland, J M; Winter, R J

    2000-09-01

    We investigated whether hospital-based specialist asthma nurses improved recognition and self-treatment of asthma episodes by patients followed up after attending accident and emergency departments (A&E) for asthma exacerbations. We carried out a randomized prospective controlled trial of adult asthma self-management, following a hospital outpatient nurse consultation in two outer-London District General Hospitals (secondary care centres). The study included 211 adults, over 18 years old (mean age 40 years) who attended for asthma in two accident and emergency departments over 13 months. One hundred and eight evaluable patients were randomized into the control group who continued with their usual medical treatment and were not offered any intervention during the study period. One hundred and three evaluable patients were randomized into the intervention group. They were offered three 6-weekly outpatient appointments with one of two specialist asthma nurses for a structured asthma consultation, after attendance at the accident and emergency department. Following assessment of their asthma treatment and control, the nurses advised patients, through the use of self-management-plans, how to recognize and manage uncontrolled asthma and when to seek medical assistance. Medication and inhaler device type were altered if necessary The primary outcome was patient reported self-management of asthma exacerbations for 6 months. Secondary outcomes were assessed at baseline, 3 months and 6 months. These included home peak flow and symptom diaries, structured telephone questionnaires and audit of general practitioner records to determine utilization of services (6 months before and after A&E). Data were analysed on an intention to treat basis by multiple and logistic regression. The intervention group increased their use of inhaled topical steroids in 31/61 (51%) vs. 15/70 (21%) attacks in controls (OR 3.91 CI 1.8-8.4, Pentry. Thirty-four percent of intervention patients vs. 42

  8. Evaluation of a web-based asynchronous pediatric emergency medicine learning tool for residents and medical students.

    Science.gov (United States)

    Burnette, Kreg; Ramundo, Maria; Stevenson, Michelle; Beeson, Michael S

    2009-12-01

    To examine the effectiveness of an asynchronous learning tool consisting of web-based lectures for trainees covering major topics pertinent to pediatric emergency medicine (PEM) and to assess resident and student evaluation of this mode of education. PEM faculty and fellows created a 21-lecture, web-based curriculum. These 20-minute online lectures used Microsoft PowerPoint with the voice-over feature. A 75-question test was created to assess the effectiveness of the web-based learning model, administered online before and after the rotation in the pediatric emergency department (PED). All fourth-year medical students and residents (across all specialties) rotating through the PED were required to complete 10 of the 21 lectures during their 1-month rotation. The main outcome variable was difference in score between pre- and post-rotation tests of participants who viewed no lectures and those who viewed at least one lecture. Evaluation of the program was assessed by anonymous survey using 5-point discrete visual analog scales. Responses of 4 or 5 were considered positive for analysis. One hundred eleven residents and fourth-year medical students participated in the program. An initial 32 completed testing before implementation of the on-line lectures (March 2007-August 2007), and another five did not complete the on-line lectures after implementation (September 2007-February 2008). Seventy-one completed testing and on-line lectures, and all but three completed at least 10 on-line lectures during their rotation. Fourteen of 111 trainees did not complete the pre- or post-test (including two who viewed the lectures). The mean change in score was a 1% improvement from pre-test to post-test for trainees who viewed no lectures and a 6.2% improvement for those who viewed the lectures (mean difference = 5.2%, 95% confidence interval = 2.5% to 7.9%). In the linear regression model, the estimate of the coefficient was 0.43 (p lecture viewed, post-test score rose by 0

  9. Impact evaluation of green-grey infrastructure interaction on built-space integrity: an emerging perspective to urban ecosystem service.

    Science.gov (United States)

    Tiwary, Abhishek; Kumar, Prashant

    2014-07-15

    This paper evaluates the role of urban green infrastructure (GI) in maintaining integrity of built-space. The latter is considered as a lateral ecosystem function, worth including in future assessments of integrated ecosystem services. The basic tenet is that integrated green-grey infrastructures (GGIs) would have three influences on built-spaces: (i) reduced wind withering from flow deviation; (ii) reduced material corrosion/degeneration from pollution removal; and (iii) act as a biophysical buffer in altering the micro-climate. A case study is presented, combining the features of computational fluid dynamics (CFD) in micro-environmental modelling with the emerging science on interactions of GGIs. The coupled seasonal dynamics of the above three effects are assessed for two building materials (limestone and steel) using the following three scenarios: (i) business as usual (BAU), (ii) summer (REGEN-S), and (iii) winter (REGEN-W). Apparently, integrated ecosystem service from green-grey interaction, as scoped in this paper, has strong seasonal dependence. Compared to BAU our results suggest that REGEN-S leads to slight increment in limestone recession (<10%), mainly from exacerbation in ozone damage, while large reduction in steel recession (up to 37%) is observed. The selection of vegetation species, especially their bVOC emission potential and seasonal foliage profile, appears to play a vital role in determining the impact GI has on the integrity of the neighbouring built-up environment. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Using Artificial Intelligence and Web Media Data to Evaluate the Growth Potential of Companies in Emerging Industry Sectors

    Directory of Open Access Journals (Sweden)

    Andrew Droll

    2017-06-01

    Full Text Available In this article, we describe our efforts to adapt and validate a web search and analytics tool – the Gnowit Cognitive Insight Engine – to evaluate the growth and competitive potential of new technology startups and existing firms in the newly emerging precision medicine sector. The results are based on two different search ontologies and two different samples of firms. The first sample includes established drug companies operating in the precision medicine field and was used to estimate the relationship between the firms’ innovativeness and the extent of online discussions focusing on their potential growth. The second sample includes new technology firms in the same sector. The firms in the second sample were used as test cases to determine whether their growth-related web search scores would relate to the degree of their innovativeness. The second part of the study applied the same methodology to the real-time monitoring of the firms’ competitive actions. In our findings, we see that our methodology reveals a moderate degree of correlation between the Insight Engine’s algorithmically computed relevance scores and independent measures of innovation potential. The existence of such correlations invites future work in attempting to analyze company growth potential using techniques founded in web content scraping, natural language processing, and machine learning.

  11. Evaluation of an accident management strategy of emergency water injection using fire engines in a typical pressurized water reactor

    Directory of Open Access Journals (Sweden)

    Soo-Yong Park

    2015-10-01

    Full Text Available Following the Fukushima accident, a special safety inspection was conducted in Korea. The inspection results show that Korean nuclear power plants have no imminent risk for expected maximum potential earthquake or coastal flooding. However long- and short-term safety improvements do need to be implemented. One of the measures to increase the mitigation capability during a prolonged station blackout (SBO accident is installing injection flow paths to provide emergency cooling water of external sources using fire engines to the steam generators or reactor cooling systems. This paper illustrates an evaluation of the effectiveness of external cooling water injection strategies using fire trucks during a potential extended SBO accident in a 1,000 MWe pressurized water reactor. With regard to the effectiveness of external cooling water injection strategies using fire engines, the strategies are judged to be very feasible for a long-term SBO, but are not likely to be effective for a short-term SBO.

  12. [Development of an index system for the comprehensive evaluation on public health emergency events surveillance system in China].

    Science.gov (United States)

    Hong, Zhiheng; Ni, Daxin; Cao, Yang; Meng, Ling; Tu, Wenxiao; Li, Leilei; Li, Qun; Jin, Lianmei

    2015-06-01

    To establish a comprehensive evaluation index system for the China Public Health Emergency Events Surveillance System (CPHEESS). A draft index system was built through literature review and under the consideration of the characteristics on CPHEESS. Delphi method was adapted to determine the final index system. The index system was divided into primary, secondary and tertiary levels. There were 4 primary indicators: System structure, Network platform, Surveillance implementation reports with Data analysis and utilization. There were 16 secondary and 70 tertiary indicators being set, with System structure including 14 tertiary indicators (accounted for 20.00%), 21 Network platforms (accounted for 30.00%). Twenty-four Surveillance implementation reports (accounted for 34.29%), 11 Data analysis and utilization (accounted for 15.71%). The average score of importance of each indicators was 4.29 (3.77-4.94), with an average coefficient variation as 0.14 (0.12-0.16). The mean Chronbach's α index was 0.84 (0.81-0.89). The adaptability of each related facilities indicator was specified. The primary indicators were set in accordance with the characteristics and goals of the surveillance systems. Secondary indicators provided key elements in the management and control of the system while the tertiary indicators were available and operative. The agreement rate of experts was high with good validity and reliability. This index system could be used for CPHEESS in future.

  13. Evaluation of a transit first-aid station providing emergency care to former Yugoslavian war victims evacuated in Ancona, Italy.

    Science.gov (United States)

    Prospero, E; Raffo, M; Appignanesi, R; Faccenda, G; Ronveaux, O; Annino; D'Errico, M M

    2000-03-01

    A first-aid station was implemented in Falconara Marittima airport (Ancona, Italy). It provided medical emergency care to war victims evacuated from former Yugoslavia in transit for further treatment. A descriptive analysis of the displaced population arriving at the first-aid station was performed using three independent datasets for administrative information, of which one included medical information. The implemented resources were also evaluated. From August 1993 to March 1995, 2272 displaced persons were registered at the first-aid station, out of which 54.2% were accompanying family members. Among those needing medical intervention (45.8% of total), most frequent diagnoses were traumatisms and burns (59.8%), neoplasms (15.6%), and congenital malformations (13.2%). The medical care provided at the first-aid station was most often basic: a medical examination alone was performed on 77.0% of the patients, and a minor dressing on 17.3%. Median length of stay was 1 day. Patients were sent to 30 different countries and 8% were forwarded to the local regional hospital. Deployed logistical resources exceeded by far actual needs but a lack of psychological assistance was observed, mainly for children. The agencies involved did not coordinate data sharing and follow-up information. The medical assistance to the war victims was efficient regarding provided care and timeliness. Effectiveness of such a programme could be improved by a better coordination between partners, allowing more adequate logistics according to appropriate epidemiological information.

  14. The evaluation of the patients who admitted to a regional hospital emergency service with suspect of rabies

    Directory of Open Access Journals (Sweden)

    Nurettin Tunç

    2012-09-01

    Full Text Available Objectives: Rabies is one of the highest mortality ratesinfectious disease. The aim was the evaluation of the patientswho admitted to The Batman Regional State HospitalEmergency Service with suspect of rabies in the datesbetween June 2011 and November 2011.Materials and methods: Totally, 166 cases who admittedto our center was recorded according to the followingdata: place of residence (rural/urban, contact type andwound information, time after the contact, whether vaccineor immunoglobulin is applied or not and also the species,breed and being owned of suspected animal.Results: Our study population consisted of a total of 166cases including 38 women (23%, 128 men (77% withthe mean age of 22.01 ± 17.90 years. Of all subjects, 105(63% lived in urban and 61 (37% lived in rural areas.Eighty-five percent of suspicious animals (51% had anowner, while 81 animals were unattended.Conclusions: Our results showed that all admitted patientswere vaccinated and the ones contacted with petsor had a surface wound were vaccinated with 3 doses.Moreover, since the 49% of our cases were contactedwith animals which cannot be follow-up, our study obviouslyreveals that in our country deficiencies in the controlof waifs still is a public health problem and increases thecost of vaccination. J Clin Exp Invest 2012; 3 (3: 383-386Key words: Rabies, suspected bite, rabies prophylaxis

  15. Comparative evaluation of differential laser-induced perturbation spectroscopy as a technique to discriminate emerging skin pathology

    Science.gov (United States)

    Kozikowski, Raymond T.; Smith, Sarah E.; Lee, Jennifer A.; Castleman, William L.; Sorg, Brian S.; Hahn, David W.

    2012-06-01

    Fluorescence spectroscopy has been widely investigated as a technique for identifying pathological tissue; however, unrelated subject-to-subject variations in spectra complicate data analysis and interpretation. We describe and evaluate a new biosensing technique, differential laser-induced perturbation spectroscopy (DLIPS), based on deep ultraviolet (UV) photochemical perturbation in combination with difference spectroscopy. This technique combines sequential fluorescence probing (pre- and post-perturbation) with sub-ablative UV perturbation and difference spectroscopy to provide a new spectral dimension, facilitating two improvements over fluorescence spectroscopy. First, the differential technique eliminates significant variations in absolute fluorescence response within subject populations. Second, UV perturbations alter the extracellular matrix (ECM), directly coupling the DLIPS response to the biological structure. Improved biosensing with DLIPS is demonstrated in vivo in a murine model of chemically induced skin lesion development. Component loading analysis of the data indicates that the DLIPS technique couples to structural proteins in the ECM. Analysis of variance shows that DLIPS has a significant response to emerging pathology as opposed to other population differences. An optimal likelihood ratio classifier for the DLIPS dataset shows that this technique holds promise for improved diagnosis of epithelial pathology. Results further indicate that DLIPS may improve diagnosis of tissue by augmenting fluorescence spectra (i.e. orthogonal sensing).

  16. Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study

    Directory of Open Access Journals (Sweden)

    Hao Wang

    2015-01-01

    Full Text Available Background. The accuracy and utility of current Emergency Department (ED crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding and patient care outcomes. Methods. A novel scoring tool (SONET: Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool was developed and validated in two EDs with both annual volumes exceeding 100,000. Patient care outcomes including the number of left without being seen (LWBS patients, average length of ED stay, ED 72-hour returns, and mortality were compared under the different crowding statuses. Results. The total number of ED patients, the number of mechanically ventilated patients, and patient acuity levels were independent risk factors affecting ED overcrowding. SONET was derived and found to better differentiate severely overcrowded, overcrowded, and not overcrowded statuses with similar results validated externally. In addition, SONET scores correlated with increased length of ED stay, number of LWBS patients, and ED 72-hour returns. Conclusions. SONET might be a better fit to determine high volume ED overcrowding. ED overcrowding negatively impacts patient care operations and often produces poor patient perceptions of standardized care delivery.

  17. Drug use evaluation of antibiotics prescribed in a Jordanian hospital outpatient and emergency clinics using WHO prescribing indicators

    International Nuclear Information System (INIS)

    Al-Niemat, Sahar I.; Bloukh, Diana T.; Al-Harasis, Manal D.; Al-Fanek, Alen F.; Salah, Rehab K.

    2008-01-01

    Objective was to evaluate the use of antibiotics prescribed in hospital outpatient and emergency clinics in King Hussein Medical Centre (KHMC) using WHO prescribing indicators in an attempt to rationalize the use of antibiotics in the Royal Medical Services. We retrospectively surveyed a sample of 187,822 antibiotic prescriptions obtained from 5 outpatient pharmacies in KHMC written over the period of 3 consecutive months May 2007 to July 2007. The percentage of encounters of an antibiotic prescribed was calculated using the methodology recommended by the WHO. An additional indicator, the percentage share of different antibiotics was also included to identify the frequency prescribed from those antibiotics. The average percentage of prescriptions involving antibiotics was 35.6% out of 187,822 prescriptions surveyed. From these, 65,500 antibiotic prescriptions were observed. Penicillins most frequently amoxcillins and Quinolones most frequently ciprofloxacinllin and norfloxacillin were the most commonly prescribed antibiotics with an average percentage of 31.8% and 27.5%. The average prescribing rate for the other antibiotic categories was as follows: macrolides 5.2%, cephalosporins 16% and amoxcillins/clavulanate 5.4%. The high percentage of prescriptions involving antibiotics observed in KHMC pharmacies requires rational use of antibiotics and judicious prescribing by Military prescribers. An insight into factors influencing antibiotic prescribing patterns and adherence to antibiotic prescribing guidelines by the Military prescribers is warranted. (author)

  18. Evaluation of emergency department performance - a systematic review on recommended performance and quality-in-care measures.

    Science.gov (United States)

    Sørup, Christian Michel; Jacobsen, Peter; Forberg, Jakob Lundager

    2013-08-09

    Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance. Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level. A number of articles addresses this study's objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, "patients left without being seen" (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles. A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study's results allow for advancement towards improved performance measurement and

  19. Challenges for the registration of vaccines in emerging countries: Differences in dossier requirements, application and evaluation processes.

    Science.gov (United States)

    Dellepiane, Nora; Pagliusi, Sonia

    2018-06-07

    The divergence of regulatory requirements and processes in developing and emerging countries contributes to hamper vaccines' registration, and therefore delay access to high-quality, safe and efficacious vaccines for their respective populations. This report focuses on providing insights on the heterogeneity of registration requirements in terms of numbering structure and overall content of dossiers for marketing authorisation applications for vaccines in different areas of the world. While it also illustrates the divergence of regulatory processes in general, as well as the need to avoid redundant reviews, it does not claim to provide a comprehensive view of all processes nor existing facilitating mechanisms, nor is it intended to touch upon the differences in assessments made by different regulatory authorities. This report describes the work analysed by regulatory experts from vaccine manufacturing companies during a meeting held in Geneva in May 2017, in identifying and quantifying differences in the requirements for vaccine registration in three aspects for comparison: the dossier numbering structure and contents, the application forms, and the evaluation procedures, in different countries and regions. The Module 1 of the Common Technical Document (CTD) of 10 countries were compared. Modules 2-5 of the CTDs of two regions and three countries were compared to the CTD of the US FDA. The application forms of eight countries were compared and the registration procedures of 134 importing countries were compared as well. The analysis indicates a high degree of divergence in numbering structure and content requirements. Possible interventions that would lead to significant improvements in registration efficiency include alignment in CTD numbering structure, a standardised model-application form, and better convergence of evaluation procedures. Copyright © 2018.

  20. Mobile in Situ Simulation as a Tool for Evaluation and Improvement of Trauma Treatment in the Emergency Department.

    Science.gov (United States)

    Amiel, Imri; Simon, Daniel; Merin, Ofer; Ziv, Amitai

    2016-01-01

    Medical simulation is an increasingly recognized tool for teaching, coaching, training, and examining practitioners in the medical field. For many years, simulation has been used to improve trauma care and teamwork. Despite technological advances in trauma simulators, including better means of mobilization and control, most reported simulation-based trauma training has been conducted inside simulation centers, and the practice of mobile simulation in hospitals' trauma rooms has not been investigated fully. The emergency department personnel from a second-level trauma center in Israel were evaluated. Divided into randomly formed trauma teams, they were reviewed twice using in situ mobile simulation training at the hospital's trauma bay. In all, 4 simulations were held before and 4 simulations were held after a structured learning intervention. The intervention included a 1-day simulation-based training conducted at the Israel Center for Medical Simulation (MSR), which included video-based debriefing facilitated by the hospital's 4 trauma team leaders who completed a 2-day simulation-based instructors' course before the start of the study. The instructors were also trained on performance rating and thus were responsible for the assessment of their respective teams in real time as well as through reviewing of the recorded videos; thus enabling a comparison of the performances in the mobile simulation exercise before and after the educational intervention. The internal reliability of the experts' evaluation calculated in the Cronbach α model was found to be 0.786. Statistically significant improvement was observed in 4 of 10 parameters, among which were teamwork (29.64%) and communication (24.48%) (p = 0.00005). The mobile in situ simulation-based training demonstrated efficacy both as an assessment tool for trauma teams' function and an educational intervention when coupled with in vitro simulation-based training, resulting in a significant improvement of the teams

  1. Use and experience of radiological evaluation tools for the early phase during nuclear emergency exercises in Belgium

    International Nuclear Information System (INIS)

    Sohier, A.; Ruts, J.; Hardeman, F.

    2003-01-01

    Full text: The Royal Decree on 'The Emergency Plan for Nuclear Risks an the Belgian Territory' describes the role and tasks of the different stakeholders involved in case of a nuclear crisis affecting Belgium. The crisis is managed from within the Governmental Crisis Coordination Centre in Brussels where various functional cells meet according to the notification and alarm levels. Decisions about countermeasures are taken at federal level by a Coordination Committee headed by the Minister of Interior. These may be preceded by rapid decision making initiated at provincial and local levels in case of an imminent radiological threat. An information cell stands for the release of official information and instructions to the media and the public and for the monitoring of public reactions. A crucial step for a sound intervention decision making is the radiological evaluation process. The evaluation cell is responsible to gather all relevant information, to analyse it and to give advice on the best intervention strategy to the coordination committee. The primary source of information originates from the nuclear operator which must legally transmit recurrent information about the actual and forecasted status and release of the plant, the actual meteorological situation, the expected off-site radiological consequences and, if possible, environmental measurements. The evaluation cell is assisted by the measurement cell which elaborates and executes a monitoring campaign based an advice of the evaluation cell. The national monitoring network called Telerad provides another input of information. In consultation with the authorities, a rather simple yet highly flexible radiological evaluation tool to be used by the two main nuclear power plants in Belgium (Doel and Tihange) during the early phase has been developed by SCK-CEN, i.e. Noodplan Kerncentrale Doel and Plan d'Urgence Zone de Production Nucleaire de Tihange. The principal module allows computing in real-time the main

  2. Human errors evaluation for muster in emergency situations applying human error probability index (HEPI, in the oil company warehouse in Hamadan City

    Directory of Open Access Journals (Sweden)

    2012-12-01

    Full Text Available Introduction: Emergency situation is one of the influencing factors on human error. The aim of this research was purpose to evaluate human error in emergency situation of fire and explosion at the oil company warehouse in Hamadan city applying human error probability index (HEPI. . Material and Method: First, the scenario of emergency situation of those situation of fire and explosion at the oil company warehouse was designed and then maneuver against, was performed. The scaled questionnaire of muster for the maneuver was completed in the next stage. Collected data were analyzed to calculate the probability success for the 18 actions required in an emergency situation from starting point of the muster until the latest action to temporary sheltersafe. .Result: The result showed that the highest probability of error occurrence was related to make safe workplace (evaluation phase with 32.4 % and lowest probability of occurrence error in detection alarm (awareness phase with 1.8 %, probability. The highest severity of error was in the evaluation phase and the lowest severity of error was in the awareness and recovery phase. Maximum risk level was related to the evaluating exit routes and selecting one route and choosy another exit route and minimum risk level was related to the four evaluation phases. . Conclusion: To reduce the risk of reaction in the exit phases of an emergency situation, the following actions are recommended, based on the finding in this study: A periodic evaluation of the exit phase and modifying them if necessary, conducting more maneuvers and analyzing this results along with a sufficient feedback to the employees.

  3. Evaluation of natural language processing from emergency department computerized medical records for intra-hospital syndromic surveillance

    Directory of Open Access Journals (Sweden)

    Pagliaroli Véronique

    2011-07-01

    Full Text Available Abstract Background The identification of patients who pose an epidemic hazard when they are admitted to a health facility plays a role in preventing the risk of hospital acquired infection. An automated clinical decision support system to detect suspected cases, based on the principle of syndromic surveillance, is being developed at the University of Lyon's Hôpital de la Croix-Rousse. This tool will analyse structured data and narrative reports from computerized emergency department (ED medical records. The first step consists of developing an application (UrgIndex which automatically extracts and encodes information found in narrative reports. The purpose of the present article is to describe and evaluate this natural language processing system. Methods Narrative reports have to be pre-processed before utilizing the French-language medical multi-terminology indexer (ECMT for standardized encoding. UrgIndex identifies and excludes syntagmas containing a negation and replaces non-standard terms (abbreviations, acronyms, spelling errors.... Then, the phrases are sent to the ECMT through an Internet connection. The indexer's reply, based on Extensible Markup Language, returns codes and literals corresponding to the concepts found in phrases. UrgIndex filters codes corresponding to suspected infections. Recall is defined as the number of relevant processed medical concepts divided by the number of concepts evaluated (coded manually by the medical epidemiologist. Precision is defined as the number of relevant processed concepts divided by the number of concepts proposed by UrgIndex. Recall and precision were assessed for respiratory and cutaneous syndromes. Results Evaluation of 1,674 processed medical concepts contained in 100 ED medical records (50 for respiratory syndromes and 50 for cutaneous syndromes showed an overall recall of 85.8% (95% CI: 84.1-87.3. Recall varied from 84.5% for respiratory syndromes to 87.0% for cutaneous syndromes. The

  4. Development and Evaluation of Senior High School Courses on Emerging Technology: A Case Study of a Course on Virtual Reality

    Science.gov (United States)

    Chen, Chi-Tung

    2012-01-01

    In Taiwan, the National Science Council has implemented the High Scope Program (HSP) since 2006. The purpose of this study was to analyze the development and effectiveness of senior high school HSP courses on emerging technology. This study used a course on virtual reality as an example, to investigate the influence of emerging technology courses…

  5. Evaluation of a Low-risk Mild Traumatic Brain Injury and Intracranial Hemorrhage Emergency Department Observation Protocol.

    Science.gov (United States)

    Yun, Brian J; Borczuk, Pierre; Wang, Lulu; Dorner, Stephen; White, Benjamin A; Raja, Ali S

    2017-11-20

    Among emergency physicians, there is wide variation in admitting practices for patients who suffered a mild traumatic brain injury (TBI) with an intracranial hemorrhage (ICH). The purpose of this study was to evaluate the effects of implementing a protocol in the emergency department (ED) observation unit for patients with mild TBI and ICH. This retrospective cohort study was approved by the institutional review board. Study subjects were patients ≥ 18 years of age with an International Classification of Diseases code corresponding to a traumatic ICH and admitted to an ED observation unit (EDOU) of an urban, academic Level I trauma center between February 1, 2015, and January 31, 2017. Patient data and discharge disposition were abstracted from the electronic health record, and imaging data, from the final neuroradiologist report. To measure kappa, two abstractors independently collected data for presence of neuro deficit from a 10% random sample of the medical charts. Using a multivariable logistic regression model with a propensity score of the probability of placement in the EDOU before and after protocol implementation as a covariate, we sought to determine the pre-post effects of implementing a protocol on the composite outcome of admission to the floor, intensive care unit, or operating room from the EDOU and the proportion of patients with worsening findings on repeat computed tomography (CT) head scan in the EDOU. A total of 379 patients were identified during the study period; 83 were excluded as they were found to have no ICH on chart review. Inter-rater reliability kappa statistic was 0.63 for 30 charts. Among the 296 patients who remained eligible and comprised the study population, 143 were in the preprotocol period and 153 after protocol implementation. The EDOU protocol was associated with an independently statistically significant decreased odds ratio (OR) for admission or worsening ICH on repeat CT scan (OR = 0.45, 95% confidence interval [CI

  6. Emergency Communication

    Science.gov (United States)

    : Environmental Documents, Reports LANL Home Calendar Search Contacts Resources » Emergency Communication Emergency Communication Stay informed of emergencies, weather delays, closures, other alerts. Find links to

  7. Evaluation of seed coating formulations of Trichoderma harzianum on cucumber seeds against pre- and post-emergence damping-off caused by Pythium ultimum

    Science.gov (United States)

    Seed coating formulations of Trichoderma harzianum were evaluated on cucumber seeds to control pre- and post-emergence damping-off caused by Pythium ultimum in greenhouse studies. Results showed that coating formulation H reduced the disease incidence significantly, and had the potential for commer...

  8. Evaluating and Measuring the Return on Investment of an Emergency Center Health Care Professional Picture Archiving and Communication Systems Training Program

    Science.gov (United States)

    Roelandt, James P.

    2012-01-01

    Picture archiving and communication system (PACS) workflow directly affects the quality of emergency patient care through radiology exam turn-around times and the speed of delivery of diagnostic radiology results. This study was a mixed methods training and performance improvement study that evaluated the effectiveness and value of a hospital…

  9. Evaluating the cascading impacts of sea level rise and coastal flooding on emergency response spatial accessibility in Lower Manhattan, New York City

    Science.gov (United States)

    Yin, Jie; Yu, Dapeng; Lin, Ning; Wilby, Robert L.

    2017-12-01

    This paper describes a scenario-based approach for evaluating the cascading impacts of sea level rise (SLR) and coastal flooding on emergency responses. The analysis is applied to Lower Manhattan, New York City, considering FEMA's 100- and 500-year flood scenarios and New York City Panel on Climate Change (NPCC2)'s high-end SLR projections for the 2050s and 2080s, using the current situation as the baseline scenario. Service areas for different response timeframes (3-, 5- and 8-min) and various traffic conditions are simulated for three major emergency responders (i.e. New York Police Department (NYPD), Fire Department, New York (FDNY) and Emergency Medical Service (EMS)) under normal and flood scenarios. The modelling suggests that coastal flooding together with SLR could result in proportionate but non-linear impacts on emergency services at the city scale, and the performance of operational responses is largely determined by the positioning of emergency facilities and the functioning of traffic networks. Overall, emergency service accessibility to the city is primarily determined by traffic flow speed. However, the situation is expected to be further aggravated during coastal flooding, with is set to increase in frequency and magnitude due to SLR.

  10. Construction of a technique plan repository and evaluation system based on AHP group decision-making for emergency treatment and disposal in chemical pollution accidents

    International Nuclear Information System (INIS)

    Shi, Shenggang; Cao, Jingcan; Feng, Li; Liang, Wenyan; Zhang, Liqiu

    2014-01-01

    Highlights: • Different chemical pollution accidents were simplified using the event tree analysis. • Emergency disposal technique plan repository of chemicals accidents was constructed. • The technique evaluation index system of chemicals accidents disposal was developed. • A combination of group decision and analytical hierarchy process (AHP) was employed. • Group decision introducing similarity and diversity factor was used for data analysis. - Abstract: The environmental pollution resulting from chemical accidents has caused increasingly serious concerns. Therefore, it is very important to be able to determine in advance the appropriate emergency treatment and disposal technology for different types of chemical accidents. However, the formulation of an emergency plan for chemical pollution accidents is considerably difficult due to the substantial uncertainty and complexity of such accidents. This paper explains how the event tree method was used to create 54 different scenarios for chemical pollution accidents, based on the polluted medium, dangerous characteristics and properties of chemicals involved. For each type of chemical accident, feasible emergency treatment and disposal technology schemes were established, considering the areas of pollution source control, pollutant non-proliferation, contaminant elimination and waste disposal. Meanwhile, in order to obtain the optimum emergency disposal technology schemes as soon as the chemical pollution accident occurs from the plan repository, the technique evaluation index system was developed based on group decision-improved analytical hierarchy process (AHP), and has been tested by using a sudden aniline pollution accident that occurred in a river in December 2012

  11. Construction of a technique plan repository and evaluation system based on AHP group decision-making for emergency treatment and disposal in chemical pollution accidents

    Energy Technology Data Exchange (ETDEWEB)

    Shi, Shenggang [College of Environmental Science and Engineering, Beijing Forestry University, Beijing 100083 (China); College of Chemistry, Baotou Teachers’ College, Baotou 014030 (China); Cao, Jingcan; Feng, Li; Liang, Wenyan [College of Environmental Science and Engineering, Beijing Forestry University, Beijing 100083 (China); Zhang, Liqiu, E-mail: zhangliqiu@163.com [College of Environmental Science and Engineering, Beijing Forestry University, Beijing 100083 (China)

    2014-07-15

    Highlights: • Different chemical pollution accidents were simplified using the event tree analysis. • Emergency disposal technique plan repository of chemicals accidents was constructed. • The technique evaluation index system of chemicals accidents disposal was developed. • A combination of group decision and analytical hierarchy process (AHP) was employed. • Group decision introducing similarity and diversity factor was used for data analysis. - Abstract: The environmental pollution resulting from chemical accidents has caused increasingly serious concerns. Therefore, it is very important to be able to determine in advance the appropriate emergency treatment and disposal technology for different types of chemical accidents. However, the formulation of an emergency plan for chemical pollution accidents is considerably difficult due to the substantial uncertainty and complexity of such accidents. This paper explains how the event tree method was used to create 54 different scenarios for chemical pollution accidents, based on the polluted medium, dangerous characteristics and properties of chemicals involved. For each type of chemical accident, feasible emergency treatment and disposal technology schemes were established, considering the areas of pollution source control, pollutant non-proliferation, contaminant elimination and waste disposal. Meanwhile, in order to obtain the optimum emergency disposal technology schemes as soon as the chemical pollution accident occurs from the plan repository, the technique evaluation index system was developed based on group decision-improved analytical hierarchy process (AHP), and has been tested by using a sudden aniline pollution accident that occurred in a river in December 2012.

  12. Evaluation of a continuous indicator for syndromic surveillance through simulation. application to vector borne disease emergence detection in cattle using milk yield.

    Directory of Open Access Journals (Sweden)

    Aurélien Madouasse

    Full Text Available Two vector borne diseases, caused by the Bluetongue and Schmallenberg viruses respectively, have emerged in the European ruminant populations since 2006. Several diseases are transmitted by the same vectors and could emerge in the future. Syndromic surveillance, which consists in the routine monitoring of indicators for the detection of adverse health events, may allow an early detection. Milk yield is routinely measured in a large proportion of dairy herds and could be incorporated as an indicator in a surveillance system. However, few studies have evaluated continuous indicators for syndromic surveillance. The aim of this study was to develop a framework for the quantification of both disease characteristics and model predictive abilities that are important for a continuous indicator to be sensitive, timely and specific for the detection of a vector-borne disease emergence. Emergences with a range of spread characteristics and effects on milk production were simulated. Milk yields collected monthly in 48 713 French dairy herds were used to simulate 576 disease emergence scenarios. First, the effect of disease characteristics on the sensitivity and timeliness of detection were assessed: Spatio-temporal clusters of low milk production were detected with a scan statistic using the difference between observed and simulated milk yields as input. In a second step, the system specificity was evaluated by running the scan statistic on the difference between observed and predicted milk yields, in the absence of simulated emergence. The timeliness of detection depended mostly on how easily the disease spread between and within herds. The time and location of the emergence or adding random noise to the simulated effects had a limited impact on the timeliness of detection. The main limitation of the system was the low specificity i.e. the high number of clusters detected from the difference between observed and predicted productions, in the absence of

  13. Childhood Emergencies

    Science.gov (United States)

    ... SUBSCRIBE Emergency 101 Share this! Home » Emergency 101 Childhood Emergencies Keeping children healthy and safe is every ... and tools to prevent, recognize and address a childhood emergency is the first step in keeping your ...

  14. Eye Emergencies

    Science.gov (United States)

    ... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of retinal detachment, a ...

  15. Emergency contraception

    Science.gov (United States)

    Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B; Family planning - emergency contraception ... IUD placed inside the uterus CHOICES FOR EMERGENCY CONTRACEPTION Two emergency contraceptive pills may be bought without a prescription. ...

  16. Step Test: a method for evaluating maximum oxygen consumption to determine the ability kind of work among students of medical emergencies.

    Science.gov (United States)

    Heydari, Payam; Varmazyar, Sakineh; Nikpey, Ahmad; Variani, Ali Safari; Jafarvand, Mojtaba

    2017-03-01

    Maximum oxygen consumption shows the maximum oxygen rate of muscle oxygenation that is acceptable in many cases, to measure the fitness between person and the desired job. Given that medical emergencies are important, and difficult jobs in emergency situations require people with high physical ability and readiness for the job, the aim of this study was to evaluate the maximum oxygen consumption, to determine the ability of work type among students of medical emergencies in Qazvin in 2016. This study was a descriptive - analytical, and in cross-sectional type conducted among 36 volunteer students of medical emergencies in Qazvin in 2016. After necessary coordination for the implementation of the study, participants completed health questionnaires and demographic characteristics and then the participants were evaluated with step tests of American College of Sport Medicine (ACSM). Data analysis was done by SPSS version 18 and U-Mann-Whitney tests, Kruskal-Wallis and Pearson correlation coefficient. Average of maximum oxygen consumption of the participants was estimated 3.15±0.50 liters per minute. 91.7% of medical emergencies students were selected as appropriate in terms of maximum oxygen consumption and thus had the ability to do heavy and too heavy work. Average of maximum oxygen consumption evaluated by the U-Mann-Whitney test and Kruskal-Wallis, had significant relationship with age (p<0.05) and weight groups (p<0.001). There was a significant positive correlation between maximum oxygen consumption with weight and body mass index (p<0.001). The results of this study showed that demographic variables of weight and body mass index are the factors influencing the determination of maximum oxygen consumption, as most of the students had the ability to do heavy, and too heavy work. Therefore, people with ability to do average work are not suitable for medical emergency tasks.

  17. Impact of international humanitarian service-learning on emerging adult social competence: A mixed-methods evaluation

    Directory of Open Access Journals (Sweden)

    Paul Schvaneveldt

    2016-09-01

    Full Text Available This article presents the results from a study into international humanitarian service-learning experiences on young adult volunteers. Specifically, the service-learning experiences of emerging adults who had served in orphanages in Latin America were assessed, in a pre- and post-test design, for their development in areas of social competency such as identity, self-efficacy, self-esteem and ethnocentric attitudes. A mixed-methods design using both qualitative and quantitative measures was used. Both qualitative and quantitative results identified significant and important impacts on the development of the social competencies of these emerging adults. In addition, several qualitative themes illustrated that longer term international service-learning experiences have a profound impact on the social competence of emerging adults. Keywords: International humanitarian service, service-learning, emerging adult competency

  18. [Estimating emergency hospital admissions to gauge short-term effects of air pollution: evaluation of health data quality].

    Science.gov (United States)

    Bois de Fer, Béatrice; Host, Sabine; Chardon, Benoît; Chatignoux, Edouard; Beaujouan, Laure; Brun-Ney, Dominique; Grémy, Isabelle

    2009-01-01

    The study of the short-term effects and health impact of air pollution is carrier out by the ERPURS regional surveillance program which utilizes hospitalization data obtained from the French hospital information system (PMSI) to determine these links. This system does not permit the distinction between emergency hospital admissions from scheduled ones, which cannot be related to short term changes in air pollution levels. This study examines how scheduled admissions affect the quality of the health indicators used to estimate air pollution effects. This indicator is compared to three new emergency hospitalisation indicators reconstructed based on data from the public hospitals in Paris, partly from the PMSI data and partly with data from an on-line emergency network that regroups all of the computerized emergency services. According to the pathology, scheduled admissions present a difficulty which affects the capacity to highlight the weakest risks with any precision.

  19. Criteria for preparation and evaluation of radiological emergency response plans and preparedness in support of nuclear power plants. Interim report

    International Nuclear Information System (INIS)

    1980-01-01

    The purpose of this document is to provide a common reference and interim guidance source for: state and local governments and nuclear facility operators in the development of radiological emergency response plans and preparedness in support of nuclear power plants; and Nuclear Regulatory Commission (NRC), Federal Emergency Management Agency (FEMA) and other Federal agency personnel engaged in the review of state, local government, and licensee plans and preparedness

  20. Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives.

    Science.gov (United States)

    Morecroft, Charles W; Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J; Wilson, Sarah E; Ashcroft, Darren M; Mensah, Noah; Pickup, Graham B

    2015-07-10

    To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October-November 2012 and April 2013); interviews with CPs (February-April 2013); follow-up interviews with patients (April-May 2013); interactive feedback sessions with general practice teams (October-November 2013). 22 community pharmacies and 6 general practices in Northwest England. 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were 'loaned' in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with

  1. Military Emergency Medical Service System Assessment: Application of the National Park Service Needs Assessment and Program Audit to Objectively Evaluate the Military EMS System of Okinawa, Japan.

    Science.gov (United States)

    Ross, Elliot M; Harper, Stephen A; Cunningham, Cord; Walrath, Benjamin D; DeMers, Gerard; Kharod, Chetan U

    2017-03-01

    As part of a Military Emergency Medical Services (EMS) system process improvement initiative, the authors sought to objectively evaluate the U.S. military EMS system for the island of Okinawa. They applied a program evaluation tool currently utilized by the U.S. National Park Service (NPS). A comprehensive needs assessment was conducted to evaluate the current Military EMS system in Okinawa, Japan. The NPS EMS Program Audit Worksheet was used to get an overall "score" of our assessment. After all the data had been collected, a joint committee of Military EMS physicians reviewed the findings and made formal recommendations. From 2011 to 2014, U.S. military EMS on Okinawa averaged 1,345 ± 137 patient transports annually. An advanced life support (ALS) provider would have been dispatched on 558 EMS runs (38%) based on chief complaint in 2014 had they been available. Over 36,000 man-hours were expended during this period to provide National Registry Emergency Medical Technician (EMT)-accredited instruction to certify 141 Navy Corpsman as EMT Basics. The NPS EMS Program Audit Worksheet was used and the program scored a total of 31, suggesting the program is well planned and operating within standards. This evaluation of the Military EMS system on Okinawa using the NPS program assessment and audit worksheet demonstrates the NPS evaluation instruments may offer a useful assessment tool for the evaluation of Military EMS systems. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  2. Reliability of emergency diesel-generators used in french NPP evaluation of the failure rate and its trend failures and dysfunctions review

    International Nuclear Information System (INIS)

    Colas, A.F.

    1990-01-01

    Emergency Diesel-Generators (EDG) reliability evaluation is based on examination of tests and operation abnormalities collected in national computerised data bank. We gather all available data in order to establish failures rate annual values and to follow their trend. Technical analysis aims at identifying failures modes in order to find palliative or curative solutions. The present paper tries to show our main findings and the way of technical approach we follow in this matters

  3. Reliability of emergency diesel-generators used in french NPP evaluation of the failure rate and its trend failures and dysfunctions review

    International Nuclear Information System (INIS)

    Colas, A.F.

    1989-04-01

    Emergency Diesel-Generators (EDG) reliability evaluation is based on examination of tests and operation abnormalities collected in national computerised data bank. We gather all available data in order to establish failures rate annual values and to follow their trend. Technical analysis aims at identifying failures modes in order to find palliative or curative solutions. The present paper tries to show our main findings and the way of technical approach we follow in this matters

  4. Pediatric Emergency Department Suicidal Patients: Two-Site Evaluation of Suicide Ideators, Single Attempters, and Repeat Attempters

    Science.gov (United States)

    Asarnow, Joan Rosenbaum; Baraff, Larry J.; Berk, Michele; Grob, Charles; Devich-Navarro, Mona; Suddath, Robert; Piacentini, John; Tang, Lingqi

    2008-01-01

    The study examines ideators, single attempters, and repeats attempters of suicide to clarify optimal strategies for emergency department management and risk assessment to help them in reducing youth suicide and suicide attempts. Depression was found to be a strong predictor of suicide/suicide attempts along with substance use, externalizing…

  5. Lung Emergencies

    Science.gov (United States)

    ... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at increased risk of sudden lung ...

  6. The Role of Radio Frequency Detection System Embedded Surgical Sponges in Preventing Retained Surgical Sponges: A Prospective Evaluation in Patients Undergoing Emergency Surgery.

    Science.gov (United States)

    Inaba, Kenji; Okoye, Obi; Aksoy, Hande; Skiada, Dimitra; Ault, Glenn; Sener, Stephen; Lam, Lydia; Benjamin, Elizabeth; Demetriades, Demetrios

    2016-10-01

    To prospectively evaluate the ability of radio frequency detection (RFD) system-embedded sponges to mitigate the incidence of retained surgical sponges (RSS) after emergency surgery. Emergency surgery patients are at high risk for retained foreign bodies. All emergent trauma and nontrauma cavitary operations over a 5-year period (January 2010-December 2014) were prospectively enrolled. For damage-control procedures, only the definitive closure was included. RFD sponges were used exclusively throughout the study period. Before closure, the sponge and instrument count was followed by RFD scanning and x-ray evaluation for retained sponges. RSS and near-misses averted using the RFD system were analyzed. In all, 2051 patients [median (range)], aged 41 (1-101) years, 72.2% male, 46.8% trauma patients, underwent 2148 operations (1824 laparotomy, 100 thoracotomy, 30 sternotomy, and 97 combined). RFD detected retained sponges in 11 (0.5%) patients (81.8%laparotomy, 18.2% sternotomy) before cavitary closure. All postclosure x-rays were negative. No retained sponges were missed by the RFD system. Body mass index was 29 (23-43), estimated blood loss 1.0 L (0-23), and operating room time 160 minutes (71-869). Procedures started after 18:00 to 06:00 hours in 45.5% of the patients. The sponge count was incorrect in 36.4%, not performed due to time constraints in 45.5%, and correct in 18.2%. The additional cost of using RFD-embedded disposables was $0.17 for a 4X18 laparotomy sponge and $0.46 for a 10 pack of 12ply, 4X8. Emergent surgical procedures are high-risk for retained sponges, even when sponge counts are performed and found to be correct. Implementation of a RFD system was effective in preventing this complication and should be considered for emergent operations in an effort to improve patient safety.

  7. Cultural Competence Training for Law Enforcement Responding to Domestic Violence Emergencies With the Deaf and Hard of Hearing: A Mixed-Methods Evaluation.

    Science.gov (United States)

    Engelman, Alina; Deardorff, Julianna

    2016-03-01

    To evaluate a training workshop for law enforcement as first responders for the purpose of increasing officers' cultural competency in working with Deaf and hard-of-hearing people (Deaf/HH) during domestic violence (DV) emergencies. This evaluation assesses the efficacy of a 2-hour training workshop for law enforcement. Thirty-four participants completed questionnaires at pre- and postintervention to assess participants' (1) satisfaction with training; (2) skills in responding to Deaf/HH individual(s) in a DV emergency; (3) attitudes toward the Deaf/HH, including bias recognition, self-assessment of cultural competency, and perceived self-efficacy; and (4) knowledge of communication. Focus groups (FGs) were also conducted (n = 6 for FG1, n = 13 for FG2). SPSS software was used to analyze survey data; principal components analysis was conducted on the survey instruments. There were significant differences between pre- and posttests for several targeted outcomes, including knowledge and perceived self-efficacy. Both survey and FG results demonstrated that participants gained cultural competency skills as indicated by changes in attitudes toward the Deaf/HH, both in DV emergencies and in large-scale emergencies. Significant differences were evident between pre and posttest results in terms of knowledge and perceived self-efficacy. Nonetheless, survey participants demonstrated a lack of knowledge about policy and the law. Survey findings also suggest that while a onetime training can improve the perceived self-efficacy of participants, shifting attitudes about the capabilities of the Deaf/HH may require different training strategies. FG participants demonstrated a greater awareness of the complexity of working with this population in a DV emergency. © 2015 Society for Public Health Education.

  8. Graphic products used in the evaluation of traditional and emerging remote sensing technologies for the detection of fugitive contamination at selected superfund hazardous waste sites

    Science.gov (United States)

    Slonecker, E. Terrence; Fisher, Gary B.

    2011-01-01

    This report presents the overhead imagery and field sampling results used to prepare U.S. Geological Survey Open-File Report 2011-1050, 'Evaluation of Traditional and Emerging Remote Sensing Technologies for the Detection of Fugitive Contamination at Selected Superfund Hazardous Waste Sites'. These graphic products were used in the evaluation of remote sensing technology in postclosure monitoring of hazardous waste sites and represent an ongoing research effort. Soil sampling results presented here were accomplished with field portable x-ray fluoresence (XRF) technology and are used as screening tools only representing the current conditions of metals and other contaminants at selected Superfund hazardous waste sites.

  9. An evaluation of the emerging interventions against Respiratory Syncytial Virus (RSV-associated acute lower respiratory infections in children

    Directory of Open Access Journals (Sweden)

    Simões Eric AF

    2011-04-01

    Full Text Available Abstract Background Respiratory Syncytial Virus (RSV is the leading cause of acute lower respiratory infections (ALRI in children. It is estimated to cause approximately 33.8 million new episodes of ALRI in children annually, 96% of these occurring in developing countries. It is also estimated to result in about 53,000 to 199,000 deaths annually in young children. Currently there are several vaccine and immunoprophylaxis candidates against RSV in the developmental phase targeting active and passive immunization. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging vaccines against RSV relevant to 12 criteria of interest. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies. The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to the sensitive nature of their involvement in such exercises. They answered questions from the CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results In the case of candidate vaccines for active immunization of infants against RSV, the experts expressed very low levels of optimism for low product cost, affordability and low cost of development; moderate levels of optimism regarding the criteria of answerability, likelihood of efficacy, deliverability, sustainability and acceptance to end users for the interventions; and high levels of optimism regarding impact on equity and acceptance to health workers. While considering the candidate vaccines targeting pregnant women, the panel expressed low levels of optimism for low product cost, affordability, answerability and low development cost

  10. An evaluation of the emerging interventions against Respiratory Syncytial Virus (RSV)-associated acute lower respiratory infections in children.

    Science.gov (United States)

    Nair, Harish; Verma, Vasundhara R; Theodoratou, Evropi; Zgaga, Lina; Huda, Tanvir; Simões, Eric A F; Wright, Peter F; Rudan, Igor; Campbell, Harry

    2011-04-13

    Respiratory Syncytial Virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in children. It is estimated to cause approximately 33.8 million new episodes of ALRI in children annually, 96% of these occurring in developing countries. It is also estimated to result in about 53,000 to 199,000 deaths annually in young children. Currently there are several vaccine and immunoprophylaxis candidates against RSV in the developmental phase targeting active and passive immunization. We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging vaccines against RSV relevant to 12 criteria of interest. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to the sensitive nature of their involvement in such exercises. They answered questions from the CHNRI framework and their "collective optimism" towards each criterion was documented on a scale from 0 to 100%. In the case of candidate vaccines for active immunization of infants against RSV, the experts expressed very low levels of optimism for low product cost, affordability and low cost of development; moderate levels of optimism regarding the criteria of answerability, likelihood of efficacy, deliverability, sustainability and acceptance to end users for the interventions; and high levels of optimism regarding impact on equity and acceptance to health workers. While considering the candidate vaccines targeting pregnant women, the panel expressed low levels of optimism for low product cost, affordability, answerability and low development cost; moderate levels of optimism for likelihood of efficacy

  11. Entrepreneurship, Emerging Technologies, Emerging Markets

    NARCIS (Netherlands)

    Thukral, Inderpreet S.; Von Ehr, James; Walsh, Steven Thomas; Groen, Arend J.; van der Sijde, Peter; Adham, Khairul Akmaliah

    2008-01-01

    Academics and practitioners alike have long understood the benefits, if not the risks, of both emerging markets and emerging technologies.Yet it is only recently that foresighted firms have embraced emerging technologies and emerging markets through entrepreneurial activity. Emerging technologies

  12. A novel two-stage evaluation system based on a Group-G1 approach to identify appropriate emergency treatment technology schemes in sudden water source pollution accidents.

    Science.gov (United States)

    Qu, Jianhua; Meng, Xianlin; Hu, Qi; You, Hong

    2016-02-01

    Sudden water source pollution resulting from hazardous materials has gradually become a major threat to the safety of the urban water supply. Over the past years, various treatment techniques have been proposed for the removal of the pollutants to minimize the threat of such pollutions. Given the diversity of techniques available, the current challenge is how to scientifically select the most desirable alternative for different threat degrees. Therefore, a novel two-stage evaluation system was developed based on a circulation-correction improved Group-G1 method to determine the optimal emergency treatment technology scheme, considering the areas of contaminant elimination in both drinking water sources and water treatment plants. In stage 1, the threat degree caused by the pollution was predicted using a threat evaluation index system and was subdivided into four levels. Then, a technique evaluation index system containing four sets of criteria weights was constructed in stage 2 to obtain the optimum treatment schemes corresponding to the different threat levels. The applicability of the established evaluation system was tested by a practical cadmium-contaminated accident that occurred in 2012. The results show this system capable of facilitating scientific analysis in the evaluation and selection of emergency treatment technologies for drinking water source security.

  13. Standard review plan for the review and evaluation of emergency plans for research and test reactors. Technical report

    International Nuclear Information System (INIS)

    Bates, E.F.; Grimes, B.K.; Ramos, S.L.

    1982-05-01

    This document provides a Standard Review Plan for the guidance of the NRC staff to assure that complete and uniform reviews are made of research and test reactor emergency plans. The report is organized under ten planning standards which correspond to the guidance criteria in Draft II of ANSI/ANS 15.16 as endorsed by Revision 1 to Regulatory Guide 2.6. The applicability of the items under each planning standard is indicated by subdivisions of the steady state thermal power levels at which the reactors are licensed to operate. Standard emergency classes and example action levels for research and test reactors which should initiate these classes are given in an Appendix

  14. Construction of a technique plan repository and evaluation system based on AHP group decision-making for emergency treatment and disposal in chemical pollution accidents.

    Science.gov (United States)

    Shi, Shenggang; Cao, Jingcan; Feng, Li; Liang, Wenyan; Zhang, Liqiu

    2014-07-15

    The environmental pollution resulting from chemical accidents has caused increasingly serious concerns. Therefore, it is very important to be able to determine in advance the appropriate emergency treatment and disposal technology for different types of chemical accidents. However, the formulation of an emergency plan for chemical pollution accidents is considerably difficult due to the substantial uncertainty and complexity of such accidents. This paper explains how the event tree method was used to create 54 different scenarios for chemical pollution accidents, based on the polluted medium, dangerous characteristics and properties of chemicals involved. For each type of chemical accident, feasible emergency treatment and disposal technology schemes were established, considering the areas of pollution source control, pollutant non-proliferation, contaminant elimination and waste disposal. Meanwhile, in order to obtain the optimum emergency disposal technology schemes as soon as the chemical pollution accident occurs from the plan repository, the technique evaluation index system was developed based on group decision-improved analytical hierarchy process (AHP), and has been tested by using a sudden aniline pollution accident that occurred in a river in December 2012. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. [Wells clinical prediction criteria in patients suspected of having deep vein thrombosis: evaluation of components and use in the emergency department].

    Science.gov (United States)

    García-Castrillo Riesgo, Luis; Jiménez Hernández, Sònia; Piñera Salmerón, Pascual

    2015-01-01

    To determine the applicability of the Wells clinical prediction criteria for deep vein thrombosis (DVT) in patients in hospital emergency departments and to evaluate the relevance of the score's components. Prospective multicenter cohort study in consecutive hospital emergency department patients suspected of having DVT. Full-leg Doppler compression ultrasound imaging was performed on all patients. We recorded information on variables related to risk for DVT and the components of clinical prediction scales. Wells and Oudega clinical prediction scores were calculated. We studied 362 patients in 23 hospital emergency departments; the mean (SD) age was 65 (18) years and 52.8% were women. DVT was diagnosed in 254 patients (70.16%); 171 (47.2%) had proximal DVT. The clinical probability of DVT according to the Wells scale and the prevalence of proximal DVT were as follows: low probability, 57 patients (14 with DVT, 24.6%); intermediate probability, 124 (43 with DVT, 34.7%), and high probability, 181 (114 with DVT, 63%). Only 5 of the components of the Wells scale were associated with the presence of proximal DVT. The prevalence of DVT is very high in the 3 categories of clinical probability indicated by the Wells score. The prevalences do not correspond to those of the cohort used to validate the scale. It appears to be necessary to develop scales adjusted for use in hospital emergency departments when DVT is suspected.

  16. Evaluation of the seasonal performance of a water reclamation pond-constructed wetland system for removing emerging contaminants.

    Science.gov (United States)

    Matamoros, Víctor; Salvadó, Victòria

    2012-01-01

    The capacity of a full-scale reclamation pond-constructed wetland (CW) system to eliminate 27 emerging contaminants (i.e. pharmaceuticals, sunscreen compounds, fragrances, antiseptics, fire retardants, pesticides, and plasticizers) and the seasonal occurrence of these contaminants is studied. The compounds with the highest concentrations in the secondary effluent are diclofenac, caffeine, ketoprofen, and carbamazepine. The results show that the constructed wetland (61%) removes emerging contaminants significantly more efficiently than the pond (51%), presumably due to the presence of plants (Phragmites and Thypa) as well as the higher hydraulic residence time (HRT) in the CW. A greater seasonal trend to the efficient removal of these compounds is observed in the pond than in the CW. The overall mass removal efficiency of each individual compound ranged from 27% to 93% (71% on average), which is comparable to reported data in advanced treatments (photo-fenton and membrane filtration). The seasonal average content of emerging contaminants in the river water (2488 ng L(-1)) next to the water reclamation plant is found to be higher than the content in the final reclaimed water (1490 ng L(-1)), suggesting that the chemical quality of the reclaimed water is better than available surface waters. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Evaluating the effectiveness of PrepSTART for promoting oral language and emergent literacy skills in disadvantaged preparatory students.

    Science.gov (United States)

    Lennox, Maria; Westerveld, Marleen F; Trembath, David

    2018-04-01

    This study examined the effectiveness of a classroom-based intervention programme aimed at improving the oral language and emergent literacy skills of students from low socio-economic, culturally diverse backgrounds within their first formal year of schooling ("prep"). Data from 137 students were available for analysis. Participants were from three primary schools located in Queensland, Australia. Eight classes were allocated to intervention and two classes acted as a business as usual control. All students received literacy instruction as per the Australian Curriculum. However, the intervention group received 24 weeks of scripted, classroom-based, book-based intervention targeting code- and meaning-related emergent literacy skills. All students were assessed individually pre- and post-intervention on code-related measures (i.e. letter identification and phonological awareness) and meaning-related measures (i.e. vocabulary, oral narrative comprehension and retell). All students made significant improvement over time for all measures. Students in the intervention group showed significantly more progress than the business as usual group on all measures, except for letter identification and oral narrative comprehension. This classroom-based book-based intervention can improve the code- and meaning-related emergent literacy skills of prep students from low socio-economic backgrounds and provide these students with the building blocks for successful literacy acquisition.

  18. Emergency preparedness

    International Nuclear Information System (INIS)

    1998-01-01

    According the conception of the Emergency Response Centre (ERC) of the Nuclear Regulatory Authority of the Slovak Republic (NRA), and the obtained experience from exercises, and as well as on the basis of recommendations of international missions, the NRA SR started, in 1997 the ERC extension. The new room enable the work for radiation protection group, reactor safety and logistic group separately. At the same time special room was build for work of the NECRA Technical Support Group of the Emergency Commission for Radiation Accidents of the SR.This group co-operates closely with ERC while evaluation the situation, and by using the information system of the NRA and database of ERC to generate the conditions of nuclear facilities in once of emergency. Extension of the mentioned rooms was carried out. The financing by the European Union helped to build the project RAMG. In this way the NRA gained a working site which, with its equipment and parameters belongs to the top working sites of regulatory bodies of developed European countries. The NRA preparation of exercise and special staff education was carried out in 1997, for employees of the NRA and members of Emergency Headquarters (EH) for work in ERC in case of nuclear installation accident. The task of education of member of EH was their preparation for carrying out three exercises. These exercises are described. In the area of emergency preparedness, in accordance with inspection plan of the Office, 7 team inspections were carried out in individual localities; in NPP Bohunice, two in NPP Mochovce and one in Bohunice Conditioning Centre for radioactive wastes. Solution of the task of development of science and technology in the area of 'Development of technical and programme means for analyses of accidents and solutions of crisis situations'continued in 1997. Another regulations were elaborated for activity of members of EH of the NRA. The following was was carried out: selection of data for transfer and the

  19. Evaluación del aprendizaje emergente: una experiencia con estudiantes universitarias de Educación Preescolar / Evaluating emergent learning: an experience with university preschool education students

    Directory of Open Access Journals (Sweden)

    Badilla Saxe, Eleonora

    2008-12-01

    Full Text Available Resumen: Se aborda en este ensayo la necesidad de comprender y evaluar el aprendizaje como un fenómeno emergente, más allá del aprendizaje previsto en los planes de estudio y diseño curricular. Se ejemplifica con la reflexión del propio aprendizaje emergente de la autora en su proceso de dirección de un proyecto de investigación-acción en la Universidad de Costa Rica. En dicha investigación-acción participaron once estudiantes de licenciatura en educación preescolar y veinticinco niños y niñas de 5 y 6 años que contaron con materiales digitales en su ambiente y proceso de aprendizaje.Abstract:This essay discusses the need to understand and evaluate learning as an emergent phenomenon that transcends what has been foreseen in the curriculum. It includes reflections of the author as Director of a Reflective-Research Project at the University of Costa Rica UCR about her own emergent learning about evaluating emergent learning. The Research project was developed by eleven university students at the School of Education at UCR and twenty five preschool children using digital technologies in their learning process and environment.

  20. Emergency medicine physicians' and pediatricians' use of computed tomography in the evaluation of pediatric patients with abdominal pain without trauma in a community hospital.

    Science.gov (United States)

    Grim, Paul Francis

    2014-05-01

    There is a paucity of data regarding emergency department (ED) provider type and computed tomography (CT) scan use in the evaluation of pediatric patients with abdominal pain without trauma. The purpose of this retrospective single community hospital study was to determine if there was a difference in CT use between emergency medicine physicians (EMPs) and pediatricians (PEDs) in all patients younger than 18 years with abdominal pain without trauma who presented to the ED during the study period. The study included 165 patients. EMPs saw 83 patients and used CT in 31 compared with PEDs who saw 82 patients and used CT in 12 (P = .002). EMPs used CT significantly more frequently than PEDs in the designated sample. Economic pressures may cause changes in ED provider type in community and rural hospitals and this study shows that ED provider type may affect medical decision making, including CT use.

  1. Characterization and Monitoring Data for Evaluating Constructed Emergent Sandbar Habitat in the Missouri River Mainstem 2004-2009

    Energy Technology Data Exchange (ETDEWEB)

    Duberstein, Corey A.

    2011-04-01

    The U.S. Army Corps of Engineers (Corps) provides the primary operational management of the Missouri River Main Stem Reservoir System. Management of the Missouri River has generally reduced peak river flows that form and maintain emergent sandbar habitat. Emergent sandbars provide non-vegetated nesting habitat for the endangered interior least tern (Sternula antillarum athalassos) and the threatened Northern Great Plains piping plover (Charadrius melodus). Since 2000, piping plover nesting habitat within the Gavins Point Reach, Garrison Reach, Lake Oahe, and Lake Sakakawea has fledged the majority of piping plovers produced along the Missouri River system. Habitats within Lewis and Clark Lake have also recently become important plover production areas. Mechanical construction of emergent sandbar habitat (ESH) within some of these reaches within the Missouri River began in 2004. Through 2009, 11 sandbar complexes had been constructed (10 in Gavins Point Reach, 1 in Lewis and Clarke Lake) totaling about 543 ac of piping plover and interior least tern nesting habitat. ESH Construction has resulted in a net gain of tern and plover nesting habitat. Both terns and plovers successfully nest and fledge young on constructed sandbars, and constructed habitats were preferred over natural habitats. Natural processes may limit the viability of constructed sandbars as nesting habitat. Continued research is needed to identify if changes in constructed sandbar engineering and management increase the length of time constructed habitats effectively function as nesting habitat. However, the transfer of information from researchers to planners through technical research reports may not be timely enough to effectively foster the feedback mechanisms of an adaptive management strategy.

  2. An economic evaluation of forest improvement opportunities and impacts from the emergence of a biomass fuel market in southwestern Nova Scotia

    International Nuclear Information System (INIS)

    Manley, A.L.; Savage, G.D.

    1993-01-01

    In 1991, Nova Scotia's public power utility initiated a process to purchase privately produced electrical power. A proposal was received to produce 20--25 megawatts from the burning of 350 to 400,000 tonnes annually of wood residue and forest biomass in a co-generation facility in southwestern Nova Scotia, Canada. This proposal has been proceeding and is nearing the construction phase. As a result of this potential market, there is an opportunity for increasing the scope and extent of forest improvement operations. Options for a closer integration of planning, harvesting, and silviculture activities will emerge. Optimum end use allocation could occur and enhance overall economic efficiency. The objective of this project is to assess the effect that this emerging market for forest biomass could have on forest management in the supply area. This project has two phases. Phase 1, presented here, develops the framework and methodology. Phase 2 will apply a linear programming-based analytical model for evaluation. Phase 1 accumulated the required data and information for both the current management and marketing situation and that including the emerging biomass market. Growth and yield of the natural stand types were calculated for a mixture of conventional roundwood products and chip equivalents. Management regimes, based on current forest type, site class, and appropriate silviculture treatments, were established. Expected multiproduct yields, by regime were estimated. Silviculture and harvest costs along with product revenues were used to calculate standing timber and soil expectation values. In Phase 2, a stand-based optimization model will be developed to explore and evaluate the long term opportunities and differences between the present and emerging management and market situations

  3. An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil.

    Science.gov (United States)

    Tallo, Fernando Sabia; Campos Vieira Abib, Simone de; Baitello, André Luciano; Lopes, Renato Delascio

    2014-09-01

    To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life. Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU. The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills necessary to adequately attend to prehospital

  4. Neurologic emergencies in sports.

    Science.gov (United States)

    Williams, Vernon B

    2014-12-01

    Sports neurology is an emerging area of subspecialty. Neurologists and non-neurologists evaluating and managing individuals participating in sports will encounter emergencies that directly or indirectly involve the nervous system. Since the primary specialty of sports medicine physicians and other practitioners involved in the delivery of medical care to athletes in emergency situations varies significantly, experience in recognition and management of neurologic emergencies in sports will vary as well. This article provides a review of information and elements essential to neurologic emergencies in sports for the practicing neurologist, although content may be of benefit to readers of varying background and expertise. Both common neurologic emergencies and less common but noteworthy neurologic emergencies are reviewed in this article. Issues that are fairly unique to sports participation are highlighted in this review. General concepts and principles related to treatment of neurologic emergencies that are often encountered unrelated to sports (eg, recognition and treatment of status epilepticus, increased intracranial pressure) are discussed but are not the focus of this article. Neurologic emergencies can involve any region of the nervous system (eg, brain, spine/spinal cord, peripheral nerves, muscles). In addition to neurologic emergencies that represent direct sports-related neurologic complications, indirect (systemic and generalized) sports-related emergencies with significant neurologic consequences can occur and are also discussed in this article. Neurologists and others involved in the care of athletes should consider neurologic emergencies in sports when planning and providing medical care.

  5. Seismic simulation and functional performance evaluation of a safety related, seismic category I control room emergency air cleaning system

    International Nuclear Information System (INIS)

    Manley, D.K.; Porco, R.D.; Choi, S.H.

    1985-01-01

    Under a nuclear contract MSA was required to design, manufacture, seismically test and functionally test a complete Safety Related, Seismic Category I, Control Room Emergency Air Cleaning System before shipment to the Yankee Atomic Electric Company, Yankee Nuclear Station in Rowe, Massachusetts. The installation of this system was required to satisfy the NRC requirements of NUREG-0737, Section III, D.3.4, ''Control Room Habitability''. The filter system tested was approximately 3 ft. wide by 8 ft. high by 18 ft. long and weighed an estimated 8300 pounds. It had a design flow rate of 3000 SCFM and contained four stages of filtration - prefilters, upstream and downstream HEPA filters and Type II sideload charcoal adsorber cells. The filter train design followed the guidelines set forth by ANSI/ASME N509-1980. Seismic Category I Qualification Testing consisted of resonance search testing and triaxial random multifrequency testing. In addition to ANSI/ASME N510-1980 testing, triaxial response accelerometers were placed at specific locations on designated prefilters, HEPA filters, charcoal adsorbers and test canisters along with accelerometers at the corresponding filter seal face locations. The purpose of this test was to demonstrate the integrity of the filters, filter seals, and monitor seismic response levels which is directly related to the system's ability to function during a seismic occurrence. The Control Room Emergency Air Cleaning System demonstrated the ability to withstand the maximum postulated earthquake for the plant site by remaining structurally sound and functional

  6. Health literacy and contraception: a readability evaluation of contraceptive instructions for condoms, spermicides and emergency contraception in the USA.

    Science.gov (United States)

    El-Ibiary, Shareen Y; Youmans, Sharon L

    2007-03-01

    To assess readability of over-the-counter (OTC) contraceptive product instructions currently available, compare the results with previous studies from a decade ago, and review the implications for health care providers, in particular pharmacists counseling on OTC contraceptives. A sample of contraceptive instructions was submitted to a readability analysis using four standard readability formulas. Products included condoms, spermicides, and emergency contraception instruction pamphlets. Reading grade levels for condoms ranged from 6th to 12th grade. The average reading levels for the spermicides were 9th-10th grade and for the emergency contraceptives 10th-12th grade. These results were consistent with those of similar studies performed a decade ago. Consumers need to have at least a high school reading level in order to comprehend current product instructions. Very little has changed in the past decade regarding readability of OTC contraceptive patient instructions, despite calls to simplify written instructions. Healthcare providers, in particular pharmacists, must be aware of these disparities to enhance patient education and advocate for simpler reading materials.

  7. Analytical method for the evaluation of the outdoor air contamination by emerging pollutants using tree leaves as bioindicators.

    Science.gov (United States)

    Barroso, Pedro José; Martín, Julia; Santos, Juan Luis; Aparicio, Irene; Alonso, Esteban

    2018-01-01

    In this work, an analytical method, based on sonication-assisted extraction, clean-up by dispersive solid-phase extraction and determination by liquid chromatography-tandem mass spectrometry, has been developed and validated for the simultaneous determination of 15 emerging pollutants in leaves from four ornamental tree species. Target compounds include perfluorinated organic compounds, plasticizers, surfactants, brominated flame retardant, and preservatives. The method was optimized using Box-Behnken statistical experimental design with response surface methodology and validated in terms of recovery, accuracy, precision, and method detection and quantification limits. Quantification of target compounds was carried out using matrix-matched calibration curves. The highest recoveries were achieved for the perfluorinated organic compounds (mean values up to 87%) and preservatives (up to 88%). The lowest recoveries were achieved for plasticizers (51%) and brominated flame retardant (63%). Method detection and quantification limits were in the ranges 0.01-0.09 ng/g dry matter (dm) and 0.02-0.30 ng/g dm, respectively, for most of the target compounds. The method was successfully applied to the determination of the target compounds on leaves from four tree species used as urban ornamental trees (Citrus aurantium, Celtis australis, Platanus hispanica, and Jacaranda mimosifolia). Graphical abstract Analytical method for the biomonitorization of emerging pollutants in outdoor air.

  8. Evaluation and analysis of emergency maintenance due by third party action's, formulation and execution of contingency plans

    Energy Technology Data Exchange (ETDEWEB)

    Torres Vega, Raul; Nunez Ribera, Gary [TRANSIERRA S.A., Santa Cruz (Bolivia)

    2009-07-01

    In September 2008, in the Yacuiba - Rio Grande Gas Pipeline (GASYRG) located in the south of Bolivia, atypical situations took place. Due to the political events and the social mobilizations in which the country was, a series of third party actions developed putting in risk the facilities of the gas pipeline. These actions resulted in the rupture of a 1 inch instrumentation pipe, causing a leak witch some time caught fire and caused an interruption of the transportation service in that section of the pipeline, later on, another action derived in safety valve shut down causing a total pipeline shut down. In addition to these events we experience a fuel shortage, road blocks and a telephone communication system failure. In spite of these obstacles the maintenance activities were realized and emergency repairs put back in operating conditions the gas pipeline, task that was accomplished in a very short time, taking in account the situation. Later analysis, including all the adverse elements of the situation, result in the adoption of a series of measures and plans directed to mitigate the risk associated to this type of events, such as Mutual Aid Plans with fellow companies and institutions, fortification of the patrimonial security, stock material handling for emergency repairs, etc. (author)

  9. Mean platelet volume as a risk stratification tool in the Emergency Department for evaluating patients with ischaemic stroke and TIA

    International Nuclear Information System (INIS)

    Dogan, N.O.; Karakurt, K.

    2013-01-01

    Objective: To investigate the variations of mean platelet volume in patients with ischaemic cerebrovascular complaints, and to find out its diagnostic utility in an acute setting to help risk stratification in patients with ischaemic stroke and transient ischaemic attacks. Methods: The prospective cross-sectional study was conducted at the Gazi University Hospital, Ankara, Turkey, from November 2009 to June 2010. It comprised 143 consecutive patients of acute ischaemic stroke, 39 patients of transient ischaemic attacks and 60 healthy volunteers. SPSS 13 was used for statistical analysis, and so were t-test, one-way analysis of variance test and correlation analysis. Statistical significance was accepted at p <0.05. Results: Mean platelet volume results were significantly higher in patients with cortical infarction and transient ischaemic attack compared to the control group (p <0.001 and p <0.002). A statistically significant increase was also noted in hospitalised patients when compared with discharged patients from the emergency department (p <0.036). A weak positive correlation was identified between the National Institute of Health Stroke Scores and mean platelet volume levels (r=0.207; p <0.001). A significant relationship was identified between mean platelet volume levels and previous stroke (p <0.005). Conclusion: The measurement of mean platelet volume levels may provide useful diagnostic and prognostic information to emergency physicians caring for patients with transient ischaemic attack and ischaemic stroke. In patients with suspected neurological ischaemic symptoms, high levels may be considered as an atherosclerotic risk factor. (author)

  10. The injector linac for the Mainz microtron

    International Nuclear Information System (INIS)

    Euteneuer, H.; Braun, H.; Herminghaus, H.; Scholer, H.; Weis, T.

    1988-01-01

    The design and setup of a 3.5 MeV, 100μA injector for a cascade of race track microtrons is presented. It replaces a 2.1 MeV Van De Graaff for getting higher reliability, improved beam dynamics in the first RTM by increased and more stable input energy, as well as an easier access and a better vacuum to launch a beam of polarized electrons. In this paper, the considerations which led under given boundary conditions to the final design concept are discussed and its realization with PARMELA is described. Details of the linac setup are given. First operation showed a good longitudinal performance (energy stability ≤ ±2 star 10 -4 , spectrum ≤ 1 star 10 -3 FWHM, bunch length ≤ ± 1.5 degrees) and an excellent reproducibility of machine operation

  11. Experimental evaluation of emergency operating procedures on multiple steam generator tube rupture in INER integral system test facility

    International Nuclear Information System (INIS)

    Liu, T.J.; Lin, Y.M.; Lee, C.H.; Chang, C.Y.; Hong, W.T.

    1997-01-01

    The multiple steam generator tube rupture (SGTR) scenario in Westinghouse type pressurized water reactor (PWR) has been investigated at the Institute of Nuclear Energy Research (INER) Integral System Test (IIST) facility. This reduced-height and reduced-pressure test facility was designed to simulate the main features of Maanshan nuclear power plant. The SGTR test scenario assumes the double-ended break of one-, two- and six- tubes without other failures. The major operator actions follow the related symptom-oriented Emergency Operating Procedure (EOP) on the reference plant. This study focuses on the investigation of thermal-hydraulics phenomena and the adequacy of associated EOP to limit primary-to-secondary leakage. Through this study, it is found that the adequacy of current EOP in minimizing the radioactivity release demands early substantial operator involvement, especially in the multi-tubes break events. Also, the detailed mechanism of the main thermal-hydraulic phenomena during the SGTR transient are explored. (author)

  12. Accident at Three Mile Island: the contribution of the social sciences to the evaluation of emergency preparedness and response

    International Nuclear Information System (INIS)

    Dynes, R.R.

    1982-01-01

    At 4:00 A.M. on 28 March 1979, a serious accident occurred in the nuclear-power plant at Three Mile Island near Middletown, Pennsylvania. It was caused by mechanical malfunctions in the plant, and for the next four days the extent and severity of the accident were not clear. Because it raised serious concerns about the safety of nuclear power, on 11 April President Carter established a commission to study and investigate the accident. Several aspects of the formation and evolution of the commission are particularly relevant to the social sciences. One was the way the original problem was defined for the commission by the presidential executive order. A second was the commission's own definition of the problem that evolved as the investigation progressed. As that definition became more inclusive, the body of social science literature relating to emergencies became increasingly relevant

  13. Retained Intra-Abdominal Surgical Clamp Complicating Emergency Laparotomy: Incidental Finding on Hysterosalpingogram for Evaluation of Tubal Infertility

    Directory of Open Access Journals (Sweden)

    Adebiyi Gbadebo Adesiyun

    2014-01-01

    Full Text Available The finding of intraperitoneal foreign body complicating surgical intervention broadly remains as an issue of safety in the operative room, a source of emotive concern for the patient, and an upsetting but equally embarrassing situation to the surgeon and the team. However, in the media world, it is a source of sumptuous and captivating headline on the newspaper and to the legal profession, an attractive case to prosecute. A middle age teacher presented with secondary infertility. She had emergency laparotomy fifteen years ago for ruptured tubal ectopic pregnancy in a private hospital and postoperative period was uneventful. Amongst other investigations to find out the cause of infertility, she had hysterosalpingography and a radio-opaque clamp was visualized on the films. She was counselled and had laparotomy. A pair of surgical Kocher clamps was retrieved buried in the mesentery.

  14. Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics.

    Science.gov (United States)

    Faudeux, Camille; Tran, Antoine; Dupont, Audrey; Desmontils, Jonathan; Montaudié, Isabelle; Bréaud, Jean; Braun, Marc; Fournier, Jean-Paul; Bérard, Etienne; Berlengi, Noémie; Schweitzer, Cyril; Haas, Hervé; Caci, Hervé; Gatin, Amélie; Giovannini-Chami, Lisa

    2017-09-01

    To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program. RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Evaluation of the Recognition of Stroke in the Emergency Room (ROSIER scale in Chinese patients in Hong Kong.

    Directory of Open Access Journals (Sweden)

    Hui-lin Jiang

    Full Text Available BACKGROUND AND PURPOSE: The objective of this study was to determine the performance of the Recognition Of Stroke In the Emergency Room (ROSIER scale in risk-stratifying Chinese patients with suspected stroke in Hong Kong. METHODS: This was a prospective cohort study in an urban academic emergency department (ED over a 7-month period. Patients over 18 years of age with suspected stroke were recruited between June 2011 and December 2011. ROSIER scale assessment was performed in the ED triage area. Logistic regression analysis was used to estimate the impacts of diagnostic variables, including ROSIER scale, past history and ED characteristics. FINDINGS: 715 suspected stroke patients were recruited for assessment, of whom 371 (52% had acute cerebrovascular disease (302 ischaemic strokes, 24 transient ischaemic attacks (TIA, 45 intracerebral haemorrhages, and 344 (48% had other illnesses i.e. stroke mimics. Common stroke mimics were spinal neuropathy, dementia, labyrinthitis and sepsis. The suggested cut-off score of>0 for the ROSIER scale for stroke diagnosis gave a sensitivity of 87% (95%CI 83-90, a specificity of 41% (95%CI 36-47, a positive predictive value of 62% (95%CI 57-66, and a negative predictive value of 75% (95%CI 68-81, and the AUC was 0.723. The overall accuracy at cut off>0 was 65% i.e. (323+141/715. INTERPRETATION: The ROSIER scale was not as effective at differentiating acute stroke from stroke mimics in Chinese patients in Hong Kong as it was in the original studies, primarily due to a much lower specificity. If the ROSIER scale is to be clinically useful in Chinese suspected stroke patients, it requires further refinement.

  16. Higher Education Institutional and Program Evaluations in Taiwan and the Emerging Roles of Higher Education Evaluation and Accreditation Council of Taiwan (HEEACT)

    Science.gov (United States)

    Lee, Lung-Sheng; Wei, Yen-Shun; Wang, Li-Yun

    2013-01-01

    Post-secondary education institutions in Taiwan are divided into two tracks, general higher education (HE) and technological and vocational education (TVE). The evaluation of all universities/colleges is mandated by the University Act. Higher education institutions receive mandated institutional evaluation every six years and program evaluation…

  17. Evaluating Emergency Response Solutions for Sustainable Community Development by Using Fuzzy Multi-Criteria Group Decision Making Approaches: IVDHF-TOPSIS and IVDHF-VIKOR

    Directory of Open Access Journals (Sweden)

    Junling Zhang

    2016-03-01

    Full Text Available Emergency management is vital in implementing sustainable community development, for which community planning must include emergency response solutions to potential natural and manmade hazards. To help maintain such solution repository, we investigate effective fuzzy multi-criteria group decision making (FMCGDM approaches for the complex problems of evaluating alternative emergency response solutions, where weights for decision makers and criteria are unknown due to problem complexity. We employ interval-valued dual hesitant fuzzy (IVDHF set to address decision hesitancy more effectively. Based on IVDHF assessments, we develop a deviation maximizing model to compute criteria weights and another compatibility maximizing model to calculate weights for decision makers. Then, two ideal-solution-based FMCGDM approaches are proposed: (i by introducing a synthesized IVDHF group decision matrix into TOPSIS, we develop an IVDHF-TOPSIS approach for fuzzy group settings; (ii when emphasizing both maximum group utility and minimum individual regret, we extend VIKOR to develop an IVDHF-VIKOR approach, where the derived decision makers’ weights are utilized to obtain group decision matrix and the determined criteria weights are integrated to reflect the relative importance of distances from the compromised ideal solution. Compared with aggregation-operators-based approach, IVDHF-TOPSIS and IVDHF-VIKOR can alleviate information loss and computational complexity. Numerical examples have validated the effectiveness of the proposed approaches.

  18. Radiology in emergency medicine

    International Nuclear Information System (INIS)

    Levy, R.; Barsan, W.G.

    1986-01-01

    This book gives a discussion of radiologic modalities currently being used in emergency situations. Radiographs, echocardiographs, radionuclide scans and CT scans are systematically analyzed and evaluated to provide a step-by-step diagnostic process for emergency physicians to follow when a radiologist is not present

  19. Screening Models for Cardiac Risk Evaluation in Emergency Abdominal Surgery. I. Evaluation of the Intraoperative Period Risk based on Data from the Preoperative Period

    Directory of Open Access Journals (Sweden)

    Mikhail Matveev

    2008-04-01

    Full Text Available A classification of intraoperative cardio-vascular complications (CVC was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA for CVC in noncardiac surgery. There were 370 intraoperative CVC registered, distributed as follows: groups with low risk (148, moderate risk (200, and high risk (22. Patient groups were formed, according to the CVC risk level, during the intraoperative period, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardiovascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. On the basis of these indices, a new distribution of the risk factors was implemented, into groups with different levels of risk of CVC during intraoperative period. This result is a solid argument, substantiating the proposal to introduce these adjustments for determining the severity of CVC in the specific conditions of emergency abdominal surgery.

  20. Emerging Hopes

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    China looks to strategically important emerging industries for innovation-driven economic growthc hina will soon announce a decision to rev up seven strategically impor- tant emerging industries,said the National

  1. Transient evaluation using EMTP at single open phase with the offsite power transformer for the emergency power supply systems of nuclear power plants

    International Nuclear Information System (INIS)

    Shimada, Yoshio

    2017-01-01

    The emergency power supply systems of nuclear power plants, as the objects of this research, are critical in supplying stable electric power to such systems as the emergency core cooling system (ECCS), and in maintaining safety of the nuclear power reactor; this was apparent in the accident at the Fukushima Daiichi Nuclear Power Station. The Nuclear Regulatory Commission (USNRC) issued regulatory documents (BL 2012-011, IN 2012-032), and has commenced evaluations on newly discovered vulnerability in the design of power supply systems which cannot be detected with under-voltage protection relays, with certain kinds of configuration of coils and iron core structures, such as when the offsite power supply side is a Y-connection and the load side is a ⊿-connection etc., when the detection of single open phase fault with the circuit of a transformer which is without a ground fault connected to the offsite power supply system. This report uses simulation by the electro magnetic transients program (EMTP) and clearly describe the response at the time of the power supply single open phase without ground fault for various configuration of coils and various iron core structures of the three-phase transformer, and identify the important issues in the response of emergency power supply systems and the safety related components of representative domestic PWR plants when the single open phase fault occurred without ground fault. This report describes the results of the simulations of operations of the protection relays of the emergency power supply systems and the safety related components of representative a domestic PWR plant with EMTP. This report explains the method to detect open-phase when the transformer is no-load which United States Electric Power Research Institute (EPRI) developed. As the detailed analyses data from EPRI related to the detection method concerned have not been disclosed officially yet, in this paper, the quantitative and detailed verification results

  2. Evaluation of the Association between Air Pollutants and Number of Cases with Severe Acute Respiratory Syndrome Recorded at Emergency Medical Centers in Tehran, Iran in 2013

    Directory of Open Access Journals (Sweden)

    sadegh khazaei

    2016-09-01

    Full Text Available Introduction and purpose: Air pollution is an important risk factor for the environment and public health, associated with increased severity of respiratory diseases. This study aimed to evaluate the association between various air pollutants and number of cases with severe acute respiratory syndrome referred to emergency medical centers in Tehran, Iran in 2013. Methods: In this ecological study, the relationship between air pollution and acute respiratory symptoms in patients referred to the emergency centers of Tehran in 2013 was assessed. In total, 36787 patients with acute respiratory symptoms has been registered in these centers. Data on the number of cases with acute respiratory symptoms and air pollutants of emergency centers and air quality monitoring stations were collected. Moreover, Poisson regression was used to assess the relationship between air pollutant concentrations (PM2.5, SO2, NO2, O3, CO and the number of cases with severe acute respiratory syndrome. Results: The results of the current study demonstrated that CO (weekly average IRR=1.1 and SO2 (three days average IRR=1.03 and weekly average IRR= 1.04 increased the risk of respiratory diseases 10%, 3%, and 4%, respectively. Consequently, longer duration of pollutants would increase the risk of respiratory syndromes. Conclusion: According to the results of this study, increased air pollutant concentrations could be associated with escalated number of patients with acute respiratory symptoms referred to the emergency medical centers in Tehran.

  3. Avaliação de herbicidas de pós-emergência na cultura da batata Evaluation of herbicides on post emergent weed control in potato crops

    Directory of Open Access Journals (Sweden)

    Jeferson Zagonel

    1999-03-01

    Full Text Available O experimento foi instalado na Fazenda Escola da UEPG, Ponta Grossa-PR, em solo Latossolo Vermelho Escuro de textura média argilosa, tendo como objetivo avaliar a eficiência e a seletividade do herbicida propaquizafop no controle pós-emergente de plantas daninhas na cultura da batata. O delineamento experimental foi de blocos ao acaso com seis tratamentos: propaquizafop (100, 125 e 150 g i.a./ha; fluazifop-p-butil (188 g i.a./ha; testemunha capinada e testemunha sem capina, em quatro repetições. O plantio foi realizado em 26 de outubro com a cultivar Elvira, usando-se o espaçamento de 0,70 x 0,35 m. As plantas daninhas presentes foram: Brachiaria plantaginea (capim-papuã, Digitaria horizontalis (capim-milhã e Eleusine indica (capim pé-de-galinha. As avaliações foram efetuadas aos 15, 30 e 45 dias após a aplicação dos tratamento. Observou-se que a aplicação de herbicidas pós-emergentes após a amontoa, permite controle adequado de plantas daninhas desde a emergência até a colheita; o herbicida propaquizafop mostrou-se eficiente no controle sobre capim-papuã e capim pé-de-galinha nas doses de 100, 125 e 150 g i.a./ha e sobre capim-milhã nas doses de 125 e 150 g i.a./ha. As perdas na produção causadas pela competição com plantas daninha foram da ordem de 57,4 %. Não foram observados efeitos fitotóxicos nas plantas de batata que pudessem ser atribuídos aos tratamentos aplicados.The presented field experiment was conducted at the Universidade Estadual de Ponta Grossa, Paraná State, Brazil, on Dark Red Latossoil, to evaluate the efficiency and selectivity of herbicides on post emergence weed control in potato crops. The experiment was laid out in a randomized block design with six treatments and four replications: propaquizafop (100, 125 and 150 g a.i/ha; fluazifop-p-butil (188 g a.i/ha, weed free and weedy. Planting was conducted on October 26, using the cultivar Elvira. Potato plants were spaced 0.70 x 0.35 m. The

  4. Medical Evaluation and Triage of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Medical Evaluation Workgroup

    Directory of Open Access Journals (Sweden)

    Kimberly Nordstrom

    2012-04-01

    Full Text Available Numerous medical and psychiatric conditions can cause agitation, some of these causes are life threatening. It is important to be able to differentiate between medical and non-medical causes of agitation so that patients can receive appropriate and timely treatment. This article aims to educate all clinicians in non-medical settings, such as mental health clinics, and medical settings on the differing levels of severity in agitation, basic triage, use of de-escalation, and factors, symptoms, and signs in determining whether a medical etiology is likely. Lastly, this article focuses on the medical workup of agitation when a medical etiology is suspected or when etiology is unclear. [West J Emerg Med. 2012;13(1:3–10.

  5. Wetland Biomass Production: emergent aquatic management options and evaluations. A final subcontract report. [Includes a bibliography containing 686 references on Typha from biological abstracts

    Energy Technology Data Exchange (ETDEWEB)

    Pratt, D.C.; Dubbe, D.R.; Garver, E.G.; Linton, P.J.

    1984-07-01

    The high yield potential and attractive chemical composition of Typha make it a particularly viable energy crop. The Minnesota research effort has demonstrated that total annual biomass yields equivalent to 30 dry tonnes/ha (13 tons/acre) are possible in planted stands. This compares with yields of total plant material between 9 and 16 dry tonnes/ha (4 to 7 tons/acre) in a typical Minnesota corn field. At least 50% of the Typha plant is comprised of a belowground rhizome system containing 40% starch and sugar. This high level of easily fermentable carbohydrate makes rhizomes an attractive feedstock for alcohol production. The aboveground portion of the plant is largely cellulose, and although it is not easily fermentable, it can be gasified or burned. This report is organized in a manner that focuses on the evaluation of the management options task. Results from stand management research performed at the University of Minnesota during 1982 and 1983 are integrated with findings from an extensive survey of relevant emergent aquatic plant research and utilization. These results and findings are then arranged in sections dealing with key steps and issues that need to be dealt with in the development of a managed emergent aquatic bio-energy system. A brief section evaluating the current status of rhizome harvesting is also included along with an indexed bibliography of the biology, ecology, and utilization of Typha which was completed with support from this SERI subcontract. 686 references, 11 figures, 17 tables.

  6. Evaluation of Coordination of Emergency Response Team through the Social Network Analysis. Case Study: Oil and Gas Refinery.

    Science.gov (United States)

    Mohammadfam, Iraj; Bastani, Susan; Esaghi, Mahbobeh; Golmohamadi, Rostam; Saee, Ali

    2015-03-01

    The purpose of this study was to examine the cohesions status of the coordination within response teams in the emergency response team (ERT) in a refinery. For this study, cohesion indicators of social network analysis (SNA; density, degree centrality, reciprocity, and transitivity) were utilized to examine the coordination of the response teams as a whole network. The ERT of this research, which was a case study, included seven teams consisting of 152 members. The required data were collected through structured interviews and were analyzed using the UCINET 6.0 Social Network Analysis Program. The results reported a relatively low number of triple connections, poor coordination with key members, and a high level of mutual relations in the network with low density, all implying that there were low cohesions of coordination in the ERT. The results showed that SNA provided a quantitative and logical approach for the examination of the coordination status among response teams and it also provided a main opportunity for managers and planners to have a clear understanding of the presented status. The research concluded that fundamental efforts were needed to improve the presented situations.

  7. Valparaiso's 2014 Fire: Evaluation of Environmental and Epidemiological Risk Factors During the Emergency Through a Crowdsourcing Tool.

    Science.gov (United States)

    Espinoza Espinoza, Sebastián Eduardo; Vivaceta De la Fuente, Anibal Enrique; Machuca Contreras, Constanza Andrea

    2017-04-01

    To describe and relate the main environmental risk factors in the emergency process after a large urban fire in Valparaiso, Chile, in April 2014. An observational, cross-sectional descriptive study was performed. All 243 reports from an ad hoc web/mobile website created on the Ushahidi/Crowdmap platform were reviewed. Reports were recorded in a new database with dichotomist variables based on either the presence or absence of the relevant category in each report. Almost one-third of the reports presented data about garbage (30%) and chemical toilets (29%). Reports related to water, infrastructural damage, and garbage had significant associations with 4 categories by chi-square test. In the logistic regression model for chemical toilets, only the variable of water was significant (P value=0.00; model P value: 0.00; R2: 11.7%). The "garbage" category confirmed infrastructural damage (P value: 0.00), water (P value: 0.028), and vectors (P value: 0.00) as predictors (model P value: 0.00; R2: 23.09%). Statistically significant evidence was found for the statistical dependence of 7 out of 10 studied variables. The most frequent environmental risk factors in the reports were garbage, chemical toilets, and donation centers. The highest correlation found was for damaged infrastructure, vectors, and garbage. (Disaster Med Public Health Preparedness. 2017;11:239-243).

  8. EmERGE project: Evaluating mHealth technology in HIV to improve Empowerment and healthcare utilisation

    Energy Technology Data Exchange (ETDEWEB)

    Chausa, P.; Gomez, A.J.; Apers, L.; Henwood, F.; Mandalia, S.; Wallitt, E.; Leon, A.; Begovac, J.; Borges, M.; Brown, A.; Block, K.; Glaysher, B.; Whetham, J.

    2016-07-01

    The EmERGE project (http://www.emergeproject.eu/) will develop a mHealth platform to enable self-management of HIV in patients with stable disease. The platform will build upon and integrate the existing mHealth solutions operated by pioneering healthcare providers in the UK and Spain and apply a rigorous co-design approach to ensure patient and clinician input to the solution. The platform will provide users with web based (clinicians) and mobile device applications (patients) which interface securely with relevant medical data and facilitate remote access to key healthcare providers. EATG, the leading European HIV patient organisation, will provide a direct and deep interaction with representative patients and clinicians from 5 EU countries. The platform and interfaces will be validated in a large study of 3900 patients using a tailored Health Technology Assessment process: the Model for Assessment of Telemedicine applications, specifically developed for the assessment of mHealth solutions including translatability as a key factor. (Author)

  9. Evaluation and Prediction present of radionuclide for surface wipe sample in Emergency Related with Fukushima Nuclear Accident

    International Nuclear Information System (INIS)

    Zalina Laili; Muhamat Omar; Woo, Y.M.

    2011-01-01

    Surface wipe samples of aircraft and container from Japan that were exposed to radioactive dust fallout due to Fukushima nuclear accident has been analysed using gamma spectrometry systems. The samples were analysed to determine their contamination levels. The surface of aircraft and container might be exposed to short and long lived fission and activation products. Thus, good evaluations, as well as a reliable and reasonable judgment were needed in order to determine the presence of fission and activation products. A work procedure has been developed to evaluate and predict the presence of fission and activation products in surface wipe samples. Good references, skilled and experienced level in analysis, a well calibrated and validated detector system were the important factors in determining the presence of fission and activation products in surface wipe samples. (author)

  10. Evaluation and Impact of the 'Advanced Pediatric Life Support' Course in the Care of Pediatric Emergencies in Spain.

    Science.gov (United States)

    Benito, Javier; Luaces-Cubells, Carlos; Mintegi, Santiago; Manrique Martínez, Ignacio; De la Torre Espí, Mercedes; Miguez Navarro, Concepción; Vazquez López, Paula; Campos Calleja, Carmen; Ferres Serrat, Francesc; Alonso Salas, María Teresa; González Del Rey, Javier

    2017-06-12

    The Advanced Pediatric Life Support (APLS) course was introduced in the training of professionals who care for pediatric emergencies in Spain in 2005. To analyze the impact of the APLS course in the current clinical practice in Spanish PEDs. The directors of APLS courses were asked about information regarding the courses given to date, especially on the results of the satisfaction survey completed by students at the end of the course. Furthermore, in December 2014, a survey was conducted through Google Drive, specifically asking APLS students about the usefulness of the APLS course in their current clinical practice. In the last 10 years since the APLS course was introduced in Spain, there have been 40 courses in 6 different venues. They involved a total of 1520 students, of whom 958 (63.0%) felt that the course was very useful for daily clinical practice. The survey was sent to 1,200 students and answered by 402 (33.5%). The respondent group most represented was pediatricians, 223 (55.5%), of whom 61 (27.3%) were pediatric emergency physicians, followed by pediatric residents, 122 (30.3%). One hundred three (25.6%) respondents had more than 10 years of professional practice and 291 (72.4%) had completed the course in the preceding four years. Three hundred forty-one of the respondents (84.9%: 95% confidence interval [CI], 81.9-87.9) said that they always use the pediatric assessment triangle (PAT) and 131 (32.6%: 95% CI, 28-37.1) reported that their organization has introduced this tool into their protocols. Two hundred twenty-three (55.5%: 95% CI, 50.6-60.3) believed that management of critically ill patients has improved, 328 (81.6%: 95% CI, 77.8-85.3) said that the PAT and the systematic approach, ABCDE, help to establish a diagnosis, and 315 (78.4%: 95% CI, 74.3-82.4) reported that the overall number of treatments has increased but that these treatments are beneficial for patients. Hospital professionals (191; 47.5%) include the PAT in their protocols more

  11. Increasing Completion Rate of an M4 Emergency Medicine Student End-of-Shift Evaluation Using a Mobile Electronic Platform and Real-Time Completion

    Directory of Open Access Journals (Sweden)

    Matthew C. Tews

    2016-06-01

    Full Text Available Introduction: Medical students on an emergency medicine rotation are traditionally evaluated at the end of each shift with paper-based forms, and data are often missing due to forms not being turned in or completed. Because students’ grades depend on these evaluations, change was needed to increase form rate of return. We analyzed a new electronic evaluation form and modified completion process to determine if it would increase the completion rate without altering how faculty scored student performance. Methods: During fall 2013, 29 faculty completed paper N=339 evaluations consisting of seven competencies for 33 students. In fall 2014, an electronic evaluation form with the same competencies was designed using an electronic platform and completed N=319 times by 27 faculty using 25 students’ electronic devices. Feedback checkboxes were added to facilitate collection of common comments. Data was analyzed with IBM® SPSS® 21.0 using multi-factor analysis of variance with the students’ global rating (GR as an outcome. Inter-item reliability was determined with Cronbach alpha. Results: There was a significantly higher completion rate (p=0.001 of 98% electronic vs. 69% paper forms, lower (p=0.001 missed GR rate (1% electronic. vs 12% paper, and higher mean scores (p=0.001 for the GR with the electronic (7.0±1.1 vs. paper (6.8±1.2 form. Feedback checkboxes were completed on every form. The inter-item reliability for electronic and paper forms was each alpha=0.95. Conclusion: The use of a new electronic form and modified completion process for evaluating students at the end of shift demonstrated a higher faculty completion rate, a lower missed data rate, a higher global rating and consistent collection of common feedback. The use of the electronic form and the process for obtaining the information made our end-of-shift evaluation process for students more reliable and provided more accurate, up-to-date information for student feedback and when

  12. An evaluation of E. coli in urinary tract infection in emergency department at KAMC in Riyadh, Saudi Arabia: retrospective study.

    Science.gov (United States)

    Alanazi, Menyfah Q; Alqahtani, Fulwah Y; Aleanizy, Fadilah S

    2018-02-09

    Urinary tract infection (UTIS) is a common infectious disease in which level of antimicrobial resistance are alarming worldwide. Therefore, this study aims to describe the prevalence and the resistance pattern of the main bacteria responsible for UTIS Escherichia coli (E. coli). Retrospective chart review for patients admitted to emergency department and diagnosed with UTIS at KAMC, in Riyadh, Saudi Arabia between January to March 2008 was performed. Antimicrobial susceptibility to ampicillin, augmentin (amoxicillin/clavulanate), cefazolin, co-trimoxazole (sulfamethoxazole/trimethoprim), ciprofloxacin, and nitrofurantoin, and cefpodoxime was determined for 101 E. coli urinary isolates. Escherichia coli was the most prevalent pathogen contributing to UTIS representing 93.55, 60.24, and 45.83% of all pathogen isolated from urine culture of pediatric, adult, and elderly, respectively. High rates of resistance to ampicillin (82.76, 58, and 63.64%) and co-trimoxazole (51.72, 42, and 59.09%), among E. coli isolated from pediatric, adult and elderly respectively. Nitrofurantoin was the most active agent, followed by ciprofloxacin, augmentin and cefazolin. 22.77% of E. coli isolates exhibited multiple drug resistance (MDR). Among 66 and 49 isolates resistant to ampicillin and co-trimoxazole, respectively, 34.84 and 42.85% were MDR. In contrast, all isolates resistant to augmentin and nitrofurantoin were MRD, while 72.7 and 82.4% of isolates resistant to ciprofloxacin and cefazolin were MDR. High resistance was observed to ampicillin and co-trimoxazole which commonly used as empirical treatments for UTIS, limiting their clinical use. This necessitates continuous surveillance for resistance pattern of uropathogens against antibiotics.

  13. Using an Emergency Department Syndromic Surveillance System to Evaluate Reporting of Potential Rabies Exposures, Illinois, 2013-2015.

    Science.gov (United States)

    Bemis, Kelley; Frias, Mabel; Patel, Megan Toth; Christiansen, Demian

    Mandatory reporting of potential rabies exposures and initiation of postexposure prophylaxis (PEP) allow local health authorities to monitor PEP administration for errors. Our objectives were to use an emergency department (ED) syndromic surveillance system to (1) estimate reporting compliance for exposure to rabies in suburban Cook County, Illinois, and (2) initiate interventions to improve reporting and reassess compliance. We queried ED records from 45 acute care hospitals in Cook County and surrounding areas from January 1, 2013, through June 30, 2015, for chief complaints or discharge diagnoses pertaining to rabies, PEP, or contact with a wild mammal (eg, bat, raccoon, skunk, fox, or coyote). We matched patients with ≥1 ED visit for potential rabies exposure to people with potential rabies exposure reported to the Cook County Department of Public Health. We considered nonmatches to have unreported exposures. We then initiated active surveillance in July 2015, disseminated education on reporting requirements in August and September 2015, and reassessed reporting completeness from July 2015 through February 2016. Of 248 patients with rabies-related ED visits from January 2013 through June 2015, 63 (25.4%) were reported. After interventions were implemented to increase reporting compliance, 53 of 98 (54.1%) patients with rabies-related ED visits from July 2015 through February 2016 were reported. Patients with ED visits for potential rabies exposure were twice as likely to be reported postintervention than preintervention (risk ratio = 2.1; 95% CI, 1.6-2.8). The volume of potential rabies exposure cases reported to the health department from July 2015 through February 2016 increased by 252% versus the previous year. Potential rabies exposures and PEP initiation are underreported in suburban Cook County. ED syndromic surveillance records can be used to estimate reporting compliance and conduct active surveillance.

  14. A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children's anxiety and pain levels in emergency department.

    Science.gov (United States)

    Felluga, Margherita; Rabach, Ingrid; Minute, Marta; Montico, Marcella; Giorgi, Rita; Lonciari, Isabella; Taddio, Andrea; Barbi, Egidio

    2016-05-01

    The aim of the study is to investigate if the presence of medical clowns during painful procedures in the emergency department (ED) affects children's anxiety and pain. Forty children (4-11 years) admitted to the ED with the need of painful procedures were prospectively enrolled. They were randomly assigned to the clown group, where children interacted with clowns or to the control group in which they were entertained by parents and ED nurses. The children's anxiety was assessed by the Children's Anxiety and Pain Scales; pain was evaluated with the Numerical Rating Scale and Wong-Backer Scale, according to the children's age. Staff and clown's opinions were evaluated by means of dedicated questionnaires. Children's anxiety levels in the clown group were significantly lower than those compared with the control group, while children's pain levels did not change between the two groups. The presence of clowns in the ED before and during painful procedures was effective in reducing children's anxiety. • Anxiety and fear caused by medical procedures exacerbate children's pain and may interfere with the procedure. • To reduce anxiety, fear, and pain and to facilitate patient's evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: • The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children's anxiety.

  15. A study on the evaluation of pneumothorax by imaging methods in patients presenting to the emergency department for blunt thoracic trauma.

    Science.gov (United States)

    Kaya, Şeyhmus; Çevik, Arif Alper; Acar, Nurdan; Döner, Egemen; Sivrikoz, Cumhur; Özkan, Ragıp

    2015-09-01

    Pneumothorax (PNX) is the collection of air between parietal and visceral pleura, and collapsed lung develops as a complication of the trapped air. PNX is likely to develop spontaneously in people with risk factors. However, it is mostly seen with blunt or penetrating trauma. Diagnosis is generally confirmed by chest radiography [posteroanterior chest radiography (PACR)]. Chest ultrasound (US) is also a promising technique for the detection of PNX in trauma patients. There is not much literature on the evaluation of blunt thoracic trauma (BTT) and pneumothorax (PNX) in the emergency department (ED). The aim of this study was to investigate the effectiveness of chest US for the diagnosis of PNX in patients presenting to ED with BTT. This study was carried out for a period of nine months in the ED of a university hospital. The chest US of patients was performed by emergency physicians trained in the field. The results were compared with anteroposterior chest radiography and/or CT scan of the chest. The APCR and chest CT results were evaluated by a radiology specialist blind to US findings. The evaluation of the radiology specialist was taken as the gold standard for diagnosis by imaging methods. Clinical follow-up was taken into consideration for the diagnosis of PNX in patients on whom CT scan was not performed. Chest US was performed on all two hundred and twelve patients (144 female and 68 male patients; mean age 45.8) who participated in this study. The supine APCR was performed on two hundred and ten (99%) patients and chest CT was performed on one hundred and twenty (56.6%). Out of the twenty-five (11.8%) diagnosed cases of PNX, 22 (88%) were diagnosed by chest US and 8 were diagnosed by APCR. For the detection of PNX, compared to clinical follow-up and chest CT, the sensitivity of chest US was 88%, specificity 99.5%, positive predictive value 95.7% and negative predictive value 98.4%. Chest US has not superseded supine and standing chest radiography for PNX

  16. The Scottish Emergency Care Summary – an evaluation of a national shared record system aiming to improve patient care: technology report

    Directory of Open Access Journals (Sweden)

    Libby MM Morris

    2013-12-01

    Full Text Available Background In Scotland, out-of-hours calls are all triaged by the National Health Service emergency service (NHS24 but the clinicians receiving calls have no direct access to patient records.Objective To improve the safety of patient care in unscheduled consultations when the usual primary care record is not available.Technology The Emergency Care Summary (ECS is a record system offering controlled access to medication and adverse reactions details for nearly every person registered with a general practice in Scotland. It holds a secure central copy of these parts of the GP practice record and is updated automatically twice daily. It is accessible under specified unplanned clinical circumstances by clinicians working in out-of-hours organisations, NHS24 and accident and emergency departments if they have consent from the patient and a current legitimate relationship for that patient’s care.Application We describe the design of the security model, management of data quality, deployment, costs and clinical benefits of the ECS over four years nationwide in Scotland, to inform the debate on the safe and effective sharing of health data in other nations.Evaluation Forms were emailed to 300 NHS24 clinicians and 81% of the 113 respondents said that the ECS was helpful or very helpful and felt that it changed their clinical management in 20% of cases.Conclusion The ECS is acceptable to patients and helpful for clinicians and is used routinely for unscheduled care when normal medical records are unavailable. Benefits include more efficient assessment and reduced drug interaction, adverse reaction and duplicate prescribing.

  17. Role of ultrasonography in the evaluation of children with acute abdomen in the emergency set-up

    Directory of Open Access Journals (Sweden)

    Aviral

    2005-01-01

    Full Text Available Background: Acute abdomen in children has been aptly described as Pandora′s box. Unlike computerized tomography (CT scan, ultrasonography (USG has no radiation hazard and the present study analyses the diagnostic yield of the USG in acute abdomen in children. Materials and Methods: Between September 2001 to October 2003, 75 patients with acute abdomen underwent clinical examination, routine biochemical tests, erect X-ray abdomen, USG and CT scan. Laparotomy and histological examination established final diagnosis. Results: The accuracy of correct diagnosis was 60%, 66.6%, 64%, 98.7% with clinical examination alone, USG alone, clinical examination combined with conventional radiography, and clinical evaluation combined with conventional radiography and USG respectively. USG helped to prevent unnecessary laparotomy in 16.3% of patients. Conclusions: USG is good investigative modality in the management of acute abdomen in children.

  18. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  19. 2013 Survey of Iowa groundwater and evaluation of public well vulnerability classifications for contaminants of emerging concern

    Science.gov (United States)

    Hruby, Claire E.; Libra, Robert D.; Fields, Chad L.; Kolpin, Dana W.; Hubbard, Laura E.; Borchardt, Mark R.; Spencer, Susan K.; Wichman, Michael D.; Hall, Nancy; Schueller, Michael D.; Furlong, Edward T.; Weyer, Peter J.

    2015-01-01

    Studies in Iowa have long documented the vulnerability of wells with less than 50 feet (15 meters) of confining materials above the source aquifer to contamination from nitrate and various pesticides. Recent studies in Wisconsin have documented the occurrence of viruses in untreated groundwater, even in wells considered to have little vulnerability to contamination from near-surface activities. In addition, sensitive methods have become available for analyses of pharmaceuticals and pesticides. This study represents the first comprehensive examination of contaminants of emerging concern in Iowa’s groundwater conducted to date, and one of the first conducted in the United States. Raw groundwater samples were collected from 66 public supply wells during the spring of 2013, when the state was recovering from drought conditions. Samples were analyzed for 206 chemical and biological parameters; including 20 general water-quality parameters and major ions, 19 metals, 5 nutrients, 10 virus groups, 3 species of pathogenic bacteria, 5 microbial indicators, 108 pharmaceuticals, 35 pesticides and pesticide degradates, and tritium. The wells chosen for this study represent a diverse range of ages, depths, confining material thicknesses, pumping rates, and land use settings. The most commonly detected contaminant group was pesticide compounds, which were present in 41% of the samples. As many as 6 pesticide compounds were found together in a sample, most of which were chloroacetanilide degradates. While none of the measured concentrations of pesticide compounds exceeded current benchmark levels, several of these compounds are listed on the U.S. Environmental Protection Agency’s Contaminant Candidate List and could be subject to drinking water standards in the future. Despite heavy use in the past decade, glyphosate was not detected, and its metabolite, aminomethylphosphonic acid, was only detected in two of 60 wells tested (3%) at the detection limit of 0.02

  20. Assessing sensitivity and specificity of the Manchester Triage System in the evaluation of acute coronary syndrome in adult patients in emergency care: a systematic review protocol.

    Science.gov (United States)

    Nishi, Fernanda Ayache; de Motta Maia, Flávia Oliveira; de Lopes Monteiro da Cruz, Dina Almeida

    2015-11-01

    The objective of this review is to assess the sensitivity and specificity of the Manchester Triage System in the evaluation of adult patients with acute coronary syndrome in emergency departments. Acute coronary syndrome (ACS) is a group of clinical conditions that include myocardial infarction with or without elevation of the ST segment and unstable angina. The term acute myocardial infarction (AMI) can be applied when there is evidence of myocardium necrosis with a clinical sign compatible with myocardial ischaemia. Acute myocardial infarction can be identified using clinical methods including electrocardiography (ECG), elevation in myocardium necrosis biomarkers, and imaging. Acute myocardial infarction is one of the leading causes of death and disability worldwide, and may be the first manifestation of coronary artery disease.Estimating the prevalence of coronary diseases in the general population is quite a complex task. In 2010, the prevalence of coronary diseases was reported as 6.4% among the general population in the United States.One of the main manifestations of ACS is chest pain. However, even in the presence of this typical symptom, early diagnosis of ACS is a challenge for health care professionals who initially attend to these patients. Several authors have indicated the importance and difficulty of recognizing chest pain of cardiac origin, where immediate medical attention is required.Triage, or risk classification, is a clinical management tool used in emergency services to guide patient flow when the need for medical attention exceeds that available. The Manchester Triage Group was developed in 1994 in the United Kingdom. The aim was to establish a consensus among physicians and nurses in the emergency room by creating a triage pattern focused on the development of the following:Thus, the Manchester Triage System (MTS) was created. The MTS simplifies the clinical management of each patient, and consequently, the whole service, by utilizing a

  1. Inspection of Emergency Arrangements

    International Nuclear Information System (INIS)

    2013-01-01

    The Working Group on Inspection Practices (WGIP) was tasked by the NEA CNRA to examine and evaluate the extent to which emergency arrangements are inspected and to identify areas of importance for the development of good inspection practices. WGIP members shared their approaches to the inspection of emergency arrangements by the use of questionnaires, which were developed from the requirements set out in IAEA Safety Standards. Detailed responses to the questionnaires from WGIP member countries have been compiled and are presented in the appendix to this report. The following commendable practices have been drawn from the completed questionnaires and views provided by WGIP members: - RBs and their Inspectors have sufficient knowledge and information regarding operator's arrangements for the preparedness and response to nuclear emergencies, to enable authoritative advice to be given to the national coordinating authority, where necessary. - Inspectors check that the operator's response to a nuclear emergency is adequately integrated with relevant response organisations. - Inspectors pay attention to consider the integration of the operator's response to safety and security threats. - The efficiency of international relations is checked in depth during some exercises (e.g. early warning, assistance and technical information), especially for near-border facilities that could lead to an emergency response abroad. - RB inspection programmes consider the adequacy of arrangements for emergency preparedness and response to multi-unit accidents. - RBs assess the adequacy of arrangements to respond to accidents in other countries. - The RB's role is adequately documented and communicated to all agencies taking part in the response to a nuclear or radiological emergency. - Inspectors check that threat assessments for NPPs have been undertaken in accordance with national requirements and that up-to-date assessments have been used as the basis for developing emergency plans for

  2. Evaluation of the smoking ban application at the emergency service of the Fundación Alcorcón Hospital

    Directory of Open Access Journals (Sweden)

    Sonia Navarro Ortega

    2007-07-01

    Full Text Available The law for the prevention of tobacco dependence came into effect on the first of January of 2006. With the application of this law, smoking is not allowed neither in public nor in private work centers. From May 2005, the Real Decreto 192/1998, that forbids smoking in medical centers, has been applied at the emergency service of the Fundación Alcorcon Hospital.Objectives: Describe and analyze the consequences of the application of the rule on smoking and non-smoking nursing personnel at the emergency service, as well as changes in smoking habits, knowledge of tobacco smoke pollution’s (TSP effect on health, tobacco effects and arguments between smokers and non-smokers.Material and methods: Cross descriptive study by means of a questionnaire directed to smoker and non-smoker personnel, with different sections for each of these groups. This questionnaire will be previously validated by a group of experts and a pilot exercise at the Fuenfría Hospital. Statistical analysis of the data will be carried out by SPSS software, establishing the frequency of the answers and comparing the obtained results.The results of this study will be usefully applied to evaluate the way of implementing smoking ban at work, detect and correct weak points in order to achieve the best compliance with the rule, and know its influence in the decrease in tobacco consumption and smoking cessation.

  3. Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients' temperatures in prehospital emergency care - an intervention study.

    Science.gov (United States)

    Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

    2015-01-01

    Background The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care. Methods A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Results Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, pthermal comfort and may prevent the negative consequences of cold stress.

  4. Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients' temperatures in prehospital emergency care--an intervention study.

    Science.gov (United States)

    Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

    2015-01-01

    The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care. A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, pthermal comfort and may prevent the negative consequences of cold stress.

  5. Evaluation of nuclear reaction cross sections for optimization of production of the emerging diagnostic radionuclide "5"5Co

    International Nuclear Information System (INIS)

    Amjed, N.; Hussain, M.; Aslam, M.N.; Tárkányi, F.; Qaim, S.M.

    2016-01-01

    The excitation functions of the "5"4Fe(d,n)"5"5Co, "5"6Fe(p,2n)"5"5Co and "5"8Ni(p,α)"5"5Co reactions were analyzed with relevance to the production of the β"+-emitter "5"5Co (T_½=17.53 h), a promising cobalt radionuclide for PET imaging. The nuclear model codes ALICE-IPPE, EMPIRE and TALYS were used to check the consistency of the experimental data. The statistically fitted excitation function was employed to calculate the integral yield of the product. The amounts of the radioactive impurities "5"6Co and "5"7Co were assessed. A comparison of the three investigated production routes is given. - Highlights: • Evaluation of "5"4Fe(d,n)"5"5Co, "5"6Fe(p,2n)"5"5Co and "5"8Ni(p,α)"5"5Co reactions. • Detailed nuclear model calculations (TALYS and EMPIRE) and statistical fitting of the selected data. • Estimation of integral yield and impurity level in the production of "5"5Co. • Comparison of major production routes of "5"5Co.

  6. Investigations of the Anopheline (Diptera: Culicidae fauna from three areas belonging to the Danube Delta Biosphere Reserve in order to evaluate the risk of malaria re-emergence

    Directory of Open Access Journals (Sweden)

    FALCUTA Elena

    2008-10-01

    Full Text Available The survey focused on the comparative analyses of the anopheline fauna belonging to the maculipennis group between three areas of the Danube Delta Biosphere Reserve, two of them situated near theRazim-Sinoe lagoonal complex and one belonging to the fluvial delta. The study that was carried out during 2006 and 2007 intended to establish the composition of the anopheline fauna as well as the longevity of the various species in order to evaluate the risk of malaria re-emergence. A number of 2437 mosquitoes, belonging to Anopheles maculipennis group were collected. The presence of the former vector species was pointed up: Anopheles atroparvus, Anophelesmesseae and Anopheles maculipennis sensu stricto. The investigations of the number of egg batches laid by a female have shown the physiological age of the respective female and namely if the female could infect or not the humans.

  7. Evaluation of load case ''switch-off of the high pressure pump of the emergency core cooling system'', measures of verification and in situ-test

    International Nuclear Information System (INIS)

    Trobitz, M.; Mattheis, A.; Kerkhof, K.; Hippelein, K.; Hofstoetter, P.

    1998-01-01

    Within the framework of periodic safety inspection of the Gundremmingen power station (RWE-Bayernwerk - KRB II), the load collectives used for the design of safety-relevant systems and components were checked for their consistency with latest updates of the design basis. It was found that there was no analytical information or study available describing a particular process and its effects, namely switch-off of the high-pressure feedwater pump of the emergency core cooling system. The paper reports the work performed for closing the gap, including preparatory analyses, accompanying measures such as vibration measurements during plant shut-down, as well as the preparation and performance of the in-situ test. The experimental results and the comparative evaluation of calculated and experimental data are presented. (orig./CB) [de

  8. Health-related quality of life for pediatric emergency department febrile illnesses: an Evaluation of the Pediatric Quality of Life Inventory™ 4.0 generic core scales

    Directory of Open Access Journals (Sweden)

    Stevens Molly W

    2009-01-01

    Full Text Available Abstract Objective We sought to assess the validity and short-term responsiveness of the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales (PedsQL™ for febrile illnesses evaluated in the pediatric emergency department (ED. Design Prospective cohort study of children 2–18 years discharged after ED evaluation for fever (≥ 38°C. Self-administered, parent-report of health-related quality of life (HRQOL was assessed using the PedsQL™ Acute Version, a validated HRQOL instrument. HRQOL was measured on ED presentation and at 7–10 day follow-up. At follow-up, duration of fever, child functional impairment, missed daycare/school, and disrupted family unit functioning, were assessed. Results Of 160 subjects enrolled, 97 (61% completed the study; mean follow-up was 8.7 days. Mean total HRQOL score on ED presentation was 76.4; mean follow-up score was 86.3. Compared to subjects that returned to baseline, statistically significant differences in HRQOL were noted for those with prolonged fever, child functional impairment, and relapse. Significant correlation was observed between HRQOL at follow-up and days of daycare/school missed (r = -0.35, p = .003 and days of family disruption (r = -0.43, p Conclusion The PedsQL™ appears to be a valid and responsive indicator of HRQOL for short-term febrile illnesses evaluated in the ED.

  9. Management of unscheduled tetanus prophylaxis in Emergency Departments: Point-of-Care implementation as a rapid tool for the evaluation of anti-tetanus antibodies

    Directory of Open Access Journals (Sweden)

    Andrea Rocchetti

    2016-03-01

    Full Text Available Background and aim: Each analytical activity, including those carried out in Point of Care (POCT must be, at law, under the control of Laboratory Medicine. Before the implementation of the rapid tetanus quick stick (TQS test for the evaluation of the specific tetanus immunisation, a multi-disciplinary and multi-professional group was created. The aim of this study was to evaluate the ability of Emergency Department (ED staff to manage and correctly understand the result of TQS test in POCT. Materials and Methods: This analysis took into consideration 152 patients admitted to ED with traumatic wounds; information on the state of tetanus immunisation at their arrival wasn’t recorded. Blood sample analysis was performed twice. The Laboratory confirmed a 100% concordance between their results and ELISA test (standard criterion. Study design consisted of 2 phases: the first one (50 test to preliminarily evaluate if any corrective action or improvement of procedures is required, and the second one (102 tests to confirm the quality of corrective actions. Results: The concordance of results between TQS test in Laboratory and POCT test in ED was 80% in the first phase and 95% in the second one.Conclusions: The use of the rapid TQS test is a valuable tool; however, to avoid serious mistakes of interpretation, periodic checks on the quality of the results must be arranged.

  10. Predictors of aggression in 3.322 patients with affective disorders and schizophrenia spectrum disorders evaluated in an emergency department setting.

    Science.gov (United States)

    Blanco, Emily A; Duque, Laura M; Rachamallu, Vivekananda; Yuen, Eunice; Kane, John M; Gallego, Juan A

    2018-05-01

    The aim of this study is to determine odds of aggression and associated factors in patients with schizophrenia-spectrum disorders (SSD) and affective disorders who were evaluated in an emergency department setting. A retrospective study was conducted using de-identified data from electronic medical records from 3.322 patients who were evaluated at emergency psychiatric settings. Data extracted included demographic information, variables related to aggression towards people or property in the past 6months, and other factors that could potentially impact the risk of aggression, such as comorbid diagnoses, physical abuse and sexual abuse. Bivariate analyses and multivariate regression analyses were conducted to determine the variables significantly associated with aggression. An initial multivariate regression analysis showed that SSD had 3.1 times the odds of aggression, while bipolar disorder had 2.2 times the odds of aggression compared to unipolar depression. A second regression analysis including bipolar subtypes showed, using unipolar depression as the reference group, that bipolar disorder with a recent mixed episode had an odds ratio (OR) of 4.3, schizophrenia had an OR of 2.6 and bipolar disorder with a recent manic episode had an OR of 2.2. Generalized anxiety disorder was associated with lower odds in both regression analyses. As a whole, the SSD group had higher odds of aggression than the bipolar disorder group. However, after subdividing the groups, schizophrenia had higher odds of aggression than bipolar disorder with a recent manic episode and lower odds of aggression than bipolar disorder with a recent mixed episode. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Evaluation of the Diagnostic Role of Bedside Lung Ultrasonography in Patients with Suspected Pulmonary Embolism in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Hüseyin Acar

    2017-08-01

    Full Text Available Background: Despite the existence of detailed consensus guidelines, challenges remain regarding efficient, appropriate, and safe imaging methods for the diagnosis of suspected pulmonary embolism. Aims: To investigate the role of the wedge sign, B-lines, and pleural effusion seen on bedside lung ultrasound in the diagnosis of pulmonary embolism. Study Design: Diagnostic accuracy study. Methods: During the first evaluation of patients with suspected pulmonary embolism, bedside lung ultrasound was performed, and the B-lines, wedge sign, and pleural effusion were investigated. Computed tomography angiography was used as a confirmatory test and was compared with the lung ultrasound findings. Results: Pulmonary embolism was detected in 38 (38% patients. In the comparison of bedside lung ultrasound results, statistically significant differences were found between the groups in terms of the B-lines and wedge sign (p=0.005 and p<0.001, respectively. There were no significant differences in terms of effusion (p=0.234. Comparison of these findings with computed tomography angiography of the chest showed weak negative correlations between the groups in terms of B-lines (r=-0297 and a moderately positive correlation in terms of the wedge sign (r=0.523. The sensitivity, specificity, and positive and negative predictive values of lung ultrasound findings alone were low. In the logistic regression analysis, the wedge sign (p<0.01, OR=69.45, 95% CI=6.94-695.17 and B-line (p=0.033, OR=1.96, 95% CI=0.41-8.40 were found to be effective in the diagnosis of pulmonary embolism. Conclusion: Although the role of lung ultrasound has been increasing in the management of critically ill patients, its value is limited and cannot replace the gold standard tests in the diagnosis of pulmonary embolism

  12. Educational program emergency planning.

    Science.gov (United States)

    Curtis, Tammy

    2009-01-01

    Tragic university shootings have prompted administrators of higher education institutions to re-evaluate their emergency preparedness plans and take appropriate measures for preventing and responding to emergencies. To review the literature and identify key components needed to prevent shootings at higher education institutions in the United States, and in particular, institutions housing radiologic science programs. Twenty-eight emergency preparedness plans were retrieved electronically and reviewed from a convenience sample of accredited radiologic science programs provided by the Joint Review Committee on Education in Radiologic Technology Web site. The review of the 28 emergency preparedness plans confirmed that most colleges are prepared for basic emergencies, but lack the key components needed to successfully address mass-casualty events. Only 5 (18%) of the 28 institutions addressed policies concerning school shootings.

  13. A comparative evaluation of emerging methods for errors of commission based on applications to the Davis-Besse (1985) event

    Energy Technology Data Exchange (ETDEWEB)

    Reer, B.; Dang, V.N.; Hirschbe