WorldWideScience

Sample records for reported higher incidence

  1. Hazmat Yearly Incident Summary Reports

    Data.gov (United States)

    Department of Transportation — Series of Incident data and summary statistics reports produced which provide statistical information on incidents by type, year, geographical location, and others....

  2. Medication incidents reported to an online incident reporting system.

    LENUS (Irish Health Repository)

    Alrwisan, Adel

    2011-01-15

    AIMS: Approximately 20% of deaths from adverse events are related to medication incidents, costing the NHS an additional £500 million annually. Less than 5% of adverse events are reported. This study aims to assess the reporting rate of medication incidents in NHS facilities in the north east of Scotland, and to describe the types and outcomes of reported incidents among different services. Furthermore, we wished to quantify the proportion of reported incidents according to the reporters\\' profession. METHODS: A retrospective description was made of medication incidents reported to an online reporting system (DATIX) over a 46-month-period (July 2005 to April 2009). Reports originated from acute and community hospitals, mental health, and primary care facilities. RESULTS: Over the study period there were 2,666 incidents reported with a mean monthly reporting rate of 78.2\\/month (SD±16.9). 6.1% of all incidents resulted in harm, with insulin being the most commonly implicated medication. Nearly three-quarters (74.2%, n=1,978) of total incidents originated from acute hospitals. Administration incidents were implicated in the majority of the reported medication incidents (59%), followed by prescribing (10.8%) and dispensing (9.9%), while the nondescript "other medication incidents" accounted for 20.3% of total incidents. The majority of reports were made by nursing and midwifery staff (80%), with medical and dental professionals reporting the lowest number of incidents (n=56, 2%). CONCLUSIONS: The majority of medication incidents in this study were reported by nursing and midwifery staff, and were due to administration incidents. There is a clear need to elucidate the reasons for the limited contribution of the medical and dental professionals to reporting medication incidents.

  3. Higher incidence of hip fracture in newly diagnosed schizophrenic ...

    African Journals Online (AJOL)

    Higher incidence of hip fracture in newly diagnosed schizophrenic patients in Taiwan. Hip fracture is a major public health concern due to its poor outcome and serious socioeconomic burden in older people (1). Evidence has shown that many factors are related to increased risk of hip fracture, but psychiatric diseases are ...

  4. Incident Reporting in Mashhad Hospitals

    Directory of Open Access Journals (Sweden)

    Davoodi R

    2013-10-01

    Full Text Available Objectives: In this study, our aim was to evaluate and classify the voluntary error reports in the hospitals of Mashhad University of Medical Sciences. Patients have the right to receive health care in accordance to the best standards. Health care carries a risk of harm for patient safety, and with respect to today’s stressful systems with a large number of patients, it would be inevitable. The meaning of risk management is to predict adverse events and reduce their occurrence.Materials and Methods: A voluntary medical error reporting form was designed and approved by the clinical governance team of Mashhad Medical University. They were then distributed inside hospitals in the way in which everyone (health providers and patients could access them easily. The forms were collected and classified monthly in all wards. Classification was performed on the base of type, outcome and reporter. Data gathering took place from spring to autumn 2012. The data was analyzed by the SPSS software. Results: 2500 errors were extracted from 1000 voluntary error reporting forms of the 12 hospitals of Mashhad Medical University. The most frequent error type was treatment errors (36% related to drug administration, standard procedures and surgical events. Conclusions: Error reporting as a basic activity has an important role in discovering pitfalls of the health care system. To promote the reporting culture, its non punitive base must become clear for all professors and staff members, because this kind of reporting could lead to fewer medical errors and higher staff awareness about probable errors.

  5. Reactor incident status 1981 annual report

    International Nuclear Information System (INIS)

    Kiser, S.H.

    1982-01-01

    Reactor Incident followup action is summarized through periodic status reports. This annual report summarizes action taken or anticipated for Reactor Incidents through December 1981. Incidents for which action has been completed, have been deleted from the report. Quarterly addende will update the report by tabulating incidents for each three month period through the coming year. The report consists of a part for the P, K, and C Reactors. Each reactor part is divided into three sections: Further Technical Analysis or Followup Needed; Funding and/or Implementation Needed; and No Further Technical Analysis Anticipated

  6. National Fire Incident Reporting System (NFIRS)

    Data.gov (United States)

    Department of Homeland Security — The National Fire Incident Reporting System (NFIRS) is a reporting standard that fire departments use to uniformly report on the full range of their activities, from...

  7. Pregnancy predispose to higher incidence of venous thromboembolism

    DEFF Research Database (Denmark)

    Andersen, Anita Sylvest; Bergholt, Thomas; Salvig, Jannie Dalby

    2015-01-01

    Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality despite the possibility to prevent and treat the disorder. The hypercoagulability of normal pregnancy predispose to an approximately six-fold higher incidence of VTE in pregnancy. Identification of risk pregnancies...... and start of prophylaxis is essential, as is early diagnosis of VTE to prevent progression and pulmonary embolism. For anticoagulant treatment and prophylaxis in pregnancy, low molecular weight heparin is the drug of choice and prophylaxis, if indicated, should initiate as soon as pregnancy is confirmed....

  8. NEA incident reporting system: Three years' experience

    International Nuclear Information System (INIS)

    Otsuka, Y.; Haeussermann, W.

    1984-01-01

    The paper presents an overview of the NEA Incident Reporting System (IRS) which was set up to collect, assess and disseminate on safety-related incidents in nuclear power plants. The IRS information exchange is significant in two senses. First, it enables regulatory authorities and utilities in participating countries to take appropriate action to prevent the reported mishaps occurring again elsewhere. Secondly, the continuous collection and systematic analysis of such information allows identification of areas of concern where safety research should be strengthened. There are two stages in the IRS information exchange. First, the national IRS Co-ordinator selects information on significant incidents, in accordance with a common reporting threshold, from the abnormal occurrences reported to the regulatory body, to be distributed through the NEA Secretariat. This screening is intended to exclude minor events, so that only significant information is sent to participating countries. Secondly, a group of experts periodically reviews the incidents reported during the preceding twelve months to identify major areas of concern. To assist this process, a computer-based data retrieval system is being developed for IRS incident reports. The paper gives some details of the IRS mechanism and discusses reporting criteria and the information included in a report. Areas of concern derived from reported incidents, an outline of the data retrieval system, and examples of feedback of lessons learned and possibilities for international co-operation are also discussed. (author)

  9. A critical incident reporting system in anaesthesia.

    Science.gov (United States)

    Madzimbamuto, F D; Chiware, R

    2001-01-01

    To audit the recently established Critical Incident Reporting System in the Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe Medical School. The system was set up with the purpose of improving the quality of care delivered by the department. Cross sectional study. A critical incident was defined as 'any adverse and reversible event in theatre, during or immediately after surgery that if it persisted without correction would cause harm to the patient'. The anaesthetic or recovery room staff filled a critical incident form anonymously. Data was collected from critical incident reporting forms for analysis. The anaesthetic service in the two teaching hospitals of Harare Central and Parirenyatwa General Hospitals. Between May and October 2000, 62 completed critical incident forms were collected. The nature of the incident and the monitoring used were recorded, the cause was classified as human, equipment or monitoring failure and the outcome for each patient reported. There was no formal system for reminding staff to fill in their critical incident forms. A total of 14,165 operations were performed over the reporting period: 62 critical incident forms were collected, reporting 130 incidents, giving a rate of 0.92% (130/14,165). Of these, 42 patients were emergencies and 20 elective. The incidents were hypotension, hypoxia, bradycardia, ECG changes, aspiration, laryngospasm, high spinal, and cardiac arrest. Monitoring present on patients who had critical incidents was: capnography 57%, oxymetry 90% and ECG 100%. Other monitors are not reported. Human error contributed in 32/62 of patients and equipment failure in 31/62 of patients. Patient outcome showed 15% died, 23% were unplanned admissions to HDU while 62% were discharged to the ward with little or no adverse outcome. Despite some under reporting, the critical incident rate was within the range reported in the literature. Supervision of juniors is not adequate, especially on call. The

  10. Factors influencing incident reporting in surgical care.

    Science.gov (United States)

    Kreckler, S; Catchpole, K; McCulloch, P; Handa, A

    2009-04-01

    To evaluate the process of incident reporting in a surgical setting. In particular: the influence of event outcome on reporting behaviour; staff perception of surgical complications as reportable events. Anonymous web-based questionnaire survey. General Surgical Department in a UK teaching hospital. Of 203 eligible staff, 55 (76.4%) doctors and 82 (62.6%) nurses participated. Knowledge and use of local reporting system; propensity to report incidents which vary by outcome (harm, no harm, harm prevented); propensity to report surgical complications; practical and psychological barriers to reporting. Nurses were significantly more likely to know of the local reporting system and to have recently completed a report than doctors. The level of harm (F(1.8,246) = 254.2, pvs 53%, z = 4.633, psystems.

  11. Higher incidence of mild cognitive impairment in familial hypercholesterolemia

    Science.gov (United States)

    Zambón, D.; Quintana, M.; Mata, P.; Alonso, R.; Benavent, J.; Cruz-Sánchez, F.; Gich, J.; Pocoví, M.; Civeira, F.; Capurro, S.; Bachman, D.; Sambamurti, K.; Nicholas, J.; Pappolla, M. A.

    2010-01-01

    Objective Hypercholesterolemia is an early risk factor for Alzheimer’s disease. Low density lipoprotein (LDL) receptors may be involved in this disorder. Our objective was to determine the risk of mild cognitive impairment in a population of patients with heterozygous familial hypercholesterolemia, a condition involving LDL receptors dysfunction and life long hypercholesterolemia. Methods Using a cohort study design, patients with (N=47) meeting inclusion criteria and comparison patients without familial hypercholesterolemia (N=70) were consecutively selected from academic specialty and primary care clinics respectively. All patients were older than 50 years. Those with disorders which could impact cognition, including history of stroke or transient ischemic attacks, were excluded from both groups. Thirteen standardized neuropsychological tests were performed in all subjects. Mutational analysis was performed in patients with familial hypercholesterolemia and brain imaging was obtained in those with familial hypercholesterolemia and mild cognitive impairment. Results Patients with familial hypercholesterolemia showed a very high incidence of mild cognitive impairment compared to those without familial hypercholesterolemia (21.3% vs. 2.9%; p = 0.00). This diagnosis was unrelated to structural pathology or white matter disease. There were significant differences between the familial hypercholesterolemia and the no-familial hypercholesterolemia groups in several cognitive measures, all in the direction of worse performance for familial hypercholesterolemia patients, independent of apoE4 or apoE2 status. Conclusions Because prior studies have shown that older patients with sporadic hypercholesterolemia do not show higher incidence of mild cognitive impairment, the findings presented here suggest that early exposure to elevated cholesterol or LDL receptors dysfunction may be risk factors for mild cognitive impairment. PMID:20193836

  12. Critical Incident Reporting Systems: Perceived Competing Social ...

    African Journals Online (AJOL)

    The safe operation of complex socio-technical systems is dependent upon the reporting of safety critical incidents by operators within a system. Through the action of reporting, systems develop the capability as a learning organisation to improve human and organisational performance. The aim of the study is therefore to ...

  13. Incidents/accidents classification and reporting in Statoil.

    Science.gov (United States)

    Berentsen, Rune; Holmboe, Rolf H

    2004-07-26

    Based on requirements in the new petroleum regulations from Norwegian Petroleum Directorate (NPD) and the realisation of a need to improve and rationalise the routines for reporting and follow up of incidents, Statoil Exploration & Production Norway (Statoil E&P Norway) has formulated a new strategy and process for handling of incidents/accidents. The following past experiences serve as basis for the changes made to incident reporting in Statoil E&P Norway; too much resources were spent on a comprehensive handling and analysis of a vast amount of incidents with less importance for the safety level, taking the focus away from the more severe and important issues at hand, the assessment of "Risk Factor", i.e. the combination of recurrence frequency and consequence, was difficult to use. The high degree of subjectivity involved in the determination of the "Risk Factor" (in particular the estimation of the recurrence frequency) resulted in poor data quality and lack of consistency in the data material. The new system for categorisation and handling of undesirable incidents was established in January 2002. The intention was to get a higher degree of focus on serious incidents (injuries, damages, loss and near misses), with a thorough handling and follow-up. This is reflected throughout the handling of the serious incidents, all the way from immediate notification of the incident, through investigation and follow-up of corrective and preventive actions. Simultaneously, it was also an objective to rationalise/simplify the handling of less serious incidents. These incidents are, however, subjected to analyses twice a year in order to utilize the learning opportunity that they also provide. A year after the introduction of this new system for categorisation and follow-up of undesirable incidents, Statoil's experiences are predominantly good; the intention to get a higher degree of focus on serious incidents (injuries, damages, loss and near misses), has been met, the data

  14. How to Report a Pesticide Incident Involving Exposures to People

    Science.gov (United States)

    Pesticides incidents must be reported by pesticide registrants. Others, such as members of the public and environmental professionals, would like to report pesticide incidents. This website will facilitate such incident reporting.

  15. The evaluation of a web-based incident reporting system.

    Science.gov (United States)

    Kuo, Ya-Hui; Lee, Ting-Ting; Mills, Mary Etta; Lin, Kuan-Chia

    2012-07-01

    A Web-based reporting system is essential to report incident events anonymously and confidentially. The purpose of this study was to evaluate a Web-based reporting system in Taiwan. User satisfaction and impact of system use were evaluated through a survey answered by 249 nurses. Incident events reported in paper and electronic systems were collected for comparison purposes. Study variables included system user satisfaction, willingness to report, number of reports, severity of the events, and efficiency of the reporting process. Results revealed that senior nurses were less willing to report events, nurses on internal medicine units had higher satisfaction than others, and lowest satisfaction was related to the time it took to file a report. In addition, the Web-based reporting system was used more often than the paper system. The percentages of events reported were significantly higher in the Web-based system in laboratory, environment/device, and incidents occurring in other units, whereas the proportions of reports involving bedsores and dislocation of endotracheal tubes were decreased. Finally, moderate injury event reporting decreased, whereas minor or minimal injury event reporting increased. The study recommends that the data entry process be simplified and the network system be improved to increase user satisfaction and reporting rates.

  16. Hazmat 10 Year Incident Summary Reports - Data Mining Tool

    Data.gov (United States)

    Department of Transportation — Series of Incident data and summary statistics reports produced which provide statistical information on incidents by type, year, geographical location, and others....

  17. Hazmat Yearly Incident Summary Reports - Data Mining Tool

    Data.gov (United States)

    Department of Transportation — Series of Incident data and summary statistics reports produced which provide statistical information on incidents by type, year, geographical location, and others....

  18. Higher Ambitions Summit. Rapporteur Report

    Science.gov (United States)

    Nash, Ian

    2014-01-01

    The Sutton Trust and Pearson two-day summit on higher ambitions in apprenticeships and vocational education drew more than 120 leaders in education, training and employment, policy makers, academics, and researchers to London. Delegates heard from political leaders stressing the importance they attach to high-quality apprenticeships. Presentations…

  19. Impact of Incidents on Enrollments at Higher Education Institutions

    Science.gov (United States)

    L'Orange, Hans P.

    2010-01-01

    Higher education is a remarkably consistent enterprise. The same general pattern, by and large, has existed since the enactment of the G.I. Bill in 1944 and large numbers of returning veterans began enrolling in American higher education. Although the definition of a traditional student is changing, many students still enroll in the fall to begin…

  20. Higher prevalence of risk factors for type 2 diabetes mellitus and subsequent higher incidence in men

    DEFF Research Database (Denmark)

    Almdal, T.; Scharling, H.; Jensen, J.S.

    2008-01-01

    Background: This study investigates risk factors and the incidence of type 2 diabetes mellitus (type 2 DM) in both sexes of a northern European population. Methods: A total of 14,223 randomly selected men and women were studied from 1976 to 1978. Patients with diabetes (self-reported type 2 DM......, non-fasting blood glucose and triglycerides. Significantly more men (242, 5.4%) than women (152, 2.5%) developed type 2 DM. The odds ratio (OR) for developing diabetes with a BMI above 30 kg/m(2) compared to a BMI of 20-25 kg/m(2) was 8.1 in women and 6.3 in men; for a non-fasting plasma glucose of 8.......4-11.0 mmol/l compared to a plasma glucose of 5.5-6.4, the ORs were 7.8 in women and 4.7 in men. The OR for developing diabetes in persons with a non-fasting triglyceride level above 2.0 mmol/l compared to 1.0-2.0 mmol/l was 1.8 in both sexes; women with non -fasting triglycerides below 1.0 mmol/l had...

  1. 49 CFR 225.11 - Reporting of accidents/incidents.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Reporting of accidents/incidents. 225.11 Section... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD ACCIDENTS/INCIDENTS: REPORTS CLASSIFICATION, AND INVESTIGATIONS § 225.11 Reporting of accidents/incidents. Each railroad subject to this part shall submit to FRA...

  2. Incidence et Caracteristiques des Signalements d'Enfants Maltraites: Comparaison Interculturelle (Incidence and Characteristics of Reported Child Abuse: Intercultural Comparisons).

    Science.gov (United States)

    Tourigny, Marc; Bouchard, Camil

    1994-01-01

    Analysis of 953 reports of child abuse in Montreal (Quebec) found the incidence slightly higher among Haitians than French-Canadians. Among Haitians, reporting tended to originate with police or school personnel, and cases consisted mainly of physical abuse. Results suggest that child-rearing practices of Haitian families are in conflict with…

  3. The incidence of secual harassment at higher education institutions in South Africa: perceptions of academic staff

    OpenAIRE

    Pierre Joubert; Christo van Wyk; Sebastiaan Rothmann

    2011-01-01

    This article aims to investigate the perceptions of academic staff relating to the incidence of sexual harassment at higher education institutions in South Africa. The results show a relatively low incidence level of sexual harassment, with gender harassment being more prevalent than unwanted sexual attention and quid pro quo harassment. No statistically significant effect of gender, age, population group or years of service was found on the perceptions of the incidence of sexual harassment. ...

  4. Reported incidences and factors associated with percutaneous ...

    African Journals Online (AJOL)

    Microsoft Office User

    precautions, training and reduction of long working hours are necessary in order to reduce infections from .... -4-. Incidences of percutaneous injuries and mucocutaneous blood exposure ... than 40 hours per week (14.9 %) (p= 0.001).

  5. A Descriptive Analysis of Incidents Reported by Community Aged Care Workers.

    Science.gov (United States)

    Tariq, Amina; Douglas, Heather E; Smith, Cheryl; Georgiou, Andrew; Osmond, Tracey; Armour, Pauline; Westbrook, Johanna I

    2015-07-01

    Little is known about the types of incidents that occur to aged care clients in the community. This limits the development of effective strategies to improve client safety. The objective of the study was to present a profile of incidents reported in Australian community aged care settings. All incident reports made by community care workers employed by one of the largest community aged care provider organizations in Australia during the period November 1, 2012, to August 8, 2013, were analyzed. A total of 356 reports were analyzed, corresponding to a 7.5% incidence rate per client year. Falls and medication incidents were the most prevalent incident types. Clients receiving high-level care and those who attended day therapy centers had the highest rate of incidents with 14% to 20% of these clients having a reported incident. The incident profile indicates that clients on higher levels of care had higher incident rates. Incident data represent an opportunity to improve client safety in community aged care. © The Author(s) 2014.

  6. Attitudes and perceived barriers influencing incident reporting by nurses and their correlation with reported incidents: A systematic review.

    Science.gov (United States)

    Fung, Wing Mei; Koh, Serena Siew Lin; Chow, Yeow Leng

    Clinical incident reporting is an integral feature of risk management system in the healthcare sector. By reporting clinical incidents, nurses allow for learning from errors, identification of error patterns and development of error preventive strategies. The need to understand attitudes to reporting, perceived barriers and incident reporting patterns by nurses are the core highlights of this review. INCLUSION CRITERIA: This review considered descriptive quantitative studies that examined nurses' attitudes or perceived barriers towards incident reporting.The participants in this review were nurses working in acute care settings or step-down care settings. Studies that included non-nursing healthcare personnel were excluded.This review considered studies which examined nurses' attitudes towards incident reporting, perceived barriers and incident reporting practices.The outcomes of interest were the attitudes that nurses have towards incident reporting, perceived barriers and the types of reported incidents in correlation with nurses' attitudes and barriers. A three-step search strategy was utilised in this review. An initial limited search of CINAHL and MEDLINE was undertaken. Search strategies were then developed using identified keywords and index terms. Lastly, the reference lists of all identified articles were examined. All searches were limited to studies published in English, between 1991 and 2010. The studies were independently assessed by two reviewers using the Joanna Briggs Institute Critical Appraisal Checklist for Descriptive/ Case Series studies. The reviewers extracted data independently from included studies using the Joanna Briggs Institute Data Extraction Form for Descriptive/ Case Series studies. Due to the descriptive nature of the study designs, statistical pooling was not possible. Therefore, the findings of this systematic review are presented in a narrative summary. Fifty-five papers were identified from the searches based on their titles and

  7. 78 FR 14877 - Pipeline Safety: Incident and Accident Reports

    Science.gov (United States)

    2013-03-07

    ... DEPARTMENT OF TRANSPORTATION Pipeline and Hazardous Materials Safety Administration [Docket ID PHMSA-2013-0028] Pipeline Safety: Incident and Accident Reports AGENCY: Pipeline and Hazardous Materials... PHMSA F 7100.2--Incident Report--Natural and Other Gas Transmission and Gathering Pipeline Systems and...

  8. Higher prevalence of risk factors for type 2 diabetes mellitus and subsequent higher incidence in men

    DEFF Research Database (Denmark)

    Almdal, Thomas; Scharling, Henrik; Jensen, Jan Skov

    2008-01-01

    , non-fasting blood glucose and triglycerides. Significantly more men (242, 5.4%) than women (152, 2.5%) developed type 2 DM. The odds ratio (OR) for developing diabetes with a BMI above 30 kg/m(2) compared to a BMI of 20-25 kg/m(2) was 8.1 in women and 6.3 in men; for a non-fasting plasma glucose of 8.......4-11.0 mmol/l compared to a plasma glucose of 5.5-6.4, the ORs were 7.8 in women and 4.7 in men. The OR for developing diabetes in persons with a non-fasting triglyceride level above 2.0 mmol/l compared to 1.0-2.0 mmol/l was 1.8 in both sexes; women with non -fasting triglycerides below 1.0 mmol/l had...... or non-fasting plasma glucose >11.1 mmol/l) were excluded. Some 6154 women and 4733 men were studied and followed up in 1981-1983 or in 1991-1994. The significance of risk factors was examined by multiple logistic regression analysis. RESULTS: Initially, a higher proportion of men than women had high...

  9. Risk factors for radiotherapy incidents and impact of an online electronic reporting system

    International Nuclear Information System (INIS)

    Chang, David W.; Cheetham, Lynn; Marvelde, Luc te; Bressel, Mathias; Kron, Tomas; Gill, Suki; Tai, Keen Hun; Ball, David; Rose, William; Silva, Linas; Foroudi, Farshad

    2014-01-01

    Background and purpose: To ascertain the rate, type, significance, trends and the potential risk factors associated with radiotherapy incidents in a large academic department. Materials and methods: Data for all radiotherapy activities from July 2001 to January 2011 were reviewed from radiotherapy incident reporting forms. Patient and treatment data were obtained from the radiotherapy record and verification database (MOSAIQ) and the patient database (HOSPRO). Logistic regression analyses were performed to determine variables associated with radiotherapy incidents. Results: In that time, 65,376 courses of radiotherapy were delivered with a reported incident rate of 2.64 per 100 courses. The rate of incidents per course increased (1.96 per 100 courses to 3.52 per 100 courses, p < 0.001) whereas the proportion of reported incidents resulting in >5% deviation in dose (10.50 to 2.75%, p < 0.001) had decreased after the introduction of an online electronic reporting system. The following variables were associated with an increased rate of incidents: afternoon treatment time, paediatric patients, males, inpatients, palliative plans, head-and-neck, skin, sarcoma and haematological malignancies. In general, complex plans were associated with higher incidence rates. Conclusion: Radiotherapy incidents were infrequent and most did not result in significant dose deviation. A number of risk factors were identified and these could be used to highlight high-risk cases in the future. Introduction of an online electronic reporting system resulted in a significant increase in the number of incidents being reported

  10. Brief Report: Incidence of and Risk Factors for Autistic Disorder in Neonatal Intensive Care Unit Survivors.

    Science.gov (United States)

    Matsuishi, Toyojiro; Yamashita, Yushiro; Ohtani, Yasuyo; Ornitz, Edward; Kuriya, Norikazu; Murakami, Yoshihiko; Fukuda, Seiichi; Hashimoto, Takeo; Yamashita, Fumio

    1999-01-01

    Analysis of the incidence of autistic disorder (AD) among 5,271 children in a neonatal intensive care unit in Japan found that 18 children were later diagnosed with AD, an incidence more than twice as high as previously reported. Children with AD had a significantly higher history of the meconium aspiration syndrome than the controls. (Author/DB)

  11. SU-E-P-07: Retrospective Analysis of Incident Reports at a Radiology Department: Feedback From Incident Reporting System

    Energy Technology Data Exchange (ETDEWEB)

    Kakinohana, Y; Toita, T; Heianna, J; Murayama, S [School of medicine, University of the Ryukyus, Nishihara-cho, Okinawa (Japan)

    2015-06-15

    Purpose: To provide an overview of reported incidents that occurred in a radiology department and to describe the most common causal source of incidents. Methods: Incident reports from the radiology department at the University of the Ryukyus Hospital between 2008 and 2013 were collected and analyzed retrospectively. The incident report form contains the following items, causal factors of the incident and desirable corrective actions to prevent recurrence of similar incidents. These items allow the institution to investigate/analyze root causes of the incidents and suggest measures to be taken to prevent further, similar incidents. The ‘causal factors of the incident’ item comprises multiple selections from among 24 selections and includes some synonymous selections. In this study, this item was re-categorized into four causal source types: (i) carelessness, (ii) lack of skill or knowledge, (iii) deficiencies in communication, and (iv) external factors. Results: There were a total of 7490 incident reports over the study period and 276 (3.7%) were identified as originating from the radiology department. The most frequent causal source type was carelessness (62%). The other three types showed similar frequencies (10–14%). The staff members involved in incidents indicate three predominant desirable corrective actions to prevent or decrease the recurrence of similar incidents. These are ‘improvement in communication’ (24%), ‘staff training/education’ (19%), and ‘daily medical procedures’ (22%), and the most frequent was ‘improvement in communication’. Even though the most frequent causal factor was related to carelessness, the most desirable corrective action indicated by the staff members was related to communication. Conclusion: Our finding suggests that the most immediate causes are strongly related to carelessness. However, the most likely underlying causes of incidents would be related to deficiencies in effective communication. At our

  12. Gender Differences in Reporting of Battering Incidences.

    Science.gov (United States)

    Edleson, Jeffrey L.; Brygger, Mary Pat

    1986-01-01

    Examined difference between male and female reports of violence and threats directed by the man toward the woman. In many categories, significantly more women were found at intake to report more threats and violence than their male partners. After extensive intervention these differences were not found in the more severe categories of violence.…

  13. What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system.

    Science.gov (United States)

    Westbrook, Johanna I; Li, Ling; Lehnbom, Elin C; Baysari, Melissa T; Braithwaite, Jeffrey; Burke, Rosemary; Conn, Chris; Day, Richard O

    2015-02-01

    To (i) compare medication errors identified at audit and observation with medication incident reports; (ii) identify differences between two hospitals in incident report frequency and medication error rates; (iii) identify prescribing error detection rates by staff. Audit of 3291 patient records at two hospitals to identify prescribing errors and evidence of their detection by staff. Medication administration errors were identified from a direct observational study of 180 nurses administering 7451 medications. Severity of errors was classified. Those likely to lead to patient harm were categorized as 'clinically important'. Two major academic teaching hospitals in Sydney, Australia. Rates of medication errors identified from audit and from direct observation were compared with reported medication incident reports. A total of 12 567 prescribing errors were identified at audit. Of these 1.2/1000 errors (95% CI: 0.6-1.8) had incident reports. Clinically important prescribing errors (n = 539) were detected by staff at a rate of 218.9/1000 (95% CI: 184.0-253.8), but only 13.0/1000 (95% CI: 3.4-22.5) were reported. 78.1% (n = 421) of clinically important prescribing errors were not detected. A total of 2043 drug administrations (27.4%; 95% CI: 26.4-28.4%) contained ≥ 1 errors; none had an incident report. Hospital A had a higher frequency of incident reports than Hospital B, but a lower rate of errors at audit. Prescribing errors with the potential to cause harm frequently go undetected. Reported incidents do not reflect the profile of medication errors which occur in hospitals or the underlying rates. This demonstrates the inaccuracy of using incident frequency to compare patient risk or quality performance within or across hospitals. New approaches including data mining of electronic clinical information systems are required to support more effective medication error detection and mitigation. © The Author 2015. Published by Oxford University Press in association

  14. Racial Justice, Hegemony, and Bias Incidents in U.S. Higher Education

    Science.gov (United States)

    Hughes, Glyn

    2013-01-01

    Formal administrative protocols for responding to bias incidents are now the norm in higher education. In considering these developments, the author of this article poses critical questions about racial justice work on campus, identifies key features of an under-acknowledged institutional racism, and contributes to discussions about ways that…

  15. Safety culture and learning from incidents: the role of incident reporting and causal analyses

    International Nuclear Information System (INIS)

    Wilpert, B.

    1994-01-01

    Nuclear industry more than any other industrial branch has developed and used predictive risk analysis as a method of feedforward control of safety and reliability. Systematic evaluation of operating experience, statistical documentation of component failures, systematic documentation and analysis of incidents are important complementary elements of feedback control: we are dealing here with adjustment and learning from experience, in particular from past incidents. Using preliminary findings from ongoing research at the Research Center Systems Safety at the Berlin University of Technology the contribution discusses preconditions for an effective use of lessons to be learnt from closely matched incident reporting and in depth analyses of causal chains leading to incidents. Such conditions are especially standardized documentation, reporting and analyzing methods of incidents; structured information flows and feedback loops; abstaining from culpability search; mutual trust of employees and management; willingness of all concerned to continually evaluate and optimize the established learning system. Thus, incident related reporting and causal analyses contribute to safety culture, which is seen to emerge from tightly coupled organizational measures and respective change in attitudes and behaviour. (author) 2 figs., 7 refs

  16. Human factors analysis of incident/accident report

    International Nuclear Information System (INIS)

    Kuroda, Isao

    1992-01-01

    Human factors analysis of accident/incident has different kinds of difficulties in not only technical, but also psychosocial background. This report introduces some experiments of 'Variation diagram method' which is able to extend to operational and managemental factors. (author)

  17. Socioeconomic Disadvantage Is Associated with a Higher Incidence of Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Nichols, Linda; Stirling, Christine; Otahal, Petr; Stankovich, Jim; Gall, Seana

    2018-03-01

    Aneurysmal subarachnoid hemorrhage (aSAH) incidence is not well studied. Varied definitions of "subarachnoid hemorrhage" have led to a lack of clarity regarding aSAH incidence. The impact of area-level socioeconomic disadvantage and geographical location on the incidence of aSAH also remains unclear. Using a population-based statewide study, we examined the incidence of aSAH in relation to socioeconomic disadvantage and geographical location. A retrospective cohort study of nontraumatic subarachnoid hemorrhages from 2010 to 2014 was undertaken. Researchers manually collected data from multiple overlapping sources including statewide administrative databases, individual digital medical records, and death registers. Age-standardized rates (ASRs) per 100,000 person years were calculated using the 2001 Australian population. Differences in incidence rate ratios were calculated by age, sex, area-level socioeconomic status, and geographical location using Poisson regression. The cohort of 237 cases (mean age, 61.0 years) with a female predominance of 166 (70.04%) included 159 confirmed aSAH, 52 community-based deaths, and 26 probable cases. The ASR for aSAH was 9.99 (95% confidence interval [CI], 8.69-11.29). A significant association between area-level socioeconomic disadvantage and incidence was observed, with the rate of aSAH in disadvantaged geographical areas being 1.40 times higher than that in advantaged areas (95% CI, 1.11-1.82; P = .012). This study uses a comprehensive search of multiple data sources to define a new baseline of aSAH within an Australian population. This study presents a higher incidence rate of aSAH with socioeconomic variations. As a key risk factor that may explain this paradox, addressing socioeconomic inequalities is important for effective prevention and management interventions. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Reporting Helicopter Emergency Medical Services in Major Incidents

    DEFF Research Database (Denmark)

    Fattah, Sabina; Johnsen, Anne Siri; Sollid, Stephen J M

    2016-01-01

    OBJECTIVE: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences...... variables were determined by consensus. These variables were formatted in a template with 4 main categories: HEMS background information, the major incident characteristics relevant to HEMS, the HEMS response to the major incident, and the key lessons learned. CONCLUSION: Based on opinions from European...

  19. Spatial Distribution of Black Bear Incident Reports in Michigan.

    Science.gov (United States)

    McFadden-Hiller, Jamie E; Beyer, Dean E; Belant, Jerrold L

    2016-01-01

    Interactions between humans and carnivores have existed for centuries due to competition for food and space. American black bears are increasing in abundance and populations are expanding geographically in many portions of its range, including areas that are also increasing in human density, often resulting in associated increases in human-bear conflict (hereafter, bear incidents). We used public reports of bear incidents in Michigan, USA, from 2003-2011 to assess the relative contributions of ecological and anthropogenic variables in explaining the spatial distribution of bear incidents and estimated the potential risk of bear incidents. We used weighted Normalized Difference Vegetation Index mean as an index of primary productivity, region (i.e., Upper Peninsula or Lower Peninsula), primary and secondary road densities, and percentage land cover type within 6.5-km2 circular buffers around bear incidents and random points. We developed 22 a priori models and used generalized linear models and Akaike's Information Criterion (AIC) to rank models. The global model was the best compromise between model complexity and model fit (w = 0.99), with a ΔAIC 8.99 units from the second best performing model. We found that as deciduous forest cover increased, the probability of bear incident occurrence increased. Among the measured anthropogenic variables, cultivated crops and primary roads were the most important in our AIC-best model and were both positively related to the probability of bear incident occurrence. The spatial distribution of relative bear incident risk varied markedly throughout Michigan. Forest cover fragmented with agriculture and other anthropogenic activities presents an environment that likely facilitates bear incidents. Our map can help wildlife managers identify areas of bear incident occurrence, which in turn can be used to help develop strategies aimed at reducing incidents. Researchers and wildlife managers can use similar mapping techniques to

  20. Spatial Distribution of Black Bear Incident Reports in Michigan.

    Directory of Open Access Journals (Sweden)

    Jamie E McFadden-Hiller

    Full Text Available Interactions between humans and carnivores have existed for centuries due to competition for food and space. American black bears are increasing in abundance and populations are expanding geographically in many portions of its range, including areas that are also increasing in human density, often resulting in associated increases in human-bear conflict (hereafter, bear incidents. We used public reports of bear incidents in Michigan, USA, from 2003-2011 to assess the relative contributions of ecological and anthropogenic variables in explaining the spatial distribution of bear incidents and estimated the potential risk of bear incidents. We used weighted Normalized Difference Vegetation Index mean as an index of primary productivity, region (i.e., Upper Peninsula or Lower Peninsula, primary and secondary road densities, and percentage land cover type within 6.5-km2 circular buffers around bear incidents and random points. We developed 22 a priori models and used generalized linear models and Akaike's Information Criterion (AIC to rank models. The global model was the best compromise between model complexity and model fit (w = 0.99, with a ΔAIC 8.99 units from the second best performing model. We found that as deciduous forest cover increased, the probability of bear incident occurrence increased. Among the measured anthropogenic variables, cultivated crops and primary roads were the most important in our AIC-best model and were both positively related to the probability of bear incident occurrence. The spatial distribution of relative bear incident risk varied markedly throughout Michigan. Forest cover fragmented with agriculture and other anthropogenic activities presents an environment that likely facilitates bear incidents. Our map can help wildlife managers identify areas of bear incident occurrence, which in turn can be used to help develop strategies aimed at reducing incidents. Researchers and wildlife managers can use similar mapping

  1. Development of Incident Report Database for Organizational Learning

    Science.gov (United States)

    Otsuka, Yuichi; Abe, Tomotaka; Noguchi, Hiroshi; Makinouchi, Akifumi

    The necessity of an incident reporting system has recently been increasing for hospitals. Japan Council for Quality Health Care (JCQHC) started operating a national incident reporting system to which domestic hospitals would report their incidents. However, the reporting system obtained an additional problem for the hospitals. They managed their own systems which collected reports by papers. The purposes of the reporting systems was to analyze considerable causes involved in incidents to improve the quality of patient safety management. On the contrary, the national reporting system aimed at collecting a statistical tendency of normal incidents. Simultaneously operating the two systems would be too much workload for safety managers. The load may have the managers rest only a short time for summarizing occurrences, not enough for analyzing their causes. However, to the authors' knowledge, there has not been an integrating policy of the two forms to adapt them to practical situations in patient safety management. The scope of this paper is to establish the integrated form in order to use in analyzing the causes of incidents as well as reporting for the national system. We have developed new data base system using XML + XSLT and Java Servlet. The developed system is composed of three computers; DB server , DB client and Data sending server. To investigate usability of the developed system, we conducted a monitoring test by real workers in reporting workplaces. The result of subjective evaluations by examinees was so preferable for the developed system. The results of usability test and the achievement of increasing the number of reports after the introduction can demonstrate the enough effectiveness of the developed system for supporting the activity of patient safety management.

  2. Which factors affect reported headache incidences after lumbar myelography?

    International Nuclear Information System (INIS)

    Sand, T.

    1989-01-01

    Nineteen publications were reviewed and subjected to a combined statistical analysis (meta-analysis) regarding the influence of study design factors upon reported headache and total symptom incidences after lumbar iohexol myelography. A significant association was found between reported side effects on one hand and needle diameter, follow-up time and the method of questioning respectively on the other. The combination of long follow-up time and specific questioning and the combination between larger diameter (20G) needles and long follow-up time, both seemed to be strong predictors for reporting high side effect incidences. Nine studies were similarly analyzed regarding the influence of early ambulation and contrast type upon reported headache incidences. Early ambulation significantly increased headache after iohexol or iopamidol lumbar myelography as opposed to metrizamide myelography. (orig.)

  3. Identifying Predictive Factors for Incident Reports in Patients Receiving Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Elnahal, Shereef M., E-mail: selnaha1@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Blackford, Amanda [Department of Oncology Biostatistics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Smith, Koren; Souranis, Annette N.; Briner, Valerie; McNutt, Todd R.; DeWeese, Theodore L.; Wright, Jean L.; Terezakis, Stephanie A. [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)

    2016-04-01

    Purpose: To describe radiation therapy cases during which voluntary incident reporting occurred; and identify patient- or treatment-specific factors that place patients at higher risk for incidents. Methods and Materials: We used our institution's incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient- and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios, and mixed-effect logistic regression models were used for group comparisons. Results: The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%), and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18 years) than in adult patients (37.7% vs 0.4%, P<.001). Patients with head and neck (16% vs 8%, P<.001) and breast (20% vs 15%, P=.03) primaries more frequently had incidents, whereas brain (18% vs 24%, P=.008) primaries were less frequent. Larger tumors (17% vs 10% had T4 lesions, P=.02), and cases on protocol (9% vs 5%, P=.005) or with intensity modulated radiation therapy/image guided intensity modulated radiation therapy (52% vs 43%, P=.001) were more likely to have incidents. Conclusions: We found several treatment- and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards, to minimize safety risks.

  4. Identifying Predictive Factors for Incident Reports in Patients Receiving Radiation Therapy

    International Nuclear Information System (INIS)

    Elnahal, Shereef M.; Blackford, Amanda; Smith, Koren; Souranis, Annette N.; Briner, Valerie; McNutt, Todd R.; DeWeese, Theodore L.; Wright, Jean L.; Terezakis, Stephanie A.

    2016-01-01

    Purpose: To describe radiation therapy cases during which voluntary incident reporting occurred; and identify patient- or treatment-specific factors that place patients at higher risk for incidents. Methods and Materials: We used our institution's incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient- and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios, and mixed-effect logistic regression models were used for group comparisons. Results: The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%), and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18 years) than in adult patients (37.7% vs 0.4%, P<.001). Patients with head and neck (16% vs 8%, P<.001) and breast (20% vs 15%, P=.03) primaries more frequently had incidents, whereas brain (18% vs 24%, P=.008) primaries were less frequent. Larger tumors (17% vs 10% had T4 lesions, P=.02), and cases on protocol (9% vs 5%, P=.005) or with intensity modulated radiation therapy/image guided intensity modulated radiation therapy (52% vs 43%, P=.001) were more likely to have incidents. Conclusions: We found several treatment- and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards, to minimize safety risks.

  5. Safety Incident Management Team Report for NIMLT Case 50796

    LENUS (Irish Health Repository)

    2017-01-17

    This is a report on the management of a patient safety incident involving BowelScreen and symptomatic colonoscopy services at Wexford General Hospital (WGH). The patient safety incident relates to the work of a Consultant Endoscopist (referred to as Clinician Y) employed by WGH who undertook screening colonoscopies on behalf of the BowelScreen Programme since the commencement of the screening programme in WGH in March 2013. Clinician Y also performed non-screening colonoscopies for the diagnosis of symptomatic patients as part of routine surgical service provision at WGH.\\r\

  6. Higher levels of albuminuria within the normal range predict incident hypertension.

    Science.gov (United States)

    Forman, John P; Fisher, Naomi D L; Schopick, Emily L; Curhan, Gary C

    2008-10-01

    Higher levels of albumin excretion within the normal range are associated with cardiovascular disease in high-risk individuals. Whether incremental increases in urinary albumin excretion, even within the normal range, are associated with the development of hypertension in low-risk individuals is unknown. This study included 1065 postmenopausal women from the first Nurses' Health Study and 1114 premenopausal women from the second Nurses' Health Study who had an albumin/creatinine ratio who did not have diabetes or hypertension. Among the older women, 271 incident cases of hypertension occurred during 4 yr of follow-up, and among the younger women, 296 incident cases of hypertension occurred during 8 yr of follow-up. Cox proportional hazards regression was used to examine prospectively the association between the albumin/creatinine ratio and incident hypertension after adjustment for age, body mass index, estimated GFR, baseline BP, physical activity, smoking, and family history of hypertension. Participants who had an albumin/creatinine ratio in the highest quartile (4.34 to 24.17 mg/g for older women and 3.68 to 23.84 mg/g for younger women) were more likely to develop hypertension than those who had an albumin/creatinine ratio in the lowest quartile (hazard ratio 1.76 [95% confidence interval 1.21 to 2.56] and hazard ratio 1.35 [95% confidence interval 0.97 to 1.91] for older and younger women, respectively). Higher albumin/creatinine ratios, even within the normal range, are independently associated with increased risk for development of hypertension among women without diabetes. The definition of normal albumin excretion should be reevaluated.

  7. Committee's report on ruthenium fall-out incident

    International Nuclear Information System (INIS)

    Borkowski, C.J.; Crawford, J.H.; Livingston, R.; Ritchie, R.H.; Rupp, A.F.; Taylor, E.H.

    1983-07-01

    Investigations of the fall-out incident of November 11 and 12, 1959, by responsible parties (Health Physics Division and Operations Division personnel) established beyond reasonable doubt that the incident had its origin in the expulsion of particles, heavily contaminated with ruthenium, which had been detached from the walls of the electric fan housing and ducts in the off-gas system associated with the brick stack. All available evidence indicates that the particles were loosened during maintenance work on the exhaust damper and the bearings of the electric fan and were carried up the stack in two bursts as particulate fall-out when this fan was put back into service. Radiographic and chemical analysis showed the activity to be almost entirely ruthenium (Ru 106 ) and its daughter rhodium (Rh 106 ) with very little, if any, strontium being present. This report summarizes the findings and sets forth the conclusions and recommendations of the Committee asked to investigate the incident

  8. EMS helicopter incidents reported to the NASA Aviation Safety Reporting System

    Science.gov (United States)

    Connell, Linda J.; Reynard, William D.

    1993-01-01

    The objectives of this evaluation were to: Identify the types of safety-related incidents reported to the Aviation Safety Reporting System (ASRS) in Emergency Medical Service (EMS) helicopter operations; Describe the operational conditions surrounding these incidents, such as weather, airspace, flight phase, time of day; and Assess the contribution to these incidents of selected human factors considerations, such as communication, distraction, time pressure, workload, and flight/duty impact.

  9. Scrutinizing incident reporting in anaesthesia: why is an incident perceived as critical?

    DEFF Research Database (Denmark)

    Maaløe, R; la Cour, M; Hansen, A

    2006-01-01

    The purpose of the present study was to measure the incidence and type of incidents that occurred in relation to anaesthesia and surgery during a 1-year period in six Danish hospitals. Furthermore, we wanted to identify risk factors for incidents, as well as risk factors for incidents being deeme...... critical....

  10. Reporter Concerns in 300 Mode-Related Incident Reports from NASA's Aviation Safety Reporting System

    Science.gov (United States)

    McGreevy, Michael W.

    1996-01-01

    A model has been developed which represents prominent reporter concerns expressed in the narratives of 300 mode-related incident reports from NASA's Aviation Safety Reporting System (ASRS). The model objectively quantifies the structure of concerns which persist across situations and reporters. These concerns are described and illustrated using verbatim sentences from the original narratives. Report accession numbers are included with each sentence so that concerns can be traced back to the original reports. The results also include an inventory of mode names mentioned in the narratives, and a comparison of individual and joint concerns. The method is based on a proximity-weighted co-occurrence metric and object-oriented complexity reduction.

  11. Potential Explanatory Factors for Higher Incident Hip Fracture Risk in Older Diabetic Adults

    Directory of Open Access Journals (Sweden)

    Elsa S. Strotmeyer

    2011-01-01

    Full Text Available Type 2 diabetes is associated with higher fracture risk. Diabetes-related conditions may account for this risk. Cardiovascular Health Study participants (N=5641; 42.0% men; 15.5% black; 72.8±5.6 years were followed 10.9 ± 4.6 years. Diabetes was defined as hypoglycemic medication use or fasting glucose (FG ≥126 mg/dL. Peripheral artery disease (PAD was defined as ankle-arm index <0.9. Incident hip fractures were from medical records. Crude hip fracture rates (/1000 person-years were higher for diabetic vs. non-diabetic participants with BMI <25 (13.6, 95% CI: 8.9–20.2 versus 11.4, 95% CI: 10.1–12.9 and BMI ≥25 to <30 (8.3, 95% CI: 5.7–11.9 versus 6.6, 95% CI: 5.6–7.7, but similar for BMI ≥30. Adjusting for BMI, sex, race, and age, diabetes was related to fractures (HR = 1.34; 95% CI: 1.01–1.78. PAD (HR = 1.25 (95% CI: 0.92–1.57 and longer walk time (HR = 1.07 (95% CI: 1.04–1.10 modified the fracture risk in diabetes (HR = 1.17 (95% CI: 0.87–1.57. Diabetes was associated with higher hip fracture risk after adjusting for BMI though this association was modified by diabetes-related conditions.

  12. Higher incidence of major complications after splenic embolization for blunt splenic injuries in elderly patients.

    Science.gov (United States)

    Wu, Shih-Chi; Fu, Chih-Yuan; Chen, Ray-Jade; Chen, Yung-Fang; Wang, Yu-Chun; Chung, Ping-Kuei; Yu, Shu-Fen; Tung, Cheng-Cheng; Lee, Kun-Hua

    2011-02-01

    Nonoperative management (NOM) of blunt splenic injuries has been widely accepted, and the application of splenic artery embolization (SAE) has become an effective adjunct to NOM. However, complications do occur after SAE. In this study, we assess the factors leading to the major complications associated with SAE. Focusing on the major complications after SAE, we retrospectively studied patients who received SAE and were admitted to 2 major referral trauma centers under the same established algorithm for management of blunt splenic injuries. The demographics, angiographic findings, and factors for major complications after SAE were examined. Major complications were considered to be direct adverse effects arising from SAE that were potentially fatal or were capable of causing disability. There were a total of 261 patients with blunt splenic injuries in this study. Of the 261 patients, 53 underwent SAE, 11 (21%) of whom were noted to have 12 major complications: 8 cases of postprocedural bleeding, 2 cases of total infarction, 1 case of splenic abscess, and 1 case of splenic atrophy. Patients older than 65 years were more susceptible to major complications after SAE. Splenic artery embolization is considered an effective adjunct to NOM in patients with blunt splenic injuries. However, risks of major complications do exist, and being elderly is, in part, associated with a higher major complication incidence. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. Increased Kawasaki Disease Incidence Associated With Higher Precipitation and Lower Temperatures, Japan, 1991-2004.

    Science.gov (United States)

    Abrams, Joseph Y; Blase, Jennifer L; Belay, Ermias D; Uehara, Ritei; Maddox, Ryan A; Schonberger, Lawrence B; Nakamura, Yosikazu

    2018-06-01

    Kawasaki disease (KD) is an acute febrile vasculitis, which primarily affects children. The etiology of KD is unknown; while certain characteristics of the disease suggest an infectious origin, genetic or environmental factors may also be important. Seasonal patterns of KD incidence are well documented, but it is unclear whether these patterns are caused by changes in climate or by other unknown seasonal effects. The relationship between KD incidence and deviations from expected temperature and precipitation were analyzed using KD incidence data from Japanese nationwide epidemiologic surveys (1991-2004) and climate data from 136 weather stations of the Japan Meteorological Agency. Seven separate Poisson-distributed generalized linear regression models were run to examine the effects of temperature and precipitation on KD incidence in the same month as KD onset and the previous 1, 2, 3, 4, 5 and 6 months, controlling for geography as well as seasonal and long-term trends in KD incidence. KD incidence was negatively associated with temperature in the previous 2, 3, 4 and 5 months and positively associated with precipitation in the previous 1 and 2 months. The model that best predicted variations in KD incidence used climate data from the previous 2 months. An increase in total monthly precipitation by 100 mm was associated with increased KD incidence (rate ratio [RR] 1.012, 95% confidence interval [CI]: 1.005-1.019), and an increase of monthly mean temperature by 1°C was associated with decreased KD incidence (RR 0.984, 95% CI: 0.978-0.990). KD incidence was significantly affected by temperature and precipitation in previous months independent of other unknown seasonal factors. Climate data from the previous 2 months best predicted the variations in KD incidence. Although fairly minor, the effect of temperature and precipitation independent of season may provide additional clues to the etiology of KD.

  14. 49 CFR 225.15 - Accidents/incidents not to be reported.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Accidents/incidents not to be reported. 225.15... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD ACCIDENTS/INCIDENTS: REPORTS CLASSIFICATION, AND INVESTIGATIONS § 225.15 Accidents/incidents not to be reported. A railroad need not report: (a) Casualties which...

  15. Towards a Sustainability Reporting Guideline in Higher Education

    Science.gov (United States)

    Huber, Sandra; Bassen, Alexander

    2018-01-01

    Purpose: So far, sustainability reporting in higher education is in a very early stage--partly, because of the lack of an established and widely recognized sustainability reporting framework for higher education institutions (HEIs). Therefore, a modification of the sustainability code for the use in the higher education context was recently…

  16. Lessons for pediatric anesthesia from audit and incident reporting.

    Science.gov (United States)

    Bell, Graham

    2011-07-01

    This review will attempt to put the various systems that allow clinicians to assess errors, omissions, or avoidable incidents into context and where possible, look for areas that deserve more or less attention and resource specifically for those of us who practice pediatric anesthesia. Different approaches will be contrasted with respect to their outputs in terms of positive impact on the practice of anesthesia. These approaches include audits by governmental organizations, national representative bodies, specialist societies, commissioned boards of inquiry, medicolegal sources, and police force investigations. Implementation strategies are considered alongside the reports as the reports cannot be considered end points themselves. Specific areas where pediatric anesthetics has failed to address recurring risk through any currently available tools will be highlighted. © 2011 Blackwell Publishing Ltd.

  17. Cumulative incidence of postoperative severe pain at Hospital Universitario San Jose, Popayan. Preliminar report

    Directory of Open Access Journals (Sweden)

    Ingrid Muñoz

    2013-12-01

    Full Text Available Introduction: Postoperative pain remains as a problem. National studies report incidences of 31% for moderate and 22% for severe pain. Inadequate analgesia is related to dissatisfaction and adverse outcomes. The aim of this study was to describe the incidence and characteristics of the postoperative pain in the post-anesthesia care unit (PACU at Hospital Universitario San José of Popayán (HUSJ in patients undergoing general anesthesia during the first postoperative hour. Methods: Cohort study. We recruited patients attending PACU and undergoing procedures using general anesthesia, between 18 and 70 years. Using a standardized collection form medical history, demographic data, medical history, anesthetic management, intraoperative analgesia and postoperative pain assessment by verbal and numerical pain scale (1-10 were recorded. Postoperative outcome data were also collected in the PACU. Results: The incidence of severe postoperative pain at 10 minutes was 12.3% 95%CI [7.1-18.2] (19 patients. Within 30 minutes of assessment 4.5% 95%CI [1.3-8.4] (7 patients and 1.9% 60 minutes 95%CI [0-4.5] (3 patients. 48.7% required rescue analgesic at PACU. Incidence of postoperative nausea and vomiting (PONV was significantly different in patients requiring rescue analgesic. Conclusion: The incidence of severe postoperative pain in the first postoperative hour at HUSJ is close to 12% and it decreases as time goes by. Patients requiring rescue analgesic have a higher incidence of postoperative complications such as PONV.

  18. Perioperative anaesthetic adverse events in Thailand (PAAd THAI) study: Incident report of perioperative convulsion.

    Science.gov (United States)

    Eiamcharoenwit, Jatuporn; Akavipat, Phuping; Ariyanuchitkul, Thidarat; Wirachpisit, Nichawan; Pulnitiporn, Aksorn; Pongraweewan, Orawan

    2018-01-01

    The aim of this study was to identify the characteristics of perioperative convulsion and to suggest possible correcting strategies. The multi-centre study was conducted prospectively in 22 hospitals across Thailand in 2015. The occurrences of perioperative adverse events were collected. The data was collated by site manager and forwarded to the data management unit. All perioperative convulsion incidences were enrolled and analysed. The consensus was documented for the relevant factors and the corrective strategies. Descriptive statistics were used. From 2,000 incident reports, perioperative convulsions were found in 16 patients. Six episodes (37.5%) were related to anaesthesia, 31.3% to patients, 18.8% to surgery, and 12.5% to systemic processes. The contributing factor was an inexperienced anaesthesia performer (25%), while the corrective strategy was improvements to supervision (43.8%). Incidents of perioperative convulsion were found to be higher than during the last decade. The initiation and maintenance of safe anaesthesia should be continued.

  19. Incidence of adult brain cancers is higher in countries where the protozoan parasite Toxoplasma gondii is common

    OpenAIRE

    Thomas, Frédéric; Lafferty, Kevin D.; Brodeur, Jacques; Elguero, Eric; Gauthier-Clerc, Michel; Missé, Dorothée

    2011-01-01

    We explored associations between the common protozoan parasite Toxoplasma gondii and brain cancers in human populations. We predicted that T. gondii could increase the risk of brain cancer because it is a long-lived parasite that encysts in the brain, where it provokes inflammation and inhibits apoptosis. We used a medical geography approach based on the national incidence of brain cancers and seroprevalence of T. gondii. We corrected reports of incidence for national gross domestic product b...

  20. Medication Incidents Related to Automated Dose Dispensing in Community Pharmacies and Hospitals - A Reporting System Study

    Science.gov (United States)

    Cheung, Ka-Chun; van den Bemt, Patricia M. L. A.; Bouvy, Marcel L.; Wensing, Michel; De Smet, Peter A. G. M.

    2014-01-01

    Introduction Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. Methods The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers. Main Outcome Measures Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. Results From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. Conclusion A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident

  1. An Evaluation of Departmental Radiation Oncology Incident Reports: Anticipating a National Reporting System

    International Nuclear Information System (INIS)

    Terezakis, Stephanie A.; Harris, Kendra M.; Ford, Eric; Michalski, Jeff; DeWeese, Theodore; Santanam, Lakshmi; Mutic, Sasa; Gay, Hiram

    2013-01-01

    Purpose: Systems to ensure patient safety are of critical importance. The electronic incident reporting systems (IRS) of 2 large academic radiation oncology departments were evaluated for events that may be suitable for submission to a national reporting system (NRS). Methods and Materials: All events recorded in the combined IRS were evaluated from 2007 through 2010. Incidents were graded for potential severity using the validated French Nuclear Safety Authority (ASN) 5-point scale. These incidents were categorized into 7 groups: (1) human error, (2) software error, (3) hardware error, (4) error in communication between 2 humans, (5) error at the human-software interface, (6) error at the software-hardware interface, and (7) error at the human-hardware interface. Results: Between the 2 systems, 4407 incidents were reported. Of these events, 1507 (34%) were considered to have the potential for clinical consequences. Of these 1507 events, 149 (10%) were rated as having a potential severity of ≥2. Of these 149 events, the committee determined that 79 (53%) of these events would be submittable to a NRS of which the majority was related to human error or to the human-software interface. Conclusions: A significant number of incidents were identified in this analysis. The majority of events in this study were related to human error and to the human-software interface, further supporting the need for a NRS to facilitate field-wide learning and system improvement

  2. An Evaluation of Departmental Radiation Oncology Incident Reports: Anticipating a National Reporting System

    Energy Technology Data Exchange (ETDEWEB)

    Terezakis, Stephanie A., E-mail: stereza1@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Harris, Kendra M. [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Ford, Eric [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Department of Radiation Oncology, University of Washington, Seattle, Washington (United States); Michalski, Jeff [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); DeWeese, Theodore [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Santanam, Lakshmi; Mutic, Sasa; Gay, Hiram [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States)

    2013-03-15

    Purpose: Systems to ensure patient safety are of critical importance. The electronic incident reporting systems (IRS) of 2 large academic radiation oncology departments were evaluated for events that may be suitable for submission to a national reporting system (NRS). Methods and Materials: All events recorded in the combined IRS were evaluated from 2007 through 2010. Incidents were graded for potential severity using the validated French Nuclear Safety Authority (ASN) 5-point scale. These incidents were categorized into 7 groups: (1) human error, (2) software error, (3) hardware error, (4) error in communication between 2 humans, (5) error at the human-software interface, (6) error at the software-hardware interface, and (7) error at the human-hardware interface. Results: Between the 2 systems, 4407 incidents were reported. Of these events, 1507 (34%) were considered to have the potential for clinical consequences. Of these 1507 events, 149 (10%) were rated as having a potential severity of ≥2. Of these 149 events, the committee determined that 79 (53%) of these events would be submittable to a NRS of which the majority was related to human error or to the human-software interface. Conclusions: A significant number of incidents were identified in this analysis. The majority of events in this study were related to human error and to the human-software interface, further supporting the need for a NRS to facilitate field-wide learning and system improvement.

  3. Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data.

    Science.gov (United States)

    Howell, Ann-Marie; Burns, Elaine M; Bouras, George; Donaldson, Liam J; Athanasiou, Thanos; Darzi, Ara

    2015-01-01

    The National Reporting and Learning System (NRLS) collects reports about patient safety incidents in England. Government regulators use NRLS data to assess the safety of hospitals. This study aims to examine whether annual hospital incident reporting rates can be used as a surrogate indicator of individual hospital safety. Secondly assesses which hospital characteristics are correlated with high incident reporting rates and whether a high reporting hospital is safer than those lower reporting hospitals. Finally, it assesses which health-care professionals report more incidents of patient harm, which report more near miss incidents and what hospital factors encourage reporting. These findings may suggest methods for increasing the utility of reporting systems. This study used a mix methods approach for assessing NRLS data. The data were investigated using Pareto analysis and regression models to establish which patients are most vulnerable to reported harm. Hospital factors were correlated with institutional reporting rates over one year to examine what factors influenced reporting. Staff survey findings regarding hospital safety culture were correlated with reported rates of incidents causing harm; no harm and death to understand what barriers influence error disclosure. 5,879,954 incident reports were collected from acute hospitals over the decade. 70.3% of incidents produced no harm to the patient and 0.9% were judged by the reporter to have caused severe harm or death. Obstetrics and Gynaecology reported the most no harm events [OR 1.61(95%CI: 1.12 to 2.27), p<0.01] and pharmacy was the hospital location where most near-misses were captured [OR 3.03(95%CI: 2.04 to 4.55), p<0.01]. Clinicians were significantly more likely to report death than other staff [OR 3.04(95%CI: 2.43 to 3.80) p<0.01]. A higher ratio of clinicians to beds correlated with reduced rate of harm reported [RR = -1.78(95%Cl: -3.33 to -0.23), p = 0.03]. Litigation claims per bed were

  4. Central nervous system tumours among adolescents and young adults (15-39 years) in Southern and Eastern Europe: Registration improvements reveal higher incidence rates compared to the US.

    Science.gov (United States)

    Georgakis, Marios K; Panagopoulou, Paraskevi; Papathoma, Paraskevi; Tragiannidis, Athanasios; Ryzhov, Anton; Zivkovic-Perisic, Snezana; Eser, Sultan; Taraszkiewicz, Łukasz; Sekerija, Mario; Žagar, Tina; Antunes, Luis; Zborovskaya, Anna; Bastos, Joana; Florea, Margareta; Coza, Daniela; Demetriou, Anna; Agius, Domenic; Strahinja, Rajko M; Sfakianos, Georgios; Nikas, Ioannis; Kosmidis, Sofia; Razis, Evangelia; Pourtsidis, Apostolos; Kantzanou, Maria; Dessypris, Nick; Petridou, Eleni Th

    2017-11-01

    To present incidence of central nervous system (CNS) tumours among adolescents and young adults (AYAs; 15-39 years) derived from registries of Southern and Eastern Europe (SEE) in comparison to the Surveillance, Epidemiology and End Results (SEER), US and explore changes due to etiological parameters or registration improvement via evaluating time trends. Diagnoses of 11,438 incident malignant CNS tumours in AYAs (1990-2014) were retrieved from 14 collaborating SEE cancer registries and 13,573 from the publicly available SEER database (1990-2012). Age-adjusted incidence rates (AIRs) were calculated; Poisson and joinpoint regression analyses were performed for temporal trends. The overall AIR of malignant CNS tumours among AYAs was higher in SEE (28.1/million) compared to SEER (24.7/million). Astrocytomas comprised almost half of the cases in both regions, albeit the higher proportion of unspecified cases in SEE registries (30% versus 2.5% in SEER). Similar were the age and gender distributions across SEE and SEER with a male-to-female ratio of 1.3 and an overall increase of incidence by age. Increasing temporal trends in incidence were documented in four SEE registries (Greater Poland, Portugal North, Turkey-Izmir and Ukraine) versus an annual decrease in Croatia (-2.5%) and a rather stable rate in SEER (-0.3%). This first report on descriptive epidemiology of AYAs malignant CNS tumours in the SEE area shows higher incidence rates as compared to the United States of America and variable temporal trends that may be linked to registration improvements. Hence, it emphasises the need for optimisation of cancer registration processes, as to enable the in-depth evaluation of the observed patterns by disease subtype. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Sci-Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting – Radiation Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Montgomery, Logan; Kildea, John [McGill University Health Centre (Canada)

    2016-08-15

    We report on the development and clinical deployment of an in-house incident reporting and learning system that implements the taxonomy of the Canadian National System for Incident Reporting – Radiation Treatment (NSIR-RT). In producing our new system, we aimed to: Analyze actual incidents, as well as potentially dangerous latent conditions. Produce recommendations on the NSIR-RT taxonomy. Incorporate features to divide reporting responsibility among clinical staff and expedite incident categorization within the NSIR-RT framework. Share anonymized incident data with the national database. Our multistep incident reporting workflow is focused around an initial report and a detailed follow-up investigation. An investigator, chosen at the time of reporting, is tasked with performing the investigation. The investigation feature is connected to our electronic medical records database to allow automatic field population and quick reference of patient and treatment information. Additional features include a robust visualization suite, as well as the ability to flag incidents for discussion at monthly Risk Management meetings and task ameliorating actions to staff. Our system was deployed into clinical use in January 2016. Over the first three months of use, 45 valid incidents were reported; 31 of which were reported as actual incidents as opposed to near-misses or reportable circumstances. However, we suspect there is ambiguity within our centre in determining the appropriate event type, which may be arising from the taxonomy itself. Preliminary trending analysis aided in revealing workflow issues pertaining to storage of treatment accessories and treatment planning delays. Extensive analysis will be undertaken as more data are accrued.

  6. Sci-Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting – Radiation Treatment

    International Nuclear Information System (INIS)

    Montgomery, Logan; Kildea, John

    2016-01-01

    We report on the development and clinical deployment of an in-house incident reporting and learning system that implements the taxonomy of the Canadian National System for Incident Reporting – Radiation Treatment (NSIR-RT). In producing our new system, we aimed to: Analyze actual incidents, as well as potentially dangerous latent conditions. Produce recommendations on the NSIR-RT taxonomy. Incorporate features to divide reporting responsibility among clinical staff and expedite incident categorization within the NSIR-RT framework. Share anonymized incident data with the national database. Our multistep incident reporting workflow is focused around an initial report and a detailed follow-up investigation. An investigator, chosen at the time of reporting, is tasked with performing the investigation. The investigation feature is connected to our electronic medical records database to allow automatic field population and quick reference of patient and treatment information. Additional features include a robust visualization suite, as well as the ability to flag incidents for discussion at monthly Risk Management meetings and task ameliorating actions to staff. Our system was deployed into clinical use in January 2016. Over the first three months of use, 45 valid incidents were reported; 31 of which were reported as actual incidents as opposed to near-misses or reportable circumstances. However, we suspect there is ambiguity within our centre in determining the appropriate event type, which may be arising from the taxonomy itself. Preliminary trending analysis aided in revealing workflow issues pertaining to storage of treatment accessories and treatment planning delays. Extensive analysis will be undertaken as more data are accrued.

  7. 30 CFR 250.187 - What are MMS' incident reporting requirements?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What are MMS' incident reporting requirements... Reporting Requirements § 250.187 What are MMS' incident reporting requirements? (a) You must report all... other permit issued by MMS, and that are related to operations resulting from the exercise of your...

  8. Utah System of Higher Education 2015-16 Annual Report

    Science.gov (United States)

    Utah System of Higher Education, 2016

    2016-01-01

    This annual report describes Utah System of Higher Education's progress in the 2015-2016 academic year in the following areas: (1) Strategic plan; (2) Enrollment and completion; (3) Paying for college; (4) Funding higher education; (5) College preparation; (6) Concurrent enrollment and math; (7) Outreach and access; and (8) Industry and the…

  9. Tuberculosis screening of travelers to higher-incidence countries: A cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Menzies Dick

    2008-06-01

    Full Text Available Abstract Background Travelers to countries with high tuberculosis incidence can acquire infection during travel. We sought to compare four screening interventions for travelers from low-incidence countries, who visit countries with varying tuberculosis incidence. Methods Decision analysis model: We considered hypothetical cohorts of 1,000 travelers, 21 years old, visiting Mexico, the Dominican Republic, or Haiti for three months. Travelers departed from and returned to the United States or Canada; they were born in the United States, Canada, or the destination countries. The time horizon was 20 years, with 3% annual discounting of future costs and outcomes. The analysis was conducted from the health care system perspective. Screening involved tuberculin skin testing (post-travel in three strategies, with baseline pre-travel tests in two, or chest radiography post-travel (one strategy. Returning travelers with tuberculin conversion (one strategy or other evidence of latent tuberculosis (three strategies were offered treatment. The main outcome was cost (in 2005 US dollars per tuberculosis case prevented. Results For all travelers, a single post-trip tuberculin test was most cost-effective. The associated cost estimate per case prevented ranged from $21,406 for Haitian-born travelers to Haiti, to $161,196 for US-born travelers to Mexico. In all sensitivity analyses, the single post-trip tuberculin test remained most cost-effective. For US-born travelers to Haiti, this strategy was associated with cost savings for trips over 22 months. Screening was more cost-effective with increasing trip duration and infection risk, and less so with poorer treatment adherence. Conclusion A single post-trip tuberculin skin test was the most cost-effective strategy considered, for travelers from the United States or Canada. The analysis did not evaluate the use of interferon-gamma release assays, which would be most relevant for travelers who received BCG

  10. Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database

    DEFF Research Database (Denmark)

    Andersen, Peter Oluf; Maaløe, Rikke; Andersen, Henning Boje

    2010-01-01

    Background Critical incident reports can identify areas for improvement in resuscitation practice. The Danish Patient Safety Database is a mandatory reporting system and receives critical incident reports submitted by hospital personnel. The aim of this study is to identify, analyse and categorize...... critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. Methods The search terms “cardiac arrest” and “resuscitation” were used to identify reports in the Danish Patient Safety Database. Identified critical incidents were then classified into categories. Results One...

  11. CHOLERA INCIDENCE AND EL NINO-RELATED HIGHER AMBIENT TEMPERATURE. (R824995)

    Science.gov (United States)

    The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

  12. Statistics Report on TEQSA Registered Higher Education Providers

    Science.gov (United States)

    Australian Government Tertiary Education Quality and Standards Agency, 2015

    2015-01-01

    This statistics report provides a comprehensive snapshot of national statistics on all parts of the sector for the year 2013, by bringing together data collected directly by TEQSA with data sourced from the main higher education statistics collections managed by the Australian Government Department of Education and Training. The report provides…

  13. Critical incidence reporting systems - an option in equine anaesthesia? Results from a panel meeting.

    Science.gov (United States)

    Hartnack, Sonja; Bettschart-Wolfensberger, Regula; Driessen, Bernd; Pang, Daniel; Wohlfender, Franziska

    2013-11-01

    To provide a brief introduction into Critical Incident Reporting Systems (CIRS) as used in human medicine, and to report the discussion from a recent panel meeting discussion with 23 equine anaesthetists in preparation for a new CEPEF-4 (Confidential Enquiry into Perioperative Equine Fatalities) study. Moderated group discussions, and review of literature. The first group discussion focused on the definition of 'preventable critical incidents' and/or 'near misses' in the context of equine anaesthesia. The second group discussion focused on categorizing critical incidents according to an established framework for analysing risk and safety in clinical medicine. While critical incidents do occur in equine anaesthesia, no critical incident reporting system including systematic collection and analysis of critical incidents is in place. Critical incident reporting systems could be used to improve safety in equine anaesthesia - in addition to other study types such as mortality studies. © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

  14. Exploring the Influence of Nurse Work Environment and Patient Safety Culture on Attitudes Toward Incident Reporting.

    Science.gov (United States)

    Yoo, Moon Sook; Kim, Kyoung Ja

    2017-09-01

    The aim of this study was to explore the influence of nurse work environments and patient safety culture on attitudes toward incident reporting. Patient safety culture had been known as a factor of incident reporting by nurses. Positive work environment could be an important influencing factor for the safety behavior of nurses. A cross-sectional survey design was used. The structured questionnaire was administered to 191 nurses working at a tertiary university hospital in South Korea. Nurses' perception of work environment and patient safety culture were positively correlated with attitudes toward incident reporting. A regression model with clinical career, work area and nurse work environment, and patient safety culture against attitudes toward incident reporting was statistically significant. The model explained approximately 50.7% of attitudes toward incident reporting. Improving nurses' attitudes toward incident reporting can be achieved with a broad approach that includes improvements in work environment and patient safety culture.

  15. Documentation of in-hospital falls on incident reports: qualitative investigation of an imperfect process.

    Science.gov (United States)

    Haines, Terry P; Cornwell, Petrea; Fleming, Jennifer; Varghese, Paul; Gray, Len

    2008-12-11

    Incident reporting is the prevailing approach to gathering data on accidental falls in hospitals for both research and quality assurance purposes, though is of questionable quality as staff time pressures, perception of blame and other factors are thought to contribute to under-reporting. This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories. Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting), secondary (patient injury), and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists. A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices.

  16. Documentation of in-hospital falls on incident reports: Qualitative investigation of an imperfect process

    Directory of Open Access Journals (Sweden)

    Fleming Jennifer

    2008-12-01

    Full Text Available Abstract Background Incident reporting is the prevailing approach to gathering data on accidental falls in hospitals for both research and quality assurance purposes, though is of questionable quality as staff time pressures, perception of blame and other factors are thought to contribute to under-reporting. Methods This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories. Results Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting, secondary (patient injury, and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists. Conclusion A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices.

  17. Higher incidence of Epstein-Barr virus-induced lymphocyte transformation in multiple sclerosis

    DEFF Research Database (Denmark)

    Tørring, Caroline Winther; Andreasen, Charlotte; Gehr, Nikolaj

    2014-01-01

    Objectives Epstein–Barr virus (EBV) infection is associated with multiple sclerosis (MS), and EBV may transform lymphoblastoid cell lines more frequently in MS patients than controls, but it is not clear whether this reflects a higher viral load or an enhanced ability to reactivate EBV. Material...

  18. Surface Movement Incidents Reported to the NASA Aviation Safety Reporting System

    Science.gov (United States)

    Connell, Linda J.; Hubener, Simone

    1997-01-01

    Increasing numbers of aircraft are operating on the surface of airports throughout the world. Airport operations are forecast to grow by more that 50%, by the year 2005. Airport surface movement traffic would therefore be expected to become increasingly congested. Safety of these surface operations will become a focus as airport capacity planning efforts proceed toward the future. Several past events highlight the prevailing risks experienced while moving aircraft during ground operations on runways, taxiways, and other areas at terminal, gates, and ramps. The 1994 St. Louis accident between a taxiing Cessna crossing an active runway and colliding with a landing MD-80 emphasizes the importance of a fail-safe system for airport operations. The following study explores reports of incidents occurring on an airport surface that did not escalate to an accident event. The Aviation Safety Reporting System has collected data on surface movement incidents since 1976. This study sampled the reporting data from June, 1993 through June, 1994. The coding of the data was accomplished in several categories. The categories include location of airport, phase of ground operation, weather /lighting conditions, ground conflicts, flight crew characteristics, human factor considerations, and airport environment. These comparisons and distributions of variables contributing to surface movement incidents can be invaluable to future airport planning, accident prevention efforts, and system-wide improvements.

  19. 76 FR 30855 - Accident/Incident Reporting Requirements

    Science.gov (United States)

    2011-05-27

    ... sidewalk/walkway D5--In airport; D6- In airplane; D7--In hotel room; E1--On parking lot; E2--In building... Control C--Auto Train Stop D--Automatic Block Signals System E--Broken Rail Monitoring F--Direct Traffic... of the accident/incident. This document updates and moves footnote number four to make it clear that...

  20. Prevalence of Candida spp. in Healthy Oral Mucosa Surfaces with Higher Incidence of Chronic Hyperplastic Candidosis.

    Science.gov (United States)

    Arruda, Claúdia; Artico, Gabriela; Freitas, Roseli; Filho, Antônio; Migliari, Dante

    2016-08-01

    Predisposing factors in chronic hyperplastic candidosis (CHC) have been poorly recognized. This study aimed at assessing the prevalence of Candida spp. in areas of the oral mucosa showing greater prevalent rate of CHC, such as the retrocomissural area, the lateral borders of the tongue, and the hard-palate mucosa in four groups of individuals presenting predisposing factors as follows: Smoking habits (group I); patients with low salivary flow rate (SFR) (hyposalivation - group II); patients with loss of vertical dimension of occlusion (LVDO -group III); and control subjects (group IV). A total of 44 individuals (age 4090 years, mean: 55.8 years) were divided into four groups: Group I (11 smokers); group II (10 hyposalivation patients); group III (10 LVDO patients); and group IV (control, 13 healthy subjects). All individuals were tested for Candida-pseudohyphae form by direct examination and for Candida spp. culture growth in samples obtained from the retrocomissural, tongue's lateral border, and hard-soft palatal mucosa. Direct examination showed a statistically significant prevalence rate for pseudohyphae (p < 0.05) on the retrocomissural and on tongue's lateral borders of individuals with LVDO. A statistically significant (p < 0.05) culture growth for Candida spp. was found on the retrocomissural areas of those with hyposalivation and with LVDO, and on the palate mucosa and on the tongue's lateral borders in the smokers and in the individuals with LVDO when compared with those of the control group. While direct examination is effective for detecting pseudohyphae, LVDO and tobacco smoking seem to be factors of relevance to the development of CHC. Since CHC has been linked to a high rate of malignant transformation, this study analyzes some clinical (and exogenous) factors that may contribute to the development of CHC and addresses some preventive measures to reduce its incidence.

  1. Residual stress analysis on materials with steep stress gradient by using X-ray incidence at higher angles

    International Nuclear Information System (INIS)

    Ohya, Shin-ichi; Yoshioka, Yasuo; Maeno, Shigeki

    1996-01-01

    X-ray stress measurements for isotropic polycrystalline are materials are usually carried out by the sin 2 ψ method under the assumption of no stress gradient in X-ray penetration depth. When a steep stress gradient exists in the vicinity of surface layer, however, non-linear sin 2 ψ relation is observed and the sin 2 ψ method cannot be applied on such cases. Although several X-ray stress analyzers have been developed for materials with steep stress gradient in the surface layer, it is desirable to use diffraction data at higher incident angles of ψ 0 as possible as close on 90 degrees in order to determine the both values of surface stress and stress gradient with high accuracy. In the present study, an X-ray stress analyzer based on Ω geometry was fabricated to enable X-ray incidence at higher angle of ψ 0 . The X-ray detector was positioned on -η side against X-ray incident beam. Both of the residual surface stress and stress gradient were determined by use of the COSψ method on shot-peened steel and silicon nitride specimens. This prototype stress analyzer was found effective to perform a biaxial or triaxial stress analysis. (author)

  2. Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database.

    Science.gov (United States)

    Cooper, Jennifer; Edwards, Adrian; Williams, Huw; Sheikh, Aziz; Parry, Gareth; Hibbert, Peter; Butlin, Amy; Donaldson, Liam; Carson-Stevens, Andrew

    2017-09-01

    A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. The extent of blame attribution in safety incident reports, which may reflect the underlying safety culture of health care systems, is unknown. This study set out to explore the nature of blame in family practice safety incident reports. We characterized a random sample of family practice patient safety incident reports from the England and Wales National Reporting and Learning System. Reports were analyzed according to prespecified classification systems to describe the incident type, contributory factors, outcomes, and severity of harm. We developed a taxonomy of blame attribution, and we then used descriptive statistical analyses to identify the proportions of blame types and to explore associations between incident characteristics and one type of blame. Health care professionals making family practice incident reports attributed blame to a person in 45% of cases (n = 975 of 2,148; 95% CI, 43%-47%). In 36% of cases, those who reported the incidents attributed fault to another person, whereas 2% of those reporting acknowledged personal responsibility. Blame was commonly associated with incidents where a complaint was anticipated. The high frequency of blame in these safety, incident reports may reflect a health care culture that leads to blame and retribution, rather than to identifying areas for learning and improvement, and a failure to appreciate the contribution of system factors in others' behavior. Successful improvement in patient safety through the analysis of incident reports is unlikely without achieving a blame-free culture. © 2017 Annals of Family Medicine, Inc.

  3. [Report of Cancer Incidence and Mortality in China, 2014].

    Science.gov (United States)

    Chen, W Q; Li, H; Sun, K X; Zheng, R S; Zhang, S W; Zeng, H M; Zou, X N; Gu, X Y; He, J

    2018-01-23

    Objective: The registration data of local cancer registries in 2014 were collected by National Central Cancer Registry (NCCR)in 2017 to estimate the cancer incidence and mortality in China. Methods: The data submitted from 449 registries were checked and evaluated, and the data of 339 registries out of them were qualified and selected for the final analysis. Cancer incidence and mortality were stratified by area, gender, age group and cancer type, and combined with the population data of 2014 to estimate cancer incidence and mortality in China. The age composition of standard population of Chinese census in 2000 and Segi's population were used for age-standardized incidence and mortality in China and worldwide, respectively. Results: Total covered population of 339 cancer registries (129 in urban and 210 in rural) in 2014 were 288 243 347 (144 061 915 in urban and 144 181 432 in rural areas). The mortality verified cases (MV%) were 68.01%. Among them, 2.19% cases were identified through death certifications only (DCO%), and the mortality to incidence ratio was 0.61. There were about 3, 804, 000 new cases diagnosed as malignant cancer and 2, 296, 000 cases dead in 2014 in the whole country. The incidence rate was 278.07/100, 000 (males 301.67/100, 000, females 253.29/100, 000) in China, age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population were 190.63/100, 000 and 186.53/100, 000, respectively, and the cumulative incidence rate (0-74 age years old) was 21.58%. The cancer incidence and ASIRC in urban areas were 302.13/100, 000 and 196.58/100, 000, respectively, whereas in rural areas, those were 248.94/100, 000 and 182.64/100, 000, respectively. The cancer mortality in China was 167.89/100, 000 (207.24/100, 000 in males and 126.54/100, 000 in females), age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population were 106.98/100, 000 and 106.09/100, 000, respectively. And

  4. Higher Levels of Albuminuria within the Normal Range Predict Incident Hypertension

    OpenAIRE

    Forman, John P.; Fisher, Naomi D.L.; Schopick, Emily L.; Curhan, Gary C.

    2008-01-01

    Higher levels of albumin excretion within the normal range are associated with cardiovascular disease in high-risk individuals. Whether incremental increases in urinary albumin excretion, even within the normal range, are associated with the development of hypertension in low-risk individuals is unknown. This study included 1065 postmenopausal women from the first Nurses’ Health Study and 1114 premenopausal women from the second Nurses’ Health Study who had an albumin/creatinine ratio

  5. Safety and Health Standard 110: Incident/accident reporting and investigation

    Energy Technology Data Exchange (ETDEWEB)

    Sones, K. [West Kootenay Power, BC (Canada)

    1999-10-01

    Incident/accident reporting requirements in effect at West Kootenay Power are discussed. Details provided include definitions of low risk, high risk, and critical events, the incidents to be reported, the nature of the reports, the timelines, the investigation to be undertaken for each type of incident/accident, counselling services available to employees involved in serious incidents, and the procedures to be followed in accidents involving serious injury to non-employees. The emphasis is on the `critical five` high risk events and the procedures relating to them.

  6. Higher incidence of nasopharyngeal carcinoma in some regions in the world confers for interplay between genetic factors and external stimuli.

    Science.gov (United States)

    Roy Chattopadhyay, Nabanita; Das, Piyanki; Chatterjee, Koustav; Choudhuri, Tathagata

    2017-01-01

    Nasopharyngeal carcinoma (NPC) is a rare variety of head and neck cancers. The risk factors include three major causes: genetic factors, viral infection, and environmental and dietary factors. The types of NPC show strong ethnic and geographic variations. The keratinizing and non-keratinizing types are prevalent in the lower incidence regions like North America and Europe; whereas the undifferentiated type is mostly found in the regions with higher incidences like China, North Africa, Arctic, and Nagaland of North-East India. These suggest a possible major role of the internal genetic factors for generation and promotion of this disease. Viral infections might accelerate the process of carcinogenesis by helping in cellular proliferation and loss of apoptosis. Diet and other environmental factors promote these neoplastic processes and further progression of the disease occurs.

  7. Health inequities: lower socio-economic conditions and higher incidences of intestinal parasites

    Directory of Open Access Journals (Sweden)

    Limoncu M Emin

    2007-11-01

    Full Text Available Abstract Background Intestinal parasitic infections affect child health and development and slow down growth, while reducing adults' productivity and work capacity. The aim of the present study was to determine and compare the incidences of intestinal parasitic infections and the socio-economic status of two near primary school children in Manisa, a western city of Turkey. Methods A total of 352 children were involved a questionnaire study from a private school (Ülkem Primary School – ÜPS, 116 children and a community-based school (Şehzadeler Primary School – ŞPS, 236 children. Of these, stool samples could be obtained from a total of 294 students; 97 (83.6% from ÜPS, and 197 (83.5% from ŞPS. The wet mount preparations of the stool samples were examined; samples were also fixed in polyvinyl alcohol and examined with modified formalin ethyl acetate sedimentation and trichrome staining techniques. Data were analyzed using SPSS for Windows version 10.0. The chi-squared test was used for the analytic assessment. Results The percentages of the students found to be infected with intestinal parasites, were 78 (39.6% and 13 (13.4% in ŞPS and ÜPS, respectively. Totally 91 (31.0% of the students from both schools were found to be infected with at least one intestinal parasite. Giardia lamblia was found to be the most common pathogenic intestinal parasite and Blastocystis hominis was prevalent independently from the hygienic conditions. The factors which significantly (p Conclusion Intestinal parasitic infections in school children were found to be a public health problem that increased due to lower socio-economic conditions. We conclude that organization of education seminars including the topics such as prevention of the infectious diseases, improving general hygienic conditions, and application of supportive programs for the parents may be suggested not only to reduce intestinal parasitic infections, but also to elevate the socio

  8. Quality Assurance in Transnational Higher Education. ENQA Workshop Report 11

    Science.gov (United States)

    Bennett, Paul; Bergan, Sjur; Cassar, Daniela; Hamilton, Marlene; Soinila, Michele; Sursock, Andree; Uvalic-Trumbic, Stamenka; Williams, Peter

    2010-01-01

    The present report is the product of an ENQA (European Association for Quality Assurance in Higher Education) Bologna Seminar "Quality Assurance in Transnational Education: from words to action" hosted by the Quality Assurance Agency (QAA, UK) in London in December, 2008. The seminar discussed the current trends in Transnational…

  9. Statistics Report on TEQSA Registered Higher Education Providers, 2016

    Science.gov (United States)

    Australian Government Tertiary Education Quality and Standards Agency, 2016

    2016-01-01

    This Statistics Report is the third release of selected higher education sector data held by the Australian Government Tertiary Education Quality and Standards Agency (TEQSA) for its quality assurance activities. It provides a snapshot of national statistics on all parts of the sector by bringing together data collected directly by TEQSA with data…

  10. 75 FR 75911 - Adjustment of Monetary Threshold for Reporting Rail Equipment Accidents/Incidents for Calendar...

    Science.gov (United States)

    2010-12-07

    ..., Notice No. 3] RIN 2130-ZA04 Adjustment of Monetary Threshold for Reporting Rail Equipment Accidents... (DOT). ACTION: Final rule. SUMMARY: This rule increases the rail equipment accident/incident reporting threshold from $9,200 to $9,400 for certain railroad accidents/incidents involving property damage that...

  11. Using Pareto Analysis with Trend Analysis: Statistical Techniques to Investigate Incident Reports within a Housing System

    Science.gov (United States)

    Luna, Andrew L.

    1998-01-01

    The purpose of this study was to determine trends and difficulties concerning student incident reports within the residence halls as they relate to the incident reporting system from the Department of Housing and Residential Life at a Southeastern Doctoral I Granting Institution. This study used the frequency distributions of each classified…

  12. Lessons for pediatric anesthesia from audit and incident reporting

    OpenAIRE

    Bell , Graham T

    2011-01-01

    Abstract This review will attempt to put the various systems that allow clinicians to assess errors, omissions or avoidable incidents into context and where possible, look for areas that deserve more or less attention and resource specifically for those of us who practice paediatric anaesthesia. Different approaches will be contrasted with respect to their outputs in terms of positive impact on the practice of anaesthesia. These approaches include audits by governmental organisatio...

  13. Agency procedures for the NRC incident response plan. Final report

    International Nuclear Information System (INIS)

    1983-02-01

    The NRC Incident Response Plan, NUREG-0728/MC 0502 describes the functions of the NRC during an incident and the kinds of actions that comprise an NRC response. The NRC response plan will be activated in accordance with threshold criteria described in the plan for incidents occurring at nuclear reactors and fuel facilities involving materials licensees; during transportation of licensed material, and for threats against facilities or licensed material. In contrast to the general overview provided by the Plan, the purpose of these agency procedures is to delineate the manner in which each planned response function is performed; the criteria for making those response decisions which can be preplanned; and the information and other resources needed during a response. An inexperienced but qualified person should be able to perform functions assigned by the Plan and make necessary decisions, given the specified information, by becoming familiar with these procedures. This rule of thumb has been used to determine the amount of detail in which the agency procedures are described. These procedures form a foundation for the training of response personnel both in their normal working environment and during planned emergency exercises. These procedures also form a ready reference or reminder checklist for technical team members and managers during a response

  14. Analysis of human factors in incidents reported by Swiss nuclear power plants to the inspectorate

    International Nuclear Information System (INIS)

    Alder, H.P.; Hausmann, W.

    1997-01-01

    197 reported incidents in Swiss Nuclear Power Plants were analyzed by a team of the Swiss Federal Nuclear Safety Inspectorate (HSK) using the OECD/NEA Incident Reporting System. The following conclusions could be drawn from this exercise. While the observed cause reported by the plant was ''technical failure'' in about 90% of the incidents, the HSK-Team identified for more than 60% of the incidents ''human factors'' as the root cause. When analyzing this root cause further it was shown that only a smaller contribution came from the side of the operators and the more important shares were caused by plant maintenance, vendors/constructors and plant management with procedural and organizational deficiencies. These findings demonstrate that root cause analysis of incidents by the IRS-Code is a most useful tool to analyze incidents and to find weak points in plant performance. (author). 5 tabs

  15. Piloting violence and incident reporting measures on one acute mental health inpatient unit.

    Science.gov (United States)

    Woods, Phil; Ashley, Carolyn; Kayto, Denise; Heusdens, Carol

    2008-05-01

    During May, 2006, on one acute mental health inpatient unit, nursing staff evaluated each patient three times a day (i.e., once each nursing shift) using the Broset Violence Checklist (BVC). Associated data were collected using the Staff Observation and Aggression Scale-Revised (SOAS-R) if an adverse incident occurred. At the end of the data collection period, the nursing staff were asked to complete a short questionnaire anonymously to evaluate how useful they had found the instruments. N = 93 patients were admitted to the unit during the month of study. Seven incidents were reported using the SOAS-R. A slight trend was noted for higher BVC score in aggressive patients. A potential high occurrence of underreporting on incidents was observed. There was limited feedback data from nursing staff at the end of the study, but the responses received were encouraging for continued use of the instruments in practice. The pilot study fulfilled its purpose in two ways. First, it allowed staff on the unit to experience using structured instruments to support their practice. Second, it allowed an opportunity to raise awareness of potential underreporting and tolerance of aggression on the unit.

  16. Survey of reportable incidents in nuclear power plants in Germany in the year 1992

    International Nuclear Information System (INIS)

    1993-01-01

    In 1992, 223 reportable incidents in German nuclear power plant have been reported. There was no radioactivity release exceeding the maximum permissible limits, and there were no hazardous effects on the population or the environment. There was no incident belonging to category S of the official event scale, requiring urgent notification, while there were two incidents requiring immediate notification. All other incidents reported belonged to category N, the lowest on the scale, requiring normal notification. 216 incidents belonged to category 0 of the INES scale, and 7 to INES category 1 (disturbance). The tabulated survey of the report lists the various events and their position on the INES scale. The reportable events have been analysed thoroughly from various viewpoints, but no systematic pattern of weak points could be detected. (orig./HP) [de

  17. 78 FR 38803 - Pipeline Safety: Information Collection Activities, Revisions to Incident and Annual Reports for...

    Science.gov (United States)

    2013-06-27

    ... Reports for Gas Pipeline Operators AGENCY: Pipeline and Hazardous Materials Safety Administration (PHMSA... DEPARTMENT OF TRANSPORTATION Pipeline and Hazardous Materials Safety Administration [Docket No... (OMB) Control No. 2137-0522, titled ``Incident and Annual Reports for Gas Pipeline Operators.'' PHMSA...

  18. Flight Attendant Fatigue. Part IV. Analysis of Incident Reports

    Science.gov (United States)

    2009-12-01

    arrangements were made, and I flew to Los Angeles. I went directly to my physician (internal medicine/cardiologist). he gave me an ekg and performed blood...had told us that we were a minimum crew of 5 and that 2 deadheaders on the flight had been informed that they would be our #3 and #5. She read out...incident, there are at least 2 or 3 that go unreported! I hope that there is someone who reads this who actually cares, because the supposed leaders

  19. Birds oiled during the Amoco Cadiz incident: an interim report

    Energy Technology Data Exchange (ETDEWEB)

    Jones, P.H.; Monnat, J.Y.; Cadbury, C.J.; Stowe, T.J.

    1978-11-01

    More than 4500 oiled birds were collected from beaches in Northwest France and the Channel Islands following the oil spillage from the super tanker Amoco Cadiz in March 1978. Some 33 bird species were recorded oiled. A notable feature of the incident was the high proportion of puffins among the birds known to have been oiled. In normal years, puffins are considered to be relatively uncommon off Brittany in spring, and so the high proportion of this species among the casualties was unexpected. A relatively large number of shags and divers were also oiled. (1 map, 8 references, 2 tables)

  20. Pilot Critical Incident Reports as a Means to Identify Human Factors of Remotely Piloted Aircraft

    Science.gov (United States)

    Hobbs, Alan; Cardoza, Colleen; Null, Cynthia

    2016-01-01

    It has been estimated that aviation accidents are typically preceded by numerous minor incidents arising from the same causal factors that ultimately produced the accident. Accident databases provide in-depth information on a relatively small number of occurrences, however incident databases have the potential to provide insights into the human factors of Remotely Piloted Aircraft System (RPAS) operations based on a larger volume of less-detailed reports. Currently, there is a lack of incident data dealing with the human factors of unmanned aircraft systems. An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. During each focus group session, a note taker produced a de-identified written record of the incident narratives. At the end of the session, participants reviewed each written incident report, and made edits and corrections as necessary. The incidents were later analyzed to identify contributing factors, with a focus on design issues that either hindered or assisted the pilot during the events. A total of 90 incidents were reported. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies. Pilots participated willingly and enthusiastically in the study

  1. Incidence of adult brain cancers is higher in countries where the protozoan parasite Toxoplasma gondii is common

    Science.gov (United States)

    Thomas, Frédéric; Lafferty, Kevin D.; Brodeur, Jacques; Elguero, Eric; Gauthier-Clerc, Michel; Missé, Dorothée

    2012-01-01

    We explored associations between the common protozoan parasite Toxoplasma gondii and brain cancers in human populations. We predicted that T. gondii could increase the risk of brain cancer because it is a long-lived parasite that encysts in the brain, where it provokes inflammation and inhibits apoptosis. We used a medical geography approach based on the national incidence of brain cancers and seroprevalence of T. gondii. We corrected reports of incidence for national gross domestic product because wealth probably increases the ability to detect cancer. We also included gender, cell phone use and latitude as variables in our initial models. Prevalence of T. gondii explained 19 per cent of the residual variance in brain cancer incidence after controlling for the positive effects of gross domestic product and latitude among nations. Infection with T. gondii was associated with a 1.8-fold increase in the risk of brain cancers across the range of T. gondii prevalence in our dataset (4–67%). These results, though correlational, suggest that T. gondii should be investigated further as a possible oncogenic pathogen of humans.

  2. A Profile of Criminal Incidents at School: Results from the 2003-05 National Crime Victimization Survey Crime Incident Report NCES 2010-318

    Science.gov (United States)

    Ruddy, Sally A.; Bauer, Lynn; Neiman, Samantha

    2010-01-01

    This report provides estimates of criminal incidents that occur at school. Incident-level data were obtained from the National Crime Victimization Survey (NCVS), the nation's primary source of information on criminal victimization and criminal incidents in the United States. The NCVS collects demographic information on respondents in the NCVS…

  3. Elevated incidence rates of diabetes in Peru: report from PERUDIAB, a national urban population-based longitudinal study.

    Science.gov (United States)

    Seclen, Segundo Nicolas; Rosas, Moises Ernesto; Arias, Arturo Jaime; Medina, Cecilia Alexandra

    2017-01-01

    A recent report from a non-nationally representative, geographically diverse sample in four separate communities in Peru suggests an unusually high diabetes incidence. We aimed to estimate the national diabetes incidence rate using PERUDIAB, a probabilistic, national urban population-based longitudinal study. 662 subjects without diabetes, selected by multistage, cluster, random sampling of households, representing the 24 administrative and the 3 (coast, highlands and jungle) natural regions across the country, from both sexes, aged 25+ years at baseline, enrolled in 2010-2012, were followed for 3.8 years. New diabetes cases were defined as fasting blood glucose ≥126 mg/dL or on medical diabetes treatment. There were 49 cases of diabetes in 2408 person-years follow-up. The weighted cumulative incidence of diabetes was 7.2% while the weighted incidence rate was estimated at 19.5 (95% CI 13.9 to 28.3) new cases per 1000 person-years. Older age, obesity and technical or higher education were statistically associated with the incidence of diabetes. Our results confirm that the incidence of diabetes in Peru is among the highest reported globally. The fast economic growth in the last 20 years, high overweight and obesity rates may have triggered this phenomenon.

  4. Cutaneous contamination after a uranyl nitrate skin burn: incident report

    International Nuclear Information System (INIS)

    Berard, P.; Chalabreysse, J.; Quesne, B.; Auriol, B.

    1994-01-01

    The authors review the circumstances of a handburn incident by a mixture of dilute nitric acid and uranyl nitrate. The burn was localised on the thumb and three fingers of the left hand. After abundant washing, external direct measurements revealed the presence of uranium on the fingers. The injured employee was maintained under observation for ten days, and therapy was performed until all the activity disappeared. External monitoring with various detectors, and measurements of the bandages and skin showed a rapid decrease of uranium fixation. All urine was collected throughout the duration of the treatment. The study shows that all the activity was retained on the burnt skin, with very little systemic uptake. Rapid peeling eliminated the cutaneous retention. Internal and external dose assessments were calculated and the committed effective dose equivalent and the committed dose equivalent for the skin and bone surfaces were low. (author)

  5. E-Community: Mobile application for reporting incidents of public services of a city

    OpenAIRE

    Jaime Suárez; Elvia Aispuro; Mónica Carreño; Andrés Sandoval; Italia Estrada; Jesús Hernández; Javier Aguilar; Yoshio Valles; Emma Ibarra

    2013-01-01

    This paper reports the mobile application call E-Community, an application of a social nature with the objective that the civilian population in the city of La Paz, Baja California Sur, Mexico, have an alternative to report incidents that deal with services public. Generally, citizens reported by telephone different types of incidents such as traffic accidents, water leaks, lighting shabby, fire, garbage collection, however sometimes the phone is not attended for various reasons so regularly ...

  6. 77 FR 69925 - Assessment of Hazardous Materials Incident Data Collection, Analysis, Reporting, and Use

    Science.gov (United States)

    2012-11-21

    ...), 126 Stat. 835, July 6, 2012) requires the Department to conduct an assessment to improve the... adequacy of and suggestions for improvement to: 1. Information requested on the accident and incident... technology; and 5. The database used by PHMSA for recording and reporting such accidents and incidents...

  7. Cancer incidence in south-east Nigeria: a report from Nnewi Cancer ...

    African Journals Online (AJOL)

    Background: This study is the first population based cancer incidence report from a cancer registry in south-east Nigeria. Objective: To evaluate the incidence of some invasive cancers in southeast Nigeria. Methodology: We collected all new cases of invasive cancers between 1st January and 31st December, 2013.

  8. Learning from Errors: Critical Incident Reporting in Nursing

    Science.gov (United States)

    Gartmeier, Martin; Ottl, Eva; Bauer, Johannes; Berberat, Pascal Oliver

    2017-01-01

    Purpose: The purpose of this paper is to conceptualize error reporting as a strategy for informal workplace learning and investigate nurses' error reporting cost/benefit evaluations and associated behaviors. Design/methodology/approach: A longitudinal survey study was carried out in a hospital setting with two measurements (time 1 [t1]:…

  9. Operating Experience from Events Reported to the IAEA Incident Reporting System for Research Reactors

    International Nuclear Information System (INIS)

    2015-03-01

    Operating experience feedback is an effective mechanism in providing lessons learned from events and the associated corrective actions to prevent them, helping to improve safety at nuclear installations. The Incident Reporting System for Research Reactors (IRSRR), which is operated by the IAEA, is an important tool for international exchange of operating experience feedback for research reactors. The IRSRR reports contain information on events of safety significance with their root causes and lessons learned which help in reducing the occurrence of similar events at research reactors. To improve the effectiveness of the system, it is essential that national organizations demonstrate an appropriate interest for the timely reporting of events important to safety and share the information in the IRSRR database. At their biennial technical meetings, the IRSRR national coordinators recommended collecting the operating experience from the events reported to the IRSRR and disseminating it in an IAEA publication. This publication highlights the root causes, safety significance, lessons learned, corrective actions and the causal factors for the events reported to the IRSRR up to September 2014. The publication also contains relevant summary information on research reactor events from sources other than the IRSRR, operating experience feedback from the International Reporting System for Operating Experience considered relevant to research reactors, and a description of the elements of an operating experience programme as established by the IAEA safety standards. This publication will be of use to research reactor operating organizations, regulators and designers, and any other organizations or individuals involved in the safety of research reactors

  10. SU-E-T-511: Inter-Rater Variability in Classification of Incidents in a New Incident Reporting System

    International Nuclear Information System (INIS)

    Pappas, D; Reis, S; Ali, A; Kapur, A

    2015-01-01

    Purpose To determine how consistent the results of different raters are when reviewing the same cases within the Radiation Oncology Incident Learning System (ROILS). Methods Three second-year medical physics graduate students filled out incident reports in spreadsheets set up to mimic ROILS. All students studied the same 33 cases and independently entered their assessments, for a total of 99 reviewed cases. The narratives for these cases were obtained from a published International Commission on Radiological Protection (ICRP) report which included shorter narratives selected from the Radiation Oncology Safety Information System (ROSIS) database. Each category of questions was reviewed to see how consistent the results were by utilizing free-marginal multirater kappa analysis. The percentage of cases where all raters shared full agreement or full disagreement was recorded to show which questions were answered consistently by multiple raters for a given case. The consistency among the raters was analyzed between ICRP and ROSIS cases to see if either group led to more reliable results. Results The categories where all raters agreed 100 percent in their choices were the event type (93.94 percent of cases 0.946 kappa) and the likelihood of the event being harmful to the patient (42.42 percent of cases 0.409 kappa). The categories where all raters disagreed 100 percent in their choices were the dosimetric severity scale (39.39 percent of cases 0.139 kappa) and the potential future toxicity (48.48 percent of cases 0.205 kappa). ROSIS had more cases where all raters disagreed than ICRP (23.06 percent of cases compared to 15.58 percent, respectively). Conclusion Despite reviewing the same cases, the results among the three raters was widespread. ROSIS narratives were shorter than ICRP, which suggests that longer narratives lead to more consistent results. This study shows that the incident reporting system can be optimized to yield more consistent results

  11. SU-E-T-511: Inter-Rater Variability in Classification of Incidents in a New Incident Reporting System

    Energy Technology Data Exchange (ETDEWEB)

    Pappas, D; Reis, S; Ali, A [Hofstra University, Hempstead, NY (United States); Kapur, A [Long Island Jewish Medical Center, New Hyde Park, NY (United States)

    2015-06-15

    Purpose To determine how consistent the results of different raters are when reviewing the same cases within the Radiation Oncology Incident Learning System (ROILS). Methods Three second-year medical physics graduate students filled out incident reports in spreadsheets set up to mimic ROILS. All students studied the same 33 cases and independently entered their assessments, for a total of 99 reviewed cases. The narratives for these cases were obtained from a published International Commission on Radiological Protection (ICRP) report which included shorter narratives selected from the Radiation Oncology Safety Information System (ROSIS) database. Each category of questions was reviewed to see how consistent the results were by utilizing free-marginal multirater kappa analysis. The percentage of cases where all raters shared full agreement or full disagreement was recorded to show which questions were answered consistently by multiple raters for a given case. The consistency among the raters was analyzed between ICRP and ROSIS cases to see if either group led to more reliable results. Results The categories where all raters agreed 100 percent in their choices were the event type (93.94 percent of cases 0.946 kappa) and the likelihood of the event being harmful to the patient (42.42 percent of cases 0.409 kappa). The categories where all raters disagreed 100 percent in their choices were the dosimetric severity scale (39.39 percent of cases 0.139 kappa) and the potential future toxicity (48.48 percent of cases 0.205 kappa). ROSIS had more cases where all raters disagreed than ICRP (23.06 percent of cases compared to 15.58 percent, respectively). Conclusion Despite reviewing the same cases, the results among the three raters was widespread. ROSIS narratives were shorter than ICRP, which suggests that longer narratives lead to more consistent results. This study shows that the incident reporting system can be optimized to yield more consistent results.

  12. Plutonium Reclamation Facility incident response project progress report

    International Nuclear Information System (INIS)

    Austin, B.A.

    1997-01-01

    This report provides status of Hanford activities in response to process deficiencies highlighted during and in response to the May 14, 1997, explosion at the Plutonium Reclamation Facility. This report provides specific response to the August 4, 1997, memorandum from the Secretary which requested a progress report, in 120 days, on activities associated with reassessing the known and evaluating new vulnerabilities (chemical and radiological) at facilities that have been shut down, are in standby, are being deactivated or have otherwise changed their conventional mode of operation in the last several years. In addition, this report is intended to provide status on emergency response corrective activities as requested in the memorandum from the Secretary on August 28, 1997. Status is also included for actions requested in the second August 28, 1997, memorandum from the Secretary, regarding timely notification of emergencies

  13. Plutonium Reclamation Facility incident response project progress report

    Energy Technology Data Exchange (ETDEWEB)

    Austin, B.A.

    1997-11-25

    This report provides status of Hanford activities in response to process deficiencies highlighted during and in response to the May 14, 1997, explosion at the Plutonium Reclamation Facility. This report provides specific response to the August 4, 1997, memorandum from the Secretary which requested a progress report, in 120 days, on activities associated with reassessing the known and evaluating new vulnerabilities (chemical and radiological) at facilities that have been shut down, are in standby, are being deactivated or have otherwise changed their conventional mode of operation in the last several years. In addition, this report is intended to provide status on emergency response corrective activities as requested in the memorandum from the Secretary on August 28, 1997. Status is also included for actions requested in the second August 28, 1997, memorandum from the Secretary, regarding timely notification of emergencies.

  14. The Diffuse Involvement of Bilateral Breasts in the Incidence of Burkitt's Lymphoma: A Case Report

    International Nuclear Information System (INIS)

    Lee, Myung Su; Lee, Sa Rah; Yang, Woo Ick; Kim, Eun Kyung; Jung, Hae Kyoung

    2009-01-01

    The incidence of Burkitt's lymphoma involving both breasts is rare. We report such a case that was diagnosed by a core biopsy of a hypoechoic lesion visualized from the ultrasonographic results of a patient that was clinically suspected of mastitis

  15. Report: Improvements Needed in CSB’s Identity and Access Management and Incident Response Security Functions

    Science.gov (United States)

    Report #18-P-0030, October 30, 2017. Weaknesses in the Identity and Access Management and Incident Response metric domains leave the CSB vulnerable to attacks occurring and not being detected in a timely manner.

  16. Department of Veterans Affairs - Monthly Report to Congress of Data Incidents (April 2014)

    Data.gov (United States)

    Department of Veterans Affairs — This is a monthly report that the VA Office of Information Technology provides to congress about data incidents that took place during the month (April 2014). The...

  17. Change in Reported Lyme Disease Incidence in the Northeast and Upper Midwest, 1991-2014

    Data.gov (United States)

    U.S. Environmental Protection Agency — This indicator shows how reported Lyme disease incidence has changed by state since 1991, based on the number of new cases per 100,000 people. The total change has...

  18. Physicians' and Nurses' Perceptions of and Attitudes Toward Incident Reporting in Palestinian Hospitals.

    Science.gov (United States)

    Rashed, Anan; Hamdan, Motasem

    2015-06-22

    Underreporting of incidents that happen in health care services undermines the ability of the systems to improve patient safety. This study assessed the attitudes of physicians and nurses toward incident reporting and the factors influencing reporting in Palestinian hospitals. It also examined clinicians' views about the preferred features of incident reporting system. Cross-sectional self-administered survey of 475 participants, 152 physicians and 323 nurses, from 11 public hospitals in the West Bank; response rate, 81.3%. There was a low level of event reporting among participants in the past year (40.3%). Adjusted for sex and age, physicians were 2.1 times more likely to report incidents than nurses (95% confidence interval, 1.32-3.417; P = 0.002). Perceived main barriers for reporting were grouped under lack of proper structure for reporting, prevalence of blame, and punitive environment. The clinicians indicated fear of administrative sanctions, social and legal liability, and of their competence being questioned (P > 0.05). Getting help for patients, learning from mistakes, and ethical obligation were equally indicated motivators for reporting (P > 0.05). Meanwhile, clinicians prefer formal reporting (77.8%) of all type of errors (65.5%), disclosure of reporters (52.7%), using reports to improve patient safety (80.3%), and willingness to report to immediate supervisors (57.6%). Clinicians acknowledge the importance of reporting incidents; however, prevalence of punitive culture and inadequate reporting systems are key barriers. Improving feedback about reported errors, simplifying procedures, providing clear guidelines on what and who should report, and avoiding blame are essential to enhance reporting. Moreover, health care organizations should consider the opinions of the clinicians in developing reporting systems.

  19. Perceptions of Police Legitimacy and Citizen Decisions to Report Hate Crime Incidents in Australia

    Directory of Open Access Journals (Sweden)

    Susann Wiedlitzka

    2018-06-01

    Full Text Available This article examines the importance of perceptions of police legitimacy in the decision to report hate crime incidents in Australia. It addresses an identified gap in the literature by analysing the 2011-2012 National Security and Preparedness Survey (NSPS results to not only explore differences between hate crime and non-hate crime reporting but also how individual characteristics and perceptions of legitimacy influence decisions about reporting crime to police. Using the NSPS survey data, we created three Generalised Linear Latent and Mixed Models (Gllamm, which explore the influence of individual characteristics and potential barriers on the decision to report crime/hate crime incidents to police. Our results suggest that hate crimes are less likely to be reported to police in comparison to non-hate crime incidents, and that more positive perceptions of police legitimacy and police cooperation are associated with the victim’s decision to report hate crime victimisation.

  20. 40 CFR 1612.3 - Published reports and material contained in the public incident investigation dockets.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Published reports and material... Published reports and material contained in the public incident investigation dockets. (a) Demands for published investigation reports should be directed to the Office of Congressional and Public Affairs, U.S...

  1. 14 CFR 234.13 - Reports by air carriers on incidents involving animals during air transport.

    Science.gov (United States)

    2010-01-01

    ... involving animals during air transport. 234.13 Section 234.13 Aeronautics and Space OFFICE OF THE SECRETARY... REPORTS § 234.13 Reports by air carriers on incidents involving animals during air transport. (a) Any air... during air transport provided by the air carrier. (b) The report shall be made in the form and manner set...

  2. Analysis of human factor aspects in connection with available incident reports obligatorily reported by German nuclear power plants

    International Nuclear Information System (INIS)

    Wilpert, B.; Freitag, M.; Miller, R.

    1993-01-01

    Goal of the present study is the analysis of human factor aspects in connection with available incident reports obligatorily reported by German nuclear power plants. Based on psychological theories and empirical studies this study develops a classification scheme which permits the identification of foci of erroneous human actions. This classification scheme is applied to a selection of human factor relevant incidents by calculating frequencies of the occurrence of human error categories. The results allow insights into human factor related problem areas. (orig.) [de

  3. The incidence of urinary tract cancers is related to preserved diuresis: a single-center report.

    Science.gov (United States)

    Premuzic, Vedran; Gamulin, Marija; Coric, Marijana; Jelakovic, Bojan

    2017-12-01

    Residual diuresis progressively decreases with longer dialysis vintage, and higher incidence of renal and urinary tract cancers was often observed in hemodialyzed patients compared to the general population so we hypothesized that patients without preserved residual diuresis have higher risk of renal and urinary tract cancers than patients with preserved residual diuresis. Retrospective clinical data and pathology reports were completed for 307 uremic patients undergoing chronic hemodialysis. Patients were divided into two subgroups regarding residual diuresis: the first group with residual diuresis  500 mL. Site- and type-specific cancers in our population of ESRD patients were all localized in estrogen-positive receptor organs. The increased risk of all types of urinary tract cancers occurred in the whole group, men and women, when compared to general population. There were a significantly higher number of patients with all types of cancers in the group with residual diuresis  500 mL. Importantly, all urinary tract cancers were present in patients with residual diuresis urinary tract cancers found in ESRD patients undergoing chronic hemodialysis is associated with lost residual diuresis. Residual diuresis in these patients might be considered a risk marker for future urinary tract cancers as well as already established markers.

  4. Statistical analysis of incidents reported in the Greek Petrochemical Industry for the period 1997-2003

    International Nuclear Information System (INIS)

    Konstandinidou, Myrto; Nivolianitou, Zoe; Markatos, Nikolaos; Kiranoudis, Chris

    2006-01-01

    This paper makes an analysis of all reported accidents and incidents in the Greek Petrochemical Industry for the period spanning from 1997 to 2003. The work performed is related to the analysis of important parameters of the incidents, their inclusion in a database adequately designed for the purposes of this analysis and an importance assessment of this reporting scheme. Indeed, various stakeholders have highlighted the importance of a reporting system for industrial accidents and incidents. The European Union has established for this purpose the Major Accident Reporting System (MARS) for the reporting of major accidents in the Member States. However, major accidents are not the only measure that can characterize the safety status of an establishment; neither are the former the only events from which important lessons can be learned. Near misses, industrial incidents without major consequences, as well as occupational accidents could equally supply with important findings the interested analyst, while statistical analysis of these incidents could give significant insight in the understanding and the prevention of similar incidents or major accidents in the future. This analysis could be more significant, if each industrial sector was separately analyzed, as the authors do for the petrochemical sector in the present article

  5. Incident reporting: Its role in aviation safety and the acquisition of human error data

    Science.gov (United States)

    Reynard, W. D.

    1983-01-01

    The rationale for aviation incident reporting systems is presented and contrasted to some of the shortcomings of accident investigation procedures. The history of the United State's Aviation Safety Reporting System (ASRS) is outlined and the program's character explained. The planning elements that resulted in the ASRS program's voluntary, confidential, and non-punitive design are discussed. Immunity, from enforcement action and misuse of the volunteered data, is explained and evaluated. Report generation techniques and the ASRS data analysis process are described; in addition, examples of the ASRS program's output and accomplishments are detailed. Finally, the value of incident reporting for the acquisition of safety information, particularly human error data, is explored.

  6. The Incidence of Human Papillomavirus in Tanzanian Adolescent Girls Before Reported Sexual Debut.

    Science.gov (United States)

    Houlihan, Catherine F; Baisley, Kathy; Bravo, Ignacio G; Kapiga, Saidi; de Sanjosé, Silvia; Changalucha, John; Ross, David A; Hayes, Richard J; Watson-Jones, Deborah

    2016-03-01

    Acquisition of human papillomavirus (HPV) in women occurs predominantly through vaginal sex. However, HPV has been detected in girls reporting no previous sex. We aimed to determine incidence and risk factors for HPV acquisition in girls who report no previous sex in Tanzania, a country with high HPV prevalence and cervical cancer incidence. We followed 503 adolescent girls aged 15-16 years in Mwanza, Tanzania, with face-to-face interviews and self-administered vaginal swabs every 3 months for 18 months; 397 girls reported no sex before enrollment or during follow-up; of whom, 120 were randomly selected. Samples from enrollment, 6-, 12-, and 18-month visits were tested for 37 HPV genotypes. Incidence, clearance, point prevalence, and duration of any HPV and genotype-specific infections were calculated and associated factors were evaluated. Of 120 girls who reported no previous sex, 119 were included, contributing 438 samples. HPV was detected in 51 (11.6%) samples. The overall incidence of new HPV infections was 29.4/100 person-years (95% confidence interval: 15.9-54.2). The point prevalence of vaccine types HPV-6,-11,-16, and -18 was .9%, .9%, 2.0%, and 0%, respectively. Spending a night away from home and using the Internet were associated with incident HPV, and reporting having seen a pornographic movie was inversely associated with HPV incidence. Incident HPV infections were detected frequently in adolescent girls who reported no previous sex over 18 months. This is likely to reflect under-reporting of sex. A low-point prevalence of HPV genotypes in licensed vaccines was seen, indicating that vaccination of these girls might still be effective. Copyright © 2016 Society for Adolescent Health and Medicine. All rights reserved.

  7. Using multiclass classification to automate the identification of patient safety incident reports by type and severity.

    Science.gov (United States)

    Wang, Ying; Coiera, Enrico; Runciman, William; Magrabi, Farah

    2017-06-12

    Approximately 10% of admissions to acute-care hospitals are associated with an adverse event. Analysis of incident reports helps to understand how and why incidents occur and can inform policy and practice for safer care. Unfortunately our capacity to monitor and respond to incident reports in a timely manner is limited by the sheer volumes of data collected. In this study, we aim to evaluate the feasibility of using multiclass classification to automate the identification of patient safety incidents in hospitals. Text based classifiers were applied to identify 10 incident types and 4 severity levels. Using the one-versus-one (OvsO) and one-versus-all (OvsA) ensemble strategies, we evaluated regularized logistic regression, linear support vector machine (SVM) and SVM with a radial-basis function (RBF) kernel. Classifiers were trained and tested with "balanced" datasets (n_ Type  = 2860, n_ SeverityLevel  = 1160) from a state-wide incident reporting system. Testing was also undertaken with imbalanced "stratified" datasets (n_ Type  = 6000, n_ SeverityLevel =5950) from the state-wide system and an independent hospital reporting system. Classifier performance was evaluated using a confusion matrix, as well as F-score, precision and recall. The most effective combination was a OvsO ensemble of binary SVM RBF classifiers with binary count feature extraction. For incident type, classifiers performed well on balanced and stratified datasets (F-score: 78.3, 73.9%), but were worse on independent datasets (68.5%). Reports about falls, medications, pressure injury, aggression and blood products were identified with high recall and precision. "Documentation" was the hardest type to identify. For severity level, F-score for severity assessment code (SAC) 1 (extreme risk) was 87.3 and 64% for SAC4 (low risk) on balanced data. With stratified data, high recall was achieved for SAC1 (82.8-84%) but precision was poor (6.8-11.2%). High risk incidents (SAC2) were confused

  8. Higher incidence of death in multi-vessel coronary artery disease patients associated with polymorphisms in chromosome 9p21

    Directory of Open Access Journals (Sweden)

    Gioli-Pereira Luciana

    2012-08-01

    Full Text Available Abstract Background We investigated whether 9p21 polymorphisms are associated with cardiovascular events in a group of 611 patients enrolled in the Medical, Angioplasty or Surgery Study II (MASS II, a randomized trial comparing treatments for patients with coronary artery disease (CAD and preserved left ventricular function. Methods The participants of the MASS II were genotyped for 9p21 polymorphisms (rs10757274, rs2383206, rs10757278 and rs1333049. Survival curves were calculated with the Kaplan–Meier method and compared with the log-rank statistic. We assessed the relationship between baseline variables and the composite end-point of death, death from cardiac causes and myocardial infarction using a Cox proportional hazards survival model. Results We observed significant differences between patients within each polymorphism genotype group for baseline characteristics. The frequency of diabetes was lower in patients carrying GG genotype for rs10757274, rs2383206 and rs10757278 (29.4%, 32.8%, 32.0% compared to patients carrying AA or AG genotypes (49.1% and 39.2%, p = 0.01; 52.4% and 40.1%, p = 0.01; 47.8% and 37.9%, p = 0.04; respectively. Significant differences in genotype frequencies between double and triple vessel disease patients were observed for the rs10757274, rs10757278 and rs1333049. Finally, there was a higher incidence of overall mortality in patients with the GG genotype for rs2383206 compared to patients with AA and AG genotypes (19.5%, 11.9%, 11.0%, respectively; p = 0.04. Moreover, the rs2383206 was still significantly associated with a 1.75-fold increased risk of overall mortality (p = 0.02 even after adjustment of a Cox multivariate model for age, previous myocardial infarction, diabetes, smoking and type of coronary anatomy. Conclusions Our data are in accordance to previous evidence that chromosome 9p21 genetic variation may constitute a genetic modulator in the cardiovascular system in different

  9. Critical Steps in Learning From Incidents: Using Learning Potential in the Process From Reporting an Incident to Accident Prevention

    NARCIS (Netherlands)

    Drupsteen, L.; Groeneweg, J.; Zwetsloot, G.I.J.M.

    2013-01-01

    Many incidents have occurred because organisations have failed to learn from lessons of the past. This means that there is room for improvement in the way organisations analyse incidents, generate measures to remedy identified weaknesses and prevent reoccurrence: the learning from incidents process.

  10. Development and test of a classification scheme for human factors in incident reports

    International Nuclear Information System (INIS)

    Miller, R.; Freitag, M.; Wilpert, B.

    1997-01-01

    The Research Center System Safety of the Berlin University of Technology conducted a research project on the analysis of Human Factors (HF) aspects in incident reported by German Nuclear Power Plants. Based on psychological theories and empirical studies a classification scheme was developed which permits the identification of human involvement in incidents. The classification scheme was applied in an epidemiological study to a selection of more than 600 HF - relevant incidents. The results allow insights into HF related problem areas. An additional study proved that the application of the classification scheme produces results which are reliable and independent from raters. (author). 13 refs, 1 fig

  11. Dropout and completion in higher education in Europe: main report

    NARCIS (Netherlands)

    Vossensteyn, Johan J.; Kottmann, Andrea; Jongbloed, Benjamin W.A.; Kaiser, Franciscus; Cremonini, Leon; Stensaker, Bjorn; Hovdhaugen, Elisabeth; Wollscheid, Sabine

    2015-01-01

    Improving completion and reducing dropout in higher education are key concerns for higher education in Europe. This study on dropout and completion in higher education in Europe demonstrates that national governments and higher education institutions use three different study success objectives:

  12. FY-2016 Methyl Iodide Higher NOx Adsorption Test Report

    Energy Technology Data Exchange (ETDEWEB)

    Soelberg, Nicholas Ray [Idaho National Lab. (INL), Idaho Falls, ID (United States); Watson, Tony Leroy [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2016-09-01

    Deep-bed methyl iodide adsorption testing has continued in Fiscal Year 2016 under the Department of Energy (DOE) Fuel Cycle Technology (FCT) Program Offgas Sigma Team to further research and advance the technical maturity of solid sorbents for capturing iodine-129 in off-gas streams during used nuclear fuel reprocessing. Adsorption testing with higher levels of NO (approximately 3,300 ppm) and NO2 (up to about 10,000 ppm) indicate that high efficiency iodine capture by silver aerogel remains possible. Maximum iodine decontamination factors (DFs, or the ratio of iodine flowrate in the sorbent bed inlet gas compared to the iodine flowrate in the outlet gas) exceeded 3,000 until bed breakthrough rapidly decreased the DF levels to as low as about 2, when the adsorption capability was near depletion. After breakthrough, nearly all of the uncaptured iodine that remains in the bed outlet gas stream is no longer in the form of the original methyl iodide. The methyl iodide molecules are cleaved in the sorbent bed, even after iodine adsorption is no longer efficient, so that uncaptured iodine is in the form of iodine species soluble in caustic scrubber solutions, and detected and reported here as diatomic I2. The mass transfer zone depths were estimated at 8 inches, somewhat deeper than the 2-5 inch range estimated for both silver aerogels and silver zeolites in prior deep-bed tests, which had lower NOx levels. The maximum iodine adsorption capacity and silver utilization for these higher NOx tests, at about 5-15% of the original sorbent mass, and about 12-35% of the total silver, respectively, were lower than for trends from prior silver aerogel and silver zeolite tests with lower NOx levels. Additional deep-bed testing and analyses are recommended to expand the database for organic iodide adsorption and increase the technical maturity if iodine adsorption processes.

  13. Community pharmacy incident reporting: a new tool for community pharmacies in Canada.

    Science.gov (United States)

    Ho, Certina; Hung, Patricia; Lee, Gary; Kadija, Medina

    2010-01-01

    Incident reporting offers insight into a variety of intricate processes in healthcare. However, it has been found that medication incidents are under reported in the community pharmacy setting. The Community Pharmacy Incident Reporting (CPhIR) program was created by the Institute for Safe Medication Practices Canada specifically for incident reporting in the community pharmacy setting in Canada. The initial development of key elements for CPhIR included several focus-group teleconferences with pharmacists from Ontario and Nova Scotia. Throughout the development and release of the CPhIR pilot, feedback from pharmacists and pharmacy technicians was constantly incorporated into the reporting program. After several rounds of iterative feedback, testing and consultation with community pharmacy practitioners, a final version of the CPhIR program, together with self-directed training materials, is now ready to launch. The CPhIR program provides users with a one-stop platform to report and record medication incidents, export data for customized analysis and view comparisons of individual and aggregate data. These unique functions allow for a detailed analysis of underlying contributing factors in medication incidents. A communication piece for pharmacies to share their experiences is in the process of development. To ensure the success of the CPhIR program, a patient safety culture must be established. By gaining a deeper understanding of possible causes of medication incidents, community pharmacies can implement system-based strategies for quality improvement and to prevent potential errors from occurring again in the future. This article highlights key features of the CPhIR program that will assist community pharmacies to improve their drug distribution system and, ultimately, enhance patient safety.

  14. Diversity Leadership in Higher Education. ASHE Higher Education Report, Volume 32, Number 3

    Science.gov (United States)

    Aguirre, Adalberto, Jr., Ed.; Martinez, Ruben O., Ed.

    2006-01-01

    This monograph examines and discusses the context for diversity leadership roles and practices in higher education by using research and theoretical and applied literatures from a variety of fields, including the social sciences, business, and higher education. Framing the discussion on leadership in this monograph is the perspective that American…

  15. Incidence of patient safety events and process-related human failures during intra-hospital transportation of patients: retrospective exploration from the institutional incident reporting system.

    Science.gov (United States)

    Yang, Shu-Hui; Jerng, Jih-Shuin; Chen, Li-Chin; Li, Yu-Tsu; Huang, Hsiao-Fang; Wu, Chao-Ling; Chan, Jing-Yuan; Huang, Szu-Fen; Liang, Huey-Wen; Sun, Jui-Sheng

    2017-11-03

    Intra-hospital transportation (IHT) might compromise patient safety because of different care settings and higher demand on the human operation. Reports regarding the incidence of IHT-related patient safety events and human failures remain limited. To perform a retrospective analysis of IHT-related events, human failures and unsafe acts. A hospital-wide process for the IHT and database from the incident reporting system in a medical centre in Taiwan. All eligible IHT-related patient safety events between January 2010 to December 2015 were included. Incidence rate of IHT-related patient safety events, human failure modes, and types of unsafe acts. There were 206 patient safety events in 2 009 013 IHT sessions (102.5 per 1 000 000 sessions). Most events (n=148, 71.8%) did not involve patient harm, and process events (n=146, 70.9%) were most common. Events at the location of arrival (n=101, 49.0%) were most frequent; this location accounted for 61.0% and 44.2% of events with patient harm and those without harm, respectively (pprocess step was the preparation of the transportation team (n=91, 48.9%). Contributing unsafe acts included perceptual errors (n=14, 7.5%), decision errors (n=56, 30.1%), skill-based errors (n=48, 25.8%), and non-compliance (n=68, 36.6%). Multivariate analysis showed that human failure found in the arrival and hand-off sub-process (OR 4.84, pprocess at the location of arrival and prevent errors other than omissions. Long-term monitoring of IHT-related events is also warranted. © 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.

  16. A self-report critical incident assessment tool for army night vision goggle helicopter operations.

    Science.gov (United States)

    Renshaw, Peter F; Wiggins, Mark W

    2007-04-01

    The present study sought to examine the utility of a self-report tool that was designed as a partial substitute for a face-to-face cognitive interview for critical incidents involving night vision goggles (NVGs). The use of NVGs remains problematic within the military environment, as these devices have been identified as a factor in a significant proportion of aircraft accidents and incidents. The self-report tool was structured to identify some of the cognitive features of human performance that were associated with critical incidents involving NVGs. The tool incorporated a number of different levels of analysis, ranging from specific behavioral responses to broader cognitive constructs. Reports were received from 30 active pilots within the Australian Army using the NVG Critical Incident Assessment Tool (NVGCIAT). The results revealed a correspondence between specific types of NVG-related errors and elements of the Human Factors Analysis and Classification System (HFACS). In addition, uncertainty emerged as a significant factor associated with the critical incidents that were recalled by operators. These results were broadly consistent with previous research and provide some support for the utility of subjective assessment tools as a means of extracting critical incident-related data when face-to-face cognitive interviews are not possible. In some circumstances, the NVGCIAT might be regarded as a substitute cognitive interview protocol with some level of diagnosticity.

  17. Educators' Reports on Incidence of Harassment and Advocacy toward LGBTQ Students

    Science.gov (United States)

    Dragowski, Eliza A.; McCabe, Paul C.; Rubinson, Florence

    2016-01-01

    This study is based on a national survey investigation of 968 educators, who reported the incidence of LGBTQ harassment in schools, and their advocacy efforts on behalf of this population. LGBTQ-related knowledge, attitudes, norms, and perceived ability to advocate were also assessed. Ninety percent of educators reported observing LGBTQ harassment…

  18. Incidence and pattern of 12 years of reported transfusion adverse events in Zimbabwe: A retrospective analysis

    NARCIS (Netherlands)

    Mafirakureva, Nyashadzaishe; Khoza, Star; Mvere, David A.; Chitiyo, McLeod E.; Postma, Maarten J.; Van Hulst, Marinus

    2014-01-01

    Background. Haemovigilance hinges on a systematically structured reporting system, which unfortunately does not always exist in resource-limited settings. We determined the incidence and pattern of transfusion-related adverse events reported to the National Blood Service Zimbabwe. Materials and

  19. 77 FR 53779 - Reports by Air Carriers on Incidents Involving Animals During Air Transport

    Science.gov (United States)

    2012-09-04

    ... Involving Animals During Air Transport AGENCY: Office of the Secretary (OST), Department of Transportation... period of an NPRM on the reporting of incidents involving animals during air transport that was published... animal during air transport. The NPRM proposed to: (1) Expand the reporting requirement to U.S. carriers...

  20. New Mexico Higher Education Department Annual Report, 2016

    Science.gov (United States)

    New Mexico Higher Education Department, 2016

    2016-01-01

    The New Mexico Higher Education Department strives to bring leadership, guidance, and assistance to New Mexico's higher education stakeholders. The HED is committed to promoting best practices, institutional fiscal responsibility, and student achievement. Everything the agency does is through the lens of supporting New Mexico's higher education…

  1. The comparative incidence of reported concussions presenting for follow-up management in South African Rugby Union.

    Science.gov (United States)

    Shuttleworth-Edwards, Ann B; Noakes, Timothy D; Radloff, Sarah E; Whitefield, Victoria J; Clark, Susan B; Roberts, Craig O; Essack, Fathima B; Zoccola, Diana; Boulind, Melissa J; Case, Stephanie E; Smith, Ian P; Mitchell, Julia L G

    2008-09-01

    The objective of this study was to compare the seasonal concussion incidence for school, university, club and provincial level Rugby Union players in South Africa. The study presents a retrospective statistical analysis of the number of reported concussions documented annually for groups of Rugby Union players as a proportion of those who received preseason neurocognitive assessment. Between 2002 and 2006, concussion management programs using computerized neuropsychological assessment were implemented for clinical and research purposes by psychologists in selected South African institutions involved in Rugby Union from school through to the professional level. The incidence figures were based on 175 concussive episodes reported for 165 athletes who were referred for neurocognitive assessment from a population of 1366 athletes who received preseason baseline testing. Concussion management routines varied according to the protocols adopted by the different psychologists and rugby organizations. It was expected that the incidence of concussion would vary significantly due to level of play and different management protocols. There was wide disparity in the manner in which concussion follow-up was managed by the various organizations. Within broadly comparable cohorts, tighter control was associated with a relatively higher concussion incidence for athletes per rugby playing season, with average institutional figures ranging from 4% to 14% at school level and 3% to 23% at adult level. This analysis suggests that concussion goes unrecognized and therefore incorrectly managed in a number of instances. Recommendations for optimal identification of concussed athletes for follow-up management are presented.

  2. In situ simulation: Taking reported critical incidents and adverse events back to the clinic

    DEFF Research Database (Denmark)

    Juul, Jonas; Paltved, Charlotte; Krogh, Kristian

    2014-01-01

    for content analysis4 and thematic analysis5. Medical experts and simulation faculty will design scenarios for in situ simulation training based on the analysis. Short-term observations using time logs will be performed along with interviews with key informants at the departments. Video data will be collected...... improve patient safety if coupled with training and organisational support2. Insight into the nature of reported critical incidents and adverse events can be used in writing in situ simulation scenarios and thus lead to interventions that enhance patient safety. The patient safety literature emphasises...... well-developed non-technical skills in preventing medical errors3. Furthermore, critical incidents and adverse events reporting systems comprise a knowledgebase to gain in-depth insights into patient safety issues. This study explores the use of critical incidents and adverse events reports to inform...

  3. SU-F-T-223: Radiotherapy Incident Reporting and Analysis System (RIRAS):Early Experience

    International Nuclear Information System (INIS)

    Kapoor, R; Palta, J; Hagan, M; Burkett, D; Leidholdt, E

    2016-01-01

    Background & Purpose: RIRAS is a web-based information system deployed on the Veterans Health Administration intranet in early 2014 to collect adverse events and good catch data; analyze the causes and contributing factors; and find ways to prevent future occurrences. Material and Methods: Incident learning consists of a feedback loop which starts with reporting an event, followed by analysis of contributing factors, and culminates in the development of a patient safety work product (PSWP) to prevent recurrence. RIRAS permits both anonymous and non-anonymous reporting. Each report is analyzed by a team of medical physicists who are independent of the reporting facility. The analysts usually contact the reporting facilities for additional information. We analyzed all reports and held telephonic interviews (when necessary) with the reporters. We then generated PSWPs with corrective/preventive and learning actions. Anonymous reporting is handled in the same manner, except without the ability to further interview the reporter. Results: In a significant number of reports, the causes and recommended preventive actions were considerably altered by the independent analysis and additional information from the facility. 130 reports have been entered in RIRAS; 9 misadministrations, 83 good catches, 3 anonymous good catches, and 35 earlier reported incidents from FY2005-14. 45% of the reported incidents occurred in the treatment delivery stages, 19% in on-treatment management, and 16% in pre-treatment verification. 80% of the good catches were found in the treatment delivery workflow. Majority of these incidents were due to inconsistent patient setup instructions or documentation, nonadherence to policies and procedures, lax time-out policy, distracted RTTs, and inadequate RTT staffing. Conclusion: RIRAS has identified many areas for improvement and elevated the quality and safety of radiation treatments in the VHA. We found that the ability to learn is significantly

  4. SU-F-T-223: Radiotherapy Incident Reporting and Analysis System (RIRAS):Early Experience

    Energy Technology Data Exchange (ETDEWEB)

    Kapoor, R; Palta, J; Hagan, M [National Radiation Oncology Program (10P4H), Dept. of Veterans Affairs, Richmond, VA (United States); Burkett, D; Leidholdt, E [National Health Physics Program (10P4X), Dept. of Veterans Affairs, Little Rock, AR (United States)

    2016-06-15

    Background & Purpose: RIRAS is a web-based information system deployed on the Veterans Health Administration intranet in early 2014 to collect adverse events and good catch data; analyze the causes and contributing factors; and find ways to prevent future occurrences. Material and Methods: Incident learning consists of a feedback loop which starts with reporting an event, followed by analysis of contributing factors, and culminates in the development of a patient safety work product (PSWP) to prevent recurrence. RIRAS permits both anonymous and non-anonymous reporting. Each report is analyzed by a team of medical physicists who are independent of the reporting facility. The analysts usually contact the reporting facilities for additional information. We analyzed all reports and held telephonic interviews (when necessary) with the reporters. We then generated PSWPs with corrective/preventive and learning actions. Anonymous reporting is handled in the same manner, except without the ability to further interview the reporter. Results: In a significant number of reports, the causes and recommended preventive actions were considerably altered by the independent analysis and additional information from the facility. 130 reports have been entered in RIRAS; 9 misadministrations, 83 good catches, 3 anonymous good catches, and 35 earlier reported incidents from FY2005-14. 45% of the reported incidents occurred in the treatment delivery stages, 19% in on-treatment management, and 16% in pre-treatment verification. 80% of the good catches were found in the treatment delivery workflow. Majority of these incidents were due to inconsistent patient setup instructions or documentation, nonadherence to policies and procedures, lax time-out policy, distracted RTTs, and inadequate RTT staffing. Conclusion: RIRAS has identified many areas for improvement and elevated the quality and safety of radiation treatments in the VHA. We found that the ability to learn is significantly

  5. The Entrepreneurial Domains of American Higher Education. ASHE Higher Education Report, Volume 34, Number 5

    Science.gov (United States)

    Mars, Matthew M.; Metcalf, Amy Scott

    2009-01-01

    This volume draws on a diverse set of literatures to represent the various ways in which entrepreneurship is understood in and applied to higher education. It provides a platform for debate for those considering applications of entrepreneurial principles to academic research and practices. Using academic entrepreneurship in the United States as…

  6. The non-technical skills used by anaesthetic technicians in critical incidents reported to the Australian Incident Monitoring System between 2002 and 2008.

    Science.gov (United States)

    Rutherford, J S; Flin, R; Irwin, A

    2015-07-01

    The outcome of critical incidents in the operating theatre has been shown to be influenced by the behaviour of anaesthetic technicians (ATs) assisting anaesthetists, but the specific non-technical skills involved have not been described. We performed a review of critical incidents (n=1433) reported to the Australian Incident Monitoring System between 2002 and 2008 to identify which non-technical skills were used by ATs. The reports were assessed if they mentioned anaesthetic assistance or had the boxes ticked to identify "inadequate assistance" or "absent supervision or assistance". A total of 90 critical incidents involving ATs were retrieved, 69 of which described their use of non-technical skills. In 20 reports, the ATs ameliorated the critical incident, whilst in 46 they exacerbated the critical incident, and three cases had both positive and negative non-technical skills described. Situation awareness was identified in 39 reports, task management in 23, teamwork in 21 and decision-making in two, but there were no descriptions of issues related to leadership, stress or fatigue management. Situation awareness, task management and teamwork appear to be important non-technical skills for ATs in the development or management of critical incidents in the operating theatre. This analysis has been used to support the development of a non-technical skills taxonomy for anaesthetic assistants.

  7. Survey to identify depth of penetration of critical incident reporting systems in Austrian healthcare facilities.

    Science.gov (United States)

    Sendlhofer, Gerald; Eder, Harald; Leitgeb, Karina; Gorges, Roland; Jakse, Heidelinde; Raiger, Marianne; Türk, Silvia; Petschnig, Walter; Pregartner, Gudrun; Kamolz, Lars-Peter; Brunner, Gernot

    2018-01-01

    Incident reporting systems or so-called critical incident reporting systems (CIRS) were first recommended for use in health care more than 15 years ago. The uses of these CIRS are highly variable among countries, ranging from being used to report critical incidents, falls, or sentinel events resulting in death. In Austria, CIRS have only been introduced to the health care sector relatively recently. The goal of this work, therefore, was to determine whether and specifically how CIRS are used in Austria. A working group from the Austrian Society for Quality and Safety in Healthcare (ASQS) developed a survey on the topic of CIRS to collect information on penetration of CIRS in general and on how CIRS reports are used to increase patient safety. Three hundred seventy-one health care professionals from 274 health care facilities were contacted via e-mail. Seventy-eight respondents (21.0%) completed the online survey, thereof 66 from hospitals and 12 from other facilities (outpatient clinics, nursing homes). In all, 64.1% of the respondents indicated that CIRS were used in the entire health care facility; 20.6% had not yet introduced CIRS and 15.4% used CIRS only in particular areas. Most often, critical incidents without any harm to patients were reported (76.9%); however, some health care facilities also use their CIRS to report patient falls (16.7%), needle stick injuries (17.9%), technical problems (51.3%), or critical incidents involving health care professionals. CIRS are not yet extensively or homogeneously used in Austria. Inconsistencies exist with respect to which events are reported as well as how they are followed up and reported to health care professionals. Further recommendations for general use are needed to support the dissemination in Austrian health care environments.

  8. Properties of incident reporting systems in relation to statistical trend and pattern analysis

    International Nuclear Information System (INIS)

    Kalfsbeek, H.W.; Arsenis, S.P.

    1990-01-01

    This paper describes the properties deemed desirable for an incident reporting system in order to render it useful for extracting valid statistical trend and pattern information. The perspective under which a data collection system is seen in this paper is the following: data are essentially gathered on a set of variables describing an event or incident (the items featuring on a reporting format) in order to learn about (multiple) dependencies (called interactions) between these variables. Hence, the necessary features of the data source are highlighted and potential problem sources limiting the validity of the results to be obtained are identified. In this frame, important issues are the reporting completeness, related to the reporting criteria and reporting frequency, and of course the reporting contents and quality. The choice of the report items (the variables) and their categorization (code dictionary) may influence (bias) the insights gained from trend and pattern analyses, as may the presence or absence of a structure for correlating the reported issues within an incident. The issues addressed in this paper are brought in relation to some real world reporting systems on safety related events in Nuclear Power Plants, so that their possibilities and limitations with regard to statistical trend and pattern analysis become manifest

  9. SU-E-T-524: Web-Based Radiation Oncology Incident Reporting and Learning System (ROIRLS)

    International Nuclear Information System (INIS)

    Kapoor, R; Palta, J; Hagan, M; Grover, S; Malik, G

    2014-01-01

    Purpose: Describe a Web-based Radiation Oncology Incident Reporting and Learning system that has the potential to improve quality of care for radiation therapy patients. This system is an important facet of continuing effort by our community to maintain and improve safety of radiotherapy.Material and Methods: The VA National Radiation Oncology Program office has embarked on a program to electronically collect adverse events and near miss data of radiation treatment of over 25,000 veterans treated with radiotherapy annually. Software used for this program is deployed on the VAs intranet as a Website. All data entry forms (adverse event or near miss reports, work product reports) utilize standard causal, RT process step taxonomies and data dictionaries defined in AAPM and ASTRO reports on error reporting (AAPM Work Group Report on Prevention of Errors and ASTROs safety is no accident report). All reported incidents are investigated by the radiation oncology domain experts. This system encompasses the entire feedback loop of reporting an incident, analyzing it for salient details, and developing interventions to prevent it from happening again. The operational workflow is similar to that of the Aviation Safety Reporting System. This system is also synergistic with ROSIS and SAFRON. Results: The ROIRLS facilitates the collection of data that help in tracking adverse events and near misses and develop new interventions to prevent such incidents. The ROIRLS electronic infrastructure is fully integrated with each registered facility profile data thus minimizing key strokes and multiple entries by the event reporters. Conclusions: OIRLS is expected to improve the quality and safety of a broad spectrum of radiation therapy patients treated in the VA and fulfills our goal of Effecting Quality While Treating Safely The Radiation Oncology Incident Reporting and Learning System software used for this program has been developed, conceptualized and maintained by TSG Innovations

  10. SU-E-T-524: Web-Based Radiation Oncology Incident Reporting and Learning System (ROIRLS)

    Energy Technology Data Exchange (ETDEWEB)

    Kapoor, R; Palta, J; Hagan, M [Virginia Commonwealth University, Richmond, VA (United States); National Radiation Oncology Program (10P4H), Richmond, VA (United States); Grover, S; Malik, G [TSG Innovations Inc., Richmond, VA (United States)

    2014-06-01

    Purpose: Describe a Web-based Radiation Oncology Incident Reporting and Learning system that has the potential to improve quality of care for radiation therapy patients. This system is an important facet of continuing effort by our community to maintain and improve safety of radiotherapy.Material and Methods: The VA National Radiation Oncology Program office has embarked on a program to electronically collect adverse events and near miss data of radiation treatment of over 25,000 veterans treated with radiotherapy annually. Software used for this program is deployed on the VAs intranet as a Website. All data entry forms (adverse event or near miss reports, work product reports) utilize standard causal, RT process step taxonomies and data dictionaries defined in AAPM and ASTRO reports on error reporting (AAPM Work Group Report on Prevention of Errors and ASTROs safety is no accident report). All reported incidents are investigated by the radiation oncology domain experts. This system encompasses the entire feedback loop of reporting an incident, analyzing it for salient details, and developing interventions to prevent it from happening again. The operational workflow is similar to that of the Aviation Safety Reporting System. This system is also synergistic with ROSIS and SAFRON. Results: The ROIRLS facilitates the collection of data that help in tracking adverse events and near misses and develop new interventions to prevent such incidents. The ROIRLS electronic infrastructure is fully integrated with each registered facility profile data thus minimizing key strokes and multiple entries by the event reporters. Conclusions: OIRLS is expected to improve the quality and safety of a broad spectrum of radiation therapy patients treated in the VA and fulfills our goal of Effecting Quality While Treating Safely The Radiation Oncology Incident Reporting and Learning System software used for this program has been developed, conceptualized and maintained by TSG Innovations

  11. Overview: 2017 Professionals in Higher Education Salary Report

    Science.gov (United States)

    Bichsel, Jacqueline; McChesney, Jasper

    2017-01-01

    The "Faculty in Higher Education Survey" collects data from approximately 700 higher education institutions on nearly 250,000 full-time faculty (tenure track and non-tenure track), as well as academic department heads and adjunct (pay-per-course) faculty. Data collected for full-time faculty include: salary, supplemental salary and…

  12. Structural higher education reform - design and evaluation: synthesis report

    NARCIS (Netherlands)

    File, Jonathan M.; Huisman, Jeroen; de Boer, Harry F.; Seeber, Marco; Vukasovic, Martina; Westerheijden, Donald F.

    2016-01-01

    This study analyses how different types of system-level (or ‘landscape’) structural reforms in higher education have been designed and implemented in selected higher education systems. In the 12 case studies that form the core of the project, the researchers examine reforms aimed at: - Increasing

  13. In-depth analysis of the causal factors of incidents reported in the Greek petrochemical industry

    International Nuclear Information System (INIS)

    Konstandinidou, Myrto; Nivolianitou, Zoe; Kefalogianni, Eirini; Caroni, Chrys

    2011-01-01

    This paper presents a statistical analysis of all reported incidents in the Greek petrochemical industry from 1997 to 2003. A comprehensive database has been developed to include industrial accidents (fires, explosions and substance releases), occupational accidents, incidents without significant consequences and near misses. The study concentrates on identifying and analyzing the causal factors related to different consequences of incidents, in particular, injury, absence from work and material damage. Methods of analysis include logistic regression with one of these consequences as dependent variable. The causal factors that are considered cover four major categories related to organizational issues, equipment malfunctions, human errors (of commission or omission) and external causes. Further analyses aim to confirm the value of recording near misses by comparing their causal factors with those of more serious incidents. The statistical analysis highlights the connection between the human factor and the underlying causes of accidents or incidents. - Highlights: → The research work is original, based on field data collected directly from the petrochemical industry. → It deals with the in-depth statistical analysis of accident data on human-organizational causes. → It researches underlying causes of accidents and the parameters affecting them. → The causal factors that are considered cover four big taxonomies. → Near misses are worth recording for comparing their causal factors with more serious incidents.

  14. In-depth analysis of the causal factors of incidents reported in the Greek petrochemical industry

    Energy Technology Data Exchange (ETDEWEB)

    Konstandinidou, Myrto [Institute of Nuclear Technology-Radiation Protection, National Center for Scientific Research ' Demokritos' , Aghia Paraskevi 15310 (Greece); Nivolianitou, Zoe, E-mail: zoe@ipta.demokritos.gr [Institute of Nuclear Technology-Radiation Protection, National Center for Scientific Research ' Demokritos' , Aghia Paraskevi 15310 (Greece); Kefalogianni, Eirini; Caroni, Chrys [School of Applied Mathematical and Physical Sciences, National Technical University of Athens, 9 Iroon Polytexneiou Str., Zografou Campus, 157 80 Athens (Greece)

    2011-11-15

    This paper presents a statistical analysis of all reported incidents in the Greek petrochemical industry from 1997 to 2003. A comprehensive database has been developed to include industrial accidents (fires, explosions and substance releases), occupational accidents, incidents without significant consequences and near misses. The study concentrates on identifying and analyzing the causal factors related to different consequences of incidents, in particular, injury, absence from work and material damage. Methods of analysis include logistic regression with one of these consequences as dependent variable. The causal factors that are considered cover four major categories related to organizational issues, equipment malfunctions, human errors (of commission or omission) and external causes. Further analyses aim to confirm the value of recording near misses by comparing their causal factors with those of more serious incidents. The statistical analysis highlights the connection between the human factor and the underlying causes of accidents or incidents. - Highlights: > The research work is original, based on field data collected directly from the petrochemical industry. > It deals with the in-depth statistical analysis of accident data on human-organizational causes. > It researches underlying causes of accidents and the parameters affecting them. > The causal factors that are considered cover four big taxonomies. > Near misses are worth recording for comparing their causal factors with more serious incidents.

  15. Incident and Trafficking Database: New Systems for Reporting and Accessing State Information

    International Nuclear Information System (INIS)

    Dimitrovski, D.; Kittley, S.

    2015-01-01

    The IAEA's Incident and Trafficking Database (ITDB) is the Agency's authoritative source for information on incidents in which nuclear and other radioactive material is out of national regulatory control. It was established in 1995 and, as of June 2014, 126 States participate in the ITDB programme. Currently, the database contains over 2500 confirmed incidents, out of which 21% involve nuclear material, 62% radioactive source and 17% radioactively contaminated material. In recent years, the system for States to report incidents to the ITDB has been evolving — moving from fax-based to secure email and most recently to secure on-line reporting. A Beta version of the on-line system was rolled out this June, offering a simple, yet secure, communication channel for member states to provide information. In addition the system serves as a central hub for information related to official communication of the IAEA with Member States so some communication that is traditionally shared by e-mail does not get lost when ITDB counterparts change. In addition the new reporting system incorporates optional features that allow multiple Member State users to collaboratively contribute toward an INF. States are also being given secure on-line access to a streamlined version of the ITDB. This improves States' capabilities to retrieve and analyze information for their own purposes. In addition, on-line access to ITDB statistical information on incidents is available to States through an ITDB Dashboard. The dashboard contains aggregate information on number and types of incidents, material involved, as well some other statistics related to the ITDB that is typically provided in the ITDB Quarterly reports. (author)

  16. Differential invariants for higher-rank tensors. A progress report

    International Nuclear Information System (INIS)

    Tapial, V.

    2004-07-01

    We outline the construction of differential invariants for higher-rank tensors. In section 2 we outline the general method for the construction of differential invariants. A first result is that the simplest tensor differential invariant contains derivatives of the same order as the rank of the tensor. In section 3 we review the construction for the first-rank tensors (vectors) and second-rank tensors (metrics). In section 4 we outline the same construction for higher-rank tensors. (author)

  17. Report of the Task Force on the Incident of 19th September 2008 at the LHC

    CERN Document Server

    Bajko, M; Catalan-Lasheras, N; Claudet, S; Cruikshank, P; Dahlerup-Petersen, K; Denz, R; Fessia, P; Garion, C; Jimenez, JM; Kirby, G; Lebrun, Ph; Le Naour, S; Mess, K-H; Modena, M; Montabonnet, V; Nunes, R; Parma, V; Perin, A; de Rijk, G; Rijllart, A; Rossi, L; Schmidt, R; Siemko, A; Strubin, P; Tavian, L; Thiesen, H; Tock, J; Todesco, E; Veness, R; Verweij, A; Walckiers, L; Van Weelderen, R; Wolf, R; Fehér, S; Flora, R; Koratzinos, M; Limon, P; Strait, J

    2009-01-01

    This report summarizes the findings and recommendations of the AT department Task Force established to investigate the 19th September 2008 incident which occurred in sector 3-4 of the LHC. It includes a number of annexes where specific analyses are detailed.

  18. 77 FR 36008 - Agency Information Collection Activities; Proposed Collection: Cargo Theft Incident Report...

    Science.gov (United States)

    2012-06-15

    ... Collection Activities; Proposed Collection: Cargo Theft Incident Report, Revision of a Currently Approved... collection: Revision of a currently approved collection. (2) The title of the form/collection: Cargo Theft... enforcement agencies. Brief Abstract: This collection is needed to collect information on cargo theft...

  19. Improvement in the incident reporting and investigation procedures using process excellence (DMAI2C) methodology

    International Nuclear Information System (INIS)

    Miles, Elizabeth N.

    2006-01-01

    In 1996, Health and Safety introduced an incident investigation process called Learning to Look ( C) to Johnson and Johnson. This process provides a systematic way of analyzing work-related injuries and illness, uncovers root cause that leads to system defects, and points to viable solutions. The process analyzed involves three steps: investigation and reporting of the incident, determination of root cause, and development and implementation of a corrective action plan. The process requires the investigators to provide an initial communication for work-related serious injuries and illness as well as lost workday cases to Corporate Headquarters within 72h of the incident with a full investigative report to follow within 10 days. A full investigation requires a written report, a cause-result logic diagram (CRLD), a corrective action plan (CAP) and a report of incident costs (SafeCost) all due to be filed electronically. It is incumbent on the principal investigator and his or her investigative teams to assemble the various parts of the investigation and to follow up with the relevant parties to ensure corrective actions are implemented, and a full report submitted to Corporate executives. Initial review of the system revealed that the process was not working as designed. A number of reports were late, not signed by the business leaders, and in some instances, all cause were not identified. Process excellence was the process used to study the issue. The team used six sigma DMAI 2 C methodologies to identify and implement system improvements. The project examined the breakdown of the critical aspects of the reporting and investigation process that lead to system errors. This report will discuss the study findings, recommended improvements, and methods used to monitor the new improved process

  20. Radioactive Materials Packaging (RAMPAC) Radioactive Materials Incident Report (RMIR). RAMTEMP users manual

    International Nuclear Information System (INIS)

    Tyron-Hopko, A.K.; Driscoll, K.L.

    1985-10-01

    The purpose of this document is to familiarize the potential user with RadioActive Materials PACkaging (RAMPAC), Radioactive Materials Incident Report (RMIR), and RAMTEMP databases. RAMTEMP is a minor image of RAMPAC. This reference document will enable the user to access and obtain reports from databases while in an interactive mode. This manual will be revised as necessary to reflect enhancements made to the system

  1. Critical steps in learning from incidents: using learning potential in the process from reporting an incident to accident prevention.

    Science.gov (United States)

    Drupsteen, Linda; Groeneweg, Jop; Zwetsloot, Gerard I J M

    2013-01-01

    Many incidents have occurred because organisations have failed to learn from lessons of the past. This means that there is room for improvement in the way organisations analyse incidents, generate measures to remedy identified weaknesses and prevent reoccurrence: the learning from incidents process. To improve that process, it is necessary to gain insight into the steps of this process and to identify factors that hinder learning (bottlenecks). This paper presents a model that enables organisations to analyse the steps in a learning from incidents process and to identify the bottlenecks. The study describes how this model is used in a survey and in 3 exploratory case studies in The Netherlands. The results show that there is limited use of learning potential, especially in the evaluation stage. To improve learning, an approach that considers all steps is necessary.

  2. Enhancing Police Responses to Domestic Violence Incidents: Reports From Client Advocates in New South Wales.

    Science.gov (United States)

    Goodman-Delahunty, Jane; Crehan, Anna Corbo

    2016-07-01

    In an online survey about experiences with the police complaint system, 239 client advocates described a recent incident in which a client with grounds to lodge a complaint declined to do so. Almost one third of those incidents involved domestic violence. Thematic analysis of case descriptions revealed that many police did not take domestic violence reports seriously. A typology of problematic police conduct was developed. Many officers failed to observe current procedures and appeared to lack knowledge of relevant laws. Citizens feared retaliatory victimization by police and/or perceived that complaining was futile. Implications of these findings are reviewed in light of procedural justice theory. © The Author(s) 2015.

  3. Emergency radiology and mass casualty incidents-report of a mass casualty incident at a level 1 trauma center.

    Science.gov (United States)

    Bolster, Ferdia; Linnau, Ken; Mitchell, Steve; Roberge, Eric; Nguyen, Quynh; Robinson, Jeffrey; Lehnert, Bruce; Gross, Joel

    2017-02-01

    The aims of this article are to describe the events of a recent mass casualty incident (MCI) at our level 1 trauma center and to describe the radiology response to the event. We also describe the findings and recommendations of our radiology department after-action review. An MCI activation was triggered after an amphibious military vehicle, repurposed for tourist activities, carrying 37 passengers, collided with a charter bus carrying 45 passengers on a busy highway bridge in Seattle, WA, USA. There were 4 deaths at the scene, and 51 patients were transferred to local hospitals following prehospital scene triage. Nineteen patients were transferred to our level 1 trauma center. Eighteen casualties arrived within 72 min. Sixteen arrived within 1 h of the first patient arrival, and 1 casualty was transferred 3 h later having initially been assessed at another hospital. Eighteen casualties (94.7 %) underwent diagnostic imaging in the emergency department. Of these 18 casualties, 15 had a trauma series (portable chest x-ray and x-ray of pelvis). Whole-body trauma computed tomography scans (WBCT) were performed on 15 casualties (78.9 %), 12 were immediate and performed during the initial active phase of the MCI, and 3 WBCTs were delayed. The initial 12 WBCTs were completed in 101 min. The mean number of radiographic studies performed per patient was 3 (range 1-8), and the total number of injuries detected was 88. The surge in imaging requirements during an MCI can be significant and exceed normal operating capacity. This report of our radiology experience during a recent MCI and subsequent after-action review serves to provide an example of how radiology capacity and workflow functioned during an MCI, in order to provide emergency radiologists and response planners with practical recommendations for implementation in the event of a future MCI.

  4. Incident reporting culture: scale development with validation and reliability and assessment of hospital nurses in Taiwan.

    Science.gov (United States)

    Chiang, Hui-Ying; Hsiao, Ya-Chu; Lin, Shu-Yuan; Lee, Huan-Fang

    2011-08-01

    To examine the psychometric validity and reliability of the incident reporting culture questionnaire (IRCQ; in Chinese) following an exploration of the reporting culture perceived by hospital nurses in Taiwan. Scale development with psychometric examination and a cross-sectional study. Ten teaching hospitals. A total of 1064 nurses participated with an average response rate of 83% between November 2008 and June 2009. The factorial construct, criterion-related validity, homogeneity and stability of the IRCQ were evaluated. The nurses' perceptions of the IRCQ were also explored. The four-factor structure of the 20-item IRCQ had satisfactory construct validity (explained variance: 49.37%), criterion-related validity (r = 0.42; P = 0.001), reliability (Cronbach's alpha: 0.83) and stability (3-week-interval correlation: r = 0.80; P = 0.001). These factors included 'application of learning from errors', 'readiness to provide feedback on incident reports', 'collegial atmospheres of unpleasantness and punishment' (CA) and 'incident management: confidential and system driven'. The nurses perceived a moderate overall reporting culture (mean positive response = 49.25%; range: 67.2-24.94%). They weakly agreed on the CA factor of five items (mean positive response = 24.94%; range: 33.0-17.2%). This study provides empirical evidence for the psychometric properties of the IRCQ and the reporting culture which nurses perceive in Taiwan. To Taiwanese nurses, the reporting culture within their work environments especially as it relates to coworker relations, inter-professional collaboration and non-punitive atmosphere is their major concern. Healthcare administrators should consider nurses' perceptions related to incident reporting when managing underreporting issues.

  5. Using incident reports to inform the prevention of medication administration errors.

    Science.gov (United States)

    Härkänen, Marja; Saano, Susanna; Vehviläinen-Julkunen, Katri

    2017-11-01

    To describe ways of preventing medication administration errors based on reporters' views expressed in medication administration incident reports. Medication administration errors are very common, and nurses play important roles in committing and in preventing such errors. Thus far, incident reporters' perceptions of how to prevent medication administration errors have rarely been analysed. This is a qualitative, descriptive study using an inductive content analysis of the incident reports related to medication administration errors (n = 1012). These free-text descriptions include reporters' views on preventing the reoccurrence of medication administration errors. The data were collected from two hospitals in Finland and pertain to incidents that were reported between 1 January 2013 and 31 December 2014. Reporters' views on preventing medication administration errors were divided into three main categories related to individuals (health professionals), teams and organisations. The following categories related to individuals in preventing medication administration errors were identified: (1) accuracy and preciseness; (2) verification; and (3) following the guidelines, responsibility and attitude towards work. The team categories were as follows: (1) distribution of work; (2) flow of information and cooperation; and (3) documenting and marking the drug information. The categories related to organisation were as follows: (1) work environment; (2) resources; (3) training; (4) guidelines; and (5) development of the work. Health professionals should administer medication with a high moral awareness and an attempt to concentrate on the task. Nonetheless, the system should support health professionals by providing a reasonable work environment and encouraging collaboration among the providers to facilitate the safe administration of medication. Although there are numerous approaches to supporting medication safety, approaches that support the ability of individual health

  6. A preliminary analysis of incident investigation reports of an integrated steel plant: some reflection.

    Science.gov (United States)

    Verma, A; Maiti, J; Gaikwad, V N

    2018-06-01

    Large integrated steel plants employ an effective safety management system and gather a significant amount of safety-related data. This research intends to explore and visualize the rich database to find out the key factors responsible for the occurrences of incidents. The study was carried out on the data in the form of investigation reports collected from a steel plant in India. The data were processed and analysed using some of the quality management tools like Pareto chart, control chart, Ishikawa diagram, etc. Analyses showed that causes of incidents differ depending on the activities performed in a department. For example, fire/explosion and process-related incidents are more common in the departments associated with coke-making and blast furnace. Similar kind of factors were obtained, and recommendations were provided for their mitigation. Finally, the limitations of the study were discussed, and the scope of the research works was identified.

  7. Survey of reportable incidents in nuclear power plants of the Federal Republic of Germany in the year 1991

    International Nuclear Information System (INIS)

    1992-01-01

    In 1991, there were 249 reportable nuclear power plant incidents in Germany (old and new federal Laender). The report comprehensively lists all these incidents. There was no release of radioactivity exceeding the maximum permissible limits, and there were no effects on man or the environment. There were no incidents of reporting category S (Urgent notification), and ten belonging to category E (immediate notification). The six incidents reported in the first half of 1991 from nuclear power plants in the new federal Laender all belonged to category AE 3, which is the lowest. (orig./DG) [de

  8. What Helps and Hinders Indigenous Student Success in Higher Education Health Programmes: A Qualitative Study Using the Critical Incident Technique

    Science.gov (United States)

    Curtis, Elana; Wikaire, Erena; Kool, Bridget; Honey, Michelle; Kelly, Fiona; Poole, Phillippa; Barrow, Mark; Airini; Ewen, Shaun; Reid, Papaarangi

    2015-01-01

    Tertiary institutions aim to provide high quality teaching and learning that meet the academic needs for an increasingly diverse student body including indigenous students. "Tatou Tatou" is a qualitative research project utilising Kaupapa "Maori" research methodology and the Critical Incident Technique interview method to…

  9. National critical incident reporting systems relevant to anaesthesia: a European survey.

    Science.gov (United States)

    Reed, S; Arnal, D; Frank, O; Gomez-Arnau, J I; Hansen, J; Lester, O; Mikkelsen, K L; Rhaiem, T; Rosenberg, P H; St Pierre, M; Schleppers, A; Staender, S; Smith, A F

    2014-03-01

    Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national co-ordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European level.

  10. Strategic Reporting Tool: Balanced Scorecards in Higher Education

    Science.gov (United States)

    Lyddon, Jan W.; McComb, Bruce E.

    2008-01-01

    In this toolbox article, the authors describe the recommended steps for creating a community college balanced scorecard that measures and reports on key performance indicators based on targets and signal values to end-users, college constituents and external stakeholders. Based on extensive experience in the field, the authors provide a…

  11. Pharmacovigilance in oncology: pattern of spontaneous notifications, incidence of adverse drug reactions and under-reporting

    Directory of Open Access Journals (Sweden)

    Marília Berlofa Visacri

    2014-04-01

    Full Text Available The high toxicity and narrow therapeutic window of antineoplastic agents makes pharmacovigilance studies essential in oncology. The objectives of the current study were to analyze the pattern of spontaneous notifications of adverse drug reactions (ADRs in oncology patients and to analyze the incidence of ADRs reported by outpatients on antineoplastic treatment in a tertiary care teaching hospital. To compose the pattern of ADR, the notification forms of reactions in oncology patients in 2010 were reviewed, and the reactions were classified based on the drug involved, mechanism, causality, and severity. To evaluate the incidence of reactions, a questionnaire at the time of chemotherapy was included, and the severity was classified based on the Common Terminology Criteria. The profiles of the 10 responses reported to the Pharmacovigilance Sector were type B, severe, possible, and they were primarily related to platinum compounds and taxanes. When the incidence of reactions was analyzed, it was observed that nausea, alopecia, fatigue, diarrhea, and taste disturbance were the most frequently reported reactions by oncology patients, and the grade 3 and 4 reactions were not reported. Based on this analysis, it is proposed that health professionals should be trained regarding notifications and clinical pharmacists should increasingly be brought on board to reduce under-reporting of ADRs.

  12. Application examples of the reports of the NEA Incident Reporting System of the OECD and evolution of the system

    International Nuclear Information System (INIS)

    Libmann, J.

    1989-06-01

    Some reports of the work group no. 1 of the Nuclear Installations Security Committee of NEA, are summarized. An example of the report coding system concerning human factors, is given. The aim of the study is to improve the report contents as well as the coding system. In this case, a fast data selection is possible, and allows an efficient analysis of a particular situation. Moreover, the corrective procedures of the nuclear installation conception or operation can be easily modified, by the national organisations. Due to the improvements in quality, the opinion of the member countries on the incident reporting systems efficiency was enhanced [fr

  13. Medical students' perceptions of a novel institutional incident reporting system : A thematic analysis.

    Science.gov (United States)

    Gordon, Morris; Parakh, Dillan

    2017-10-01

    Errors in healthcare are a major patient safety issue, with incident reporting a key solution. The incident reporting system has been integrated within a new medical curriculum, encouraging medical students to take part in this key safety process. The aim of this study was to describe the system and assess how students perceived the reporting system with regards to its role in enhancing safety. Employing a thematic analysis, this study used interviews with medical students at the end of the first year. Thematic indices were developed according to the information emerging from the data. Through open, axial and then selective stages of coding, an understanding of how the system was perceived was established. Analysis of the interview specified five core themes: (1) Aims of the incident reporting system; (2) internalized cognition of the system; (3) the impact of the reporting system; (4) threshold for reporting; (5) feedback on the systems operation. Selective analysis revealed three overriding findings: lack of error awareness and error wisdom as underpinned by key theoretical constructs, student support of the principle of safety, and perceptions of a blame culture. Students did not interpret reporting as a manner to support institutional learning and safety, rather many perceived it as a tool for a blame culture. The impact reporting had on students was unexpected and may give insight into how other undergraduates and early graduates interpret such a system. Future studies should aim to produce interventions that can support a reporting culture.

  14. Criteria for classification and reporting of fire incidences in nuclear power plants of India

    International Nuclear Information System (INIS)

    Kapoor, R.K.

    1998-01-01

    Is is important that all fires in and around fire effective neighbourhood of Nuclear Power Plant (NPP) should be promptly reported (Reportable fires) and investigated. However, the depth of investigation and the range of authorities to whom the individual fire incidence need to be reported depends upon the severity of fire. In case of conventional non-chemical industries, the severity of fire depends mainly on the extent of loss caused by fire on property and the burn injury to persons. In case of NPP, two additional losses viz, release of radioactivity to working/public environment and the risk to safety related systems of NPP due to fire assume greater importance. This paper describes the criteria used in NPPs of India for classification of reportable fire incidences into four categories, viz. Insignificant, small, medium and large fires. It also gives the level of investigation depending upon the severity of fire. The fire classification scheme is explained in this paper with the help of worked out examples and two incidences of fire in Indian NPPs. (author)

  15. The Incidence of Needlestick Injuries During Perineorrhaphy and Attitudes Toward Occurrence Reports Among Medical Students

    Directory of Open Access Journals (Sweden)

    Nalinee Panichyawat

    2016-07-01

    Full Text Available Background: Medical students are at risk of needlestick injuries (NSIs while performing obstetrical procedures especially perineorrhaphy, because of their less experience. This study aims to determine the incidence and causes of NSIs during perineorrhaphy and medical students’ attitudes toward occurrence reports. Methods: A cross-sectional study was conducted. After completion of Obstetrics & Gynaecology rotation, the data from final year medical students were collected using a self-administered questionnaire. Results: Of 390 medical students, 290 (74.4% returned questionnaires with complete data. The annual NSIs incidence during perineorrhaphy was 26.9%. The most common site of injury was the index finger of the non- dominant hand (66.2%. Common causes of NSIs were time pressure (52.1% and lack of surgical skills (50.7%. Nearly half of students (41% did not report their occurrence, and 81.3% of injured students believed that NSIs were harmless. Conclusion: The incidence of NSIs during perineorrhaphy and the non-reporting occurrence were quite high among medical students. Structural clinical supervision by medical staffs, HBV vaccination for all medical students, and instruction on standard pre-exposure precaution should be applied. We advocate a strategy plan for increasing students’ awareness and having a simple occurrence reporting system for NSIs, with clear guidelines on post-exposure protocols in all medical schools and teaching hospitals.

  16. Patients with Duchenne muscular dystrophy are significantly shorter than those with Becker muscular dystrophy, with the higher incidence of short stature in Dp71 mutated subgroup.

    Science.gov (United States)

    Matsumoto, Masaaki; Awano, Hiroyuki; Lee, Tomoko; Takeshima, Yasuhiro; Matsuo, Masafumi; Iijima, Kazumoto

    2017-11-01

    Duchenne and Becker muscular dystrophy (DMD/BMD) are caused by mutations in the dystrophin gene and are characterized by severe and mild progressive muscle wasting, respectively. Short stature has been reported as a feature of DMD in the Western hemisphere, but not yet confirmed in Orientals. Height of young BMD has not been fully characterized. Here, height of ambulant and steroid naive Japanese 179 DMD and 42 BMD patients between 4 and 10 years of age was retrospectively examined using height standard deviation score (SDS). The mean height SDS of DMD was -1.08 SD that was significantly smaller than normal (p < 0.001), indicating short stature of Japanese DMD. Furthermore, the mean height SDS of BMD was -0.27 SD, suggesting shorter stature than normal. Remarkably, the mean height SDS of DMD was significantly smaller than that of BMD (p < 0.0001). In DMD higher incidence of short stature (height SDS < -2.5 SD) was observed in Dp71 subgroup having mutations in dystrophin exons 63-79 than others having mutations in exons 1-62 (27.8% vs. 7.5%, p = 0.017). These suggested that height is influenced by dystrophin in not only DMD but also BMD and that dystrophin Dp71 has a role in height regulation. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Association Between Old Firm Football Matches and Reported Domestic (Violence Incidents in Strathclyde, Scotland

    Directory of Open Access Journals (Sweden)

    Damien J. Williams

    2013-09-01

    Full Text Available Media reports have suggested that the number of reports of domestic violence may increase when Scotland’s two largest, Glasgow-based football (soccer clubs, Rangers and Celtic (traditionally referred to as the “Old Firm” play one another. This study considers the number of domestic (violence incidents reported to Strathclyde Police between 2008 and 2011 in the 24 hours following these matches, and compares it with the number reported during two appropriate comparator periods. There is a statistically significant increase in the number of reports following Old Firm matches compared with the comparator periods. This preliminary analysis confirms previous speculation concerning the association between Old Firm matches and reports of domestic violence, and highlights the need to better understand the factors leading to such violence to inform preventive interventions.

  18. Long sleep duration and afternoon napping are associated with higher risk of incident diabetes in middle-aged and older Chinese: the Dongfeng-Tongji cohort study.

    Science.gov (United States)

    Han, Xu; Liu, Bing; Wang, Jing; Pan, An; Li, Yaru; Hu, Hua; Li, Xiulou; Yang, Kun; Yuan, Jing; Yao, Ping; Miao, Xiaoping; Wei, Sheng; Wang, Youjie; Liang, Yuan; Zhang, Xiaomin; Guo, Huan; Yang, Handong; Hu, Frank B; Wu, Tangchun; He, Meian

    2016-01-01

    In this study, we investigated the independent and combined effects of sleep duration and afternoon napping on the risk of incident diabetes among a cohort of middle-aged and older Chinese adults. Information of sleep and napping was obtained by questionnaires during face-to-face interviews. We categorized sleep duration into napping was divided into no napping (0 min) (reference), 1-30 min, 31-60 min, 61-90 min, and > 90 min. Cox proportional hazard regression models were used. Compared with referential sleeping group, subjects sleeping ≥10 h had a 42% higher risk of developing diabetes. The HR was 1.28 for napping > 90 min when compared with no napping. These associations were more pronounced in individuals without hypertension. Combined effects of long sleep duration and afternoon napping were further identified. Individuals with both sleep duration ≥ 10 h and napping > 60 min had a 72% higher risk of incident diabetes than those with sleeping 7∼napping 0 min (all above p napping were independently and jointly associated with higher risk of incident diabetes. Key messages Sleep duration was associated with diabetes, but whether it is a real cause of incident diabetes especially in Chinese still remains to be elucidated. The association of afternoon napping and diabetes was not consistent and definite, we clarified this association in a large prospective study. Long sleep duration and afternoon napping were independently and jointly associated with higher risk of incident diabetes.

  19. Nuclear power plant operating experiences from the IAEA / Nea incident reporting system 2002-2005

    International Nuclear Information System (INIS)

    2006-01-01

    The Incident Reporting System (IRS) is an essential element of the international operating experience feedback system for nuclear power plants. The IRS is jointly operated and managed by the Nuclear Energy Agency (NEA), a semi-autonomous body within the Organisation for Economic Co-operation and Development (OECD), and the International Atomic Energy Agency (IAEA), a specialized agency within the United Nations System. (author)

  20. SU-F-T-462: Lessons Learned From a Machine Incident Reporting System

    International Nuclear Information System (INIS)

    Sutlief, S; Hoisak, J

    2016-01-01

    Purpose: Linear accelerators must operate with minimal downtime. Machine incident logs are a crucial tool to meet this requirement. They providing a history of service and demonstrate whether a fix is working. This study investigates the information content of a large department linear accelerator incident log. Methods: Our department uses an electronic reporting system to provide immediate information to both key department staff and the field service department. This study examines reports for five linac logs during 2015. The report attributes for analysis include frequency, level of documentation, who solved the problem, and type of fix used. Results: Of the reports, 36% were documented as resolved. In another 25% the resolution allowed treatment to proceed although the reported problem recurred within days. In 5% only intermediate troubleshooting was documented. The remainder lacked documentation. In 60% of the reports, radiation therapists resolved the problem, often by clearing the appropriate faults or reinitializing a software or hardware service. 22% were resolved by physics and 10% by field service engineers. The remaining 8% were resolved by IT, Facilities, or resolved spontaneously. Typical fixes, in order of scope, included clearing the fault and moving on, closing and re-opening the patient session or software, cycling power to a sub-unit, recalibrating a device (e.g., optical surface imaging), and calling in Field Service (usually resolving the problem through maintenance or component replacement). Conclusion: The reports with undocumented resolution represent a missed opportunity for learning. Frequency of who resolves a problem scales with the proximity of the person’s role (therapist, physicist, or service engineer), which is inversely related to the permanence of the resolution. Review of lessons learned from machine incident logs can form the basis for guidance to radiation therapists and medical physicists to minimize equipment downtime and

  1. SU-F-T-462: Lessons Learned From a Machine Incident Reporting System

    Energy Technology Data Exchange (ETDEWEB)

    Sutlief, S; Hoisak, J [University of California, San Diego, La Jolla, CA (United States)

    2016-06-15

    Purpose: Linear accelerators must operate with minimal downtime. Machine incident logs are a crucial tool to meet this requirement. They providing a history of service and demonstrate whether a fix is working. This study investigates the information content of a large department linear accelerator incident log. Methods: Our department uses an electronic reporting system to provide immediate information to both key department staff and the field service department. This study examines reports for five linac logs during 2015. The report attributes for analysis include frequency, level of documentation, who solved the problem, and type of fix used. Results: Of the reports, 36% were documented as resolved. In another 25% the resolution allowed treatment to proceed although the reported problem recurred within days. In 5% only intermediate troubleshooting was documented. The remainder lacked documentation. In 60% of the reports, radiation therapists resolved the problem, often by clearing the appropriate faults or reinitializing a software or hardware service. 22% were resolved by physics and 10% by field service engineers. The remaining 8% were resolved by IT, Facilities, or resolved spontaneously. Typical fixes, in order of scope, included clearing the fault and moving on, closing and re-opening the patient session or software, cycling power to a sub-unit, recalibrating a device (e.g., optical surface imaging), and calling in Field Service (usually resolving the problem through maintenance or component replacement). Conclusion: The reports with undocumented resolution represent a missed opportunity for learning. Frequency of who resolves a problem scales with the proximity of the person’s role (therapist, physicist, or service engineer), which is inversely related to the permanence of the resolution. Review of lessons learned from machine incident logs can form the basis for guidance to radiation therapists and medical physicists to minimize equipment downtime and

  2. Reporting Crime Victimizations to the Police and the Incidence of Future Victimizations: A Longitudinal Study.

    Science.gov (United States)

    Ranapurwala, Shabbar I; Berg, Mark T; Casteel, Carri

    2016-01-01

    Law enforcement depends on cooperation from the public and crime victims to protect citizens and maintain public safety; however, many crimes are not reported to police because of fear of repercussions or because the crime is considered trivial. It is unclear how police reporting affects the incidence of future victimization. To evaluate the association between reporting victimization to police and incident future victimization. We conducted a retrospective cohort study using National Crime Victimization Survey 2008-2012 data. Participants were 12+ years old household members who may or may not be victimized, were followed biannually for 3 years, and who completed at least one follow-up survey after their first reported victimization between 2008 and 2012. Crude and adjusted generalized linear mixed regression for survey data with Poisson link were used to compare rates of future victimization. Out of 18,657 eligible participants, 41% participants reported to their initial victimization to police and had a future victimization rate of 42.8/100 person-years (PY) (95% CI: 40.7, 44.8). The future victimization rate of those who did not report to the police (59%) was 55.0/100 PY (95% CI: 53.0, 57.0). The adjusted rate ratio comparing police reporting to not reporting was 0.78 (95%CI: 0.72, 0.84) for all future victimizations, 0.80 (95% CI: 0.72, 0.90) for interpersonal violence, 0.73 (95% CI: 0.68, 0.78) for thefts, and 0.95 (95% CI: 0.84, 1.07) for burglaries. Reporting victimization to police is associated with fewer future victimization, underscoring the importance of police reporting in crime prevention. This association may be attributed to police action and victim services provisions resulting from reporting.

  3. Feedback from incident reporting: information and action to improve patient safety.

    Science.gov (United States)

    Benn, J; Koutantji, M; Wallace, L; Spurgeon, P; Rejman, M; Healey, A; Vincent, C

    2009-02-01

    Effective feedback from incident reporting systems in healthcare is essential if organisations are to learn from failures in the delivery of care. Despite the wide-scale development and implementation of incident reporting in healthcare, studies in the UK suggest that information concerning system vulnerabilities could be better applied to improve operational safety within organisations. In this article, the findings and implications of research to identify forms of effective feedback from incident reporting are discussed, to promote best practices in this area. The research comprised a mixed methods review to investigate mechanisms of effective feedback for healthcare, drawing upon experience within established reporting programmes in high-risk industry and transport domains. Systematic searches of published literature were undertaken, and 23 case studies describing incident reporting programmes with feedback were identified for analysis from the international healthcare literature. Semistructured interviews were undertaken with 19 subject matter experts across a range of domains, including: civil aviation, maritime, energy, rail, offshore production and healthcare. In analysis, qualitative information from several sources was synthesised into practical requirements for developing effective feedback in healthcare. Both action and information feedback mechanisms were identified, serving safety awareness, improvement and motivational functions. The provision of actionable feedback that visibly improved systems was highlighted as important in promoting future reporting. Fifteen requirements for the design of effective feedback systems were identified, concerning: the role of leadership, the credibility and content of information, effective dissemination channels, the capacity for rapid action and the need for feedback at all levels of the organisation, among others. Above all, the safety-feedback cycle must be closed by ensuring that reporting, analysis and

  4. Change in Reported Lyme Disease Incidence in the Northeast and Upper Midwest, 1991-2014

    Science.gov (United States)

    This indicator shows how reported Lyme disease incidence has changed by state since 1991, based on the number of new cases per 100,000 people. The total change has been estimated from the average annual rate of change in each state. This map is limited to the 14 states where Lyme disease is most common, where annual rates are consistently above 10 cases per 100,000. Connecticut, New York, and Rhode Island had too much year-to-year variation in reporting practices to allow trend calculation. For more information: www.epa.gov/climatechange/science/indicators

  5. Contributory factors in surgical incidents as delineated by a confidential reporting system.

    Science.gov (United States)

    Mushtaq, F; O'Driscoll, C; Smith, Fct; Wilkins, D; Kapur, N; Lawton, R

    2018-05-01

    Background Confidential reporting systems play a key role in capturing information about adverse surgical events. However, the value of these systems is limited if the reports that are generated are not subjected to systematic analysis. The aim of this study was to provide the first systematic analysis of data from a novel surgical confidential reporting system to delineate contributory factors in surgical incidents and document lessons that can be learned. Methods One-hundred and forty-five patient safety incidents submitted to the UK Confidential Reporting System for Surgery over a 10-year period were analysed using an adapted version of the empirically-grounded Yorkshire Contributory Factors Framework. Results The most common factors identified as contributing to reported surgical incidents were cognitive limitations (30.09%), communication failures (16.11%) and a lack of adherence to established policies and procedures (8.81%). The analysis also revealed that adverse events were only rarely related to an isolated, single factor (20.71%) - with the majority of cases involving multiple contributory factors (79.29% of all cases had more than one contributory factor). Examination of active failures - those closest in time and space to the adverse event - pointed to frequent coupling with latent, systems-related contributory factors. Conclusions Specific patterns of errors often underlie surgical adverse events and may therefore be amenable to targeted intervention, including particular forms of training. The findings in this paper confirm the view that surgical errors tend to be multi-factorial in nature, which also necessitates a multi-disciplinary and system-wide approach to bringing about improvements.

  6. Self-Reported Minimalist Running Injury Incidence and Severity: A Pilot Study.

    Science.gov (United States)

    Ostermann, Katrina; Ridpath, Lance; Hanna, Jandy B

    2016-08-01

    Minimalist running entails using shoes with a flexible thin sole and is popular in the United States. Existing literature disagrees over whether minimalist running shoes (MRS) improve perceived severity of injuries associated with running in traditional running shoes (TRS). Additionally, the perceived injury patterns associated with MRS are relatively unknown. To examine whether injury incidence and severity (ie, degree of pain) by body region change after switching to MRS, and to determine if transition times affect injury incidences or severity with MRS. Runners who were either current or previous users of MRS were recruited to complete an Internet-based survey regarding self-reported injury before switching to MRS and whether self-reported pain from that injury decreased after switching. Questions regarding whether new injuries developed in respondents after switching to MRS were also included. Analyses were calculated using t tests, Wilcoxon signed rank tests, and Fischer exact tests. Forty-seven runners completed the survey, and 16 respondents reported injuries before switching to MRS. Among these respondents, pain resulting from injuries of the feet (P=.03) and knees (P=.01) decreased. Eighteen respondents (38.3%) indicated they sustained new injuries after switching to MRS, but the severity of these did not differ significantly from no injury. Neither time allowed for transition to MRS nor use or disuse of a stretching routine during this period was correlated with an increase in the incidence or severity of injuries. After switching to MRS, respondents perceived an improvement in foot and knee injuries. Additionally, respondents using MRS reported an injury rate of 38.3%, compared with the approximately 64% that the literature reports among TRS users. Future studies should be expanded to determine the full extent of the differences in injury patterns between MRS and TRS.

  7. Nuclear power plant operating experiences from the IAEA/NEA Incident Reporting System 1999-2002

    International Nuclear Information System (INIS)

    2003-01-01

    Incident reporting has become an increasingly important aspect of the operation and regulation of all public health and safety-related industries. Diverse industries such as aeronautics, chemicals, pharmaceuticals and explosives all depend on operating experience feedback to provide lessons learned about safety. The Incident Reporting System (IRS) is an essential element of the system for feeding back international operating experience for nuclear power plants. IRS reports contain information on events of Safety significance with important lessons learned. These experiences assist in reducing or eliminating recurrence of events at other plants. The IRS is jointly operated and managed by the Nuclear Energy Agency (NEA), a semi-autonomous body within the Organisation for Economic Co-operation and Development (OECD), and the International Atomic Energy Agency (IAEA). It is important that sufficient national resources be allocated to enable timely and high quality reporting of events important to safety, and to share these events in the IRS database. The first report, which covered the period July 1996 - June 1999, was widely acclaimed and encouraged both agencies to prepare this second report in order to highlight important lessons learned from around 300 events reported to the IRS for the period July 1999 - December 2002. Several areas were selected in this report to show the range of important topics available in the IRS. These include different types of failure in a variety of plant systems, as well as human performance considerations. This report is primarily aimed at senior officials in industry and government who have decision-making roles in the nuclear power industry

  8. Potential impact on HIV incidence of higher HIV testing rates and earlier antiretroviral therapy initiation in MSM

    DEFF Research Database (Denmark)

    Phillips, Andrew N; Cambiano, Valentina; Miners, Alec

    2015-01-01

    count 350/μl. We investigated what would be required to reduce HIV incidence in MSM to below 1 per 1000 person-years (i.e. cost-effective. METHODS: A dynamic, individual-based simulation model was calibrated to multiple data sources...... with viral suppression to 80%, and it would be 90%, if ART is initiated at diagnosis. The scenarios required for such a policy to be cost-effective are presented. CONCLUSION: This analysis provides targets for the proportion of all HIV-positive MSM with viral suppression required to achieve substantial......BACKGROUND: Increased rates of testing, with early antiretroviral therapy (ART) initiation, represent a key potential HIV-prevention approach. Currently, in MSM in the United Kingdom, it is estimated that 36% are diagnosed by 1 year from infection, and the ART initiation threshold is at CD4 cell...

  9. [Detection of a higher incidence of pathologic somatic findings in globus sensation by use of high frequency cinematography].

    Science.gov (United States)

    Hannig, C; Wuttge-Hannig, A; Bockmeyer, M

    1987-07-01

    Since December 1984 303 patients have undergone examination in our Multidisciplinary Consultation Service for Swallowing Disorders; 117 of them were suffering from typical globus symptoms. We were able to increase the yield of detection of organic lesions by use of the technique of 35 mm film cineradiography with a rate of 50 frames/s. Frame-by-frame analysis and computer-assisted evaluation showed that 80% of the patients with globus symptoms suffered from one or more underlying organic diseases, which could often be treated later with success. We found an increased incidence of early hypopharyngeal diverticula, webs, and motility disorders of the upper esophageal sphincter often associated with gastro-esophageal reflux or weakness of the pharyngeal wall. Cineradiography proved to be a very important tool in the analysis of the pharyngeal swallow in globus pharyngis.

  10. Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

    Directory of Open Access Journals (Sweden)

    Tariq Amina

    2012-11-01

    Full Text Available Abstract Background Medication incident reporting (MIR is a key safety critical care process in residential aged care facilities (RACFs. Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a design MIR artefacts that facilitate identification of the root causes of medication incidents, b integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.

  11. Changing incidence of diverticular disease of the colon in Korea : a serial radiologic study (report III)

    Energy Technology Data Exchange (ETDEWEB)

    Kwoen, Young Teck; Han, Sung Il; Chung, Soo Kyo; Bahk, Yong Whee [Catholic University Medical College, Seoul (Korea, Republic of)

    1988-10-15

    Diverticular disease of the colon (DDC), the most common affliction in developed countries, increases in incidence. It is an acquired disease where overactivity of smooth muscle of the colon causes mucosa and sub mucosa to herniate through the muscle layer of the bowel. Starting from 1964, we have periodically carried out radiologic survey to acertain the tendency of DDC to gradually increase in the Koreans. Initially Kim reported the incidence to be 0.2% in 1964 but the incidence in 1979 increased to 2.5% as reported by Chung et al. As the third survey on the series of the study on DDC, we have recently reviewed 1,859 consecutive new cases of double contrast barium enemas performed at the department of radiology, Kangnam St. Mary's Hospital, Catholic University Medical College during the 5 year's period from Feb. 1983 to May 1987. The results were as follows. 1. The present study revealed an incidence 6.0% of DDC, 7.2% in male and 5.0% in female. 2. The distribution of diverticular was 37.0% in cecum, 39.0% in ascending colon, 13.6% in transverse colon, 6.2% in descending colon, 3.7% in sigmoid colon. 3. The mean number of diverticular was 5. 4. The average age of patients with DDC was 50.5 years. From the present study, it has emerged that the diverticular disease of the colon in the Koreans is definitely on gradual increase with a significant change in the site of predominant involvement from the right to the left colon.

  12. Changing incidence of diverticular disease of the colon in Korea : a serial radiologic study (report III)

    International Nuclear Information System (INIS)

    Kwoen, Young Teck; Han, Sung Il; Chung, Soo Kyo; Bahk, Yong Whee

    1988-01-01

    Diverticular disease of the colon (DDC), the most common affliction in developed countries, increases in incidence. It is an acquired disease where overactivity of smooth muscle of the colon causes mucosa and sub mucosa to herniate through the muscle layer of the bowel. Starting from 1964, we have periodically carried out radiologic survey to acertain the tendency of DDC to gradually increase in the Koreans. Initially Kim reported the incidence to be 0.2% in 1964 but the incidence in 1979 increased to 2.5% as reported by Chung et al. As the third survey on the series of the study on DDC, we have recently reviewed 1,859 consecutive new cases of double contrast barium enemas performed at the department of radiology, Kangnam St. Mary's Hospital, Catholic University Medical College during the 5 year's period from Feb. 1983 to May 1987. The results were as follows. 1. The present study revealed an incidence 6.0% of DDC, 7.2% in male and 5.0% in female. 2. The distribution of diverticular was 37.0% in cecum, 39.0% in ascending colon, 13.6% in transverse colon, 6.2% in descending colon, 3.7% in sigmoid colon. 3. The mean number of diverticular was 5. 4. The average age of patients with DDC was 50.5 years. From the present study, it has emerged that the diverticular disease of the colon in the Koreans is definitely on gradual increase with a significant change in the site of predominant involvement from the right to the left colon.

  13. Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

    Science.gov (United States)

    2012-01-01

    Background Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes. PMID:23122411

  14. Creating European guidelines for Chiropractic Incident Reporting and Learning Systems (CIRLS: relevance and structure

    Directory of Open Access Journals (Sweden)

    Wangler Martin

    2011-04-01

    Full Text Available Abstract Background In 2009, the heads of the Executive Council of the European Chiropractors' Union (ECU and the European Academy of Chiropractic (EAC involved in the European Committee for Standardization (CEN process for the chiropractic profession, set out to establish European guidelines for the reporting of adverse reactions to chiropractic treatment. There were a number of reasons for this: first, to improve the overall quality of patient care by aiming to reduce the application of potentially harmful interventions and to facilitate the treatment of patients within the context of achieving maximum benefit with a minimum risk of harm; second, to inform the training objectives for the Graduate Education and Continuing Professional Development programmes of all 19 ECU member nations, regarding knowledge and skills to be acquired for maximising patient safety; and third, to develop a guideline on patient safety incident reporting as it is likely to be part of future CEN standards for ECU member nations. Objective To introduce patient safety incident reporting within the context of chiropractic practice in Europe and to help individual countries and their national professional associations to develop or improve reporting and learning systems. Discussion Providing health care of any kind, including the provision of chiropractic treatment, can be a complex and, at times, a risky activity. Safety in healthcare cannot be guaranteed, it can only be improved. One of the most important aspects of any learning and reporting system lies in the appropriate use of the data and information it gathers. Reporting should not just be seen as a vehicle for obtaining information on patient safety issues, but also be utilised as a tool to facilitate learning, advance quality improvement and to ultimately minimise the rate of the occurrence of errors linked to patient care. Conclusions Before a reporting and learning system can be established it has to be clear

  15. Higher Serum Direct Bilirubin Levels Were Associated with a Lower Risk of Incident Chronic Kidney Disease in Middle Aged Korean Men

    Science.gov (United States)

    Ryu, Seungho; Chang, Yoosoo; Zhang, Yiyi; Woo, Hee-Yeon; Kwon, Min-Jung; Park, Hyosoon; Lee, Kyu-Beck; Son, Hee Jung; Cho, Juhee; Guallar, Eliseo

    2014-01-01

    Background The association between serum bilirubin levels and incident chronic kidney disease (CKD) in the general population is unknown. We aimed to examine the association between serum bilirubin concentration (total, direct, and indirect) and the risk of incident CKD. Methods and Findings Longitudinal cohort study of 12,823 Korean male workers 30 to 59 years old without CKD or proteinuria at baseline participating in medical health checkup program in a large worksite. Study participants were followed for incident CKD from 2002 through 2011. Estimated glomerular filtration rate (eGFR) was estimated by using the CKD-EPI equation. CKD was defined as eGFR bilirubin were 0.93 (95% CI 0.67–1.28), 0.88 (0.60–1.27) and 0.60 (0.42–0.88), respectively. In multivariable models, the adjusted hazard ratio for CKD comparing the highest to the lowest quartile of serum direct bilirubin levels was 0.60 (95% CI 0.41–0.87; P trend = 0.01). Neither serum total nor indirect bilirubin levels were significantly associated with the incidence of CKD. Conclusions Higher serum direct bilirubin levels were significantly associated with a lower risk of developing CKD, even adjusting for a variety of cardiometabolic parameters. Further research is needed to elucidate the mechanisms underlying this association and to establish the role of serum direct bilirubin as a marker for CKD risk. PMID:24586219

  16. Pesticide exposure and self-reported incident depression among wives in the Agricultural Health Study.

    Science.gov (United States)

    Beard, John D; Hoppin, Jane A; Richards, Marie; Alavanja, Michael C R; Blair, Aaron; Sandler, Dale P; Kamel, Freya

    2013-10-01

    Depression in women is a public health problem. Studies have reported positive associations between pesticides and depression, but few studies were prospective or presented results for women separately. We evaluated associations between pesticide exposure and incident depression among farmers' wives in the Agricultural Health Study, a prospective cohort study in Iowa and North Carolina. We used data on 16,893 wives who did not report physician-diagnosed depression at enrollment (1993-1997) and who completed a follow-up telephone interview (2005-2010). Among these wives, 1054 reported physician diagnoses of depression at follow-up. We collected information on potential confounders and on ever use of any pesticide, 11 functional and chemical classes of pesticides, and 50 specific pesticides by wives and their husbands via self-administered questionnaires at enrollment. We used inverse probability weighting to adjust for potential confounders and to account for possible selection bias induced by the death or loss of 10,639 wives during follow-up. We used log-binomial regression models to estimate risk ratios and 95% confidence intervals. After weighting for age at enrollment, state of residence, education level, diabetes diagnosis, and drop out, wives' incident depression was positively associated with diagnosed pesticide poisoning, but was not associated with ever using any pesticide. Use of individual pesticides or functional or chemical classes of pesticides was generally not associated with wives' depression. Among wives who never used pesticides, husbands' ever use of individual pesticides or functional or chemical classes of pesticides was generally not associated with wives' incident depression. Our study adds further evidence that high level pesticide exposure, such as pesticide poisoning, is associated with increased risk of depression and sets a lower bound on the level of exposure related to depression, thereby providing reassurance that the moderate levels

  17. International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process.

    Science.gov (United States)

    Howell, Ann-Marie; Burns, Elaine M; Hull, Louise; Mayer, Erik; Sevdalis, Nick; Darzi, Ara

    2017-02-01

    Patient safety incident reporting systems (PSRS) have been established for over a decade, but uncertainty remains regarding the role that they can and ought to play in quantifying healthcare-related harm and improving care. To establish international, expert consensus on the purpose of PSRS regarding monitoring and learning from incidents and developing recommendations for their future role. After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised. Forty recommendations emerged from the Delphi procedure on the role and use of PSRS. Experts agreed reporting system should not be used as an epidemiological tool to monitor the rate of harm over time or to appraise the relative safety of hospitals. They agreed reporting is a valuable mechanism for identifying organisational safety needs. The benefit of a national system was clear with respect to medication error, device failures, hospital-acquired infections and never events as these problems often require solutions at a national level. Experts recommended training for senior healthcare professionals in incident investigation. Consensus recommendation was for hospitals to take responsibility for creating safety solutions locally that could be shared nationally. We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. Critical incidents and mortality reporting in pediatric anesthesia: the Australian experience.

    Science.gov (United States)

    Ragg, Philip

    2011-07-01

    Since 1960, the collection and analysis of mortality data for anesthesia in Australia has been of significant benefit to practising anesthetists. These figures include pediatric deaths which fortunately have been rare and often inevitable because of severe underlying disease and patient risk factors. The reporting of critical incidents and serious morbidity, on the other hand, has been far less impressive. Only one state in Australia, Victoria, currently has a committee that collects morbidity data and, as this reporting is voluntary, is likely to under-represent the true numbers of critical events. There is no specific pediatric morbidity database in Australia so much of this discussion will be regarding overall anesthesia critical event reporting which includes pediatrics as a subset. © 2011 Blackwell Publishing Ltd.

  19. Identifying medication error chains from critical incident reports: a new analytic approach.

    Science.gov (United States)

    Huckels-Baumgart, Saskia; Manser, Tanja

    2014-10-01

    Research into the distribution of medication errors usually focuses on isolated stages within the medication use process. Our study aimed to provide a novel process-oriented approach to medication incident analysis focusing on medication error chains. Our study was conducted across a 900-bed teaching hospital in Switzerland. All reported 1,591 medication errors 2009-2012 were categorized using the Medication Error Index NCC MERP and the WHO Classification for Patient Safety Methodology. In order to identify medication error chains, each reported medication incident was allocated to the relevant stage of the hospital medication use process. Only 25.8% of the reported medication errors were detected before they propagated through the medication use process. The majority of medication errors (74.2%) formed an error chain encompassing two or more stages. The most frequent error chain comprised preparation up to and including medication administration (45.2%). "Non-consideration of documentation/prescribing" during the drug preparation was the most frequent contributor for "wrong dose" during the administration of medication. Medication error chains provide important insights for detecting and stopping medication errors before they reach the patient. Existing and new safety barriers need to be extended to interrupt error chains and to improve patient safety. © 2014, The American College of Clinical Pharmacology.

  20. Patient involvement in patient safety: Protocol for developing an intervention using patient reports of organisational safety and patient incident reporting

    Directory of Open Access Journals (Sweden)

    Armitage Gerry

    2011-05-01

    Full Text Available Abstract Background Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety - a patient measure of organisational safety (PMOS, and a patient incident reporting tool (PIRT - to help the NHS prevent patient safety incidents by learning more about when and why they occur. Methods To develop the PMOS 1 literature will be reviewed to identify similar measures and key contributory factors to error; 2 four patient focus groups will ascertain practicality and feasibility; 3 25 patient interviews will elicit approximately 60 items across 10 domains; 4 10 patient and clinician interviews will test acceptability and understanding. Qualitative data will be analysed using thematic content analysis. To develop the PIRT 1 individual and then combined patient and clinician focus groups will provide guidance for the development of three potential reporting tools; 2 nine wards across three hospital directorates will pilot each of the tools for three months. The best performing tool will be identified from the frequency, volume and quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the PMOS and PIRT during their stay in hospital. A sub-sample (N = 50 will complete the PMOS again one week later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed by comparing reported incidents with those identified from case note review and the existing staff reporting scheme. In a subsequent study these tools will be used to provide information to wards/units about their

  1. [Preliminary results of an anonymous internet-based reporting system for critical incidents in ambulatory primary care].

    Science.gov (United States)

    Brun, A

    2005-03-01

    To learn from errors is not always easy, especially if they happened to others! This paper describes the organization and management of a critical incident reporting system for primary care physicians in Switzerland and reports about the difficulties and experiences during the first 18 months since the start of the program. It seems to be particularly difficult to enhance the attentiveness of physicians for apparently harmless daily critical incidents and to motivate them to report it even in an anonymous reporting system. As incentives for more intensive participation there are the hope for comments on reported cases by other participants and the expectation that reported errors will be avoided by the readers.

  2. Higher plasma levels of advanced glycation end products are associated with incident cardiovascular disease and all-cause mortality in type 1 diabetes

    DEFF Research Database (Denmark)

    Nin, Johanna W; Jorsal, Anders; Ferreira, Isabel

    2011-01-01

    -grade inflammation, and arterial stiffness. RESEARCH DESIGN AND METHODS: We prospectively followed 169 individuals with diabetic nephropathy and 170 individuals with persistent normoalbuminuria who were free of CVD at study entry and in whom levels of N(ε)-(carboxymethyl)lysine, N(ε)-(carboxyethyl)lysine......OBJECTIVE: To investigate the associations of plasma levels of advanced glycation end products (AGEs) with incident cardiovascular disease (CVD) and all-cause mortality in type 1 diabetes and the extent to which any such associations could be explained by endothelial and renal dysfunction, low...... or endothelial dysfunction, low-grade inflammation, or arterial stiffness. CONCLUSIONS: Higher levels of AGEs are associated with incident fatal and nonfatal CVD as well as all-cause mortality in individuals with type 1 diabetes, independently of other risk factors and of several potential AGEs...

  3. The role of the NEA incident reporting system in trend and pattern studies

    International Nuclear Information System (INIS)

    Ishack, G.; Iwabuchi, H.

    1990-01-01

    When the Incident Reporting System of the OECD Nuclear Energy Agency (NEA-IRS) was first instituted in 1980, Members recognized the fact that since the data thus collected only pertains to significant safety-related incidents, the system cannot be used for in-depth statistical analyses. Rather, the NEA-IRS is best suited, in addition to single event assessments, to studies that provide indications related to system, component or human performance; these indications could also initiate trend analyses on more complete data bases. Examples are the generic studies on the Loss of Containment Functions (completed last year) and the Loss of Residual Heat Removal (due for completion this year), and the studies related to the human factor. Another type of use of the IRS data was started last year by the NEA Principal Working Group 1 on Operating Experience and Human Factors (PWG 1) in response to the encouragement of the OECD/NEA Committee on the Safety of Nuclear Installations (CSNI), to make the best use of Operating Experience, notably of information disseminated through the NEA-IRS. These applications consisted of scanning the IRS data base for events that could be of interest to specialized domains such as radiation protection, fracture mechanics and fire protection. In the paragraphs which follow, some highlights of the results of these scans are presented (reference is made at the end of this paper to the reports detailing the results of these applications)

  4. The United States Department of Energy (DOE) Computerized Accident/Incident Reporting System (CAIRS)

    International Nuclear Information System (INIS)

    Briscoe, G.J.

    1993-01-01

    The Department of Energy's (DOE) Computerized Accident/Incident Reporting System (CAIRS) is a comprehensive data base containing more than 50,000 investigation reports of injury/illness, property damage and vehicle accident cases representing safety data from 1975 to the present for more than 150 DOE contractor organizations. A special feature is that the text of each accident report is translated using a controlled dictionary and rigid sentence structure called Factor Relationship and Sequence of Events (FRASE) that enhances the ability to retrieve specific types of information and to perform detailed analyses. DOE summary and individual contractor reports are prepared quarterly and annually. In addition, ''Safety Performance Profile'' reports for individual organizations are prepared to provide advance information to appraisal teams, and special topical reports are prepared for areas of concern such as an increase in the number of security injuries or environmental releases. The data base is open to all DOE and Contractor registered users with no access restrictions other than that required by the Privacy Act

  5. Review of incidents to be reported under the Radiation Protection Ordinance for the years 1987 and 1988

    International Nuclear Information System (INIS)

    1989-01-01

    The total of 80 incidents were caused by human failure, intentional disruption, theft, fire, violation of rules, transport losses, accidents, equipment deficiencies. 15 ionization smoke detectors were reported lost or stolen. (HP) [de

  6. Completeness of tuberculosis reporting forms in five Brazilian capitals with a high incidence of the disease *

    Science.gov (United States)

    dos Santos, Normeide Pedreira; Lírio, Monique; Passos, Louran Andrade Reis; Dias, Juarez Pereira; Kritski, Afrânio Lineu; Galvão-Castro, Bernardo; Grassi, Maria Fernanda Rios

    2013-01-01

    The aim of this study was to evaluate the completeness of tuberculosis reporting forms in the greater metropolitan areas of five Brazilian capitals where the incidence of tuberculosis was high in 2010-Salvador, Rio de Janeiro, Cuiabá, Porto Alegre, and Belém-using tabulations obtained from the Sistema Nacional de Informação de Agravos de Notificação (National Case Registry Database). The degree of completeness was highest in Porto Alegre and Cuiabá, whereas it was lowest in Rio de Janeiro, where there are more reported cases of tuberculosis than in any other Brazilian capital. A low degree of completeness of these forms can affect the quality of the Brazilian National Tuberculosis Control Program, which will have negative consequences for health care and decision-making processes. PMID:23670508

  7. Investigation and evaluation of cracking incidents in piping in pressurized water reactors. Technical report

    International Nuclear Information System (INIS)

    1980-09-01

    This report summarizes an investigation of known cracking incidents in pressurized water reactor plants. Several instances of cracking in feedwater piping in 1979, together with reported cases of stress corrosion cracking at Three Mile Island Unit 1, led to the establishment of the third Pipe Crack Study Group. Major differences between the scope of the third PCSG and the previous two are: (1) the emphasis given to systems safety implications of cracking, and (2) the consideration given all cracking mechanisms known to affect PWR piping, including the failure of small lines in secondary safety systems. The present PCSG reviewed existing information on cracking of PWR pipe systems, either contained in written records of collected from meetings in the United States, and made recommendations in response to the PCSG charter questions and to othe major items that may be considered to either reduce the potential for cracking or to improve licensing bases

  8. Communicating the Improvements Developed from Critical Incident Reports is an Essential Part of CIRS.

    Science.gov (United States)

    Hubertus, J; Piehlmeier, W; Heinrich, M

    2016-09-01

    The Critical Incident Reporting System (CIRS) is a tool for employees to report anonymously of near misses. Its efficiency and improvement of safety is proved by many studies. Our department introduced CIRS in 2009 and it is used frequently. As the number of reports decreased over time we asked for factors responsible for the reduced use. All employees had access to CIRS and have been trained in several courses of instruction. Accomplished results and consequences were published in biannual newsletters. In 2014 we initiated an anonymous employee attitude survey to ask for their experience and satisfaction with CIRS. 88 near misses were reported since 2009. 44 (50%) reports were classified as RS1, 34 (38.6%) as RS2, and 10 (11.4%) as RS3. No RS4 reports were notified. Most reports concerned problems with administration of medication (n=26; 29.5%) and problems with technical devices (n=18; 20.5%). 75 (83%) of our employees participated in the survey. 64 (86.5%) discerned that CIRS is anonymous. 31 (41.9%) reported already a near miss. Of note, two-third didn't realize an improvement following their report. On the other hand, only half of the pollees stated to read the newsletter. Even if efficiency and advantages of CIRS are proved and undeniable, sufficient and perpetual feedback of results and improvements developed by the CIRS team and regular trainings of the employees are mandatory for the success of CIRS. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study.

    Science.gov (United States)

    Panagioti, Maria; Blakeman, Thomas; Hann, Mark; Bower, Peter

    2017-05-30

    Increasing evidence suggests that patient safety is a serious concern for older patients with long-term conditions. Despite this, there is a lack of research on safety incidents encountered by this patient group. In this study, we sought to examine patient reports of safety incidents and factors associated with reports of safety incidents in older patients with long-term conditions. The baseline cross-sectional data from a longitudinal cohort study were analysed. Older patients (n=3378 aged 65 years and over) with a long-term condition registered in general practices were included in the study. The main outcome was patient-reported safety incidents including availability and appropriateness of medical tests and prescription of wrong types or doses of medication. Binary univariate and multivariate logistic regression analyses were undertaken to examine factors associated with patient-reported safety incidents. Safety incidents were reported by 11% of the patients. Four factors were significantly associated with patient-reported safety incidents in multivariate analyses. The experience of multiple long-term conditions (OR=1.09, 95% CI 1.05 to 1.13), a probable diagnosis of depression (OR=1.36, 95% CI 1.06 to 1.74) and greater relational continuity of care (OR=1.28, 95% CI 1.08 to 1.52) were associated with increased odds for patient-reported safety incidents. Perceived greater support and involvement in self-management was associated with lower odds for patient-reported safety incidents (OR=0.95, 95% CI 0.93 to 0.97). We found that older patients with multimorbidity and depression are more likely to report experiences of patient safety incidents. Improving perceived support and involvement of patients in their care may help prevent patient-reported safety incidents. © 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.

  10. Higher incidence of spontaneous sister-chromatid exchanges (SCEs) and X-ray-induced chromosome aberrations in peripheral blood lymphocytes during pregnancy

    International Nuclear Information System (INIS)

    Sharma, T.; Das, B.C.

    1986-01-01

    In vitro cultures of peripheral blood lymphocytes from human and muntjac (barking deer) females who were at an advanced stage of pregnancy (32-37 weeks pregnant women and 20-24 weeks pregnant muntjacs) showed an enhanced frequency of SCEs and X-ray-induced chromosome aberrations when compared with those of nonpregnant females. Lymphocyte cultures of nonpregnant females to which sex hormones progesterone, oestrogen and human chorionic gonadotropin (HCG) were added together exogenously also showed higher frequency of SCEs. The plausible reason(s) for such high incidence of SCEs during pregnancy is discussed. (orig.)

  11. Analysis of Aviation Safety Reporting System Incident Data Associated with the Technical Challenges of the Atmospheric Environment Safety Technology Project

    Science.gov (United States)

    Withrow, Colleen A.; Reveley, Mary S.

    2014-01-01

    This study analyzed aircraft incidents in the NASA Aviation Safety Reporting System (ASRS) that apply to two of the three technical challenges (TCs) in NASA's Aviation Safety Program's Atmospheric Environment Safety Technology Project. The aircraft incidents are related to airframe icing and atmospheric hazards TCs. The study reviewed incidents that listed their primary problem as weather or environment-nonweather between 1994 and 2011 for aircraft defined by Federal Aviation Regulations (FAR) Parts 121, 135, and 91. The study investigated the phases of flight, a variety of anomalies, flight conditions, and incidents by FAR part, along with other categories. The first part of the analysis focused on airframe-icing-related incidents and found 275 incidents out of 3526 weather-related incidents over the 18-yr period. The second portion of the study focused on atmospheric hazards and found 4647 incidents over the same time period. Atmospheric hazards-related incidents included a range of conditions from clear air turbulence and wake vortex, to controlled flight toward terrain, ground encounters, and incursions.

  12. IAEA/NEA incident reporting system (IRS). Reporting guidelines. Feedback from safety related operating experience for nuclear power plants

    International Nuclear Information System (INIS)

    1998-01-01

    The Incident Reporting System (IRS) is an international system jointly operated by the International Atomic Energy Agency (IAEA) and the Nuclear Energy Agency of the Organisation for Economic Cooperation and Development (OECD/NEA). The fundamental objective of the IRS is to contribute to improving the safety of commercial nuclear power plants (NPPs) which are operated worldwide. This objective can be achieved by providing timely and detailed information on both technical and human factors related to events of safety significance which occur at these plants. The purpose of these guidelines, which supersede the previous IAEA Safety Series No. 93 (Part II) and the NEA IRS guidelines, is to describe the system and to give users the necessary background and guidance to enable them to produce IRS reports meeting a high standard of quality while retaining the high efficiency of the system expected by all Member States operating nuclear power plants. These guidelines have been jointly developed and approved by the NEA/IAEA

  13. [Unerupted first deciduous molar located higher to the first premolar: a case report].

    Science.gov (United States)

    Zhan, Y; Liu, H

    2017-02-18

    Tooth eruption is defined as the movement of a tooth from its site of development within the alveolar process to its functional position in the oral cavity. The process of tooth eruption can be divided into different phases: pre-eruptive bone stage, alveolar bone stage, mucosal stage, preocclusal stage, occlusal stage and maturation stage. Any disturbance in these phases can lead to eruptive anomalies. The incidence of unerupted teeth is usually higher among permanent teeth than among deciduous ones. Of the primary teeth reported as unerupted, second deciduous molars are the teeth most frequently involved, followed by primary central incisors. At present almost no coverage is seen about the impaction of the first deciduous molar. In this case, a 4-year-old boy who presented with an impacted left maxillary first deciduous molar came to the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. This tooth, located higher to the left maxillary first premolar, was well near to the maxillary sinus. The family and medical histories were noncontributory and his physical findings were within normal limits. The mother was reported as having experienced no illness or other complications and taken no medications during pregnancy. His clinical extraoral examination was noncontributory. His clinical intra-oral examination revealed that the maxillary left first primary molar was not present. No enlargement of the area was apparent visually or on palpation. The remaining primary dentition was well aligned and in good condition. His oral hygiene was good, although there were incipient occlusal carious lesions in the mandibular second primary molars. There was no history or evidence of dental trauma. A diagnosis of a left maxillary first deciduous molar was made on the basis of the clinical and radiographic evidence. Numerous local etiologic factors have been described for impacted teeth. These include anomalous teeth, malposition, fusion with

  14. Incident reporting to BfArM - regulatory framework, results and challenges.

    Science.gov (United States)

    Seidel, Robin; Stößlein, Ekkehard; Lauer, Wolfgang

    2016-04-01

    Medical devices are manifold and one of the most innovative fields of technology. As technologies advance, former limits cease to exist and complex devices become reality. Medical devices represent a very dynamic field with high economic relevance. The manufacturer of a medical device is obliged to minimize product-related risks as well as to demonstrate compliance with the so-called "essential requirements" regarding safety and performance before placing the device on the market. Any critical incident in relation to the application of a medical device has to be reported to the competent authority for risk assessment, which in Germany is either the Federal Institute for Drugs and Medical Devices (BfArM) or the Paul Ehrlich Institute (PEI) depending on the type of device. In this article, the German regulatory framework for medical devices and the resulting tasks for BfArM are described as well as the topics of its recently installed research and development group on prospective risk identification and application safety for medical devices. Results of failure mode and root cause analyses of incident data are presented as well as further data on cases with the result "root-cause analysis not possible". Finally an outlook is given on future challenges regarding risk assessment for medical devices.

  15. Reducing barriers to energy efficiency in the German higher education sector. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Schleich, J.; Boede, U.

    2000-12-01

    This report describes the empirical research into barriers to energy efficiency in the German higher education (HE) sector. It is one of nine such reports in the BARRIERS project. The report contains description and analysis of six case studies of energy management in German universities. The results are analysed using the theoretical framework developed for the BARRIERS project (Sorrell et al., 2000). The report also provides brief recommendations on how these barriers to the rational use of energy (RUE) may be overcome and how energy efficiency within the sector may be improved. The results of the study for the higher education sector in Germany are summarised in this executive summary under the following headings: - Characterising the higher education sector; - Case studies of energy management in the German higher education sector; - Evidence of barriers in the German higher education sector; - The role of energy service companies in the higher education sector; - Policy implications. (orig.)

  16. Ventilator-Related Adverse Events: A Taxonomy and Findings From 3 Incident Reporting Systems.

    Science.gov (United States)

    Pham, Julius Cuong; Williams, Tamara L; Sparnon, Erin M; Cillie, Tam K; Scharen, Hilda F; Marella, William M

    2016-05-01

    In 2009, researchers from Johns Hopkins University's Armstrong Institute for Patient Safety and Quality; public agencies, including the FDA; and private partners, including the Emergency Care Research Institute and the University HealthSystem Consortium (UHC) Safety Intelligence Patient Safety Organization, sought to form a public-private partnership for the promotion of patient safety (P5S) to advance patient safety through voluntary partnerships. The study objective was to test the concept of the P5S to advance our understanding of safety issues related to ventilator events, to develop a common classification system for categorizing adverse events related to mechanical ventilators, and to perform a comparison of adverse events across different adverse event reporting systems. We performed a cross-sectional analysis of ventilator-related adverse events reported in 2012 from the following incident reporting systems: the Pennsylvania Patient Safety Authority's Patient Safety Reporting System, UHC's Safety Intelligence Patient Safety Organization database, and the FDA's Manufacturer and User Facility Device Experience database. Once each organization had its dataset of ventilator-related adverse events, reviewers read the narrative descriptions of each event and classified it according to the developed common taxonomy. A Pennsylvania Patient Safety Authority, FDA, and UHC search provided 252, 274, and 700 relevant reports, respectively. The 3 event types most commonly reported to the UHC and the Pennsylvania Patient Safety Authority's Patient Safety Reporting System databases were airway/breathing circuit issue, human factor issues, and ventilator malfunction events. The top 3 event types reported to the FDA were ventilator malfunction, power source issue, and alarm failure. Overall, we found that (1) through the development of a common taxonomy, adverse events from 3 reporting systems can be evaluated, (2) the types of events reported in each database were related

  17. Ventilator-Related Adverse Events: A Taxonomy and Findings From 3 Incident Reporting Systems

    Science.gov (United States)

    Pham, Julius Cuong; Williams, Tamara L; Sparnon, Erin M; Cillie, Tam K; Scharen, Hilda F; Marella, William M

    2016-01-01

    BACKGROUND: In 2009, researchers from Johns Hopkins University's Armstrong Institute for Patient Safety and Quality; public agencies, including the FDA; and private partners, including the Emergency Care Research Institute and the University HealthSystem Consortium (UHC) Safety Intelligence Patient Safety Organization, sought to form a public-private partnership for the promotion of patient safety (P5S) to advance patient safety through voluntary partnerships. The study objective was to test the concept of the P5S to advance our understanding of safety issues related to ventilator events, to develop a common classification system for categorizing adverse events related to mechanical ventilators, and to perform a comparison of adverse events across different adverse event reporting systems. METHODS: We performed a cross-sectional analysis of ventilator-related adverse events reported in 2012 from the following incident reporting systems: the Pennsylvania Patient Safety Authority's Patient Safety Reporting System, UHC's Safety Intelligence Patient Safety Organization database, and the FDA's Manufacturer and User Facility Device Experience database. Once each organization had its dataset of ventilator-related adverse events, reviewers read the narrative descriptions of each event and classified it according to the developed common taxonomy. RESULTS: A Pennsylvania Patient Safety Authority, FDA, and UHC search provided 252, 274, and 700 relevant reports, respectively. The 3 event types most commonly reported to the UHC and the Pennsylvania Patient Safety Authority's Patient Safety Reporting System databases were airway/breathing circuit issue, human factor issues, and ventilator malfunction events. The top 3 event types reported to the FDA were ventilator malfunction, power source issue, and alarm failure. CONCLUSIONS: Overall, we found that (1) through the development of a common taxonomy, adverse events from 3 reporting systems can be evaluated, (2) the types of

  18. Wheelchair incidents

    NARCIS (Netherlands)

    Drongelen AW van; Roszek B; Hilbers-Modderman ESM; Kallewaard M; Wassenaar C; LGM

    2002-01-01

    This RIVM study was performed to gain insight into wheelchair-related incidents with powered and manual wheelchairs reported to the USA FDA, the British MDA and the Dutch Center for Quality and Usability Research of Technical Aids (KBOH). The data in the databases do not indicate that incidents with

  19. First Annual Report: NASA-ONERA Collaboration on Human Factors in Aviation Accidents and Incidents

    Science.gov (United States)

    Srivastava, Ashok; Fabiani, Patrick

    2012-01-01

    This is the first annual report jointly prepared by NASA and ONERA on the work performed under the agreement to collaborate on a study of the human factors entailed in aviation accidents and incidents particularly focused on consequences of decreases in human performance associated with fatigue. The objective of this Agreement is to generate reliable, automated procedures that improve understanding of the levels and characteristics of flight-crew fatigue factors whose confluence will likely result in unacceptable crew performance. This study entails the analyses of numerical and textual data collected during operational flights. NASA and ONERA are collaborating on the development and assessment of automated capabilities for extracting operationally significant information from very large, diverse (textual and numerical) databases much larger than can be handled practically by human experts. This report presents the approach that is currently expected to be used in processing and analyzing the data for identifying decrements in aircraft performance and examining their relationships to decrements in crewmember performance due to fatigue. The decisions on the approach were based on samples of both the numerical and textual data that will be collected during the four studies planned under the Human Factors Monitoring Program (HFMP). Results of preliminary analyses of these sample data are presented in this report.

  20. The Supply of Part-Time Higher Education in the UK. Research Report

    Science.gov (United States)

    Callender, Claire; Birkbeck, Anne Jamieson; Mason, Geoff

    2010-01-01

    This report explores the supply of part-time higher education in the UK, with particular consideration to the study of part-time undergraduate provision in England. It is the final publication in the series of reports on individual student markets that were commissioned by Universities UK following the publication of the reports on the Future size…

  1. Patient safety with reference to the occurrence of adverse events in admitted patients on the basis of incident reporting in a tertiary care hospital in North India

    OpenAIRE

    Moonis Mirza; Farooq A. Jan; Rauf Ahmad Wani; Fayaz Ahmad Sofi

    2016-01-01

    Background: A good quality report should lend itself for detailed analysis of the chain of events that lead to the incident. This knowledge can then be used to consider what interventions, and at what level in the chain, can prevent the incident from occurring again. Aim was to study the occurrence of adverse events on the basis of incident reporting. Methods: Critical analysis of incident reporting of adverse events taking place in admitted patients for one year by using WHO Structured q...

  2. Elevated incidence rates of diabetes in Peru: report from PERUDIAB, a national urban population-based longitudinal study

    OpenAIRE

    Seclen, Segundo Nicolas; Rosas, Moises Ernesto; Arias, Arturo Jaime; Medina, Cecilia Alexandra

    2017-01-01

    Objective A recent report from a non-nationally representative, geographically diverse sample in four separate communities in Peru suggests an unusually high diabetes incidence. We aimed to estimate the national diabetes incidence rate using PERUDIAB, a probabilistic, national urban population-based longitudinal study. Research design and methods 662 subjects without diabetes, selected by multistage, cluster, random sampling of households, representing the 24 administrative and the 3 (coast, ...

  3. Investigation of reactor incident reports with regard to human malfunctions as far as these had an effect on the incident history

    International Nuclear Information System (INIS)

    Hoffmann, E.

    1984-01-01

    The study has the aim to examine by means of a human failure analysis the operation of a nuclear power plant with regard to its weak points, in order to deduce by this starting-points for operational improvements. Contrary to most studies published on this subject and which are often based on free-hand hypotheses and plausibility studies here, the experience gained in the operation is systematically examined with regard to human malfunction and their deeper causes, i.e. on the experience which was founded on some 1,000 collected reports on incidents. (orig./GL) [de

  4. Patient safety in palliative care: A mixed-methods study of reports to a national database of serious incidents.

    Science.gov (United States)

    Yardley, Iain; Yardley, Sarah; Williams, Huw; Carson-Stevens, Andrew; Donaldson, Liam J

    2018-06-01

    Patients receiving palliative care are vulnerable to patient safety incidents but little is known about the extent of harm caused or the origins of unsafe care in this population. To quantify and qualitatively analyse serious incident reports in order to understand the causes and impact of unsafe care in a population receiving palliative care. A mixed-methods approach was used. Following quantification of type of incidents and their location, a qualitative analysis using a modified framework method was used to interpret themes in reports to examine the underlying causes and the nature of resultant harms. Reports to a national database of 'serious incidents requiring investigation' involving patients receiving palliative care in the National Health Service (NHS) in England during the 12-year period, April 2002 to March 2014. A total of 475 reports were identified: 266 related to pressure ulcers, 91 to medication errors, 46 to falls, 21 to healthcare-associated infections (HCAIs), 18 were other instances of disturbed dying, 14 were allegations against health professions, 8 transfer incidents, 6 suicides and 5 other concerns. The frequency of report types differed according to the care setting. Underlying causes included lack of palliative care experience, under-resourcing and poor service coordination. Resultant harms included worsened symptoms, disrupted dying, serious injury and hastened death. Unsafe care presents a risk of significant harm to patients receiving palliative care. Improvements in the coordination of care delivery alongside wider availability of specialist palliative care support may reduce this risk.

  5. Patient-reported experiences of patient safety incidents need to be utilized more systematically in promoting safe care.

    Science.gov (United States)

    Sahlström, Merja; Partanen, Pirjo; Turunen, Hannele

    2018-04-16

    To analyze patient safety incidents (PSIs) reported by patients and their use in Finnish healthcare organizations. Cross-sectional study. About 15 Finnish healthcare organizations ranging from specialized hospital care to home care, outpatient and inpatient clinics, and geographically diverse areas of Finland. The study population included all Finnish patients who had voluntarily reported PSI via web-based system in 2009-15. Quantitative analysis of patients' safety reports, inductive content analysis of patients' suggestions to prevent the reoccurrence incidents and how those suggestions were used in healthcare organizations. Patients reported 656 PSIs, most of which were classified by the healthcare organizations' analysts as problems associated with information flow (32.6%) and medications (18%). Most of the incidents (65%) did not cause any harm to patients. About 76% of the reports suggested ways to prevent reoccurrence of PSIs, most of which were feasible, system-based amendments of processes for reviewing or administering treatment, anticipating risks or improving diligence in patient care. However, only 6% had led to practical implementation of corrective actions in the healthcare organizations. The results indicate that patients report diverse PSIs and suggest practical systems-based solutions to prevent their reoccurrence. However, patients' reports rarely lead to corrective actions documented in the registering system, indicating that there is substantial scope to improve utilization of patients' reports. There is also a need for strong patient safety management, including willingness and commitment of HCPs and leaders to learn from safety incidents.

  6. 12 CFR 250.181 - Reports of change in control of bank management incident to a merger.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Reports of change in control of bank management... change in control of bank management incident to a merger. (a) A State member bank has inquired whether Pub. L. 88-593 (78 Stat. 940) requires reports of change in control of bank management in situations...

  7. Determinants of medication incident reporting, recovery, and learning in community pharmacies: a conceptual model.

    Science.gov (United States)

    Boyle, Todd A; Mahaffey, Thomas; Mackinnon, Neil J; Deal, Heidi; Hallstrom, Lars K; Morgan, Holly

    2011-03-01

    Evidence suggests that the underreporting of medication errors and near misses, collectively referred to as medication incidents (MIs), in the community pharmacy setting, is high. Despite the obvious negative implications, MIs present opportunities for pharmacy staff and regulatory authorities to learn from these mistakes and take steps to reduce the likelihood that they reoccur. However, these activities can only take place if such errors are reported and openly discussed. This research proposes a model of factors influencing the reporting, service recovery, and organizational learning resulting from MIs within Canadian community pharmacies. The conceptual model is based on a synthesis of the literature and findings from a pilot study conducted among pharmacy management, pharmacists, and pharmacy technicians from 13 community pharmacies in Nova Scotia, Canada. The purpose of the pilot study was to identify various actions that should be taken to improve MI reporting and included staff perceptions of the strengths and weaknesses of their current MI-reporting process, desired characteristics of a new process, and broader external and internal activities that would likely improve reporting. Out of the 109 surveys sent, 72 usable surveys were returned (66.1% response rate). Multivariate analysis of variance found no significant differences among staff type in their perceptions of the current or new desired system but were found for broader initiatives to improve MI reporting. These findings were used for a proposed structural equation model (SEM). The SEM proposes that individual-perceived self-efficacy, MI process capability, MI process support, organizational culture, management support, and regulatory authority all influence the completeness of MI reporting, which, in turn, influences MI service recovery and learning. This model may eventually be used to enable pharmacy managers to make better decisions. By identifying risk factors that contribute to low MI

  8. Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis.

    Science.gov (United States)

    Schmucker, J; Seide, S; Wienbergen, H; Fiehn, E; Stehmeier, J; Günther, K; Ahrens, W; Hambrecht, R; Pohlabeln, H; Fach, A

    2017-09-22

    The importance of socioeconomic status (SES) for coronary heart disease (CHD)-morbidity is subject of ongoing scientific investigations. This study was to explore the association between SES in different city-districts of Bremen/Germany and incidence, severity, treatment modalities and prognosis for patients with ST-elevation myocardial infarctions (STEMI). Since 2006 all STEMI-patients from the metropolitan area of Bremen are documented in the Bremen STEMI-registry. Utilizing postal codes of their home address they were assigned to four groups in accordance to the Bremen social deprivation-index (G1: high, G2: intermediate high, G3: intermediate low, G4: low socioeconomic status). Three thousand four hundred sixty-two consecutive patients with STEMI admitted between 2006 and 2015 entered analysis. City areas with low SES showed higher adjusted STEMI-incidence-rates (IR-ratio 1.56, G4 vs. G1). This elevation could be observed in both sexes (women IRR 1.63, men IRR 1.54) and was most prominent in inhabitants  3000 U/l, OR 1.95, 95% CI 1.4-2.8) and severe impairment of LV-function post-STEMI (OR 2.0, 95% CI 1.2-3.4). Long term follow-up revealed that lower SES was associated with higher major adverse cardiac or cerebrovascular event (MACCE)-rates after 5 years: G1 30.8%, G2 35.7%, G3 36.0%, G4 41.1%, p (for trend) = 0.02. This worse prognosis could especially be shown for young STEMI-patients (<50 yrs. of age) 5-yr. mortality-rates(G4 vs. G1) 18.4 vs. 3.1%, p = 0.03 and 5-year-MACCE-rates (G4 vs. G1) 32 vs. 6.3%, p = 0.02. This registry-data confirms the negative association of low socioeconomic status and STEMI-incidence, with higher rates of smoking and obesity, more extensive infarctions and worse prognosis for the socio-economically deprived.

  9. Longer Sleep Duration and Midday Napping Are Associated with a Higher Risk of CHD Incidence in Middle-Aged and Older Chinese: the Dongfeng-Tongji Cohort Study.

    Science.gov (United States)

    Yang, Liangle; Yang, Handong; He, Meian; Pan, An; Li, Xiulou; Min, Xinwen; Zhang, Ce; Xu, Chengwei; Zhu, Xiaoyan; Yuan, Jing; Wei, Sheng; Miao, Xiaoping; Hu, Frank B; Wu, Tangchun; Zhang, Xiaomin

    2016-03-01

    To analyze the independent and combined relations of sleep duration and midday napping with coronary heart diseases (CHD) incidence along with the underlying changes of cardiovascular disease (CVD) risk factors among Chinese adults. We included 19,370 individuals aged 62.8 years at baseline from September 2008 to June 2010, and they were followed until October 2013. Cox proportional hazards models and general linear models were used for multivariate longitudinal analyses. Compared with sleeping 7- napping > 90 min compared with 1-30 min. When sleep duration and midday napping were combined, individuals having sleep duration ≥ 10 h and midday napping > 90 min were at a greater risk of CHD than those with sleeping 7- napping 1-30 min: the HR was 1.67 (95% CI = 1.04 to 2.66; P for trend = 0.017). In addition, longer sleep duration ≥ 10 h was significantly associated with increases in triglycerides and waist circumference, and a reduction in HDL-cholesterol; while longer midday napping > 90 min was related to increased waist circumference. Both longer sleep duration and midday napping were independently and jointly associated with a higher risk of CHD incidence, and altered lipid profile and waist circumference may partially explain the relationships. © 2016 Associated Professional Sleep Societies, LLC.

  10. Research on the Training of Higher Cognitive Learning and Thinking Skills. Final Report. Report No. 5560.

    Science.gov (United States)

    Nickerson, R. S.

    The technical reports summarized in this paper were prepared as part of a project designed to determine what is known about the teaching of cognitive skills and to formulate questions relating to such teaching for further research. Topics discussed in the 22 reports include the following: (1) teaching thinking; (2) Aristotle's logic; (3) a…

  11. Semantic Language and Tools for Reporting Human Factors Incidents, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Incidents related to impaired human performance in space operations can be caused by environmental conditions, situational challenges, and operational deficiencies....

  12. Charting the Future of US Higher Education: A Look at the Spellings Report Ten Years Later

    Science.gov (United States)

    Neuman, W. Russell

    2017-01-01

    September marked the tenth anniversary of the release of "A Test of Leadership: Charting the Future of US Higher Education," the report of the Secretary of Education's Commission on the Future of Higher Education, also known as the Spellings Commission. Blue ribbon panels rarely say much that is new or stimulate much sustained attention,…

  13. Employability: A Review of the Literature 2012 to 2016. A Report for the Higher Education Academy

    Science.gov (United States)

    Artess, Jane; Hooley, Tristram; Mellors-Bourne, Robin

    2017-01-01

    This report for the Higher Education Academy, in partnership with the University of Derby and the Career Development Organisation, examined 187 pieces of research published between 2012 and 2016 that describe how the subject of employability has been addressed during this period. It draws out some of the key implications for higher education…

  14. A Methodology for Sustainability Evaluation and Reporting in Higher Education Institutions

    Science.gov (United States)

    Madeira, Ana C.; Carravilla, Maria Antonia; Oliveira, Jose F.; Costa, Carlos A. V.

    2011-01-01

    The purpose of this paper is to present a methodology that allows higher education institutions (HEIs) to promote, to evaluate and to report on sustainability. The ultimate goal of the afore-mentioned methodology is to help HEIs achieve sustainability. First, a model entitled Sustainability in Higher Education Institutions (SusHEI) that generally…

  15. Pediatric critical incidents reported over 15 years at a tertiary care teaching hospital of a developing country.

    Science.gov (United States)

    Abbasi, Shemila; Khan, Fauzia Anis; Khan, Sobia

    2018-01-01

    The role of critical incident (CI) reporting is well established in improving patient safety but only a limited number of available reports relate to pediatric incidents. Our aim was to analyze the reported CIs specific to pediatric patients in our database and to reevaluate the value of this program in addressing issues in pediatric anesthesia practice. Incidents related to pediatric population from neonatal period till the age of 12 years were selected. A review of all CI records collected between January 1998 and December 2012, in the Department of Anaesthesiology of Aga Khan University hospital was done. This was retrospective form review. The Department has a structured CI form in use since 1998 which is intermittently evaluated and modified if needed. A total of 451 pediatric CIs were included. Thirty-four percent of the incidents were reported in infants. Ninety-six percent of the reported incidents took place during elective surgery and 4% during emergency surgery. Equipment-related events (n = 114), respiratory events (n = 112), and drug events (n = 110) were equally distributed (25.6%, 25.3%, and 24.7%). Human factors accounted for 74% of reports followed by, equipment failure (10%) and patient factors (8%). Only 5% of the incidents were system errors. Failure to check (equipment/drugs/doses) was the most common cause for human factors. Poor outcome was seen in 7% of cases. Medication and equipment are the clinical areas that need to be looked at more closely. We also recommend quality improvement projects in both these areas as well as training of residents and staff in managing airway-related problems in pediatric patients.

  16. 29 CFR 1904.39 - Reporting fatalities and multiple hospitalization incidents to OSHA.

    Science.gov (United States)

    2010-07-01

    ... to OSHA. 1904.39 Section 1904.39 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY... fatalities and multiple hospitalization incidents to OSHA. (a) Basic requirement. Within eight (8) hours... Administration (OSHA), U.S. Department of Labor, that is nearest to the site of the incident. You may also use...

  17. Development of a theoretical framework of factors affecting patient safety incident reporting: a theoretical review of the literature.

    Science.gov (United States)

    Archer, Stephanie; Hull, Louise; Soukup, Tayana; Mayer, Erik; Athanasiou, Thanos; Sevdalis, Nick; Darzi, Ara

    2017-12-27

    The development and implementation of incident reporting systems within healthcare continues to be a fundamental strategy to reduce preventable patient harm and improve the quality and safety of healthcare. We sought to identify factors contributing to patient safety incident reporting. To facilitate improvements in incident reporting, a theoretical framework, encompassing factors that act as barriers and enablers ofreporting, was developed. Embase, Ovid MEDLINE(R) and PsycINFO were searched to identify relevant articles published between January 1980 and May 2014. A comprehensive search strategy including MeSH terms and keywords was developed to identify relevant articles. Data were extracted by three independent researchers; to ensure the accuracy of data extraction, all studies eligible for inclusion were rescreened by two reviewers. The literature search identified 3049 potentially eligible articles; of these, 110 articles, including >29 726 participants, met the inclusion criteria. In total, 748 barriers were identified (frequency count) across the 110 articles. In comparison, 372 facilitators to incident reporting and 118 negative cases were identified. The top two barriers cited were fear of adverse consequences (161, representing 21.52% of barriers) and process and systems of reporting (110, representing 14.71% of barriers). In comparison, the top two facilitators were organisational (97, representing 26.08% of facilitators) and process and systems of reporting (75, representing 20.16% of facilitators). A wide range of factors contributing to engagement in incident reporting exist. Efforts that address the current tendency to under-report must consider the full range of factors in order to develop interventions as well as a strategic policy approach for improvement. © 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.

  18. Development of a theoretical framework of factors affecting patient safety incident reporting: a theoretical review of the literature

    Science.gov (United States)

    Hull, Louise; Soukup, Tayana; Mayer, Erik; Athanasiou, Thanos; Sevdalis, Nick; Darzi, Ara

    2017-01-01

    Objectives The development and implementation of incident reporting systems within healthcare continues to be a fundamental strategy to reduce preventable patient harm and improve the quality and safety of healthcare. We sought to identify factors contributing to patient safety incident reporting. Design To facilitate improvements in incident reporting, a theoretical framework, encompassing factors that act as barriers and enablers ofreporting, was developed. Embase, Ovid MEDLINE(R) and PsycINFO were searched to identify relevant articles published between January 1980 and May 2014. A comprehensive search strategy including MeSH terms and keywords was developed to identify relevant articles. Data were extracted by three independent researchers; to ensure the accuracy of data extraction, all studies eligible for inclusion were rescreened by two reviewers. Results The literature search identified 3049 potentially eligible articles; of these, 110 articles, including >29 726 participants, met the inclusion criteria. In total, 748 barriers were identified (frequency count) across the 110 articles. In comparison, 372 facilitators to incident reporting and 118 negative cases were identified. The top two barriers cited were fear of adverse consequences (161, representing 21.52% of barriers) and process and systems of reporting (110, representing 14.71% of barriers). In comparison, the top two facilitators were organisational (97, representing 26.08% of facilitators) and process and systems of reporting (75, representing 20.16% of facilitators). Conclusion A wide range of factors contributing to engagement in incident reporting exist. Efforts that address the current tendency to under-report must consider the full range of factors in order to develop interventions as well as a strategic policy approach for improvement. PMID:29284714

  19. Recent events in NPPs and incident reporting system (IRS) activity. Working material

    International Nuclear Information System (INIS)

    1996-01-01

    The IAEA convened the 1996 Joint Meeting to Exchange Information on Recent Events in Nuclear Power Plants and the Technical Committee-Annual Meeting of the Incident Reporting System (IRS) national co-ordinators, organized jointly with the Nuclear Energy Agency (NEA) of the OECD in Paris, France from 22-26 April 1996. These consecutive meetings took place at the OECD Headquarters, 2 rue Andre Pascal. The main objective of the first meeting (22-24 April 1996) was to exchange and discuss information on recent events which occurred in NPPs. The second meeting (25-26 April 1996) was devoted to the IAEA and NEA activity in the framework of the IRS. The main issues of the programme at the meetings were as follows: in-depth discussion on NPP recent events, presented by the participants; panel discussion on operational safety experience issues identified by the participants; IAEA and NEA activities on IRS subjects in 1995-1996 and plans for the future; issues from the inter-agency's IRS Advisory Committee. Annexes I and II provide more information on the programme at the meetings. A list of participants is given in Annex III (50 participants from 22 countries and 3 international organization). Annexes IV and V provide information on national presentations on recent events. Figs, tabs

  20. Report of the independent Ad Hoc Group for the Davis-Besse incident

    International Nuclear Information System (INIS)

    1986-06-01

    The Nuclear Regulatory Commission established an independent Ad Hoc Group in January 1986 to review issues subsequent to a complete loss of feedwater event at Davis-Besse Nuclear Power Station on June 9, 1985, including the NRC Incident Investigation Team (IIT) investigation of that event. The Commission asked the Group to identify additional lessons that might be learned and from these to make recommendations to improve NRC oversight of reactor licensees. To fulfill its charter, the Ad Hoc Group examined the following: (1) pre-event interactions between the licensee and NRC concerning reliability of the auxiliary feedwater system and associated systems; (2) pre-event probabilistic assessments of the reliability of plant safety systems, NRC's review of them, and their use in regulatory decisionmaking; (3) licensee management, operation and maintenance programs as they may have contributed to equipment failures and NRC oversight of such programs; and (4) the mandate, capabilities of members, operation, and results of the NRC Davis-Besse IIT, and the use to which its report was put by the regulatory staff

  1. Patient safety incident reporting: a qualitative study of thoughts and perceptions of experts 15 years after 'To Err is Human'.

    Science.gov (United States)

    Mitchell, Imogen; Schuster, Anne; Smith, Katherine; Pronovost, Peter; Wu, Albert

    2016-02-01

    One of the key recommendations of the Institute of Medicine's (IOM) report, To Err is Human, 15 years ago was for greater attention to incident reporting in healthcare, analogous to the role it has played in aviation and other high-risk industries. With the passage of time and maturation of the patient safety field, we conducted semistructured interviews with 11 international patient safety experts with knowledge of the US healthcare and meeting at least one of the following criteria: (1) involved in the development of the IOM's recommendations, (2) responsible for the design and/or implementation of national or regional incident reporting systems, (3) conducted research on patient safety/incident reporting at a national level. Five key challenges emerged to explain why incident reporting has not reached its potential: poor processing of incident reports (triaging, analysis, recommendations), inadequate engagement of doctors, insufficient subsequent visible action, inadequate funding and institutional support of incident reporting systems and inadequate usage of evolving health information technology. Leading patient safety experts acknowledge the current challenges of incident reports. The future of incident reporting lies in targeted incident reporting, effective triaging and robust analysis of the incident reports and meaningful engagement of doctors. Incident reporting must be coupled with visible, sustainable action and linkage of incident reports to the electronic health record. If the healthcare industry wants to learn from its mistakes, miss or near miss events, it will need to take incident reporting as seriously as the health budget. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. The national incidence and clinical picture of SLE in children in Australia - a report from the Australian Paediatric Surveillance Unit.

    Science.gov (United States)

    Mackie, F E; Kainer, G; Adib, N; Boros, C; Elliott, E J; Fahy, R; Munro, J; Murray, K; Rosenberg, A; Wainstein, B; Ziegler, J B; Singh-Grewal, D

    2015-01-01

    The objectives of this paper are to prospectively determine the incidence of paediatric systemic lupus erythematosus (pSLE) in Australia as well as describe the demographics, clinical presentation and one-year outcome. Newly diagnosed cases of pSLE were ascertained prospectively from October 2009 to October 2011 through the Australian Paediatric Surveillance Unit (a national monthly surveillance scheme for notification of childhood rare diseases) as well as national subspecialty groups. Questionnaires were sent to notifying physicians at presentation and at one year. The annual incidence rate was 0.32 per 10(5) children aged less than 16 years. The incidence was significantly higher in children of Asian or Australian Aboriginal and Torres Strait Islander parents. Approximately one-third of children underwent a renal biopsy at presentation and 7% required dialysis initially although only one child had end-stage kidney disease (ESKD) at one-year follow-up. The incidence of pSLE in Australia is comparable to that worldwide with a significantly higher incidence seen in children of Asian and Australian Aboriginal and Torres Strait Islander backgrounds. Renal involvement is common but progression to ESKD, at least in the short term, is rare. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  3. Brief Report: Impact of Early Antiretroviral Therapy on the Performance of HIV Rapid Tests and HIV Incidence Assays.

    Science.gov (United States)

    Fogel, Jessica M; Piwowar-Manning, Estelle; Debevec, Barbara; Walsky, Tamara; Schlusser, Katherine; Laeyendecker, Oliver; Wilson, Ethan A; McCauley, Marybeth; Gamble, Theresa; Tegha, Gerald; Soko, Dean; Kumwenda, Johnstone; Hosseinipour, Mina C; Chen, Ying Q; Cohen, Myron S; Eshleman, Susan H

    2017-08-01

    Antiretroviral therapy (ART) can downregulate antibody responses to HIV infection. We evaluated the impact of early vs. delayed ART on the performance of HIV diagnostic and incidence assays. Samples were obtained from 207 participants in the HPTN 052 trial, who were stably suppressed on ART for ≥4 years [Malawi sites; pre-ART CD4 cell count 350-550 cells/mm (early ART arm, N = 180) or ART arm, N = 27)]. Samples were tested with 2 HIV rapid tests and 2 HIV incidence assays; selected samples were also tested with two fourth-generation immunoassays and a Western blot (WB) assay. A pre-ART sample was analyzed if the follow-up sample had a false-negative or weakly-reactive rapid test result, or had an incidence assay result indicative of recent infection (false-recent result). Ten (4.8%) samples had a nonreactive or weakly-reactive rapid test result (7/180 early ART arm, 3/27 delayed ART arm, P = 0.13); one sample had nonreactive fourth-generation assay results and 3 had indeterminate WBs. Forty (18.9%) samples had a false-recent incidence assay result; 16 (7.8%) had false-recent results with both incidence assays. Baseline samples had stronger rapid test and WB bands, higher fourth-generation assay signal-to-cutoff values, and fewer HIV incidence assay results indicative of recent infection. False-negative/weakly-reactive HIV rapid tests and false-recent HIV incidence assay results were observed in virally-suppressed individuals, regardless of pre-ART CD4 cell count. Downregulation of the antibody response to HIV infection in the setting of ART may impact population-level surveys of HIV prevalence and incidence.

  4. Analysis of general aviation single-pilot IFR incident data obtained from the NASA Aviation Safety Reporting System

    Science.gov (United States)

    Bergeron, H. P.

    1983-01-01

    An analysis of incident data obtained from the NASA Aviation Safety Reporting System (ASRS) has been made to determine the problem areas in general aviation single-pilot IFR (SPIFR) operations. The Aviation Safety Reporting System data base is a compilation of voluntary reports of incidents from any person who has observed or been involved in an occurrence which was believed to have posed a threat to flight safety. This paper examines only those reported incidents specifically related to general aviation single-pilot IFR operations. The frequency of occurrence of factors related to the incidents was the criterion used to define significant problem areas and, hence, to suggest where research is needed. The data was cataloged into one of five major problem areas: (1) controller judgment and response problems, (2) pilot judgment and response problems, (3) air traffic control (ATC) intrafacility and interfacility conflicts, (4) ATC and pilot communication problems, and (5) IFR-VFR conflicts. In addition, several points common to all or most of the problems were observed and reported. These included human error, communications, procedures and rules, and work load.

  5. Design of a medical record review study on the incidence and preventability of adverse events requiring a higher level of care in Belgian hospitals

    Directory of Open Access Journals (Sweden)

    Vlayen Annemie

    2012-08-01

    Full Text Available Abstract Background Adverse events are unintended patient injuries that arise from healthcare management resulting in disability, prolonged hospital stay or death. Adverse events that require intensive care admission imply a considerable financial burden to the healthcare system. The epidemiology of adverse events in Belgian hospitals has never been assessed systematically. Findings A multistage retrospective review study of patients requiring a transfer to a higher level of care will be conducted in six hospitals in the province of Limburg. Patient records are reviewed starting from January 2012 by a clinical team consisting of a research nurse, a physician and a clinical pharmacist. Besides the incidence and the level of causation and preventability, also the type of adverse events and their consequences (patient harm, mortality and length of stay will be assessed. Moreover, the adequacy of the patient records and quality/usefulness of the method of medical record review will be evaluated. Discussion This paper describes the rationale for a retrospective review study of adverse events that necessitate a higher level of care. More specifically, we are particularly interested in increasing our understanding in the preventability and root causes of these events in order to implement improvement strategies. Attention is paid to the strengths and limitations of the study design.

  6. National Incident Management System (NIMS) Standards Review Panel Workshop Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    Stenner, Robert D.; Kirk, Jennifer L.; Stanton, James R.; Shebell, Peter; Schwartz, Deborah S.; Judd, Kathleen S.; Gelston, Gariann M.

    2006-02-07

    The importance and need for full compliant implementation of NIMS nationwide was clearly demonstrated during the Hurricane Katrina event, which was clearly expressed in Secretary Chertoff's October 4, 2005 letter addressed to the State's governors. It states, ''Hurricane Katrina was a stark reminder of how critical it is for our nation to approach incident management in a coordinated, consistent, and efficient manner. We must be able to come together, at all levels of government, to prevent, prepare for, respond to, and recover from any emergency or disaster. Our operations must be seamless and based on common incident management doctrine, because the challenges we face as a nation are far greater than capabilities of any one jurisdiction.'' The NIMS is a system/architecture for organizing response on a ''national'' level. It incorporations ICS as a main component of that structure (i.e., it institutionalizes ICS in NIMS). In a paper published on the NIMS Website, the following statements were made: ''NIMS represents a core set of doctrine, principles, terminology, and organizational processes to enable effective, efficient and collaborative incident management at all levels. To provide the framework for interoperability and compatibility, the NIMS is based on a balance between flexibility and standardization.'' Thus the NIC is challenged with the need to adopt quality SDO generated standards to support NIMS compliance, but in doing so maintain the flexibility necessary so that response operations can be tailored for the specific jurisdictional and geographical needs across the nation. In support of this large and complex challenge facing the NIC, the Pacific Northwest National Laboratory (PNNL) was asked to provide technical support to the NIC, through their DHS Science and Technology ? Standards Portfolio Contract, to help identify, review, and develop key standards for NIMS compliance. Upon

  7. The Process of Change in Higher Education Institutions. AAHE-ERIC/Higher Education Research Report, No. 7, 1982.

    Science.gov (United States)

    Nordvall, Robert C.

    Conditions that inhibit change in higher education institutions and various models of the change process are described. Attention is also directed to: organizational character, structural features, planning procedures, key individuals in the change process, and practical advice about change. The major change models for higher education…

  8. Whole-genome sequencing of asian lung cancers: second-hand smoke unlikely to be responsible for higher incidence of lung cancer among Asian never-smokers.

    Science.gov (United States)

    Krishnan, Vidhya G; Ebert, Philip J; Ting, Jason C; Lim, Elaine; Wong, Swee-Seong; Teo, Audrey S M; Yue, Yong G; Chua, Hui-Hoon; Ma, Xiwen; Loh, Gary S L; Lin, Yuhao; Tan, Joanna H J; Yu, Kun; Zhang, Shenli; Reinhard, Christoph; Tan, Daniel S W; Peters, Brock A; Lincoln, Stephen E; Ballinger, Dennis G; Laramie, Jason M; Nilsen, Geoffrey B; Barber, Thomas D; Tan, Patrick; Hillmer, Axel M; Ng, Pauline C

    2014-11-01

    Asian nonsmoking populations have a higher incidence of lung cancer compared with their European counterparts. There is a long-standing hypothesis that the increase of lung cancer in Asian never-smokers is due to environmental factors such as second-hand smoke. We analyzed whole-genome sequencing of 30 Asian lung cancers. Unsupervised clustering of mutational signatures separated the patients into two categories of either all the never-smokers or all the smokers or ex-smokers. In addition, nearly one third of the ex-smokers and smokers classified with the never-smoker-like cluster. The somatic variant profiles of Asian lung cancers were similar to that of European origin with G.C>T.A being predominant in smokers. We found EGFR and TP53 to be the most frequently mutated genes with mutations in 50% and 27% of individuals, respectively. Among the 16 never-smokers, 69% had an EGFR mutation compared with 29% of 14 smokers/ex-smokers. Asian never-smokers had lung cancer signatures distinct from the smoker signature and their mutation profiles were similar to European never-smokers. The profiles of Asian and European smokers are also similar. Taken together, these results suggested that the same mutational mechanisms underlie the etiology for both ethnic groups. Thus, the high incidence of lung cancer in Asian never-smokers seems unlikely to be due to second-hand smoke or other carcinogens that cause oxidative DNA damage, implying that routine EGFR testing is warranted in the Asian population regardless of smoking status. ©2014 American Association for Cancer Research.

  9. Which aspects of safety culture predict incident reporting behavior in neonatal intensive care units? A multilevel analysis

    NARCIS (Netherlands)

    Snijders, Cathelijne; Kollen, Boudewijn J.; van Lingen, Richard A.; Fetter, Willem P. F.; Molendijk, Harry; Kok, J. H.; te Pas, E.; Pas, H.; van der Starre, C.; Bloemendaal, E.; Lopes Cardozo, R. H.; Molenaar, A. M.; Giezen, A.; van Lingen, R. A.; Maat, H. E.; Molendijk, A.; Snijders, C.; Lavrijssen, S.; Mulder, A. L. M.; de Kleine, M. J. K.; Koolen, A. M. P.; Schellekens, M.; Verlaan, W.; Vrancken, S.; Fetter, W. P. F.; Schotman, L.; van der Zwaan, A.; van der Tuijn, Y.; Tibboel, D.; van der Schaaf, T. W.; Klip, H.; Kollen, B. J.

    2009-01-01

    OBJECTIVES: Safety culture assessments are increasingly used to evaluate patient-safety programs. However, it is not clear which aspects of safety culture are most relevant in understanding incident reporting behavior, and ultimately improving patient safety. The objective of this study was to

  10. Effects of patient safety culture interventions on incident reporting in general practice : A cluster randomised trial a cluster randomised trial

    NARCIS (Netherlands)

    Verbakel, Natasha J.; Langelaan, Maaike; Verheij, Theo J M; Wagner, Cordula; Zwart, Dorien L M

    2015-01-01

    Background: A constructive safety culture is essential for the successful implementation of patient safety improvements. Aim: To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture. Design and setting: A three-arm cluster randomised trial

  11. Public and Private Sectors in Asian Higher Education Systems: Issues and Prospects. Reports from the International Seminar on Higher Education in Asia (3rd, Hiroshima, Japan, 1987).

    Science.gov (United States)

    Hiroshima Univ. (Japan). Research Inst. for Higher Education.

    The roles of public and private sectors of higher education in Asia and relationships to national systems are explored in reports from the Third International Seminar on Higher Education in Asia. The focus was China, Indonesia, Korea, the Philippines, Japan, and Thailand. Patterns by which national systems of higher education are differentiated…

  12. Evaluation of the effectiveness of ATM messages used during incidents : final report.

    Science.gov (United States)

    2016-01-01

    This project investigated the use of Intelligent Lane Control Signs based Active Traffic Management for : Incident Management on a heavily traveled urban freeway. The subject of the research was the ILCS : system on I-94 westbound in downtown Minneap...

  13. Simulation analysis of route diversion strategies for freeway incident management : final report.

    Science.gov (United States)

    1995-02-01

    The purpose of this project was to investigate whether simulation models could : be used as decision aids for defining traffic diversion strategies for effective : incident management. A methodology was developed for using such a model to : determine...

  14. Airborne incidents : an econometric analysis of severity, December 19, 2014 : Final report

    Science.gov (United States)

    2014-12-19

    Airborne loss of separation incidents occur when an aircraft breaches the defined separation limit (vertical and/or horizontal) with another aircraft or terrain imposed by Air Traffic Control. Identifying conditions that lead to more severe loss of s...

  15. Estimating the incidence reporting rates of new influenza pandemics at an early stage using travel data from the source country.

    Science.gov (United States)

    Chong, K C; Fong, H F; Zee, C Y

    2014-05-01

    During the surveillance of influenza pandemics, underreported data are a public health challenge that complicates the understanding of pandemic threats and can undermine mitigation efforts. We propose a method to estimate incidence reporting rates at early stages of new influenza pandemics using 2009 pandemic H1N1 as an example. Routine surveillance data and statistics of travellers arriving from Mexico were used. Our method incorporates changes in reporting rates such as linearly increasing trends due to the enhanced surveillance. From our results, the reporting rate was estimated at 0·46% during early stages of the pandemic in Mexico. We estimated cumulative incidence in the Mexican population to be 0·7% compared to 0·003% reported by officials in Mexico at the end of April. This method could be useful in estimation of actual cases during new influenza pandemics for policy makers to better determine appropriate control measures.

  16. A cross-national comparison of incident reporting systems implemented in German and Swiss hospitals.

    Science.gov (United States)

    Manser, Tanja; Imhof, Michael; Lessing, Constanze; Briner, Matthias

    2017-06-01

    This study aimed to empirically compare incident reporting systems (IRS) in two European countries and to explore the relationship of IRS characteristics with context factors such as hospital characteristics and characteristics of clinical risk management (CRM). We performed exploratory, secondary analyses of data on characteristics of IRS from nationwide surveys of CRM practices. The survey was originally sent to 2136 hospitals in Germany and Switzerland. Persons responsible for CRM in 622 hospitals completed the survey (response rate 29%). None. Differences between IRS in German and Swiss hospitals were assessed using Chi2, Fisher's Exact and Freeman-Halton-Tests, as appropriate. To explore interrelations between IRS characteristics and context factors (i.e. hospital and CRM characteristics) we computed Cramer's V. Comparing participating hospitals across countries, Swiss hospitals had implemented IRS earlier, more frequently and more often provided introductory IRS training systematically. German hospitals had more frequently systematically implemented standardized procedures for event analyses. IRS characteristics were significantly associated with hospital characteristics such as hospital type as well as with CRM characteristics such as existence of strategic CRM objectives and of a dedicated position for central CRM coordination. This study contributes to an improved understanding of differences in the way IRS are set up in two European countries and explores related context factors. This opens up new possibilities for empirically informed, strategic interventions to further improve dissemination of IRS and thus support hospitals in their efforts to move patient safety forward. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  17. Technology-related medication errors in a tertiary hospital: a 5-year analysis of reported medication incidents.

    Science.gov (United States)

    Samaranayake, N R; Cheung, S T D; Chui, W C M; Cheung, B M Y

    2012-12-01

    Healthcare technology is meant to reduce medication errors. The objective of this study was to assess unintended errors related to technologies in the medication use process. Medication incidents reported from 2006 to 2010 in a main tertiary care hospital were analysed by a pharmacist and technology-related errors were identified. Technology-related errors were further classified as socio-technical errors and device errors. This analysis was conducted using data from medication incident reports which may represent only a small proportion of medication errors that actually takes place in a hospital. Hence, interpretation of results must be tentative. 1538 medication incidents were reported. 17.1% of all incidents were technology-related, of which only 1.9% were device errors, whereas most were socio-technical errors (98.1%). Of these, 61.2% were linked to computerised prescription order entry, 23.2% to bar-coded patient identification labels, 7.2% to infusion pumps, 6.8% to computer-aided dispensing label generation and 1.5% to other technologies. The immediate causes for technology-related errors included, poor interface between user and computer (68.1%), improper procedures or rule violations (22.1%), poor interface between user and infusion pump (4.9%), technical defects (1.9%) and others (3.0%). In 11.4% of the technology-related incidents, the error was detected after the drug had been administered. A considerable proportion of all incidents were technology-related. Most errors were due to socio-technical issues. Unintended and unanticipated errors may happen when using technologies. Therefore, when using technologies, system improvement, awareness, training and monitoring are needed to minimise medication errors. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Analysis of Aviation Safety Reporting System Incident Data Associated With the Technical Challenges of the Vehicle Systems Safety Technology Project

    Science.gov (United States)

    Withrow, Colleen A.; Reveley, Mary S.

    2014-01-01

    This analysis was conducted to support the Vehicle Systems Safety Technology (VSST) Project of the Aviation Safety Program (AVsP) milestone VSST4.2.1.01, "Identification of VSST-Related Trends." In particular, this is a review of incident data from the NASA Aviation Safety Reporting System (ASRS). The following three VSST-related technical challenges (TCs) were the focus of the incidents searched in the ASRS database: (1) Vechicle health assurance, (2) Effective crew-system interactions and decisions in all conditions; and (3) Aircraft loss of control prevention, mitigation, and recovery.

  19. Sensationalization of reports of the Kashiwazaki-Kariwa nuclear power plant incident. A search for top stories in Japanese newspapers

    International Nuclear Information System (INIS)

    Nakajima, Tatsuo

    2009-01-01

    The purpose of this study is to clarify whether reports of nuclear accidents, particularly the damage done by the 2007 Niigata-ken Chuetsu-Oki earthquake to the Kashiwazaki-Kariwa nuclear power plant in Niigata, Japan, tend to be exaggerated by national media. News related to the Kashiwazaki incident was compared with that for nine other high-profile accidents in Japan, including the 1999 JCO critical accident and the 2005 JR-West Fukuchiyama Line derailment. Articles were extracted from four national newspapers in Japan, focusing on the 30 issues immediately following each accident. The numbers of articles and top stories related to the relevant accidents appearing on the front pages of the newspapers were counted. Based on these numbers, the Kashiwazaki incident was reported at a level similar to the JCO accident and Fukuchiyama line derailment in some newspapers, although these two accidents were more serious than the Kashiwazaki incident. This suggests that at least some newspapers in Japan sensationalized reports of the Kashiwazaki incident. (author)

  20. Application of an aviation model of incident reporting and investigation to the neurosurgical scenario: method and preliminary data.

    Science.gov (United States)

    Ferroli, Paolo; Caldiroli, Dario; Acerbi, Francesco; Scholtze, Maurizio; Piro, Alfonso; Schiariti, Marco; Orena, Eleonora F; Castiglione, Melina; Broggi, Morgan; Perin, Alessandro; DiMeco, Francesco

    2012-11-01

    Incident reporting systems are universally recognized as important tools for quality improvement in all complex adaptive systems, including the operating room. Nevertheless, introducing a safety culture among neurosurgeons is a slow process, and few studies are available in the literature regarding the implementation of an incident reporting system within a neurosurgical department. The authors describe the institution of an aviation model of incident reporting and investigation in neurosurgery, focusing on the method they have used and presenting some preliminary results. In 2010, the Inpatient Safety On-Board project was developed through cooperation between a team of human factor and safety specialists with aviation backgrounds (DgSky team) and the general manager of the Fondazione Istituto Neurologico Carlo Besta. In 2011, after specific training in safety culture, the authors implemented an aviation-derived prototype of incident reporting within the Department of Neurosurgery. They then developed an experimental protocol to track, analyze, and categorize any near misses that happened in the operating room. This project officially started in January 2012, when a dedicated team of assessors was established. All members of the neurosurgical department were asked to report near misses on a voluntary, confidential, and protected form (Patient Incident Reporting System form, Besta Safety Management Programme). Reports were entered into an online database and analyzed by a dedicated team of assessors with the help of a facilitator, and an aviation-derived root cause analysis was performed. Since January 2012, 14 near misses were analyzed and classified. The near-miss contributing factors were mainly related to human factors (9 of 14 cases), technology (1 of 14 cases), organizational factors (3 of 14 cases), or procedural factors (1 of 14 cases). Implementing an incident reporting system is quite demanding; the process should involve all of the people who work within

  1. Diet quality is associated with reduced incidence of cancer and self-reported chronic disease: Observations from Alberta's Tomorrow Project.

    Science.gov (United States)

    Solbak, Nathan M; Xu, Jian-Yi; Vena, Jennifer E; Csizmadi, Ilona; Whelan, Heather K; Robson, Paula J

    2017-08-01

    The objective of this study was to assess diet quality using the Healthy Eating Index-2005 Canada (HEI-2005-Canada) and its association with risk of cancer and chronic disease in a sample of Alberta's Tomorrow Project (ATP) participants. Food frequency questionnaires completed by 25,169 participants (38% men; mean age 50.3 (9.2)) enrolled between 2000 and 2008 were used to calculate HEI-2005-Canada scores. Data from a subset of participants (n=10,735) who reported no chronic disease at enrollment were used to investigate the association between HEI-2005-Canada score and development of self-reported chronic disease at follow-up (2008). Participants were divided into HEI-2005-Canada score quartiles. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for cancer and chronic disease incidence. In this cohort, mean HEI-2005-Canada scores for men and women were 50.9 and 55.5 (maximum range 0-100), respectively. In men, higher HEI-2005-Canada score (Q4 vs. Q1) was associated with lower cancer risk (HR (95% CI) 0.63 (0.49-0.83)) over the course of follow-up (mean (SD)=10.4 (2.3) years); the same was not observed in women. In contrast, higher overall HEI-2005-Canada score (Q4 vs. Q1) was associated with lower risk of self-reported chronic disease (0.85 (0.75-0.97)) in both men and women over follow-up (4.2 (2.3) years). In conclusion, in this cohort better diet quality was associated with a lower risk of cancer in men and lower risk of chronic disease in both sexes. Future studies with longer follow-up and repeated measures of diet may be helpful to elucidate sex-specific associations between dietary quality and disease outcomes. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  2. Public Policies, Prices, and Productivity in American Higher Education. Stretching the Higher Education Dollar. Special Report 3

    Science.gov (United States)

    Hauptman, Arthur M.

    2013-01-01

    Rapid increases in what colleges charge and what they spend per student have been and remain one of the most controversial aspects of American higher education. Tuition, fees, and other college charges have increased in both the public and private sectors at more than twice the rate of inflation for over a quarter century. Trends over time in what…

  3. Reported incidence and precipitating factors of work-related stress and mental ill-health in the United Kingdom (1996-2001).

    Science.gov (United States)

    Cherry, Nicola M; Chen, Yiqun; McDonald, J Corbett

    2006-09-01

    Work-related mental ill-health appears to be increasing. Population-based data on incidence are scarce but in the United Kingdom occupational physicians and psychiatrists report these conditions to voluntary surveillance schemes. To estimate the incidence of work-related stress and mental illness reported 1996-2001 by occupational physicians and 1999-2001 by psychiatrists. Estimated annual average incidence rates were calculated by sex, occupation and industry against appropriate populations at risk. An in-house coding scheme was used to classify and analyse data on precipitating events. An estimated annual average of 3,624 new cases were reported by psychiatrists, and 2,718 by occupational physicians; the rates were higher for men in reports based on the former and for women on the latter. Most diagnoses were of anxiety/depression or work-related stress, with post-traumatic stress accounting for approximately 10% of cases reported by psychiatrists. High rates of ill-health were seen among professional and associated workers and in those in personal and protective services. Factors (such as work overload) intrinsic to the job and issues with interpersonal relations were the most common causes overall. The steep increase in new cases of work-related mental ill-health reported by occupational physicians since 1996 may reflect a greater willingness by workers to seek help but may also signify an increasing dissonance between workers' expectations and the work environment. Greater expertise is needed to improve the workplace by adjustment of job demands, improvement of working relations, increasing workers' capacities and management of organizational change.

  4. Colorectal cancer incidence in path_MLH1 carriers subjected to different follow-up protocols: a Prospective Lynch Syndrome Database report.

    Science.gov (United States)

    Seppälä, Toni; Pylvänäinen, Kirsi; Evans, Dafydd Gareth; Järvinen, Heikki; Renkonen-Sinisalo, Laura; Bernstein, Inge; Holinski-Feder, Elke; Sala, Paola; Lindblom, Annika; Macrae, Finlay; Blanco, Ignacio; Sijmons, Rolf; Jeffries, Jacqueline; Vasen, Hans; Burn, John; Nakken, Sigve; Hovig, Eivind; Rødland, Einar Andreas; Tharmaratnam, Kukatharmini; de Vos Tot Nederveen Cappel, Wouter H; Hill, James; Wijnen, Juul; Jenkins, Mark; Genuardi, Maurizio; Green, Kate; Lalloo, Fiona; Sunde, Lone; Mints, Miriam; Bertario, Lucio; Pineda, Marta; Navarro, Matilde; Morak, Monika; Frayling, Ian M; Plazzer, John-Paul; Sampson, Julian R; Capella, Gabriel; Möslein, Gabriela; Mecklin, Jukka-Pekka; Møller, Pål

    2017-01-01

    We have previously reported a high incidence of colorectal cancer (CRC) in carriers of pathogenic MLH1 variants (path_MLH1 ) despite follow-up with colonoscopy including polypectomy. The cohort included Finnish carriers enrolled in 3-yearly colonoscopy ( n  = 505; 4625 observation years) and carriers from other countries enrolled in colonoscopy 2-yearly or more frequently ( n  = 439; 3299 observation years). We examined whether the longer interval between colonoscopies in Finland could explain the high incidence of CRC and whether disease expression correlated with differences in population CRC incidence. Cumulative CRC incidences in carriers of path_MLH1 at 70-years of age were 41% for males and 36% for females in the Finnish series and 58% and 55% in the non-Finnish series, respectively ( p  > 0.05). Mean time from last colonoscopy to CRC was 32.7 months in the Finnish compared to 31.0 months in the non-Finnish (p > 0.05) and was therefore unaffected by the recommended colonoscopy interval. Differences in population incidence of CRC could not explain the lower point estimates for CRC in the Finnish series. Ten-year overall survival after CRC was similar for the Finnish and non-Finnish series (88% and 91%, respectively; p > 0.05). The hypothesis that the high incidence of CRC in path_MLH1 carriers was caused by a higher incidence in the Finnish series was not valid. We discuss whether the results were influenced by methodological shortcomings in our study or whether the assumption that a shorter interval between colonoscopies leads to a lower CRC incidence may be wrong. This second possibility is intriguing, because it suggests the dogma that CRC in path_MLH1 carriers develops from polyps that can be detected at colonoscopy and removed to prevent CRC may be erroneous. In view of the excellent 10-year overall survival in the Finnish and non-Finnish series we remain strong advocates of current surveillance practices for those with LS pending

  5. Characteristics of bias-based harassment incidents reported by a national sample of U.S. adolescents.

    Science.gov (United States)

    Jones, Lisa M; Mitchell, Kimberly J; Turner, Heather A; Ybarra, Michele L

    2018-06-01

    Using a national sample of youth from the U.S., this paper examines incidents of bias-based harassment by peers that include language about victims' perceived sexual orientation, race/ethnicity, religion, weight or height, or intelligence. Telephone interviews were conducted with youth who were 10-20 years old (n = 791). One in six youth (17%) reported at least one experience with bias-based harassment in the past year. Bias language was a part of over half (52%) of all harassment incidents experienced by youth. Perpetrators of bias-based harassment were similar demographically to perpetrators of non-biased harassment. However, bias-based incidents were more likely to involve multiple perpetrators, longer timeframes and multiple harassment episodes. Even controlling for these related characteristics, the use of bias language in incidents of peer harassment resulted in significantly greater odds that youth felt sad as a result of the victimization, skipped school, avoided school activities, and lost friends, compared to non-biased harassment incidents. Copyright © 2018 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  6. The provision of aids and adaptations, risk assessments, and incident reporting and recording procedures in relation to injury prevention for adults with intellectual disabilities: cohort study.

    Science.gov (United States)

    Finlayson, J; Jackson, A; Mantry, D; Morrison, J; Cooper, S-A

    2015-06-01

    Adults with intellectual disabilities (IDs) experience a higher incidence of injury, compared with the general population. The aim of this study was to investigate the provision of aids and adaptations, residential service providers' individual risk assessments and training in these, and injury incident recording and reporting procedures, in relation to injury prevention. Interviews were conducted with a community-based cohort of adults with IDs (n = 511) who live in Greater Glasgow, Scotland, UK and their key carer (n = 446). They were asked about their aids and adaptations at home, and paid carers (n = 228) were asked about individual risk assessments, their training, and incident recording and reporting procedures. Four hundred and twelve (80.6%) of the adults with IDs had at least one aid or adaptation at home to help prevent injury. However, a proportion who might benefit, were not in receipt of them, and surprisingly few had temperature controlled hot water or a bath thermometer in place to help prevent burns/scalds, or kitchen safety equipment to prevent burns/scalds from electric kettles or irons. Fifty-four (23.7%) of the paid carers were not aware of the adult they supported having had any risk assessments, and only 142 (57.9%) had received any training on risk assessments. Considerable variation in incident recording and reporting procedures was evident. More work is needed to better understand, and more fully incorporate, best practice injury prevention measures into routine support planning for adults with IDs within a positive risk-taking and risk reduction framework. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  7. Modernisation of Higher Education in Europe 2014: Access, Retention and Employability. Eurydice Report

    Science.gov (United States)

    Crosier, David; Horvath, Anna; Kerpanova, Viera; Kocanova, Daniela; Riiheläinen, Jari Matti

    2014-01-01

    The report sheds light on current national and institutional policies and practices aimed at increasing and widening access, reducing student dropout, and improving the employability of higher education graduates in Europe. The primary objective is to support Member States in their reform efforts by outlining and analysing national policies, and…

  8. The Changing Profile of College Students. ERIC/Higher Education Research Report No. 10, 1973.

    Science.gov (United States)

    Fenske, Robert H.; Scott, Craig S.

    This report reviews recent literature concerning enrollment trends in higher education and also presents the results of a recently completed extensive survey of student characteristics. In general, there is a declining rate of enrollment, while at the same time diversity among students is on the increase. This study should be of value to those…

  9. Environmental Reporting for Global Higher Education Institutions using the World Wide Web.

    Science.gov (United States)

    Walton, J.; Alabaster, T.; Richardson, S.; Harrison, R.

    1997-01-01

    Proposes the value of voluntary environmental reporting by higher education institutions as an aid to implementing environmental policies. Suggests that the World Wide Web can provide a fast, up-to-date, flexible, participatory, multidimensional medium for information exchange and management. Contains 29 references. (PVD)

  10. SU-E-T-469: Implementation of VAs Web-Based Radiotherapy Incident Reporting and Analysis System (RIRAS)

    International Nuclear Information System (INIS)

    Kapoor, R; Palta, J; Hagan, M; Malik, G

    2015-01-01

    Purpose: This Web-based Radiotherapy Incident Reporting and Analysis System (RIRAS) is a tool to improve quality of care for radiation therapy patients. This system is an important facet of continuing effort by our community to maintain and improve safety of radiotherapy.Material and Methods: VA’s National Radiation Oncology Program office has embarked on a program to electronically collect adverse events and good-catch data of radiation treatment of over 25,000 veterans treated with radiotherapy annually. This VA-Intranet based software design has made use of dataset taxonomies and data dictionaries defined in AAPM/ASTRO reports on error reporting. We used proven industrial and medical event reporting techniques to avoid several common problems faced in effective data collection such as incomplete data due to data entry fatigue by the reporters, missing data due to data difficult to obtain or not familiar to most reporters, missing reports due to fear of reprisal etc. This system encompasses the entire feedback loop of reporting an incident, analyzing it for salient details, and developing interventions to prevent it from happening again. The analysis reports with corrective, learning actions are shared with the reporter/facility and made public to the community (after deidentification) as part of the learning process. Results: Till date 50 incident/good catches have been reported in RIRAS and we have completed analysis on 100% of these reports. This is done due to the fact that each reported incidents is investigated and a complete analysis/patient-safety-work-product report is generated by radiation oncology domain-experts. Conclusions Because of the completeness of the data, the system has enabled us to analyze process steps and track trends of major errors which in the future will lead to implementing system wide process improvement steps and safe standard operating procedures for each radiotherapy treatment modality/technique and fulfills our goal of

  11. SU-E-T-469: Implementation of VAs Web-Based Radiotherapy Incident Reporting and Analysis System (RIRAS)

    Energy Technology Data Exchange (ETDEWEB)

    Kapoor, R; Palta, J; Hagan, M [Veteran Health Administration, Richmond, Virginia (United States); Virginia Commonwealth University, Richmond, VA (United States); Malik, G [TSG Innovations Inc. (United States)

    2015-06-15

    Purpose: This Web-based Radiotherapy Incident Reporting and Analysis System (RIRAS) is a tool to improve quality of care for radiation therapy patients. This system is an important facet of continuing effort by our community to maintain and improve safety of radiotherapy.Material and Methods: VA’s National Radiation Oncology Program office has embarked on a program to electronically collect adverse events and good-catch data of radiation treatment of over 25,000 veterans treated with radiotherapy annually. This VA-Intranet based software design has made use of dataset taxonomies and data dictionaries defined in AAPM/ASTRO reports on error reporting. We used proven industrial and medical event reporting techniques to avoid several common problems faced in effective data collection such as incomplete data due to data entry fatigue by the reporters, missing data due to data difficult to obtain or not familiar to most reporters, missing reports due to fear of reprisal etc. This system encompasses the entire feedback loop of reporting an incident, analyzing it for salient details, and developing interventions to prevent it from happening again. The analysis reports with corrective, learning actions are shared with the reporter/facility and made public to the community (after deidentification) as part of the learning process. Results: Till date 50 incident/good catches have been reported in RIRAS and we have completed analysis on 100% of these reports. This is done due to the fact that each reported incidents is investigated and a complete analysis/patient-safety-work-product report is generated by radiation oncology domain-experts. Conclusions Because of the completeness of the data, the system has enabled us to analyze process steps and track trends of major errors which in the future will lead to implementing system wide process improvement steps and safe standard operating procedures for each radiotherapy treatment modality/technique and fulfills our goal of

  12. EP&R Standards Project Report: Technical Review of National Incident Management Standards

    Energy Technology Data Exchange (ETDEWEB)

    Stenner, Robert D.

    2007-04-24

    The importance and necessity for a fully developed and implemented National Incident Management System (NIMS) has been demonstrated in recent years by the impact of national events such as Hurricane Katrina in 2005. Throughout the history of emergency response to major disasters, especially when multiple response organizations are involved, there have been systemic problems in the consistency and uniformity of response operations. Identifying national standards that support the development and implementation of NIMS is key to helping solve these systemic problems. The NIMS seeks to provide uniformity and consistency for incident management by using common terminology and protocols that will enable responders to coordinate their efforts to ensure an efficient response.

  13. Early Intervention Programs. Opening the Door to Higher Education. ASHE-ERIC Higher Education Report Vol. 25, No. 6.

    Science.gov (United States)

    Fenske, Robert H.; Geranios, Christine A.; Keller, Jonathan E.; Moore, David E.

    This report addresses issues related to the increasing growth of early intervention programs to encourage high school graduation and college attendance among students from low-income and minority groups. It first presents a brief review of the societal goals of equality for the nation's education system. It then defines the programs "early…

  14. Masking in reports of "most serious" events: bias in estimators of sports injury incidence in Canadian children

    Directory of Open Access Journals (Sweden)

    A. Gupta

    2016-08-01

    Full Text Available Introduction: Surveys that collect information on injuries often focus on the single "most serious" event to help limit recall error and reduce survey length. However, this can mask less serious injuries and result in biased incidence estimates for specific injury subcategories. Methods: Data from the 2002 Health Behaviour in School-aged Children (HBSC survey and from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP were used to compare estimates of sports injury incidence in Canadian children. Results: HBSC data indicate that 6.7% of children report sustaining a sports injury that required an emergency department (ED visit. However, details were only collected on a child's "most serious" injury, so children who had multiple injuries requiring an ED visit may have had sports injuries that went unreported. The rate of 6.7% can be seen to be an underestimate by as much as 4.3%. Corresponding CHIRPP surveillance data indicate an incidence of 9.9%. Potential masking bias is also highlighted in our analysis of injuries attended by other health care providers. Conclusion: The "one most serious injury" line of questioning induces potentially substantial masking bias in the estimation of sports injury incidence, which limits researchers' ability to quantify the burden of sports injury. Longer survey recall periods naturally lead to greater masking. The design of future surveys should take these issues into account. In order to accurately inform policy decisions and the direction of future research, researchers must be aware of these limitations.

  15. A global model of malaria climate sensitivity: comparing malaria response to historic climate data based on simulation and officially reported malaria incidence

    Directory of Open Access Journals (Sweden)

    Edlund Stefan

    2012-09-01

    Full Text Available Abstract Background The role of the Anopheles vector in malaria transmission and the effect of climate on Anopheles populations are well established. Models of the impact of climate change on the global malaria burden now have access to high-resolution climate data, but malaria surveillance data tends to be less precise, making model calibration problematic. Measurement of malaria response to fluctuations in climate variables offers a way to address these difficulties. Given the demonstrated sensitivity of malaria transmission to vector capacity, this work tests response functions to fluctuations in land surface temperature and precipitation. Methods This study of regional sensitivity of malaria incidence to year-to-year climate variations used an extended Macdonald Ross compartmental disease model (to compute malaria incidence built on top of a global Anopheles vector capacity model (based on 10 years of satellite climate data. The predicted incidence was compared with estimates from the World Health Organization and the Malaria Atlas. The models and denominator data used are freely available through the Eclipse Foundation’s Spatiotemporal Epidemiological Modeller (STEM. Results Although the absolute scale factor relating reported malaria to absolute incidence is uncertain, there is a positive correlation between predicted and reported year-to-year variation in malaria burden with an averaged root mean square (RMS error of 25% comparing normalized incidence across 86 countries. Based on this, the proposed measure of sensitivity of malaria to variations in climate variables indicates locations where malaria is most likely to increase or decrease in response to specific climate factors. Bootstrapping measures the increased uncertainty in predicting malaria sensitivity when reporting is restricted to national level and an annual basis. Results indicate a potential 20x improvement in accuracy if data were available at the level ISO 3166–2

  16. Learning from incident reports in the Australian medical imaging setting: handover and communication errors.

    Science.gov (United States)

    Hannaford, N; Mandel, C; Crock, C; Buckley, K; Magrabi, F; Ong, M; Allen, S; Schultz, T

    2013-02-01

    To determine the type and nature of incidents occurring within medical imaging settings in Australia and identify strategies that could be engaged to reduce the risk of their re-occurrence. 71 search terms, related to clinical handover and communication, were applied to 3976 incidents in the Radiology Events Register. Detailed classification and thematic analysis of a subset of incidents that involved handover or communication (n=298) were undertaken to identify the most prevalent types of error and to make recommendations about patient safety initiatives in medical imaging. Incidents occurred most frequently during patient preparation (34%), when requesting imaging (27%) and when communicating a diagnosis (23%). Frequent problems within each of these stages of the imaging cycle included: inadequate handover of patients (41%) or unsafe or inappropriate transfer of the patient to or from medical imaging (35%); incorrect information on the request form (52%); and delayed communication of a diagnosis (36%) or communication of a wrong diagnosis (36%). The handover of patients and clinical information to and from medical imaging is fraught with error, often compromising patient safety and resulting in communication of delayed or wrong diagnoses, unnecessary radiation exposure and a waste of limited resources. Corrective strategies to address safety concerns related to new information technologies, patient transfer and inadequate test result notification policies are relevant to all healthcare settings. Handover and communication errors are prevalent in medical imaging. System-wide changes that facilitate effective communication are required.

  17. Self-Reported Sleep Duration, Napping, and Incident Heart Failure: Prospective Associations in the British Regional Heart Study.

    Science.gov (United States)

    Wannamethee, S Goya; Papacosta, Olia; Lennon, Lucy; Whincup, Peter H

    2016-09-01

    To examine the associations between self-reported nighttime sleep duration and daytime sleep and incident heart failure (HF) in men with and without preexisting cardiovascular disease (CVD). Population-based prospective study. General practices in 24 British towns. Men aged 60-79 without prevalent HF followed for 9 years (N = 3,723). Information on incident HF cases was obtained from primary care records. Assessment of sleep was based on self-reported sleep duration at night and daytime napping. Self-reported short nighttime sleep duration and daytime sleep of longer than 1 hour were associated with preexisting CVD, breathlessness, depression, poor health, physical inactivity, and manual social class. In all men, self-reported daytime sleep of longer than 1 hour duration was associated with significantly greater risk of HF after adjustment for potential confounders (adjusted hazard ratio (aHR) = 1.69, 95% CI = 1.06-2.71) than in those who reported no daytime napping. Self-reported nighttime sleep duration was not associated with HF risk except in men with preexisting CVD (napping of longer than 1 hour is associated with greater risk of HF in older men. Self-reported short sleep (<6 hours) in men with CVD is associated with particularly high risk of developing HF. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

  18. Characteristics and outcomes of e-cigarette exposure incidents reported to 10 European Poison Centers: a retrospective data analysis

    OpenAIRE

    Vardavas, Constantine I.; Girvalaki, Charis; Filippidis, Filippos T; Oder, Mare; Kastanje, Ruth; de Vries, Irma; Scholtens, Lies; Annas, Anita; Plackova, Silvia; Turk, Rajka; Gruzdyte, Laima; Rato, F?tima; Genser, Dieter; Schiel, Helmut; Bal?zs, Andrea

    2017-01-01

    BACKGROUND: The use of e-cigarettes has increased during the past few years. Exposure to e-cigarette liquids, whether intentional or accidental, may lead to adverse events our aim was to assess factors associated with e-cigarette exposures across European Union Member States (EU MS). METHODS: A retrospective analysis of exposures associated with e-cigarettes reported to national poison centers was performed covering incidents from 2012 to March 2015 from 10 EU MS. De-identified and anonymous ...

  19. Risk factors for sexual violence in the military: an analysis of sexual assault and sexual harassment incidents and reporting

    OpenAIRE

    Souder, William C., III

    2017-01-01

    Approved for public release; distribution is unlimited Using the 2014 RAND Military Workplace Study, this thesis studies the effects of demographics, prior victimization, deployment status, and workplace characteristics—specifically, command climate, leadership and training quality—on both incidence and reporting of sexual assault and sexual harassment. Sexual assault consists of a nonconsensual sexual act coupled with a use of force or threat thereof that is likely to cause physical harm ...

  20. Incidence of skin cancer among Nagasaki atomic bomb survivors; Preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Sadamori, Naoki; Mine, Mariko; Hori, Makoto (Nagasaki Univ. (Japan). School of Medicine) (and others)

    1990-09-01

    Among a total of 65,268 Nagasaki atomic bomb survivors recorded in the Scientific Data Center of Atomic Bomb Disaster, Nagasaki University School of Medicine, 140 cases with skin cancer were collected from 31 hospitals in Nagasaki City from 1961 through 1987. Subsequently, these cases of skin cancer in Nagasaki atomic bomb survivors were statistically analyzed in relation to the estimated distance from the hypocenter by age, sex, histology and latent period. The results were as follows: (1) A high correlation was observed between the incidence of skin cancer and the distance from the hypocenter. (2) The incidence of skin cancer in Nagasaki atomic bomb survivors now appears to be increasing in relation to exposure distance. (3) Among 140 cases, basal cell epithelioma was observed in 67 cases (47.9%) and squamous cell carcinoma in 43 cases (30.7%). (author).

  1. Childhood Cancer Incidence in India Betweem 2012 and 2014: Report of a Population-based Cancer Registry.

    Science.gov (United States)

    Das, Suman; Paul, Dilip Kumar; Anshu, Kumar; Bhakta, Subhajit

    2017-12-15

    To provide an overview of childhood cancer incidence in India between 2012-2014. Secondary data analysis on age-adjusted rates of cancer incidence for children (0-14 years) were collected from the report of the National Cancer Registry Programme in the year 2016. Age-adjusted rates of childhood cancer incidence ranged from 18.5 per million in the state of Nagaland to 235.3 per million in Delhi for boys. The rates were 11.4 per million in East Khasi Hill district and 152.3 per million in Delhi for girls. Leukemia was the most predominant cancer for both boys and girls. Lymphoma was the second most common cancer in boys, and brain tumors in girls. Childhood cancer incidence is increasing in India compared to population-based cancer registry survey of 2009-2011. Cancers are mostly affecting 0-4 years age group, and there is a rising trend of Non-Hodgkin's lymphoma.

  2. Accidental nuclear excursion Recuplex operation 234-5 facility. Final report: Date of incident: April 7, 1962

    Energy Technology Data Exchange (ETDEWEB)

    1962-08-01

    On Saturday morning, April 7, 1962, at about 1059 Armed Forces time, an accidental nuclear excursion occurred in the plutonium waste recovery facility (Recuplex) of the 234-5 Building. This excursion did not result in any mechanical damage or spread of contamination. Three employees of the General Electric Company received overexposures to gamma and neutron radiation. None were fatally exposed; in each case the overexposure was recognized promptly, and following medical observation and testing the men were released to return to work. In compliance with AEC Manual Chapter 0703, an AEC-HAPO committee composed of two AEC employees and five General Electric employees was appointed by the Manger, HOO, with the concurrence of the General Manager, HAPO, to conduct an investigation of the incident. The committee`s purpose was to determine the cause, nature, and extent of the incident, and recommend action to be taken by others to minimize or preclude future incidents of this magnitude. A study of operating practices and operating conditions that appeared to exist prior to, during, and subsequent to the accident was made by the committee. The committee believes that this report provides sufficient information to answer questions which may arise as a result of the criticality incident except those relating to its cause.

  3. [Results of provisional use of a system for voluntary anonymous reporting of incidents that threaten patient safety in the emergency medical services of Asturias].

    Science.gov (United States)

    Galván Núñez, Pablo; Santander Barrios, María Dolores; Villa Álvarez, María Cristina; Castro Delgado, Rafael; Alonso Lorenzo, Julio C; Arcos González, Pedro

    2016-06-01

    To describe the reported incidents and adverse events in the emergency medical services of Asturias, Spain, and assess their consequences, delays caused, and preventability. Prospective, observational study of incidents reported by the staff of the emergency medical services of Asturias after implementation of a system devised by the researchers. Incident reports were received for 0.48% (95% CI, 0.41%-0.54%) of the emergencies attended. Patient safety was compromised in 74.7% of the reported incidents. Problems arising in the emergency response coordination center (ERCC) accounted for 37.6% of the incidents, transport problems for 13.4%, vehicular problems for 10.8%, and communication problems for 8.8%. Seventy percent of the reported incidents caused delays in care; 55% of the reported incidents that put patients at risk (according to severity assessment code ratings) corresponded to problems related to human or material resources. A total of 88.1% of the incidents reported were considered avoidable. Some type of intervention was required to attenuate the effects of 46.2% of the adverse events reported. The measures that staff members most often proposed to prevent adverse events were to increase human and material resources (28.3%), establish protocols (14.5%), and comply with quality of care recommendations (9.7%). It is important to promote a culture of safety and incident reporting among health care staff in Asturias given the number of serious adverse events. Reporting is necessary for understanding the errors made and taking steps to prevent them. The ERCC is the point in the system where incidents are particularly likely to appear and be noticed and reported.

  4. Reported credibility techniques in higher education evaluation studies that use qualitative methods: A research synthesis.

    Science.gov (United States)

    Liao, Hongjing; Hitchcock, John

    2018-06-01

    This synthesis study examined the reported use of credibility techniques in higher education evaluation articles that use qualitative methods. The sample included 118 articles published in six leading higher education evaluation journals from 2003 to 2012. Mixed methods approaches were used to identify key credibility techniques reported across the articles, document the frequency of these techniques, and describe their use and properties. Two broad sets of techniques were of interest: primary design techniques (i.e., basic), such as sampling/participant recruitment strategies, data collection methods, analytic details, and additional qualitative credibility techniques (e.g., member checking, negative case analyses, peer debriefing). The majority of evaluation articles reported use of primary techniques although there was wide variation in the amount of supporting detail; most of the articles did not describe the use of additional credibility techniques. This suggests that editors of evaluation journals should encourage the reporting of qualitative design details and authors should develop strategies yielding fuller methodological description. Copyright © 2018 Elsevier Ltd. All rights reserved.

  5. Snowball Vs. House-to-House Technique for Measuring Annual Incidence of Kala-azar in the Higher Endemic Blocks of Bihar, India: A Comparison.

    Science.gov (United States)

    Siddiqui, Niyamat A; Rabidas, Vidya N; Sinha, Sanjay K; Verma, Rakesh B; Pandey, Krishna; Singh, Vijay P; Ranjan, Alok; Topno, Roshan K; Lal, Chandra S; Kumar, Vijay; Sahoo, Ganesh C; Sridhar, Srikantaih; Pandey, Arvind; Das, Pradeep

    2016-09-01

    Visceral Leishmaniasis, commonly known as kala-azar, is widely prevalent in Bihar. The National Kala-azar Control Program has applied house-to-house survey approach several times for estimating Kala-azar incidence in the past. However, this approach includes huge logistics and operational cost, as occurrence of kala-azar is clustered in nature. The present study aims to compare efficiency, cost and feasibility of snowball sampling approach to house-to-house survey approach in capturing kala-azar cases in two endemic districts of Bihar, India. A community based cross-sectional study was conducted in two highly endemic Primary Health Centre (PHC) areas, each from two endemic districts of Bihar, India. Snowball technique (used to locate potential subjects with help of key informants where subjects are hard to locate) and house-to-house survey technique were applied to detect all the new cases of Kala-azar during a defined reference period of one year i.e. June, 2010 to May, 2011. The study covered a total of 105,035 households with 537,153 populations. Out of total 561 cases and 17 deaths probably due to kala-azar, identified by the study, snowball sampling approach captured only 221 cases and 13 deaths, whereas 489 cases and 17 deaths were detected by house-to-house survey approach. Higher value of McNemar's χ² statistics (64; phouse-to-house survey approach than snowball sampling and relative difference (>1) indicates that most of the kala-azar cases missed by snowball sampling were captured by house-to-house approach with 13% of omission. Snowball sampling was not found sensitive enough as it captured only about 50% of VL cases. However, it captured about 77% of the deaths probably due to kala-azar and was found more cost-effective than house-to-house approach. Standardization of snowball approach with improved procedure, training and logistics may enhance the sensitivity of snowball sampling and its application in national Kala-azar elimination programme as cost

  6. The importance of critical incident reporting – and how to do it

    Directory of Open Access Journals (Sweden)

    Tim Fetherston

    2015-09-01

    Full Text Available If you asked a group of people whether you were more likely to die from an accident when you were in hospital or when you were travelling, either by air or by car, most people would probably say that it was safer to be in hospital. In fact, this couldn’t be further from the truth. If you are a patient, you are a hundred times more likely to die from a critical incident or error in hospital than you are in a transport accident.

  7. Report from Mongolia – How much do we know about the incidence of rare cases in less developed countries: a case series

    Directory of Open Access Journals (Sweden)

    Dünser Martin W

    2008-11-01

    Full Text Available Abstract Introduction Case reports are important instruments to describe rare disease conditions and give a rough estimation of their global incidence. Even though collected in international databases, most case reports are published by clinicians from industrialized nations and little is known about the incidence of rare cases in less developed countries, which are home to 75% of the world's population. Case presentation We present seven patients who suffered from diseases which are either considered to be rare or have not yet been described before according to international databases, but occurred during a 5-month period in one intensive care unit of a less developed country. During the observation period, patients with a spontaneous infratentorial subdural hematoma (Asian, female, 41 years, general exanthema and acute renal failure after diesel ingestion (Asian, male, 30 years, transient cortical blindness complicating hepatic encephalopathy (Asian, female, 49 years, Fournier gangrene complicating acute necrotizing pancreatitis (Asian, male, 37 years, acute renal failure due to acetic acid intoxication (Asian, male, 42 years, haemolytic uremic syndrome following septic abortion (Asian, female, 45 years, and a metal needle as an unusual cause of chest pain (Asian, male, 41 years were treated. According to the current literature, all seven disease conditions are considered either rare or have so far not yet been reported. Conclusion The global incidence of rare cases may be underestimated by contemporary international databases. Diseases which are currently considered to be rare in industrialized nations may occur at a higher frequency in less developed countries. Reasons may not only be a geographically different burden of certain diseases, limited diagnostic and therapeutic facilities, but also a relevant publication bias.

  8. Higher risk of incident hepatitis C virus among young women who inject drugs compared with young men in association with sexual relationships: a prospective analysis from the UFO Study cohort.

    Science.gov (United States)

    Tracy, Daniel; Hahn, Judith A; Fuller Lewis, Crystal; Evans, Jennifer; Briceño, Alya; Morris, Meghan D; Lum, Paula J; Page, Kimberly

    2014-05-29

    Female injection drug users (IDUs) may report differences in injection behaviours that put them at greater risk for hepatitis C virus (HCV). Few studies have examined these in association with HCV incidence. Longitudinal data from a cohort of 417 HCV-uninfected IDU aged 30 or younger were analysed. Cox proportional hazards was used to model female sex as a predictor of new HCV infection. General estimating equation (GEE) analysis was used to model female sex as a predictor of HCV-associated risk behaviour prospectively. Women were significantly more likely than men to become infected with HCV during study follow-up (HR 1.4, p<0.05), and were also more likely than men to report high-risk injecting behaviours, especially in the context of sexual and injecting relationships. Sex differences in injecting behaviours appeared to explain the relationship between sex and HCV infection. Young women's riskier injection practices lead to their higher rates of HCV infection. Further study on the impact of intimate partnership on women's risk behaviour is warranted. 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. Social motivation in prospective memory: higher importance ratings and reported performance rates for social tasks.

    Science.gov (United States)

    Penningroth, Suzanna L; Scott, Walter D; Freuen, Margaret

    2011-03-01

    Few studies have addressed social motivation in prospective memory (PM). In a pilot study and two main studies, we examined whether social PM tasks possess a motivational advantage over nonsocial PM tasks. In the pilot study and Study 1, participants listed their real-life important and less important PM tasks. Independent raters categorized the PM tasks as social or nonsocial. Results from both studies showed a higher proportion of tasks rated as social when important tasks were requested than when less important tasks were requested. In Study 1, participants also reported whether they had remembered to perform each PM task. Reported performance rates were higher for tasks rated as social than for those rated as nonsocial. Finally, in Study 2, participants rated the importance of two hypothetical PM tasks, one social and one nonsocial. The social PM task was rated higher in importance. Overall, these findings suggest that social PM tasks are viewed as more important than nonsocial PM tasks and they are more likely to be performed. We propose that consideration of the social relevance of PM will lead to a more complete and ecologically valid theoretical description of PM performance. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

  10. Higher plasma soluble Receptor for Advanced Glycation End Products (sRAGE) levels are associated with incident cardiovascular disease and all-cause mortality in type 1 diabetes

    DEFF Research Database (Denmark)

    Nin, Johanna W M; Jorsal, Anders; Ferreira, Isabel

    2010-01-01

    To investigate the associations of plasma levels of soluble receptor for advanced glycation end products (sRAGE) with incident cardiovascular disease (CVD) and all-cause mortality in type 1 diabetes and the extent to which any such associations could be explained by endothelial and renal dysfunct......To investigate the associations of plasma levels of soluble receptor for advanced glycation end products (sRAGE) with incident cardiovascular disease (CVD) and all-cause mortality in type 1 diabetes and the extent to which any such associations could be explained by endothelial and renal...

  11. The child sexual abuse epidemic in addis ababa: some reflections on reported incidents, psychosocial consequences and implications.

    Science.gov (United States)

    Jemal, Jibril

    2012-03-01

    Though child sexual abuse is a universal phenomenon, only reported cases of the incidence are common source of information to get insight on how to understand the problem. Besides, investigating complaints presented by victims themselves would be a stepping stone for designing prevention and rehabilitation programs. The objective of this study was to identify the nature of sexual incidence and experience victims face. The research was conducted by collecting reported child sexual abuse cases from Child Protection Units of Addis Ababa Police Commission and three selected non-governmental organizations working for the welfare of sexually abused children in Addis Ababa. 64 selected samples of victim children were included from the three organizations. They completed a semi-structured questionnaire and data were analyzed. Of the total reported crime cases committed against children (between July 2005 and December 2006), 23% of them were child sexual victimization. On average, 21 children were reported to be sexually abused each month where majority of the sexual abuse incidence were committed against female children in their own home by someone they closely know. The psychological trauma and physical complaints presented by victims include symptoms of anxiety and depression. It was found out that child sexual abuse cases presented to the legal office was not properly managed. Female children appear to be more prone to sexual abuse than their male counterparts. By virtue of their nature, many children are at risk of sexual victimization by people they truest. Based on the findings, several implications are made, which includes the importance of nation-wide study to formulate a comprehensive policy guideline for protection and criminalization of child sexual abuse in Ethiopia.

  12. To what extent are adverse events found in patient records reported by patients and healthcare professionals via complaints, claims and incident reports?

    Directory of Open Access Journals (Sweden)

    van der Wal Gerrit

    2011-02-01

    Full Text Available Abstract Background Patient record review is believed to be the most useful method for estimating the rate of adverse events among hospitalised patients. However, the method has some practical and financial disadvantages. Some of these disadvantages might be overcome by using existing reporting systems in which patient safety issues are already reported, such as incidents reported by healthcare professionals and complaints and medico-legal claims filled by patients or their relatives. The aim of the study is to examine to what extent the hospital reporting systems cover the adverse events identified by patient record review. Methods We conducted a retrospective study using a database from a record review study of 5375 patient records in 14 hospitals in the Netherlands. Trained nurses and physicians using a method based on the protocol of The Harvard Medical Practice Study previously reviewed the records. Four reporting systems were linked with the database of reviewed records: 1 informal and 2 formal complaints by patients/relatives, 3 medico-legal claims by patients/relatives and 4 incident reports by healthcare professionals. For each adverse event identified in patient records the equivalent was sought in these reporting systems by comparing dates and descriptions of the events. The study focussed on the number of adverse event matches, overlap of adverse events detected by different sources, preventability and severity of consequences of reported and non-reported events and sensitivity and specificity of reports. Results In the sample of 5375 patient records, 498 adverse events were identified. Only 18 of the 498 (3.6% adverse events identified by record review were found in one or more of the four reporting systems. There was some overlap: one adverse event had an equivalent in both a complaint and incident report and in three cases a patient/relative used two or three systems to complain about an adverse event. Healthcare professionals

  13. Queering Transformation in Higher Education

    Science.gov (United States)

    Msibi, Thabo

    2013-01-01

    Transformation in higher education has tended to focus on race and sex, at the expense of other forms of discrimination. This article addresses the silencing of "queer" issues in higher education. Using queer theory as a framework, and drawing on current literature, popular media reports, two personal critical incidents and a project…

  14. Shoulder injuries in rugby: Report of its incidence and severity in a group of Portuguese male players during a season

    Directory of Open Access Journals (Sweden)

    E. Cruz-Ferreira

    2018-04-01

    Full Text Available Objective: Rugby union is a fast growing sport all over the world, due to its nature as a contact sport it is frequent for players to sustain injuries, more specifically on the shoulder joint, were the injuries occur with greater severity. Method: The authors present a cohort prospective study focusing on the incidence and severity of shoulder injuries in a population of 51 male of top-tier Portuguese Rugby Union players aiming, to characterize relevant epidemiological aspects, conducted between September 2013 and May 2014. All data was collected and recorded according to the consensus statement for epidemiological studies in Rugby Union. Results: A total injury incidence rate of 23.68 per 1000 player match-hours was found with a mean severity of injuries of 34.22, a value higher than expected when comparing with previous studies. New and recurrent injuries occurred in a 7:2 ratio. Reported mean severity of 41.57 days in new injuries versus 8.50 days. Conclusion: The proportion of recurrent injuries alerts us for the importance of preventing measures. Poor physical condition of the players seems to have contributed to the increased number of shoulder injuries of our target population. Specific training programs to improve muscle strength and directed training to improve correct technical aspects of the tackling engagement during the fatigue periods of the game could be very important in the prevention of shoulder injuries. Resumen: Objetivo: El rugby es un deporte de rápido crecimiento en todo el mundo, debido a su naturaleza, tratándose de un deporte de contacto es frecuente que los jugadores sufran lesiones, más específicamente en la articulación del hombro, donde las lesiones suceden con mayor severidad. Método: Los autores presentan un estudio de cohorte prospectivo centrado en la incidencia y la gravedad de las lesiones de hombro en una población de 51 jugadores de primer nivel de Rugby de la liga portuguesa, caracterizando aspectos

  15. Can patients report patient safety incidents in a hospital setting? A systematic review.

    Science.gov (United States)

    Ward, Jane K; Armitage, Gerry

    2012-08-01

    Patients are increasingly being thought of as central to patient safety. A small but growing body of work suggests that patients may have a role in reporting patient safety problems within a hospital setting. This review considers this disparate body of work, aiming to establish a collective view on hospital-based patient reporting. This review asks: (a) What can patients report? (b) In what settings can they report? (c) At what times have patients been asked to report? (d) How have patients been asked to report? 5 databases (MEDLINE, EMBASE, CINAHL, (Kings Fund) HMIC and PsycINFO) were searched for published literature on patient reporting of patient safety 'problems' (a number of search terms were utilised) within a hospital setting. In addition, reference lists of all included papers were checked for relevant literature. 13 papers were included within this review. All included papers were quality assessed using a framework for comparing both qualitative and quantitative designs, and reviewed in line with the study objectives. Patients are clearly in a position to report on patient safety, but included papers varied considerably in focus, design and analysis, with all papers lacking a theoretical underpinning. In all papers, reports were actively solicited from patients, with no evidence currently supporting spontaneous reporting. The impact of timing upon accuracy of information has yet to be established, and many vulnerable patients are not currently being included in patient reporting studies, potentially introducing bias and underestimating the scale of patient reporting. The future of patient reporting may well be as part of an 'error detection jigsaw' used alongside other methods as part of a quality improvement toolkit.

  16. Incident Reporting to Improve Patient Safety: The Effects of Process Variance on Pediatric Patient Safety in the Emergency Department.

    Science.gov (United States)

    OʼConnell, Karen J; Shaw, Kathy N; Ruddy, Richard M; Mahajan, Prashant V; Lichenstein, Richard; Olsen, Cody S; Funai, Tomohiko; Blumberg, Stephen; Chamberlain, James M

    2018-04-01

    Medical errors threaten patient safety, especially in the pediatric emergency department (ED) where overcrowding, multiple handoffs, and workflow interruptions are common. Errors related to process variance involve situations that are not consistent with standard ED operations or routine patient care. We performed a planned subanalysis of the Pediatric Emergency Care Applied Research Network incident reporting data classified as process variance events. Confidential deidentified incident reports (IRs) were collected and classified by 2 independent investigators. Events categorized as process variance were then subtyped for severity and contributing factors. Data were analyzed using descriptive statistics. The study intention was to describe and measure reported medical errors related to process variance in 17 EDs in the Pediatric Emergency Care Applied Research Network from 2007 to 2008. Between July 2007 and June 2008, 2906 eligible reports were reviewed. Process variance events were identified in 15.4% (447/2906). The majority were related to patient flow (35.4%), handoff communication (17.2%), and patient identification errors (15.9%). Most staff involved included nurses (47.9%) and physicians (28%); trainees were infrequently reported. The majority of events did not result in harm (65.7%); 17.9% (80/447) of cases were classified as unsafe conditions but did not reach the patient. Temporary harm requiring further treatment or hospitalization was reported in 5.6% (25/447). No events resulted in permanent harm, near death, or death. Contributing factors included human factors (92.1%), in particular handoff communication, interpersonal skills, and compliance with established procedures, and system-level errors (18.1%), including unclear or unavailable policies and inadequate staffing levels. Although process variance events accounted for approximately 1 in 6 reported safety events, very few led to patient harm. Because human and system-level factors contributed to

  17. Parent-reported otorrhea in children with tympanostomy tubes: incidence and predictors.

    Directory of Open Access Journals (Sweden)

    Thijs M A van Dongen

    Full Text Available PURPOSE: Although common in children with tympanostomy tubes, the current incidence of tympanostomy tube otorrhea (TTO is uncertain. TTO is generally a sign of otitis media, when middle ear fluid drains through the tube. Predictors for otitis media are therefore suggested to have predictive value for the occurrence of TTO. OBJECTIVE: To determine the incidence of TTO and its predictors. METHODS: We performed a cohort study, using a parental web-based questionnaire to retrospectively collect data on TTO episodes and its potential predictors from children younger than 10 years of age with tympanostomy tubes. RESULTS: Of the 1,184 children included in analyses (total duration of time since tube placement was 768 person years with a mean of 7.8 months per child, 616 children (52% experienced one or more episodes of TTO. 137 children (12% had TTO within the calendar month of tube placement. 597 (50% children had one or more acute TTO episodes (duration <4 weeks and 46 children (4% one or more chronic TTO episodes (duration ≥4 weeks. 146 children (12% experienced recurrent TTO episodes. Accounting for time since tube placement, 67% of children developed one or more TTO episodes in the year following tube placement. Young age, recurrent acute otitis media being the indication for tube placement, a recent history of recurrent upper respiratory tract infections and the presence of older siblings were independently associated with the future occurrence of TTO, and can therefore be seen as predictors for TTO. CONCLUSIONS: Our survey confirms that otorrhea is a common sequela in children with tympanostomy tubes, which occurrence can be predicted by age, medical history and presence of older siblings.

  18. Report on state liability for radioactive materials transportation incidents: A survey of laws

    International Nuclear Information System (INIS)

    1989-10-01

    The purpose of this report is to provide a synopsis of the liability laws of the Southern States Energy Board's (SSEB's) 16 member states. It begins by briefly reviewing potential sources of liability, immunity from liability, waiver of immunity, and statutes of limitation, followed by liability laws of member states. The report was prepared by reviewing legal literature pertaining to governmental liability, with particular emphasis on nuclear waste transportation, including law review articles, legal treatises, technical reports, state statutes and regulations

  19. Patient safety incident reports related to traditional Japanese Kampo medicines: medication errors and adverse drug events in a university hospital for a ten-year period.

    Science.gov (United States)

    Shimada, Yutaka; Fujimoto, Makoto; Nogami, Tatsuya; Watari, Hidetoshi; Kitahara, Hideyuki; Misawa, Hiroki; Kimbara, Yoshiyuki

    2017-12-21

    Kampo medicine is traditional Japanese medicine, which originated in ancient traditional Chinese medicine, but was introduced and developed uniquely in Japan. Today, Kampo medicines are integrated into the Japanese national health care system. Incident reporting systems are currently being widely used to collect information about patient safety incidents that occur in hospitals. However, no investigations have been conducted regarding patient safety incident reports related to Kampo medicines. The aim of this study was to survey and analyse incident reports related to Kampo medicines in a Japanese university hospital to improve future patient safety. We selected incident reports related to Kampo medicines filed in Toyama University Hospital from May 2007 to April 2017, and investigated them in terms of medication errors and adverse drug events. Out of 21,324 total incident reports filed in the 10-year survey period, we discovered 108 Kampo medicine-related incident reports. However, five cases were redundantly reported; thus, the number of actual incidents was 103. Of those, 99 incidents were classified as medication errors (77 administration errors, 15 dispensing errors, and 7 prescribing errors), and four were adverse drug events, namely Kampo medicine-induced interstitial pneumonia. The Kampo medicine (crude drug) that was thought to induce interstitial pneumonia in all four cases was Scutellariae Radix, which is consistent with past reports. According to the incident severity classification system recommended by the National University Hospital Council of Japan, of the 99 medication errors, 10 incidents were classified as level 0 (an error occurred, but the patient was not affected) and 89 incidents were level 1 (an error occurred that affected the patient, but did not cause harm). Of the four adverse drug events, two incidents were classified as level 2 (patient was transiently harmed, but required no treatment), and two incidents were level 3b (patient was

  20. Incidence of self-reported brain injury and the relationship with substance abuse: findings from a longitudinal community survey

    Directory of Open Access Journals (Sweden)

    Butterworth Peter

    2010-03-01

    Full Text Available Abstract Background Traumatic or serious brain injury (BI has persistent and well documented adverse outcomes, yet 'mild' or 'moderate' BI, which often does not result in hospital treatment, accounts for half the total days of disability attributed to BI. There are currently few data available from community samples on the incidence and correlates of these injuries. Therefore, the study aimed to assess the 1 incidence of self-reported mild (not requiring hospital admission and moderate (admitted to hospital brain injury (BI, 2 causes of injury 3 physical health scores and 4 relationship between BI and problematic alcohol or marijuana use. Methods An Australian community sequential-cohort study (cohorts aged 20-24, 40-44 and 60-64 years at wave one used a survey methodology to assess BI and substance use at baseline and four years later. Results Of the 7485 wave one participants, 89.7% were re-interviewed at wave two. There were 56 mild (230.8/100000 person-years and 44 moderate BI (180.5/100000 person-years reported between waves one and two. Males and those in the 20-24 year cohort had increased risk of BI. Sports injury was the most frequent cause of BI (40/100 with traffic accidents being a greater proportion of moderate (27% than mild (7% BI. Neither alcohol nor marijuana problems at wave one were predictors of BI. BI was not a predictor of developing substance use problems by wave two. Conclusions BI were prevalent in this community sample, though the incidence declined with age. Factors associated with BI in community samples differ from those reported in clinical samples (e.g. typically traumatic brain injury with traffic accidents the predominate cause. Further, detailed evaluation of the health consequences of these injuries is warranted.

  1. Higher CD3(+) and CD34(+) cell doses in the graft increase the incidence of acute GVHD in children receiving BMT for thalassemia.

    Science.gov (United States)

    Gaziev, J; Isgrò, A; Marziali, M; Daniele, N; Gallucci, C; Sodani, P; Simone, M D; Adorno, G; Paciaroni, K; Andreani, M; Lanti, A; Del Proposto, G; Testi, M; De Angelis, G; Roveda, A; Alfieri, C; Saltarelli, F; Lucarelli, G

    2012-01-01

    We evaluated the incidence of GVHD, risk factors and the impact of graft composition on acute GVHD (aGVHD) in 92 children who underwent BMT for thalassemia following busulfan/cyclophosphamide (BUCY)-based conditioning regimens and GVHD prophylaxis with CSA/short-MTX and methylprednisolone. The incidence of grade 2-4 and 3-4 aGVHD was 35% (95% confidence interval (CI) 25-44) and 9% (95% CI 4-16), respectively. We found that CD3(+) and CD34(+) cell doses above the median were associated with high incidence of grade 2-4 aGVHD (49 vs 20%, P=0.005 and 46 vs 23%, P=0.021, respectively). In multivariate analysis, high CD3(+) (hazard ratio (HR) 4.6; 95% CI 1.4-14.7; P=0.010) and CD34(+) (HR 4.3; 95% CI 1.4-12.7; P=0.011) cell doses were associated with grade 2-4 aGVHD. We further examined the effect of CD3(+) and CD34(+) cell doses on aGVHD using quartile cutoff points and found a minimum threshold for CD3(+) (38 × 10(6)/kg) and CD34(+) (4 × 10(6)/kg) cells above which the incidence of grade 2-4 aGVHD is significantly increased. This study shows for the first time a positive correlation between the number of CD3(+) and CD34(+) cells and aGVHD in children receiving sibling BMT, and indicates that using tailored and more intensive post transplant immunosuppression may permit to better control aGVHD.

  2. Black American College Students Report Higher Memory of Love for Mothers in Childhood Than White Students.

    Science.gov (United States)

    Patihis, Lawrence; Jackson, Corai E; Diaz, Jonathan C; Stepanova, Elena V; Herrera, Mario E

    2018-01-01

    Cultural differences between Black and White individuals in the South are connected to the inequitable history of the United States. We wondered if these cultural differences would translate to a particularly precious aspect of life: memories of love felt in childhood toward one's parents. Some past studies have shown that Whites score higher on parental attachment measures to parents than Blacks, while other studies show no significant differences. However, no previous study has ever measured memory of feelings of love in relation to differences between ethnicities. In this study, Black ( n = 124) and White ( n = 125) undergraduates self-reported the strength and frequency of their past feelings of love toward their mother and father in first, sixth, and ninth grade as well as their current feelings of love. Results suggested that Black students reported feeling more love for their mothers in first, sixth, and ninth grades compared to White students. These findings were not explained when we statistically adjusted for age, gender, socioeconomic status, education levels, income, number of years spent living with mother or father, stress, or personality. Therefore, this relationship may be explained by unmeasured or unmeasurable cultural differences. The direction of this effect was in the opposite direction from what we expected based on past attachment research. Given the inequities in U.S. history and the current discussions around ethnicity and race in the United States, the finding that Blacks reported higher remembered feelings of love for their mothers in childhood is intriguing and worthy of dissemination and discussion.

  3. Department of the Navy Suicide Incident Report (DONSIR): Preliminary Findings January-June 1999

    National Research Council Canada - National Science Library

    Hourani, Laurel

    1999-01-01

    .... The purposes of the DONSIR are to standardize the review and reporting process on Navy and Marine Corps suicides, and to develop a database to be used to identify risk factors and improve prevention...

  4. A human error taxonomy for analysing healthcare incident reports: assessing reporting culture and its effects on safety perfomance

    DEFF Research Database (Denmark)

    Itoh, Kenji; Omata, N.; Andersen, Henning Boje

    2009-01-01

    The present paper reports on a human error taxonomy system developed for healthcare risk management and on its application to evaluating safety performance and reporting culture. The taxonomy comprises dimensions for classifying errors, for performance-shaping factors, and for the maturity...

  5. Analysis of fuel-handling incidents (safety analysis detailed report no. 5). PEC Brasimone reactor design basis accidents

    Energy Technology Data Exchange (ETDEWEB)

    1988-01-15

    The features covered by this report deal with the equipment and cells in which the handling, examination, measurement, conditioning and storage of core elements are carried out. The operations covered range from the receiving of new element shipments to their insertion in the vessel (excluding handling inside the vessel itself, which is covered in report no. 2) and removal of the spent-elements from the vessel, transfer to their final storage and their ultimate loading into containers for transport outside the plant. The incident analysis along the path of the spent fuel was conducted with the same method adopted for other plant systems. It is treated separately here because the operation of the handling system is practically autonomous from reactor operation.

  6. Emergency preparedness incident response and radiation monitoring in Finland. Annual report 1999

    International Nuclear Information System (INIS)

    Ristonmaa, S.

    2000-04-01

    The Radiation and Nuclear Safety Authority (STUK) publishes annually a report about STUK's preparedness measures. The report describes notifications received by STUK's on duty system and further measures carried out after receiving a message. In addition, the emergence exercises STUK participated in during the year are described. The radiation situation in Finland is continuously monitored. STUK is the authority who carries out a wide range of environmental measurements, sampling and sensitive laboratory analyses. The measurement results are presented in the form of tables and graphically. (editor)

  7. Emergency preparedness incident response and radiation monitoring in Finland. Annual report 1998

    International Nuclear Information System (INIS)

    Ristonmaa, S.

    1999-03-01

    The Radiation and Nuclear Safety Authority (STUK) publishes annually a report about STUK's preparedness measures. The report describes notifications received by STUK's on duty system and further measures carried out after receiving a message. In addition, the emergence exercises STUK participated in during the year are described. The radiation situation in Finland is continuously monitored. STUK is the authority who carries out a wide range of environmental measurements, sampling and sensitive laboratory analyses. The measurement results are presented in the form of tables and graphically. (editor)

  8. European downstream oil industry safety performance. Statistical summary of reported incidents 2009

    International Nuclear Information System (INIS)

    Burton, A.; Den Haan, K.H.

    2010-10-01

    The sixteenth such report by CONCAWE, this issue includes statistics on workrelated personal injuries for the European downstream oil industry's own employees as well as contractors for the year 2009. Data were received from 33 companies representing more than 97% of the European refining capacity. Trends over the last sixteen years are highlighted and the data are also compared to similar statistics from related industries. In addition, this report presents the results of the first Process Safety Performance Indicator data gathering exercise amongst the CONCAWE membership.

  9. How often are patients harmed when they visit the computed tomography suite? A multi-year experience, in incident reporting, in a large academic medical center

    International Nuclear Information System (INIS)

    Mansouri, Mohammad; Aran, Shima; Shaqdan, Khalid W.; Abujudeh, Hani H.

    2016-01-01

    Our goal is to present our multi-year experience in incident reporting in CT in a large medical centre. This is an IRB-approved, HIPAA-compliant study. Informed consent was waived for this study. The electronic safety incident reporting system of our hospital was searched for the variables from April 2006 to September 2012. Incident classifications were diagnostic test orders, ID/documentation, safety/security/conduct, service coordination, surgery/procedure, line/tube, fall, medication/IV safety, employee general incident, environment/equipment, adverse drug reaction, skin/tissue and diagnosis/treatment. A total of 1918 incident reports occurred in the study period and 843,902 CT examinations were performed. The rate of safety incident was 0.22 % (1918/843,902). The highest incident rates were due to adverse drug reactions (652/843,902 = 0.077 %) followed by medication/IV safety (573/843,902 = 0.068 %) and diagnostic test orders (206/843,902 = 0.024 %). Overall 45 % of incidents (869/1918) caused no harm and did not affect the patient, 33 % (637/1918) caused no harm but affected the patient, 22 % (420/1918) caused temporary or minor harm/damage and less than 1 % (10/1918) caused permanent or major harm/damage or death. Our study shows a total safety incident report rate of 0.22 % in CT. The most common incidents are adverse drug reaction, medication/IV safety and diagnostic test orders. (orig.)

  10. Safety analysis of fusion reactors pertaining to nuclear incidents and accidents. Final report

    International Nuclear Information System (INIS)

    Raeder, J.; Weller, A.; Wolf, R.; Jin, X.; Boccaccini, L.V.; Stieglitz, R.; Carloni, D.; Pistner, C.; Herb, J.

    2013-11-01

    The BfS gave the projekt partners IPP, KIT, Oeko-Institut e. V., and GRS the order to carry out a literature study on the topic of safety of fusion power plants regarding nuclear incidents and accidents. In the framework of this study the actual status of science and technology of the safety concept of fusion power plants should be determined and the applicability of the nuclear safety regulations hitherto developed for nuclear power plants checked. For future commercial fusion power plants today only conceptional designs exist. The most advanced conceptual study for a future fusion power plant is the European Power Plant Conceptual Study (PPCS) from the year 2005, which is based on the tokamak principle. In this study also fundamental aspects of the safety concept of nuclear fusion are treated. Hereby several different conceptual approaches are discussed, which differ among others also in the lay-out approaches relevant for the safety of a facility like for instance the choice of the breeding concept or the materials for the blanket/divertor structure and the coolants. The safety concept of nuclear fusion is oriented on safety concepts for facilities with radioactive inventory. It is based on the concept of tiered safety levels. In order to check whether for the nuclear fusion a safety concept comparable with the nuclear fission at all is necessary, in a first step it was considered, which consequences are possible at a postulated release o large parts of the radioactive inventory of a fusion power plant. Such a worst-case scenario was compared with a corresponding, postulated release of large parts of the radioactive inventory of a nuclear power plant. As scale hereby served the radiological criterion, at the transgression of which in the environment of the facility an evacuation would be necessary. In a next step the transferability of the safety concept of the tiered safety levels of nuclear technology to the fusion was checked. Beside events transferable from

  11. Preliminary report on operational guidelines developed for use in emergency preparedness and response to a radiological dispersal device incident.

    Energy Technology Data Exchange (ETDEWEB)

    Yu, C.; Cheng, J.-J.; Kamboj, S.; Domotor, S.; Wallo, A.; Environmental Science Division; DOE

    2006-12-15

    This report presents preliminary operational guidelines and supporting work products developed through the interagency Operational Guidelines Task Group (OGT). The report consolidates preliminary operational guidelines, all ancillary work products, and a companion software tool that facilitates their implementation into one reference source document. The report is intended for interim use and comment and provides the foundation for fostering future reviews of the operational guidelines and their implementation within emergency preparedness and response initiatives in the event of a radiological dispersal device (RDD) incident. The report principally focuses on the technical derivation and presentation of the operational guidelines. End-user guidance providing more details on how to apply these operational guidelines within planning and response settings is being considered and developed elsewhere. The preliminary operational guidelines are categorized into seven groups on the basis of their intended application within early, intermediate, and long-term recovery phases of emergency response. We anticipate that these operational guidelines will be updated and refined by interested government agencies in response to comments and lessons learned from their review, consideration, and trial application. This review, comment, and trial application process will facilitate the selection of a final set of operational guidelines that may be more or less inclusive of the preliminary operational guidelines presented in this report. These and updated versions of the operational guidelines will be made available through the OGT public Web site (http://ogcms.energy.gov) as they become finalized for public distribution and comment.

  12. Factors that influence the recognition, reporting and resolution of incidents related to medical devices and other healthcare technologies: a systematic review.

    Science.gov (United States)

    Polisena, Julie; Gagliardi, Anna; Urbach, David; Clifford, Tammy; Fiander, Michelle

    2015-03-29

    Medical devices have improved the treatment of many medical conditions. Despite their benefit, the use of devices can lead to unintended incidents, potentially resulting in unnecessary harm, injury or complications to the patient, a complaint, loss or damage. Devices are used in hospitals on a routine basis. Research to date, however, has been primarily limited to describing incidents rates, so the optimal design of a hospital-based surveillance system remains unclear. Our research objectives were twofold: i) to explore factors that influence device-related incident recognition, reporting and resolution and ii) to investigate interventions or strategies to improve the recognition, reporting and resolution of medical device-related incidents. We searched the bibliographic databases: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and PsycINFO database. Grey literature (literature that is not commercially available) was searched for studies on factors that influence incident recognition, reporting and resolution published and interventions or strategies for their improvement from 2003 to 2014. Although we focused on medical devices, other health technologies were eligible for inclusion. Thirty studies were included in our systematic review, but most studies were concentrated on other health technologies. The study findings indicate that fear of punishment, uncertainty of what should be reported and how incident reports will be used and time constraints to incident reporting are common barriers to incident recognition and reporting. Relevant studies on the resolution of medical errors were not found. Strategies to improve error reporting include the use of an electronic error reporting system, increased training and feedback to frontline clinicians about the reported error. The available evidence on factors influencing medical device-related incident recognition, reporting and resolution by healthcare professionals can inform data collection and

  13. Compendium on Financing of Higher Education: Final Report of the Financing the Students' Future Project

    Science.gov (United States)

    Payne, Bethan; Charonis, George-Konstantinos; Haaristo, Hanna-Stella; Maurer, Moritz; Kaiser, Florian; Siegrist, Rahel; McVitty, Debbie; Gruber, Angelika; Heerens, Nik; Xhomaqi, Brikena; Nötzl, Tina; Semjonov, Meeli; Primožic, Rok

    2013-01-01

    Higher education plays a vital role in society and the quality, accessibility, and form of higher education is highly dependent on financing. Financing of higher education is conceived to be of central importance for the future creation and dissemination of knowledge and research. Therefore, the financing of higher education is a topic that has…

  14. Confirmation of the reported association of clonal chromosomal mosaicism with an increased risk of incident hematologic cancer.

    Directory of Open Access Journals (Sweden)

    Ursula M Schick

    Full Text Available Chromosomal abnormalities provide clinical utility in the diagnosis and treatment of hematologic malignancies, and may be predictive of malignant transformation in individuals without apparent clinical presentation of a hematologic cancer. In an effort to confirm previous reports of an association between clonal mosaicism and incident hematologic cancer, we applied the anomDetectBAF algorithm to call chromosomal anomalies in genotype data from previously conducted Genome Wide Association Studies (GWAS. The genotypes were initially collected from DNA derived from peripheral blood of 12,176 participants in the Group Health electronic Medical Records and Genomics study (eMERGE and the Women's Health Initiative (WHI. We detected clonal mosaicism in 169 individuals (1.4% and large clonal mosaic events (>2 mb in 117 (1.0% individuals. Though only 9.5% of clonal mosaic carriers had an incident diagnosis of hematologic cancer (multiple myeloma, myelodysplastic syndrome, lymphoma, or leukemia, the carriers had a 5.5-fold increased risk (95% CI: 3.3-9.3; p-value = 7.5×10(-11 of developing these cancers subsequently. Carriers of large mosaic anomalies showed particularly pronounced risk of subsequent leukemia (HR = 19.2, 95% CI: 8.9-41.6; p-value = 7.3×10(-14. Thus we independently confirm the association between detectable clonal mosaicism and hematologic cancer found previously in two recent publications.

  15. EXTRAGONADAL CHORIOCARCINOMA OF THE COLON – INCIDENCE, DIAGNOSIS, AND TREATMENT - A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Sergey Dimitrov Iliev

    2018-04-01

    Full Text Available Choriocarcinoma is a malignant trophoblastic cancer. It could be gestational and non-gestational. The primary extragonadal choriocarcinoma of the colon is an exceptionally rare tumor. There are only 12 cases of this tumor described in the literature. Only four of these 12 cases are pure primary choriocarcinomas of the colon. In the other eight cases, there is an adenocarcinoma with a choriocarcinoma component. In that reason, rare case like this is advisable to be reported. Case presentation The purpose of this report was to systematize the existing information about the frequency, diagnosis, and treatment of primary choriocarcinoma of the colon and to present our experience with diagnostic and therapeutic approaches to this exceptionally rare and not well-known tumor. Primary extragonadal choriocarcinoma is most frequently found in the retroperitoneal space, mediastinum, pituitary gland and, very rarely, in the gastrointestinal tract. The stomach is the most frequent localization in the gastrointestinal tract. In our case, an extended right hemicolectomy was performed according to the principles of oncologic resection. Chemotherapy for gonadal choriocarcinoma was started. At present - four months after the surgical intervention, the Bulgarian patient does not show progression of the disease and is in good general health. Conclusion There is still no algorithm for treatment of primary choriocarcinoma of the colon because this is an extremely rare tumor. The behavior in this type of tumors remains a challenge for clinicians.

  16. Higher Incidence of Stroke on the Last Day of the Month in Hungary-a Role for Psychosocial Factors and Financial Insecurity?

    Science.gov (United States)

    Folyovich, András; Biczó, Dávid; Bajnok, Anna; Bessenyei, Dávid; Kis, Ibolya; Gimesi-Országh, Judit; Béres-Molnár, Anna K; Toldi, Gergely

    2016-05-01

    The seasonal cumulation of acute ischemic stroke events is a well-known phenomenon. Critical days are determined by both biological and psychosocial factors. We hypothesized that the financial stability of those with a monthly income living in an economically unpredictable environment rises upon the arrival of their salary and decreases in the preceding days, leading to anxiety and existential insecurity, which may increase the incidence of acute ischemic stroke. We assessed the daily average number of thrombolytic treatments due to acute ischemic stroke in Hungary between December 1, 2005, and November 30, 2013, calculating the ratio of thrombolytic treatments on the last day of the month (irrespectively whether it was the 28th-31st days) to thrombolytic treatments on the other days, and determined 95% confidence intervals. In this period, 7880 thrombolytic treatments were performed nationwide (2.70/day), out of which 1867 occurred on the last day of the month (19.45/day). If the 28th, 29th, or 30th was not the last day of the month, 15.8, 20.6, and 22 times less thrombolytic treatments, respectively, were performed than on the last day of that month. We propose that financial insecurity on the days prior to the receipt of a salary might play a role in the elevation of stroke incidence observed on the last day of the month in Hungary. Further analysis of this phenomenon and its psychosocial effects is needed to adequately allocate healthcare resources and to take preventive measures in the high-risk population. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Dry Eye Disease Patients with Xerostomia Report Higher Symptom Load and Have Poorer Meibum Expressibility.

    Science.gov (United States)

    Fostad, Ida G; Eidet, Jon R; Utheim, Tor P; Ræder, Sten; Lagali, Neil S; Messelt, Edvard B; Dartt, Darlene A

    2016-01-01

    The purpose of the study was to investigate if xerostomia (dry mouth) is associated with symptoms and signs of dry eye disease (DED). At the Norwegian Dry Eye Clinic, patients with symptomatic DED with different etiologies were consecutively included in the study. The patients underwent a comprehensive ophthalmological work-up and completed self-questionnaires on symptoms of ocular dryness (Ocular Surface Disease Index [OSDI] and McMonnies Dry Eye Questionnaire) and the Sjögren's syndrome (SS) questionnaire (SSQ). Three hundred and eighteen patients (52% women and 48% men) with DED were included. Patient demographics were: 0 to 19 years (1%), 20 to 39 (25%), 40 to 59 (34%), 60 to 79 (35%) and 80 to 99 (5%). Xerostomia, defined as "daily symptoms of dry mouth the last three months" (as presented in SSQ) was reported by 23% of the patients. Female sex was more common among patients with xerostomia (81%) than among non-xerostomia patients (44%; Pxerostomia (60 ± 15 years) were older than those without xerostomia (51 ± 17; Pxerostomia patients (65%) than among non-xerostomia patients (35%; Pxerostomia had a higher OSDI score (19.0 ± 10.0) than those without xerostomia (12.9 ± 8.0; Pxerostomia patients had more pathological meibum expressibility (0.9 ± 0.7) than those without xerostomia (0.7 ± 0.8; P = 0.046). Comparisons of OSDI and ocular signs were performed after controlling for the effects of sex, age and the number of systemic prescription drugs used. In conclusion, xerostomia patients demonstrated a higher DED symptom load and had poorer meibum expressibility than non-xerostomia patients.

  18. Male-female differences in the number of reported incident dengue fever cases in six Asian countries

    Directory of Open Access Journals (Sweden)

    Martha Anker

    2011-06-01

    Full Text Available Introduction. Demographic factors, such as age and sex, are associated with the likelihood of exposure to Aedes aegypti, the vector for dengue. However, dengue date disaggregated by both sex and ageare not routinely reported or analyzed by national surveillance systems. This study analysed the reported number of incident dengue cases by age and sex for six countries in Asia. Methods. Data for the Lao People's Democratic Republic, the Philippines, Singapore and Sri Lanka were obtained from DengueNet; the number of male and female dengue cases was available for four age groups ( 15 years over a cumulative period of six to 10 years. Data for Cambodia (2010 and Malaysia (1997–2008 were obtained from their respective ministries of health. Results. An excess of males was found among reported dengue cases > 15 years of age. This pattern was observed consistently over several years across six culturally and economically diverse countries. Discussion. These data indicated the importance of reporting data stratified by both sex and age since collapsing the data over all ages would have masked some of the observed differences. In order to target preventive measures appropriately, assessment of gender by age is important for dengue because biological or gender-related factors can change over the human lifespan and gender-related factors may differ across countries.

  19. Data Mining and the Twitter Platform for Prescribed Burn and Wildfire Incident Reporting with Geospatial Applications

    Science.gov (United States)

    Endsley, K.; McCarty, J. L.

    2012-12-01

    Data mining techniques have been applied to social media in a variety of contexts, from mapping the evolution of the Tahrir Square protests in Egypt to predicting influenza outbreaks. The Twitter platform is a particular favorite due to its robust application programming interface (API) and high throughput. Twitter, Inc. estimated in 2011 that over 2,200 messages or "tweets" are generated every second. Also helpful is Twitter's semblance in operation to the short message service (SMS), better known as "texting," available on cellular phones and the most popular means of wide telecommunications in many developing countries. In the United States, Twitter has been used by a number of federal, state and local officials as well as motivated individuals to report prescribed burns in advance (sometimes as part of a reporting obligation) or to communicate the emergence, response to, and containment of wildfires. These reports are unstructured and, like all Twitter messages, limited to 140 UTF-8 characters. Through internal research and development at the Michigan Tech Research Institute, the authors have developed a data mining routine that gathers potential tweets of interest using the Twitter API, eliminates duplicates ("retweets"), and extracts relevant information such as the approximate size and condition of the fire. Most importantly, the message is geocoded and/or contains approximate locational information, allowing for prescribed and wildland fires to be mapped. Natural language processing techniques, adapted to improve computational performance, are used to tokenize and tag these elements for each tweet. The entire routine is implemented in the Python programming language, using open-source libraries. As such, it is demonstrated in a web-based framework where prescribed burns and/or wildfires are mapped in real time, visualized through a JavaScript-based mapping client in any web browser. The practices demonstrated here generalize to an SMS platform (or any short

  20. Elective Stoma Reversal Has a Higher Incidence of Postoperative Clostridium Difficile Infection Compared With Elective Colectomy: An Analysis Using the American College of Surgeons National Surgical Quality Improvement Program and Targeted Colectomy Databases.

    Science.gov (United States)

    Skancke, Matthew; Vaziri, Khashayar; Umapathi, Bindu; Amdur, Richard; Radomski, Michal; Obias, Vincent

    2018-05-01

    Clostridium difficile infection is caused by the proliferation of a gram-positive anaerobic bacteria after medical or surgical intervention and can result in toxic complications, emergent surgery, and death. This analysis evaluates the incidence of C difficile infection in elective restoration of intestinal continuity compared with elective colon resection. This was a retrospective database review of the 2015 American College of Surgeons National Surgical Quality Improvement Project and targeted colectomy database. The intervention cohort was defined as the primary Current Procedural Terminology codes for ileostomy/colostomy reversal (44227, 44620, 44625, and 44626) and International Classification of Diseases codes for ileostomy/colostomy status (VV44.2, VV44.3, VV55.2, VV55.3, Z93.2, Z93.3, Z43.3, and Z43.2). A total of 2235 patients underwent elective stoma reversal compared with 10403 patients who underwent elective colon resection. Multivariate regression modeling of the impact of stoma reversal on postoperative C difficile infection risk was used as the study intervention. The incidence of C difficile infection in the 30 days after surgery was measured. The incidence of C difficile infection in the 30-day postoperative period was significantly higher (3.04% vs 1.25%; p difficile infection incidence in the 30-day postoperative period. The study was limited because it was a retrospective database review with observational bias. Patients who undergo elective stoma reversal have a higher incidence of postoperative C difficile infection compared with patients who undergo an elective colectomy. Given the impact of postoperative C difficile infection, a heightened sense of suspicion should be given to symptomatic patients after stoma reversal. See at Video Abstract at http://links.lww.com/DCR/A553.

  1. Geophysical variables and behavior: LIII. Epidemiological considerations for incidence of cancer and depression in areas of frequent UFO reports.

    Science.gov (United States)

    Persinger, M A

    1988-12-01

    Luminous phenomena and anomalous physical forces have been hypothesized to be generated by focal tectonic strain fields that precede earthquakes. If these geophysical processes exist, then their spatial and temporal density should be greatest during periods of protracted, localized UFO reports; they might be used as dosimetric indicators. Contemporary epidemiological data concerning the health risks of power frequency electromagnetic fields and radon gas levels (expected correlates of certain tectonic strain fields), suggest that increased incidence (odds ratios greater 1:3) of brain tumors and leukemia should be evident within "flap" areas. In addition the frequency of variants of temporal lobe lability, psychological depression and posttraumatic stress should be significantly elevated. UFO field investigators, because they have repeated, intermittent close proximity to these fields, are considered to be a particularly high risk population for these disorders.

  2. Geophysical variables and behavior: LIII. Epidemiological considerations for incidence of cancer and depression in areas of frequent UFO reports

    International Nuclear Information System (INIS)

    Persinger, M.A.

    1988-01-01

    Luminous phenomena and anomalous physical forces have been hypothesized to be generated by focal tectonic strain fields that precede earthquakes. If these geophysical processes exist, then their spatial and temporal density should be greatest during periods of protracted, localized UFO reports; they might be used as dosimetric indicators. Contemporary epidemiological data concerning the health risks of power frequency electromagnetic fields and radon gas levels (expected correlates of certain tectonic strain fields), suggest that increased incidence (odds ratios greater 1:3) of brain tumors and leukemia should be evident within flap areas. In addition the frequency of variants of temporal lobe lability, psychological depression and posttraumatic stress should be significantly elevated. UFO field investigators, because they have repeated, intermittent close proximity to these fields, are considered to be a particularly high risk population for these disorders. 22 references

  3. Institutional wide implementation of key advice for socially inclusive teaching in higher education. A Practice Report

    Directory of Open Access Journals (Sweden)

    Lisa Thomas

    2014-03-01

    Full Text Available Government policy and institutional initiatives have influenced increases in enrolment of non-traditional students to Australian universities. For these students, university culture is often incongruent with their own, making it difficult to understand the tacit requirements for participation and success. Academic teaching staff are important in creating socially inclusive learning experiences, particularly in first year subjects. This paper presents an institution-wide approach to enhancing socially inclusive teaching at one Australian university. Underpinned by a framework of ”bridging social-incongruity” the initiative was guided by six principles of socially inclusive teaching to support practice as proposed in the 2012 “Effective support of students from low socioeconomic backgrounds in higher education” report commissioned by the Australian Office of Learning and Teaching. Feedback from 150 academic teaching staff from various disciplines and campus locations, suggests this initiative was effective in increasing understanding of socially inclusive teaching practices with many participants indicating the teaching enhancements were applicable for their teaching context.

  4. ACE Inhibitor-Induced Angioedema of the Intestine: Case Report, Incidence, Pathophysiology, Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Gavin Oudit

    2001-01-01

    Full Text Available A case report of fosinopril-induced angioedema of the intestine with a chronic course accompanied by multiple acute exacerbations is described. Angiotensin-converting enzyme (ACE inhibitor-induced angioedema of the intestine (AIAI occurs in a minority of patients taking an ACE inhibitor. The clinical presentation encompasses acute abdominal symptoms, pronounced bowel edema and ascites with occasional facial and/or oropharyngeal swelling. AIAI is diagnosed based on the temporal relationship between the symptomatic presentation and drug use, absence of alternative diagnoses including other causes of angioedema, and the prompt resolution of symptoms upon discontinuation of the ACE inhibitor. Prompt radiological investigation (abdominal computerized tomography and/or ultrasound is critical in making an early diagnosis and in preventing unnecessary surgical intervention. There is a female predominance of AIAI, which may reflect the interaction of estradiol with the various pathways involved in the pathophysiology of AIAI. Management of AIAI consists mainly of conservative measures and discontinuation of the ACE inhibitor. Angiotensin II receptor antagonists should not be considered as appropriate alternatives. Awareness and knowledge of AIAI are important because of the increasing use of ACE inhibitors, current delays in making the diagnosis, obvious management strategies once the diagnosis is made and the dysutility of alternative diagnoses, which may lead to considerable morbidity. AIAI must be considered in patients taking ACE inhibitors who develop gastrointestinal complaints irrespective of the duration of the therapy.

  5. The true incidence of cryptorchidism in Denmark

    DEFF Research Database (Denmark)

    Cortes, Dina; Kjellberg, Emma M; Breddam, Mette

    2008-01-01

    testes. Conclusions: In a small cohort of newborns the incidence of cryptorchidism in Denmark has not changed, and is similar to previous reports from the 1950s. The risk is higher in low birth weight singleton neonates but does not appear to be higher in twins, despite lower birth weight and prematurity...

  6. Are Cancer incidence Rates Among Present And Past Workers Of The research Centers Of The Atomic Energy Commission higher Than The Rates Among The General Population?

    International Nuclear Information System (INIS)

    Litai, D.

    1999-01-01

    Cancer incidence rates among the workers of the AEC and its retirees have increased several fold in the last decade compared to the rates experienced in previous ones. This has brought about a wave of claims for compensation with negative repercussions in the media about the state of radiation safety in the nuclear research centers in the country. The Nuclear Research Center - Negev, being, generally closed to public and media visits, has taken the brunt of this criticism. Consequently, the question spelled out in the title has caused much concern and deserves to be discussed and explained. The purpose of this paper is to review what we know in this context and to show that the observed morbidity rates, worrying as they may be, are entirely natural, and, by and large, unrelated to the occupational exposures of the workers. It is well known that cancer incidence rates in the population rise steeply with age, especially over 50. As both research centers are approaching the age of 40, it is clear that a very large fraction of the workers and all retirees have passed this age and many are already in their sixties and even seventies. It is a well established fact that close to 40% of the population in this country (and many others as well) develop some type of cancer during their lifetime and close to a half of these succumb to it. As most of those cancers occur after the age of 50, this explains the increased rates alluded to above. Notably, numerous research centers around the globe have reached similar ages in the last decade and experience similar increases in morbidity, that have caused understandable concern and the initiation of epidemiological studies intended to identify the health effects of extended exposures to low doses, if any. Such studies have been carried out in several countries and followed, altogether, about 100,000 workers through 40 years. The studies showed no excess of cancer mortality among workers compared to the general population (adjusted

  7. Despite higher body fat content, Ecuadorian subjects with Laron syndrome have less insulin resistance and lower incidence of diabetes than their relatives.

    Science.gov (United States)

    Guevara-Aguirre, Jaime; Procel, Patricio; Guevara, Carolina; Guevara-Aguirre, Marco; Rosado, Verónica; Teran, Enrique

    2016-06-01

    In the present pandemics of obesity and insulin resistant diabetes mellitus (DM), the specific contribution of etiological factors such as shifts in nutritional and exercise patterns, genetic and hormonal, is subject of ongoing research. Among the hormonal factors implicated, we selected obesity-driven insulin resistance for further evaluation. It is known that growth hormone (GH) has profound effects on carbohydrate metabolism. In consequence, we compared the effects of the lack of the counter-regulatory effects of GH, in a group of subjects with GH receptor deficiency (GHRD) due to a mutated GH receptor vs. that of their normal relatives. It was found that, despite their obesity, subjects with GHRD, have diminished incidence of diabetes, lower glucose and insulin concentrations, and lower values of indexes indicative of insulin resistance such as HOMA-IR. The GHRD subjects were also capable of appropriately handling glucose or mixed meal loads despite diminished insulin secretion. These observations allow us to suggest that the association of obesity with increased risk for diabetes appears to be dependent on intact growth hormone signaling. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. An Upgrade on the Rabbit Model of Anthracycline-Induced Cardiomyopathy: Shorter Protocol, Reduced Mortality, and Higher Incidence of Overt Dilated Cardiomyopathy

    Science.gov (United States)

    Talavera, Jesús; Fernández-Del-Palacio, María Josefa; García-Nicolás, Obdulio; Seva, Juan; Brooks, Gavin; Moraleda, Jose M.

    2015-01-01

    Current protocols of anthracycline-induced cardiomyopathy in rabbits present with high premature mortality and nephrotoxicity, thus rendering them unsuitable for studies requiring long-term functional evaluation of myocardial function (e.g., stem cell therapy). We compared two previously described protocols to an in-house developed protocol in three groups: Group DOX2 received doxorubicin 2 mg/kg/week (8 weeks); Group DAU3 received daunorubicin 3 mg/kg/week (10 weeks); and Group DAU4 received daunorubicin 4 mg/kg/week (6 weeks). A cohort of rabbits received saline (control). Results of blood tests, cardiac troponin I, echocardiography, and histopathology were analysed. Whilst DOX2 and DAU3 rabbits showed high premature mortality (50% and 33%, resp.), DAU4 rabbits showed 7.6% premature mortality. None of DOX2 rabbits developed overt dilated cardiomyopathy; 66% of DAU3 rabbits developed overt dilated cardiomyopathy and quickly progressed to severe congestive heart failure. Interestingly, 92% of DAU4 rabbits showed overt dilated cardiomyopathy and 67% developed congestive heart failure exhibiting stable disease. DOX2 and DAU3 rabbits showed alterations of renal function, with DAU3 also exhibiting hepatic function compromise. Thus, a shortened protocol of anthracycline-induced cardiomyopathy as in DAU4 group results in high incidence of overt dilated cardiomyopathy, which insidiously progressed to congestive heart failure, associated to reduced systemic compromise and very low premature mortality. PMID:26788502

  9. What have we learned from reporting safety incidents in the Surgical Block?: Cross-sectional descriptive study of two-years of activity of a multidisciplinary analytical group.

    Science.gov (United States)

    Caba Barrientos, F; Rodríguez Morillo, A; Galisteo Domínguez, R; Del Nozal Nalda, M; Almeida González, C V; Echevarría Moreno, M

    2018-05-01

    Incident Reporting Systems (IRS) are considered a tool that facilitates learning and safety culture. Using the experience gained with SENSAR, we evaluated the feasibility and the activity of a multidisciplinary group analyzing incidents in the surgical patient notified to a general community system, that of the Observatory for Patient Safety (OPS). Cross-sectional observational study planned for two years. After training in the analysis, a multidisciplinary group was created in terms of specialties and professional categories, which would analyze the incidents in the surgical patient notified to the OPS. Incidents are classified and their circumstances analyzed. Between March 2015 and 2017, 95 incidents were reported (4 by non-professionals). Doctors reported more than nurses, at 54 (56.84%) vs. 37 (38.94%). The anaesthesia unit reported most at 46 (48.42%) (P=.025). The types of incidents mainly related to the care procedure (30.52%); to the preoperative period (42.10%); and to the place, the surgical area (48.42%). Significant differences were detected according to the origin of the notifier (P=.03). No harm, or minor morbidity, constituted 88% of the incidents. Errors were identified in 79%. The analysis of the incidents directed the measures to be taken. The activity undertaken by the multidisciplinary analytical group during the period of study facilitated knowledge of the system among the professionals and enabled the identification of areas for improvement in the Surgical Block at different levels. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Incidence of seizure exacerbation and seizures reported as adverse events during adjunctive treatment with eslicarbazepine acetate: A pooled analysis of three Phase III controlled trials.

    Science.gov (United States)

    Carreño, Mar; Benbadis, Selim; Rocha, Francisco; Blum, David; Cheng, Hailong

    2017-12-01

    To investigate whether adjunctive eslicarbazepine acetate (ESL) could lead to exacerbation of seizures in some patients. Post-hoc analysis of data pooled from three Phase III trials of adjunctive ESL (studies 301, 302, and 304) for refractory partial-onset seizures (POS). Following an 8-week baseline period, patients were randomized to receive placebo or ESL 400, 800, or 1,200 mg once daily (2-week titration, 12-week maintenance, 2-4 week tapering-off periods). Patient seizure diary data and seizure treatment-emergent adverse event (TEAE) reports were pooled for analysis. The modified intent-to-treat and safety populations comprised 1,410 patients and 1,447 patients, respectively. Titration period : Compared with placebo (32/21%), significantly smaller proportions of patients taking ESL 800 mg (20/15%) and 1,200 mg (22/12%) had a ≥25/≥50% increase in standardized seizure frequency (SSF) from baseline; there was no significant difference between placebo and ESL 400 mg. Maintenance period : Compared with placebo (20%), significantly smaller proportions of patients taking ESL (400 mg, 12%; 800 mg, 12%; 1,200 mg, 14%) had an increase in SSF ≥25%. When evaluating ≥50% increases in SSF, only ESL 800 mg (7%) was significantly different from placebo (12%). Some patients had no secondarily generalized tonic-clonic (sGTC) seizures during baseline but had ≥1 sGTC seizure during maintenance treatment (placebo, 11%; ESL 400 mg, 5%; 800 mg, 10%; 1,200 mg, 5%). Fewer patients had a ≥25% increase in sGTC seizure frequency with ESL (400 mg, 11%; 800 mg, 9%; 1,200 mg, 14%) versus placebo (19%). The incidence of seizures reported as TEAEs was low in all treatment groups; incidences were generally lower with ESL versus placebo. Tapering-off period : Similar proportions of patients taking ESL and placebo had a ≥25/≥50% increase in SSF. Seizure TEAE incidence was numerically higher with ESL versus placebo. Treatment with adjunctive ESL does not appear to

  11. Pesticide residues in honeybees, honey and bee pollen by LC-MS/MS screening: reported death incidents in honeybees.

    Science.gov (United States)

    Kasiotis, Konstantinos M; Anagnostopoulos, Chris; Anastasiadou, Pelagia; Machera, Kyriaki

    2014-07-01

    The aim of this study was to investigate reported cases of honeybee death incidents with regard to the potential interrelation to the exposure to pesticides. Thus honeybee, bee pollen and honey samples from different areas of Greece were analyzed for the presence of pesticide residues. In this context an LC-ESI-MS/MS multiresidue method of total 115 analytes of different chemical classes such as neonicotinoids, organophosphates, triazoles, carbamates, dicarboximides and dinitroanilines in honeybee bodies, honey and bee pollen was developed and validated. The method presents good linearity over the ranges assayed with correlation coefficient values r(2)≥0.99, recoveries ranging for all matrices from 59 to 117% and precision (RSD%) values ranging from 4 to 27%. LOD and LOQ values ranged - for honeybees, honey and bee pollen - from 0.03 to 23.3 ng/g matrix weight and 0.1 up to 78 ng/g matrix weight, respectively. Therefore this method is sufficient to act as a monitoring tool for the determination of pesticide residues in cases of suspected honeybee poisoning incidents. From the analysis of the samples the presence of 14 active substances was observed in all matrices with concentrations ranging for honeybees from 0.3 to 81.5 ng/g, for bee pollen from 6.1 to 1273 ng/g and for honey one sample was positive to carbendazim at 1.6 ng/g. The latter confirmed the presence of such type of compounds in honeybee body and apicultural products. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Equal Educational Opportunity. The Status of Black Americans in Higher Education, 1975-1977. ISEP Third Status Report.

    Science.gov (United States)

    Howard Univ., Washington, DC. Inst. for the Study of Educational Policy.

    This report analyzes the status of black Americans in higher education from 1975-1977. The book opens with a review of basic concepts of equal educational opportunity and the Federal role in guaranteeing equal opportunity. The social and economic context for higher education is then examined with a focus on the national commitment to higher…

  13. The Hunt Report and Higher Education Policy in the Republic of Ireland: "An International Solution to an Irish Problem?"

    Science.gov (United States)

    Walsh, John; Loxley, Andrew

    2015-01-01

    The "National Strategy for Higher Education to 2030" in the Republic of Ireland (universally known as the Hunt Report) represents the latest and most assertive attempt by the Irish state to re-construct higher education in accordance with economic utilitarian objectives. This paper sets out to analyse the historical context, key themes…

  14. Physical Aggression in Higher Education: Student-Athletes' Perceptions and Reporting Behaviors

    Science.gov (United States)

    Pappas, Jason Christopher

    2010-01-01

    This study examined internal (personal) and external (situational) factors that previous research found affected perceptions of physical aggression and associated reporting behaviors among student-athletes. Results of this study suggested certain factors significantly impacted a student-athlete's decision to report and who received that report.…

  15. Medical Education for Tennessee. A Report of the Tennessee Higher Education Commission.

    Science.gov (United States)

    Boone, Jerry N.; Woods, Myra S.

    This study of medical education was conducted as a part of the Tennessee Higher Education Commission's responsibility to design a master plan for higher education in Tennessee. It provides a background of information on Tennessee's needs for physicians and on the production of physicians by the three medical schools in the state. The study…

  16. Egyptian greenhouse cultivation at a higher level with Dutch Technology ; Annual Report 2013

    NARCIS (Netherlands)

    Elings, A.; Helm, van der F.P.M.; Blok, C.; Meijer, R.J.M.; Lahiani, Y.; Janmaat, A.; Zaki, M.; Hassan, H.

    2014-01-01

    The project ‘Egyptian greenhouse cultivation at a higher level with Dutch technology’ is co-funded under the Top Sector Programme Horticulture and Starting Materials. The project wants to realizes through the use of Dutch technology a higher level of sustainability of Egyptian protected cultivation,

  17. Governance and Adaptation to Innovative Modes of Higher Education Provision. Research Report

    Science.gov (United States)

    McGrath, Cecile Hoareau; Hofman, Joanna; Bajziková, Lubica; Harte, Emma; Lasakova, Anna; Pankowska, Paulina; Sasso, S.; Belanger, Julie; Florea, S.; Krivogra, J.

    2016-01-01

    At a time when more students than ever are attending higher education, its provision is becoming more fluid, global and competitive. For example, developments in new technologies mean that higher education institutions (HEIs) can make their courses available all over the world. These developments bring into question the traditional delivery model…

  18. Measuring the Contribution of Higher Education to Innovation Capacity in the EU. Final Report: Revised Version

    Science.gov (United States)

    European Commission, 2017

    2017-01-01

    This current study is part of the actions taken aiming to analyse the links between the operations and effects of higher-education institutions on the capacity to innovate in the economies in Europe. Providing insights into the contribution of higher education to the innovative capacity of the EU economies is crucial for policy making and the…

  19. Reporting radiological incidents

    International Nuclear Information System (INIS)

    McGinty, Lawrence

    1989-01-01

    An account is given of the information available from and disseminated by government sources to television journalists about the premature re-entry to the earth's atmosphere of a Soviet nuclear powered satellite, in 1988. There was a possibility of it landing in the United Kingdom with resultant contamination. This account is used to illustrate the poverty of information available, which in turn, affects the quality of information available to the public on matters of nuclear safety. A shorter 'information chain' is suggested so that journalists would have direct access to scientists with accurate, up-to-date information on a potential radiation hazard. (U.K.)

  20. Crash Reporting - Incidents Data

    Data.gov (United States)

    Montgomery County of Maryland — This dataset provides general information about each collision and details of all traffic collisions occurring on county and local roadways within Montgomery County,...

  1. Fire Incident Reporting Manual

    Science.gov (United States)

    1984-02-01

    bedridden and cannot cannot open in his escape path. escape without assistance. 3. CONDITION PREVENTING ESCAP. J3. CONDITION PREVENTING ESCAPE1x*/t’D~ zo 5 I...PART OF BODY INJURED 2. Body, trunk, back. ’oo 32"- 3. Arm. ’ ___ 4. LcI. 17. PART OF BODY INJURED S. HadFoot. 7. Intern-l. Included are respiratory ... functions or evolution in which the aircraft is involved. For this reason, the section is modified to indicate aircraft evolution. 970. Engine start

  2. Incidence and Progression of Diabetic Retinopathy in Urban India: Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SN-DREAMS II), Report 1.

    Science.gov (United States)

    Raman, Rajiv; Ganesan, Suganeswari; Pal, Swakshyar Saumya; Gella, Laxmi; Kulothungan, Vaitheeswaran; Sharma, Tarun

    2017-10-01

    To evaluate the 4-year incidence and progression of and risk factors for diabetic retinopathy (DR) in an Indian population. From a cross-sectional study of 1425 subjects with diabetes, 911 (63.9%) returned for 4-year follow-up. After excluding 21 with ungradable retinal images, data from 890 subjects were analyzed. Participants underwent examinations based on a standard protocol, which included grading of retinal photographs. The incidences of DR, diabetic macular edema (DME), and sight-threatening diabetic retinopathy (STDR) were 9.2%, 2.6%, and 5.0%, respectively. In subjects with DR at baseline, the incidence of DME and STDR had increased (11.5% and 22.7%, respectively). 1-step and 2-step progressions of DR were seen in 30.2% and 12.6% of participants, respectively, and 1-step and 2-step regressions were seen in 12.0% and 1.8%, respectively. Incident DR, DME, and STDR were associated with higher systolic blood pressure (odds ratio, OR, 1.21, 2.11 and 1.72, respectively, for every 10 mmHg increase). Incident DR and DME were associated with increasing duration of diabetes (OR 2.29 and 4.77, respectively, for every 10-year increase) and presence of anemia (OR 1.96 and 10.14, respectively). Incident DR was also associated with higher hemoglobin A1c (OR 1.16 for every 1% increase). Variables associated with 1-step progression were every 10 mg/dL increase in serum total cholesterol (OR 15.65) as a risk factor, and 10 mg/dL increase in serum triglyceride (OR 0.52) as a protective factor. The incidences of STDR and DME were higher in people with pre-existing DR than in those without DR at baseline.

  3. The incidence of transient neurologic syndrome after spinal anesthesia with lidocaine or bupivacaine: The effects of needle type and surgical position: brief report

    Directory of Open Access Journals (Sweden)

    Etezadi F

    2011-10-01

    Full Text Available "nBurning Transient Neurologic Syndrome (TNS which was first described by Schneider et al in 1993, is defined as a transient pain and dysesthesia in waist, buttocks and the lower limbs after spinal anesthesia.1,2 The incidence of TNS after spinal anesthesia with lidocaine is reported to be as high as 10-40%.3,4 This prospective study was designed to determine the incidence of TNS with two different types of drugs, lidocaine and bupivacaine, in lithotomy or supine positions as the primary outcomes and to determine the association between two different types of needles and surgical positions with the occurrence of TNS as the secondary outcome."nThe present study was conducted on 250 patients (ASA I-II, aged 18-60 years old, who were candidates for surgery in supine or lithotomy positions. According to the needle type (Sprotte or Quincke and the local anesthetic (lidocaine or bupivacaine all patients were randomly divided into four groups. After establishing standard monitoring, spinal anesthesia was performed in all sitting patients by attending anesthesiologists at L2-L3 or L3-L4 levels. The patients were placed in supine or lithotomy position, in regards to the surgical procedure. During the first three postoperative days, patients were observed for post spinal anesthesia complications, especially TNS. Any sensation of pain, dysesthesia, paresthesia or hyperalgesia in the low back area, buttocks, the anterior or posterior thigh, knees, either foot or both feet were recorded. Moreover, duration of pain, its radiation and its relation to sleep and the patients' position were all carefully considered. Ultimately, the patients' response to opioid (pethidine for analgesia was determined."nThe incidence of TNS was higher when spinal anesthesia was induced with lidocaine (68% vs. 22%, P=0.003. TNS developed in 85% of the patients in lidocaine group and 58% in bupivacaine group after surgery in lithotomy position (P=0.002. In 77 patients pain

  4. A Bayesian approach for estimating under-reported dengue incidence with a focus on non-linear associations between climate and dengue in Dhaka, Bangladesh.

    Science.gov (United States)

    Sharmin, Sifat; Glass, Kathryn; Viennet, Elvina; Harley, David

    2018-04-01

    Determining the relation between climate and dengue incidence is challenging due to under-reporting of disease and consequent biased incidence estimates. Non-linear associations between climate and incidence compound this. Here, we introduce a modelling framework to estimate dengue incidence from passive surveillance data while incorporating non-linear climate effects. We estimated the true number of cases per month using a Bayesian generalised linear model, developed in stages to adjust for under-reporting. A semi-parametric thin-plate spline approach was used to quantify non-linear climate effects. The approach was applied to data collected from the national dengue surveillance system of Bangladesh. The model estimated that only 2.8% (95% credible interval 2.7-2.8) of all cases in the capital Dhaka were reported through passive case reporting. The optimal mean monthly temperature for dengue transmission is 29℃ and average monthly rainfall above 15 mm decreases transmission. Our approach provides an estimate of true incidence and an understanding of the effects of temperature and rainfall on dengue transmission in Dhaka, Bangladesh.

  5. Incidence and body location of reported acute sport injuries in seven sports using a national insurance database.

    Science.gov (United States)

    Åman, M; Forssblad, M; Larsén, K

    2018-03-01

    Sports with high numbers of athletes and acute injuries are an important target for preventive actions at a national level. Both for the health of the athlete and to reduce costs associated with injury. The aim of this study was to identify injuries where injury prevention should focus, in order to have major impact on decreasing acute injury rates at a national level. All athletes in the seven investigated sport federations (automobile sports, basketball, floorball, football (soccer), handball, ice hockey, and motor sports) were insured by the same insurance company. Using this insurance database, the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), at each body location, was calculated. Comparisons were made between sports, sex, and age. In total, there were 84 754 registered injuries during the study period (year 2006-2013). Athletes in team sports, except in male ice hockey, had the highest risk to sustain an injury and PMI in the lower limb. Females had higher risk of injury and PMI in the lower limb compared to males, in all sports except in ice hockey. This study recommends that injury prevention at national level should particularly focus on lower limb injuries. In ice hockey and motor sports, head/neck and upper limb injuries also need attention. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Self-Reported Periodontitis and Incident Type 2 Diabetes among Male Workers from a 5-Year Follow-Up to MY Health Up Study.

    Directory of Open Access Journals (Sweden)

    Atsushi Miyawaki

    Full Text Available The purpose of this study was to examine whether periodontitis is associated with incident type 2 diabetes in a Japanese male worker cohort.The study participants were Japanese men, aged 36-55 years, without diabetes. Data were extracted from the MY Health Up study, consisting of self-administered questionnaire surveys at baseline and following annual health examinations for an insurance company in Japan. The oral health status of the participants was classified by two self-reported indicators: (1 gingival hemorrhage and (2 tooth loosening. Type 2 diabetes incidence was determined by self-reporting or blood test data. Modified Poisson regression approach was used to estimate the relative risks and the 95% confidence intervals of incident diabetes with periodontitis. Covariates included age, body mass index, family history of diabetes, hypertension, current smoking habits, alcohol use, dyslipidemia, and exercise habits.Of the 2895 candidates identified at baseline in 2004, 2469 men were eligible for follow-up analysis, 133 of whom were diagnosed with diabetes during the 5-year follow-up period. Tooth loosening was associated with incident diabetes [adjusted relative risk = 1.73, 95% confidence interval = 1.14-2.64] after adjusting for other confounding factors. Gingival hemorrhage displayed a similar trend but was not significantly associated with incident diabetes [adjusted relative risk = 1.32, 95% confidence interval = 0.95-1.85].Tooth loosening is an independent predictor of incident type 2 diabetes in Japanese men.

  7. Self-reported physical exposure association with medial and lateral epicondylitis incidence in a large longitudinal study.

    Science.gov (United States)

    Descatha, Alexis; Dale, Ann Marie; Jaegers, Lisa; Herquelot, Eléonore; Evanoff, Bradley

    2013-09-01

    Although previous studies have related occupational exposure and epicondylitis, the evidence is moderate and mostly based on cross-sectional studies. Suspected physical exposures were tested over a 3-year period in a large longitudinal cohort study of workers in the USA. In a population-based study including a variety of industries, 1107 newly employed workers were examined; only workers without elbow symptoms at baseline were included. Baseline questionnaires collected information on personal characteristics and self-reported physical work exposures and psychosocial measures for the current or most recent job at 6 months. Epicondylitis (lateral and medial) was the main outcome, assessed at 36 months based on symptoms and physical examination (palpation or provocation test). Logistic models included the most relevant associated variables. Of 699 workers tested after 36 months who did not have elbow symptoms at baseline, 48 suffered from medial or lateral epicondylitis (6.9%), with 34 cases of lateral epicondylitis (4.9%), 30 cases of medial epicondylitis (4.3%) and 16 workers who had both. After adjusting for age, lack of social support and obesity, consistent associations were observed between self-reported wrist bending/twisting and forearm twisting/rotating/screwing motion and future cases of medial or lateral epicondylitis (ORs 2.8 (1.2 to 6.2) and 3.6 (1.2 to 11.0) in men and women, respectively). Self-reported physical exposures that implicate repetitive and extensive/prolonged wrist bend/twisting and forearm movements were associated with incident cases of lateral and medial epicondylitis in a large longitudinal study, although other studies are needed to better specify the exposures involved.

  8. The Use of Categorized Time-Trend Reporting of Radiation Oncology Incidents: A Proactive Analytical Approach to Improving Quality and Safety Over Time

    International Nuclear Information System (INIS)

    Arnold, Anthony; Delaney, Geoff P.; Cassapi, Lynette; Barton, Michael

    2010-01-01

    Purpose: Radiotherapy is a common treatment for cancer patients. Although incidence of error is low, errors can be severe or affect significant numbers of patients. In addition, errors will often not manifest until long periods after treatment. This study describes the development of an incident reporting tool that allows categorical analysis and time trend reporting, covering first 3 years of use. Methods and Materials: A radiotherapy-specific incident analysis system was established. Staff members were encouraged to report actual errors and near-miss events detected at prescription, simulation, planning, or treatment phases of radiotherapy delivery. Trend reporting was reviewed monthly. Results: Reports were analyzed for the first 3 years of operation (May 2004-2007). A total of 688 reports was received during the study period. The actual error rate was 0.2% per treatment episode. During the study period, the actual error rates reduced significantly from 1% per year to 0.3% per year (p < 0.001), as did the total event report rates (p < 0.0001). There were 3.5 times as many near misses reported compared with actual errors. Conclusions: This system has allowed real-time analysis of events within a radiation oncology department to a reduced error rate through focus on learning and prevention from the near-miss reports. Plans are underway to develop this reporting tool for Australia and New Zealand.

  9. The role of patient simulation and incident reporting in the development and evaluation of medical devices and the training of their users

    DEFF Research Database (Denmark)

    Dieckmann, P; Rall, M; Østergaard, Doris

    2009-01-01

    incident report. Simulation can serve as a laboratory to analyse such cases and to create relevant and effective training scenarios based on such analyses. We will describe a methodological framework for analysing simulation scenarios in a way that allows discovering and discussing mismatches between...... conceptual models of the device design and mental models users hold about the device and its use. We further describe how incident reporting systems can be used as one source of data to conduct the necessary needs analyses - both for training and further needs for closer analysis of specific devices or some...

  10. Leveraging Sustainability Reporting in Higher Education Institutions--A Multidimensional Research Agenda

    Science.gov (United States)

    Schoormann, Thorsten; Bührig, Jan; Behrens, Dennis; Knackstedt, Ralf

    2017-01-01

    Sustainability has become increasingly important to research and practice. In order to determine impacts, identify improvement potential and to disclose efforts towards sustainability, an organization needs appropriate reporting. Thus, sustainability reporting has become a topic of broader interest, for example, to assess own situations, enable…

  11. Brief Report: Anal Cancer in the HIV-Positive Population: Slowly Declining Incidence After a Decade of cART

    NARCIS (Netherlands)

    Richel, Olivier; van der Zee, Ramon P.; Smit, Colette; de Vries, Henry J. C.; Prins, Jan M.

    2015-01-01

    We surveyed trends in incidence (1995-2012) and risk factors for anal cancer in the Dutch HIV-positive population. After an initial increase with a peak incidence in 2005-2006 of 114 [95% confidence interval (CI): 74 to 169] in all HIV+ patients and 168 (95% CI: 103 to 259) in HIV+ men who have sex

  12. A review of recent analyses of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS

    Directory of Open Access Journals (Sweden)

    D. Potter

    2015-01-01

    Full Text Available Introduction: The objective of this analysis is to identify, assess the quality and summarize the findings of peer-reviewed articles that used data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS published since November 2011 and data from provincial oversamples of the CIS as well as to illustrate evolving uses of these datasets. Methods: Articles were identified from the Public Health Agency of Canada's data request records tracking access to CIS data and publications produced from that data. At least two raters independently reviewed and appraised the quality of each article. Results: A total of 32 articles were included. Common strengths of articles included clearly stated research aims, appropriate control variables and analyses, sufficient sample sizes, appropriate conclusions and relevance to practice or policy. Common problem areas of articles included unclear definitions for variables and inclusion criteria of cases. Articles frequently measured the associations between maltreatment, child, caregiver, household and agency/referral characteristics and investigative outcomes such as opening cases for ongoing services and placement. Conclusion: Articles using CIS data were rated positively on most quality indicators. Researchers have recently focussed on inadequately studied categories of maltreatment (exposure to intimate partner violence [IPV], neglect and emotional maltreatment and examined factors specific to First Nations children. Data from the CIS oversamples have been underutilized. The use of multivariate analysis techniques has increased.

  13. Understanding the nature of errors in nursing: using a model to analyse critical incident reports of errors which had resulted in an adverse or potentially adverse event.

    Science.gov (United States)

    Meurier, C E

    2000-07-01

    Human errors are common in clinical practice, but they are under-reported. As a result, very little is known of the types, antecedents and consequences of errors in nursing practice. This limits the potential to learn from errors and to make improvement in the quality and safety of nursing care. The aim of this study was to use an Organizational Accident Model to analyse critical incidents of errors in nursing. Twenty registered nurses were invited to produce a critical incident report of an error (which had led to an adverse event or potentially could have led to an adverse event) they had made in their professional practice and to write down their responses to the error using a structured format. Using Reason's Organizational Accident Model, supplemental information was then collected from five of the participants by means of an individual in-depth interview to explore further issues relating to the incidents they had reported. The detailed analysis of one of the incidents is discussed in this paper, demonstrating the effectiveness of this approach in providing insight into the chain of events which may lead to an adverse event. The case study approach using critical incidents of clinical errors was shown to provide relevant information regarding the interaction of organizational factors, local circumstances and active failures (errors) in producing an adverse or potentially adverse event. It is suggested that more use should be made of this approach to understand how errors are made in practice and to take appropriate preventative measures.

  14. Self-Reported Exercise Prevalence and Determinants in the Long Term After Stroke: The North East Melbourne Stroke Incidence Study.

    Science.gov (United States)

    Simpson, Dawn; Callisaya, Michele L; English, Coralie; Thrift, Amanda G; Gall, Seana L

    2017-12-01

    Exercise has established benefits following stroke. We aimed to describe self-reported exercise 5 and 10 years after stroke, change in exercise over time, and to identify factors associated with long-term exercise. Data on exercise (defined as 20 minutes' duration, causing sweating and increased heart rate) were obtained by questionnaire from a population-based stroke incidence study with 10-year follow-up. For change in exercise between 5 and 10 years (n = 276), we created 4 categories of exercise (no exercise, ceased exercising, commenced exercising, continued exercising). Multinomial regression determined associations between exercise categories and exercising before stroke, receiving exercise advice and functional ability and demographic factors. The prevalence of exercise at 5 years (n = 520) was 18.5% (n = 96) (mean age 74.7 [standard deviation {SD} 14] years, 50.6% male) and 24% (n = 78) at 10 years. In those with data at both 5 and 10 years (mean age 69 [standard deviation 14] years, 52.9% male), 15% (n = 42) continued exercising, 10% (n = 27) commenced exercising, 14% (n = 38) ceased exercising, and 61% (n = 169) reported no exercise. Continued exercise was associated with younger age (relative risk [RR] .47 95% confidence interval [CI] .25-0.89), greater Barthel score (RR 2.97 95% CI 1.00-8.86), independent walking (RR 2.32 95% CI 1.16-4.68), better quality of life (RR 10.9 95% CI 2.26-52.8), exercising before stroke (RR 16.0 95%CI 4.98-51.5), and receiving advice to exercise (RR 2.99 95% CI 1.73-5.16). Few people exercise after stroke and fewer commence exercise long term. Innovative interventions to promote and maintain exercise are required after stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Incidence of hyperthyroidism in Sweden.

    Science.gov (United States)

    Abraham-Nordling, Mirna; Byström, Kristina; Törring, Ove; Lantz, Mikael; Berg, Gertrud; Calissendorff, Jan; Nyström, Helena Filipsson; Jansson, Svante; Jörneskog, Gun; Karlsson, F Anders; Nyström, Ernst; Ohrling, Hans; Orn, Thomas; Hallengren, Bengt; Wallin, Göran

    2011-12-01

    The incidence of hyperthyroidism has been reported in various countries to be 23-93/100,000 inhabitants per year. This extended study has evaluated the incidence for ~40% of the Swedish population of 9 million inhabitants. Sweden is considered to be iodine sufficient country. All patients including children, who were newly diagnosed with overt hyperthyroidism in the years 2003-2005, were prospectively registered in a multicenter study. The inclusion criteria are as follows: clinical symptoms and/or signs of hyperthyroidism with plasma TSH concentration below 0.2 mIE/l and increased plasma levels of free/total triiodothyronine and/or free/total thyroxine. Patients with relapse of hyperthyroidism or thyroiditis were not included. The diagnosis of Graves' disease (GD), toxic multinodular goiter (TMNG) and solitary toxic adenoma (STA), smoking, initial treatment, occurrence of thyroid-associated eye symptoms/signs, and demographic data were registered. A total of 2916 patients were diagnosed with de novo hyperthyroidism showing the total incidence of 27.6/100,000 inhabitants per year. The incidence of GD was 21.0/100,000 and toxic nodular goiter (TNG=STA+TMNG) occurred in 692 patients, corresponding to an annual incidence of 6.5/100,000. The incidence was higher in women compared with men (4.2:1). Seventy-five percent of the patients were diagnosed with GD, in whom thyroid-associated eye symptoms/signs occurred during diagnosis in every fifth patient. Geographical differences were observed. The incidence of hyperthyroidism in Sweden is in a lower range compared with international reports. Seventy-five percent of patients with hyperthyroidism had GD and 20% of them had thyroid-associated eye symptoms/signs during diagnosis. The observed geographical differences require further studies.

  16. Dissociative Tendencies and Traffic Incidents

    Directory of Open Access Journals (Sweden)

    Valle, Virginia

    2012-01-01

    Full Text Available This paper analyses the relationship between dissociative experiences and road traffic incidents (crashes and traffic tickets in drivers (n=295 from Mar del Plata (Argentina city. A self-report questionnaire was applied to assess traffic crash involvement and sociodemographic variables. Dissociative tendencies were assessed by a modified version of the DES scale. To examine differences in DES scores tests of the difference of means were applied. Drivers who reported to be previously involved in traffic incidents obtained higher puntuations in the dissociative experiences scale than drivers who did not report such events. This result is observed for the total scale and for the three sub-scales (absorption, amnesia and depersonalization. However, differences appeared mainly for minor damage collisions. Further studies are needed to evaluate the role of dissociative tendencies as a risk factor in road traffic safety.

  17. Incidents in transport of radioactive materials for civil use: IRSN draws lessons from events reported between 1999 and 2007

    International Nuclear Information System (INIS)

    2008-01-01

    Some 900,000 packages of radioactive materials for civil use are transported each year in France. The great majority of these shipments involve radioactive materials used in the fields of medicine, pharmaceuticals, industry or property. Transport of radioactive materials linked to the nuclear fuel cycle actually represents only 15% of transport. A great variety of material is transported, differing in weight (from a few grams to tens of tons), form, activity and packaging. The associated risks are also different: radioactive contamination, external exposure to ionising radiation, chemical risk etc. In its role of technical support to safety and radioprotection authorities, IRSN's mission is to assess the design, manufacturing, testing and use of packaging and transport systems. The Institute is also involved in the management and analysis of events that occur during transport of radioactive materials. To assist with this, the IRSN manages a database which lists reported deviations, anomalies, incidents and accidents (known in a generic way as 'events') relating to transport. With an aim of reduction of the risks related to transport, the feedback resulting from the thorough analysis of the notified events is capitalized by IRSN, just as the feedback of the assessments of the safety analysis reports of the various package designs. Based on these feedbacks, IRSN proposes axes of improvement relating to package designs and transport operations, and regulatory evolutions, as well as priority topics for the inspections carried out by the French Nuclear safety authority (ASN). The IRSN has carried out a transversal analysis of all events in transport of radioactive materials that occurred in France from 1999 to 2007 as listed in its database (i.e. 901 events). For each event, some 70 parameters have been recorded from the analysis of the notifications and reports of the events, transmitted by the operators (type of event, type of package, level on the INES scale). This

  18. The Need for Higher Education in Iran. Technical Report No. 16.

    Science.gov (United States)

    Lusignan, Bruce B.; And Others

    The role of television in meeting the need for higher education in Iran is discussed. Topics covered in the first chapter include impact on a typical curriculum, transition characteristics, television production techniques, cost effectiveness, additional applications, and centralization or duplication. The second chapter presents a planning…

  19. 2014-2015 State of CRM Use in Higher Education Report

    Science.gov (United States)

    American Association of Collegiate Registrars and Admissions Officers (AACRAO), 2010

    2010-01-01

    The American Association of Collegiate Registrars and Admissions Officers (AACRAO) periodically undertakes research projects to keep themselves and the higher education community in general, informed about relevant current and emerging practices. The aim of this survey was to measure the extent of ownership of Constituent (or Customer)…

  20. The system of higher education in Morocco : a brief introductory report

    OpenAIRE

    Meziani, Ahmed

    1999-01-01

    Describes higher education in Morocco, briefly touching on the country's socioeconomic history, then explaining Morocco's three types of post secondary institutions: the public university system, the public non-university system, and the private system. Presents details about Moroccan universities, which are state institutions, focusing on autonomy, financing, and the teaching staff.

  1. The System of Higher Education in Morocco: A Brief Introductory Report.

    Science.gov (United States)

    Meziani, Ahmed

    1999-01-01

    Describes higher education in Morocco, briefly touching on the country's socioeconomic history, then explaining Morocco's three types of postsecondary institutions: the public university system, the public non-university system, and the private system. Presents details about Moroccan universities, which are state institutions, focusing on…

  2. 2015 Global Information Technology Report: Consequences on Knowledge Management in Higher Education Institutions in Nigeria

    Science.gov (United States)

    Ololube, Nwachukwu Prince; Agbor, Comfort Nkogho; Major, Nanighe Baldwin; Agabi, Chinyere O.; Wali, Worlu I.

    2016-01-01

    This research is a continuation of a theoretical review that evaluated ICT Policy Outcomes for National Development in relation to Networked Readiness Index (NRI) and the impact it has on knowledge integration and management in higher education institutions in Nigeria. A new dawn in information technology (IT) has initiated new trends in…

  3. Brief Report: Joint Attention and Information Processing in Children with Higher Functioning Autism Spectrum Disorder

    Science.gov (United States)

    Mundy, Peter; Kim, Kwnanguk; McIntyre, Nancy; Lerro, Lindsay; Jarrold, William

    2016-01-01

    Theory suggests that information processing during joint attention may be atypical in children with Autism Spectrum Disorder (ASD). This hypothesis was tested in a study of school-aged children with higher functioning ASD and groups of children with symptoms of ADHD or typical development. The results indicated that the control groups displayed…

  4. Brief Report: Joint Attention and Information Processing in Children with Higher Functioning Autism Spectrum Disorders

    Science.gov (United States)

    Mundy, Peter; Kim, Kwanguk; McIntyre, Nancy; Lerro, Lindsay; Jarrold, William

    2016-01-01

    Theory suggests that information processing during joint attention may be atypical in children with Autism Spectrum Disorder (ASD). This hypothesis was tested in a study of school-aged children with higher functioning ASD and groups of children with symptoms of ADHD or typical development. The results indicated that the control groups displayed…

  5. Evaluation and Development of Administrators. AAHE-ERIC/Higher Education Research Report No. 6, 1979.

    Science.gov (United States)

    Nordvall, Robert C.

    Needs and methods for the evaluation and development of higher education administrators are reviewed in this monograph. Three major reasons for evaluation are cited: external and internal pressure, improvement of performance of individual administrators, and improvement of performance of the institution. Different approaches to evaluation are…

  6. Assessing Tuition- and Debt-Free Higher Education. NASFAA Task Force Report

    Science.gov (United States)

    National Association of Student Financial Aid Administrators, 2017

    2017-01-01

    The Assessing Tuition- and Debt-Free Higher Education Task Force was convened in July 2016. Charged by the National Association of Student Financial Aid Administrators's (NASFAA's) Board of Directors with evaluating the existing landscape of state and local promise programs with a focus on scaling such models to the national level, the task force…

  7. Toward a Definition of Verbal Reasoning in Higher Education. Research Report. ETS RR-09-33

    Science.gov (United States)

    Burton, Nancy W.; Welsh, Cynthia; Kostin, Irene; VanEssen, Thomas

    2009-01-01

    This paper briefly summarizes the literatures of reading and reasoning in the last quarter century, focusing mainly on the disciplines of cognitive science, cognitive developmental psychology, linguistics, and educational psychology. These literatures were synthesized to create a framework for defining verbal reasoning in higher education. Eight…

  8. The State of Early Childhood Higher Education in California. Technical Report

    Science.gov (United States)

    Austin, Lea J. E.; Kipnis, Fran; Whitebook, Marcy; Sakai, Laura

    2015-01-01

    Teacher preparation in the field of early childhood education (ECE) has historically included a variety of higher education degree programs, in various child-related disciplines, all of which have generally been considered equally acceptable. And too often, these highly diverse degree programs are assumed to produce equivalent results. In…

  9. The State of Early Childhood Higher Education in Nebraska. Technical Report

    Science.gov (United States)

    Sakai, Laura; Austin, Lea J. E.; Bloechliger, Olivia; Whitebook, Marcy; Amanta, Felippa

    2015-01-01

    Teacher preparation in the field of early childhood education (ECE) has historically included a variety of higher education degree programs, in various child-related disciplines, all of which have generally been considered equally acceptable. And too often, these highly diverse degree programs are assumed to produce equivalent results (Maxwell,…

  10. Student Support Funding for Higher Education Institutions, 2001-02. Report.

    Science.gov (United States)

    Higher Education Funding Council for England, Bristol.

    This publication provides information about the allocation of funds for student support to higher education institutions in England in 2001-2002 and requests monitoring information on the use of these funds. Student support funds include a variety of services to students, including fee waivers, help with living costs in some cases, and child care…

  11. Incidence and etiology of lumbar spondylolysis: review of the literature.

    Science.gov (United States)

    Sakai, Toshinori; Sairyo, Koichi; Suzue, Naoto; Kosaka, Hirofumi; Yasui, Natsuo

    2010-05-01

    Lumbar spondylolysis is a defect of the pars interarticularis known to occur as a stress fracture. Its incidence varies considerably depending on ethnicity, sex, and sports activity. However, there are few literature reviews describing its incidence in different ethnic groups or in people who engage in different sports. We reviewed the most relevant articles on spondylolysis published in scientific journals. First, we focused on its incidence in various ethnic groups distributed by sex, the familial occurrence, and in patients with relevant diseases. Second, we focused on the incidence of spondylolysis in relation to the sports practiced by the patients. Although placing special emphasis on the incidence of lumbar spondylolysis in the general population in Japan, we also reviewed the Japanese and English literature to investigate its incidence among those who engage in different sports. The incidence of lumbar spondylolysis in the general Japanese population was 5.9%. Most studies report that the incidence in higher in male subjects than in female subjects. We found that Japanese rugby and judo players were prone to suffer lumbar spondylolysis, at an incidence of about 20%. However, the incidence for Japanese professional soccer and baseball players was much higher, at 30%, which was more than five times the incidence in the general Japanese population. The incidence of lumbar spondylolysis varies depending on ethnicity, sex, family history, relevant disease, and sports activity.

  12. Analysis of Aviation Safety Reporting System Incident Data Associated with the Technical Challenges of the System-Wide Safety and Assurance Technologies Project

    Science.gov (United States)

    Withrow, Colleen A.; Reveley, Mary S.

    2015-01-01

    The Aviation Safety Program (AvSP) System-Wide Safety and Assurance Technologies (SSAT) Project asked the AvSP Systems and Portfolio Analysis Team to identify SSAT-related trends. SSAT had four technical challenges: advance safety assurance to enable deployment of NextGen systems; automated discovery of precursors to aviation safety incidents; increasing safety of human-automation interaction by incorporating human performance, and prognostic algorithm design for safety assurance. This report reviews incident data from the NASA Aviation Safety Reporting System (ASRS) for system-component-failure- or-malfunction- (SCFM-) related and human-factor-related incidents for commercial or cargo air carriers (Part 121), commuter airlines (Part 135), and general aviation (Part 91). The data was analyzed by Federal Aviation Regulations (FAR) part, phase of flight, SCFM category, human factor category, and a variety of anomalies and results. There were 38 894 SCFM-related incidents and 83 478 human-factorrelated incidents analyzed between January 1993 and April 2011.

  13. Substantiated Reports of Child Maltreatment From the Canadian Incidence Study of Reported Child Abuse and Neglect 2008: Examining Child and Household Characteristics and Child Functional Impairment.

    Science.gov (United States)

    Afifi, Tracie O; Taillieu, Tamara; Cheung, Kristene; Katz, Laurence Y; Tonmyr, Lil; Sareen, Jitender

    2015-07-01

    Identifying child and household characteristics that are associated with specific child maltreatment types and child functional impairment are important for informing prevention and intervention efforts. Our objectives were to examine the distribution of several child and household characteristics among substantiated child maltreatment types in Canada; to determine if a specific child maltreatment type relative to all other types was associated with increased odds of child functional impairment; and to determine which child and household characteristics were associated with child functional impairment. Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect (collection 2008) from 112 child welfare sites across Canada (n = 6163 children). Physical abuse, sexual abuse, and emotional maltreatment were highly prevalent among children aged 10 to 15 years. For single types of child maltreatment, the highest prevalence of single-parent homes (50.6%), social assistance (43.0%), running out of money regularly (30.7%), and unsafe housing (30.9%) were reported for substantiated cases of neglect. Being male, older age, living in a single-parent home, household running out of money, moving 2 or more times in the past year, and household overcrowding were associated with increased odds of child functional impairment. More work is warranted to determine if providing particular resources for single-parent families, financial counselling, and facilitating adequate and stable housing for families with child maltreatment histories or at risk for child maltreatment could be effective for improving child functional outcomes.

  14. Substantiated Reports of Child Maltreatment From the Canadian Incidence Study of Reported Child Abuse and Neglect 2008: Examining Child and Household Characteristics and Child Functional Impairment

    Science.gov (United States)

    Afifi, Tracie O; Taillieu, Tamara; Cheung, Kristene; Katz, Laurence Y; Tonmyr, Lil; Sareen, Jitender

    2015-01-01

    Objective: Identifying child and household characteristics that are associated with specific child maltreatment types and child functional impairment are important for informing prevention and intervention efforts. Our objectives were to examine the distribution of several child and household characteristics among substantiated child maltreatment types in Canada; to determine if a specific child maltreatment type relative to all other types was associated with increased odds of child functional impairment; and to determine which child and household characteristics were associated with child functional impairment. Method: Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect (collection 2008) from 112 child welfare sites across Canada (n = 6163 children). Results: Physical abuse, sexual abuse, and emotional maltreatment were highly prevalent among children aged 10 to 15 years. For single types of child maltreatment, the highest prevalence of single-parent homes (50.6%), social assistance (43.0%), running out of money regularly (30.7%), and unsafe housing (30.9%) were reported for substantiated cases of neglect. Being male, older age, living in a single-parent home, household running out of money, moving 2 or more times in the past year, and household overcrowding were associated with increased odds of child functional impairment. Conclusions: More work is warranted to determine if providing particular resources for single-parent families, financial counselling, and facilitating adequate and stable housing for families with child maltreatment histories or at risk for child maltreatment could be effective for improving child functional outcomes. PMID:26175390

  15. Colorectal cancer incidence in path_MLH1 carriers subjected to different follow-up protocols : A Prospective Lynch Syndrome Database report

    NARCIS (Netherlands)

    Seppala, Toni; Pylvanainen, Kirsi; Evans, Dafydd Gareth; Jarvinen, Heikki; Renkonen-Sinisalo, Laura; Bernstein, Inge; Holinski-Feder, Elke; Sala, Paola; Lindblom, Annika; Macrae, Finlay; Blanco, Ignacio; Sijmons, Rolf; Jeffries, Jacqueline; Vasen, Hans; Burn, John; Nakken, Sigve; Hovig, Eivind; Rodland, Einar Andreas; Tharmaratnam, Kukatharmini; Cappel, Wouter H. de Vos tot Nederveen; Hill, James; Wijnen, Juul; Jenkins, Mark; Genuardi, Maurizio; Green, Kate; Lalloo, Fiona; Sunde, Lone; Mints, Miriam; Bertario, Lucio; Pineda, Marta; Navarro, Matilde; Morak, Monika; Frayling, Ian M.; Plazzer, John-Paul; Sampson, Julian R.; Capella, Gabriel; Moslein, Gabriela; Mecklin, Jukka-Pekka; Moller, Pal

    2017-01-01

    BACKGROUND: We have previously reported a high incidence of colorectal cancer (CRC) in carriers of pathogenicMLH1variants(path_MLH1) despite follow-up with colonoscopy including polypectomy. METHODS: The cohort included Finnish carriers enrolled in 3-yearly colonoscopy (n = 505; 4625 observation

  16. Giving to Excellence: Generating Philanthropic Support for UK Higher Education. Ross-CASE Report 2016

    Science.gov (United States)

    Jain, Yashraj

    2016-01-01

    This report presents findings from the 2016 Ross-CASE Survey of Philanthropic Giving to Universities in UK. The project was conducted by CASE Europe and funded by HEFCE and the Ross-Group. This year's survey comes at a time of great change for the UK charity sector. The historical trend data of previous surveys will be invaluable in helping…

  17. CEBAF at higher energies: Working group report on hadron spectroscopy and production

    Energy Technology Data Exchange (ETDEWEB)

    Barnes, T. [Oak Ridge National Laboratory, TN (United States)]| [Univ. of Tennessee, Knoxville (United States); Napolitano, J. [Rensselaer Polytechnic Inst., Troy, NY (United States)

    1994-04-01

    This report summarizes topics in hadron spectroscopy and production which could be addressed at CEBAF with an energy upgrade to E{sub {gamma}} = 8 GeV and beyond. The topics discussed include conventional meson and baryon spectrocopy, spectroscopy of exotica (especially molecules and hybrids), CP and CPT tests using {phi} mesons, and new detector and accelerator options.

  18. Opportunities for prevention and intervention with young children: lessons from the Canadian incidence study of reported child abuse and neglect

    Directory of Open Access Journals (Sweden)

    Fallon Barbara

    2013-02-01

    Full Text Available Abstract Background The most effective way to provide support to caregivers with infants in order to promote good health, social, emotional and developmental outcomes is the subject of numerous debates in the literature. In Canada, each province adopts a different approach which range from universal to targeted programs. Nonetheless, each year a group of vulnerable infants is identified to the child welfare system with concerns about their well-being and safety. This study examines maltreatment-related investigations in Canada involving children under the age of one year to identify which factors determine service provision at the conclusion of the investigation. Methods A secondary analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect CIS-2008 (PHAC, 2010 dataset was conducted. Multivariate analyses were conducted to understand the profile of investigations involving infants (n=1,203 and which predictors were significant in the decision to transfer a case to ongoing services at the conclusion of the investigation. Logistic Regression and Classification and Regression Trees (CART were conducted to examine the relationship between the outcome and predictors. Results The results suggest that there are three main sources that refer infants to the Canadian child welfare system: hospital, police, and non-professionals. Infant maltreatment-related investigations involve young caregivers who struggle with poverty, single-parenthood, drug/solvent and alcohol abuse, mental health issues, lack of social supports, and intimate partner violence. Across the three referral sources, primary caregiver risk factors are the strongest predictor of the decision to transfer a case to ongoing services. Conclusions Multivariate analyses indicate that the presence of infant concerns does not predict ongoing service provision, except when the infant is identified with positive toxicology at birth. The opportunity for early intervention and the

  19. Gene-enzyme relationships in somatic cells and their organismal derivatives in higher plants. Progress report

    International Nuclear Information System (INIS)

    Jensen, R.A.

    1983-01-01

    Several enzymes involved in the biosynthesis of aromatic amino acids have been isolated from Nicotiana silvestris. Isozymes of chlorismate mutase were isolated, partially purified and subjected to enzyme kinetic analysis. In addition, studies investigating the role of 5-enolpyruvyl-shikimate-3-phosphate synthetase, 3-deoxy-D-arabino-heptulosonate 7-phosphate synthetase, shikimate dehydrogenase, prephenate aminotransferase, arogenate dehydrogenase and phenylalanine ammonia-lyase in regulation of aromatic amino acids levels in tobacco are reported

  20. Workplace interpersonal conflicts among the healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center.

    Directory of Open Access Journals (Sweden)

    Jih-Shuin Jerng

    Full Text Available There have been concerns about the workplace interpersonal conflict (WIC among healthcare workers. As healthcare organizations have applied the incident reporting system (IRS widely for safety-related incidents, we proposed that this system might provide a channel to explore the WICs.We retrospectively reviewed the reports to the IRS from July 2010 to June 2013 in a medical center. We identified the WICs and typed these conflicts according to the two foci (task content/process and interpersonal relationship and the three properties (disagreement, interference, and negative emotion, and analyzed relevant data.Of the 147 incidents with WIC, the most common related processes were patient transfer (20%, laboratory tests (17%, surgery (16% and medical imaging (16%. All of the 147 incidents with WIC focused on task content or task process, but 41 (27.9% also focused on the interpersonal relationship. We found disagreement, interference, and negative emotion in 91.2%, 88.4%, and 55.8% of the cases, respectively. Nurses (57% were most often the reporting workers, while the most common encounter was the nurse-doctor interaction (33%, and the majority (67% of the conflicts were experienced concurrently with the incidents. There was a significant difference in the distribution of worker job types between cases focused on the interpersonal relationship and those without (p = 0.0064. The doctors were more frequently as the reporter when the conflicts focused on the interpersonal relationship (34.1% than not on it (17.0%. The distributions of worker job types were similar between those with and without negative emotion (p = 0.125.The institutional IRS is a useful place to report the workplace interpersonal conflicts actively. The healthcare systems need to improve the channels to communicate, manage and resolve these conflicts.

  1. Workplace interpersonal conflicts among the healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center.

    Science.gov (United States)

    Jerng, Jih-Shuin; Huang, Szu-Fen; Liang, Huey-Wen; Chen, Li-Chin; Lin, Chia-Kuei; Huang, Hsiao-Fang; Hsieh, Ming-Yuan; Sun, Jui-Sheng

    2017-01-01

    There have been concerns about the workplace interpersonal conflict (WIC) among healthcare workers. As healthcare organizations have applied the incident reporting system (IRS) widely for safety-related incidents, we proposed that this system might provide a channel to explore the WICs. We retrospectively reviewed the reports to the IRS from July 2010 to June 2013 in a medical center. We identified the WICs and typed these conflicts according to the two foci (task content/process and interpersonal relationship) and the three properties (disagreement, interference, and negative emotion), and analyzed relevant data. Of the 147 incidents with WIC, the most common related processes were patient transfer (20%), laboratory tests (17%), surgery (16%) and medical imaging (16%). All of the 147 incidents with WIC focused on task content or task process, but 41 (27.9%) also focused on the interpersonal relationship. We found disagreement, interference, and negative emotion in 91.2%, 88.4%, and 55.8% of the cases, respectively. Nurses (57%) were most often the reporting workers, while the most common encounter was the nurse-doctor interaction (33%), and the majority (67%) of the conflicts were experienced concurrently with the incidents. There was a significant difference in the distribution of worker job types between cases focused on the interpersonal relationship and those without (p = 0.0064). The doctors were more frequently as the reporter when the conflicts focused on the interpersonal relationship (34.1%) than not on it (17.0%). The distributions of worker job types were similar between those with and without negative emotion (p = 0.125). The institutional IRS is a useful place to report the workplace interpersonal conflicts actively. The healthcare systems need to improve the channels to communicate, manage and resolve these conflicts.

  2. Status Update on the NCRP Scientific Committee SC 5-1 Report: Decision Making for Late-Phase Recovery from Nuclear or Radiological Incidents - 13450

    International Nuclear Information System (INIS)

    Chen, S.Y.

    2013-01-01

    In August 2008, the U.S. Department of Homeland Security (DHS) issued its final Protective Action Guide (PAG) for radiological dispersal device (RDD) and improvised nuclear device (IND) incidents. This document specifies protective actions for public health during the early and intermediate phases and cleanup guidance for the late phase of RDD or IND incidents, and it discusses approaches to implementing the necessary actions. However, while the PAG provides specific guidance for the early and intermediate phases, it prescribes no equivalent guidance for the late-phase cleanup actions. Instead, the PAG offers a general description of a complex process using a site-specific optimization approach. This approach does not predetermine cleanup levels but approaches the problem from the factors that would bear on the final agreed-on cleanup levels. Based on this approach, the decision-making process involves multifaceted considerations including public health, the environment, and the economy, as well as socio-political factors. In an effort to fully define the process and approach to be used in optimizing late-phase recovery and site restoration following an RDD or IND incident, DHS has tasked the NCRP with preparing a comprehensive report addressing all aspects of the optimization process. Preparation of the NCRP report is a three-year (2010-2013) project assigned to a scientific committee, the Scientific Committee (SC) 5-1; the report was initially titled, Approach to Optimizing Decision Making for Late- Phase Recovery from Nuclear or Radiological Terrorism Incidents. Members of SC 5-1 represent a broad range of expertise, including homeland security, health physics, risk and decision analysis, economics, environmental remediation and radioactive waste management, and communication. In the wake of the Fukushima nuclear accident of 2011, and guided by a recent process led by the White House through a Principal Level Exercise (PLE), the optimization approach has since

  3. Status Update on the NCRP Scientific Committee SC 5-1 Report: Decision Making for Late-Phase Recovery from Nuclear or Radiological Incidents - 13450

    Energy Technology Data Exchange (ETDEWEB)

    Chen, S.Y. [Environmental Science Division, Argonne National Laboratory, 9700 South Cass Avenue, Argonne, IL 60439 (United States)

    2013-07-01

    In August 2008, the U.S. Department of Homeland Security (DHS) issued its final Protective Action Guide (PAG) for radiological dispersal device (RDD) and improvised nuclear device (IND) incidents. This document specifies protective actions for public health during the early and intermediate phases and cleanup guidance for the late phase of RDD or IND incidents, and it discusses approaches to implementing the necessary actions. However, while the PAG provides specific guidance for the early and intermediate phases, it prescribes no equivalent guidance for the late-phase cleanup actions. Instead, the PAG offers a general description of a complex process using a site-specific optimization approach. This approach does not predetermine cleanup levels but approaches the problem from the factors that would bear on the final agreed-on cleanup levels. Based on this approach, the decision-making process involves multifaceted considerations including public health, the environment, and the economy, as well as socio-political factors. In an effort to fully define the process and approach to be used in optimizing late-phase recovery and site restoration following an RDD or IND incident, DHS has tasked the NCRP with preparing a comprehensive report addressing all aspects of the optimization process. Preparation of the NCRP report is a three-year (2010-2013) project assigned to a scientific committee, the Scientific Committee (SC) 5-1; the report was initially titled, Approach to Optimizing Decision Making for Late- Phase Recovery from Nuclear or Radiological Terrorism Incidents. Members of SC 5-1 represent a broad range of expertise, including homeland security, health physics, risk and decision analysis, economics, environmental remediation and radioactive waste management, and communication. In the wake of the Fukushima nuclear accident of 2011, and guided by a recent process led by the White House through a Principal Level Exercise (PLE), the optimization approach has since

  4. Higher luminosities via alternative incident channels

    International Nuclear Information System (INIS)

    Spencer, J.E.

    1985-04-01

    We show that PEP provides some unique opportunities for one and two photon physics with real photons as well as for QCD studies with internal targets. Photon beams would avoid the major limitation on the luminosity of present machines and could provide PEP an ideal b-physics factory producing the full range of J/sub c//sup PC/ and J/sub b//sup PC/ states that may not be observable otherwise as well as allow a whole new class of ''missing-mass'' experiments. These latter particles are the pseudo-Goldstone bosons and their supersymmetric counterparts. These and related possibilities like a single-pass, ''free electron laser'' facility or even synchrotron radiation beam lines all favor a mini-maxi configuration for the low-beta insertions in PEP. This allows more diverse experiments without excluding any ongoing experimental programs. Such possibilities have interesting implications for a number of proposed facilities including the SSC. Some systematic machine physics studies over a range of energies are suggested. 24 refs., 6 figs

  5. Lessons learnt from the development of the Patient Safety Incidents Reporting an Learning System for the Spanish National Health System: SiNASP.

    Science.gov (United States)

    Vallejo-Gutiérrez, Paula; Bañeres-Amella, Joaquim; Sierra, Eduardo; Casal, Jesús; Agra, Yolanda

    2014-01-01

    To describe the development process and characteristics of a patient safety incidents reporting system to be implemented in the Spanish National Health System, based on the context and the needs of the different stakeholders. Literature review and analysis of most relevant reporting systems, identification of more than 100 stakeholder's (patients, professionals, regional governments representatives) expectations and requirements, analysis of the legal context, consensus of taxonomy, development of the software and pilot test. Patient Safety Events Reporting and Learning system (Sistema de Notificación y Aprendizajepara la Seguridad del Paciente, SiNASP) is a generic reporting system for all types of incidents related to patient safety, voluntary, confidential, non punitive, anonymous or nominative with anonimization, system oriented, with local analysis of cases and based on the WHO International Classification for Patient Safety. The electronic program has an on-line form for reporting, a software to manage the incidents and improvement plans, and a scoreboard with process indicators to monitor the system. The reporting system has been designed to respond to the needs and expectations identified by the stakeholders, taking into account the lessons learned from the previous notification systems, the characteristics of the National Health System and the existing legal context. The development process presented and the characteristics of the system provide a comprehensive framework that can be used for future deployments of similar patient safety systems. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  6. Stakeholder Engagement in Sustainability Reporting in Higher Education: An Analysis of Key Internal Stakeholders' Expectations

    Science.gov (United States)

    Ferrero-Ferrero, Idoya; Fernández-Izquierdo, María Ángeles; Muñoz-Torres, María Jesús; Bellés-Colomer, Lucía

    2018-01-01

    Purpose: The purpose of this study is to improve the understanding of stakeholder engagement in the context of sustainability reporting (SR) for higher education institutions (HEIs), together with the materiality principle and stakeholder expectations. Design/methodology/approach: This research uses an exploratory approach based on content…

  7. Higher Education in Further Education Colleges: Indirectly Funded Partnerships: Codes of Practice for Franchise and Consortia Arrangements. Report.

    Science.gov (United States)

    Higher Education Funding Council for England, Bristol.

    This report provides codes of practice for two types of indirectly funded partnerships entered into by higher education institutions and further education sector colleges: franchises and consortia. The codes of practice set out guidance on the principles that should be reflected in the franchise and consortia agreements that underpin indirectly…

  8. Quality of Higher Education: Organisational or Educational? A Content Analysis of Chinese University Self-Evaluation Reports

    Science.gov (United States)

    Zou, Yihuan; Du, Xiangyun; Rasmussen, Palle

    2012-01-01

    Based on a study of Chinese university self-evaluation reports, this paper argues that higher education institutions are trying to manage the tensions between educational and organisational quality and the increasing and worldwide concerns about quality assurance. After 30 years of dramatic educational reform, China has established a nationwide…

  9. Higher Reported Levels of Depression, Stress, and Anxiety Are Associated with Increased Endorsement of ADHD Symptoms by Postsecondary Students

    Science.gov (United States)

    Harrison, Allyson G.; Alexander, Sandra J.; Armstrong, Irene T.

    2013-01-01

    This study examined the extent to which postsecondary students endorse symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) and whether experienced level of stress, depression, or anxiety are associated with higher reporting of ADHD symptoms. Students attending a combined health and counseling service completed the Conners Adult ADHD Rating…

  10. Flipped Classroom Implementation: A Case Report of Two Higher Education Institutions in the United States and Australia

    Science.gov (United States)

    McLaughlin, Jacqueline E.; White, Paul J.; Khanova, Julia; Yuriev, Elizabeth

    2016-01-01

    This case report explored the implementation of flipped classrooms at two higher education institutions. Experiences and publications from the institutions were used to identify and describe common themes, including successes and challenges encountered along with potential solutions to common misalignments, particularly as related to…

  11. Sustainability in Higher Education's Annual Reports: An Empirical Study on Australian and Austrian Universities

    Science.gov (United States)

    Schaffhauser-Linzatti, Michaela Maria; Ossmann, Stefan F.

    2018-01-01

    Purpose: Higher education institutions are regarded as forerunners and pioneers of sustainability. However, it is to question whether they actually fulfill their role model function. This paper aims to reveal whether selected universities in Australia and Austria meet the reporting expectations about their activities on sustainability in very…

  12. Mit Expertenwissen zu Aussagen über künftige Entwicklungen — der Horizon Report Higher Education

    Directory of Open Access Journals (Sweden)

    Rudolf Mumenthaler

    2014-03-01

    Full Text Available Der Horizon Report Higher Education dient auch für Hochschulbibliotheken als wichtige Referenz zur Bewertung aktueller Trends und künftiger Entwicklungen. Der Autor stellt die dem Report zugrunde liegende Methode vor, beleuchtet diese kritisch und reflektiert die Aussagekraft der Prognosen. Die Stärken des Horizon Report liegen in der breiten Abstützung, der Offenheit des Verfahrens und der Publikation sowie der Ausarbeitung der von Expertinnen und Experten ausgewählten Themen. Gewisse Schwächen sieht der Autor in der Abhängigkeit von anderen Trendstudien sowie beim Auswahlverfahren der Trendthemen.

  13. Brief Report: Joint Attention and Information Processing in Children with Higher Functioning Autism Spectrum Disorders.

    Science.gov (United States)

    Mundy, Peter; Kim, Kwanguk; McIntyre, Nancy; Lerro, Lindsay; Jarrold, William

    2016-07-01

    Theory suggests that information processing during joint attention may be atypical in children with Autism Spectrum Disorder (ASD). This hypothesis was tested in a study of school-aged children with higher functioning ASD and groups of children with symptoms of ADHD or typical development. The results indicated that the control groups displayed significantly better recognition memory for pictures studied in an initiating joint attention (IJA) rather than responding to joint attention (RJA) condition. This effect was not evident in the ASD group. The ASD group also recognized fewer pictures from the IJA condition than controls, but not the RJA condition. Atypical information processing may be a marker of the continued effects of joint attention disturbance in school aged children with ASD.

  14. Regulation of chloroplast number and DNA synthesis in higher plants. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Mullet, J.E.

    1995-11-10

    The long term objective of this research is to understand the process of chloroplast development and its coordination with leaf development in higher plants. This is important because the photosynthetic capacity of plants is directly related to leaf and chloroplast development. This research focuses on obtaining a detailed description of leaf development and the early steps in chloroplast development including activation of plastid DNA synthesis, changes in plastid DNA copy number, activation of chloroplast transcription and increases in plastid number per cell. The grant will also begin analysis of specific biochemical mechanisms by isolation of the plastid DNA polymerase, and identification of genetic mutants which are altered in their accumulation of plastid DNA and plastid number per cell.

  15. Self-reported whole-grain intake and plasma alkylresorcinol concentrations in combination in relation to the incidence of colorectal cancer

    DEFF Research Database (Denmark)

    Knudsen, Markus Dines; Kyrø, Cecilie; Olsen, Anja

    2014-01-01

    -grain consumption (HELGA, 1992-1998). Incidence rate ratios and 95% confidence intervals were calculated using conditional logistic regression. Plasma alkylresorcinol concentrations alone and Howe's score with ranks were inversely associated with the incidence of distal colon cancer when the highest quartile...... (colon, proximal, distal or rectum cancer) when using an FFQ as the measure/exposure variable for whole-grain intake. The results suggest that assessing whole-grain intake using a combination of FFQs and biomarkers slightly increases the precision in estimating the risk of colon or rectal cancer......Self-reported food frequency questionnaires (FFQs) have occasionally been used to investigate the association between whole-grain intake and the incidence of colorectal cancer, but the results from those studies have been inconsistent. We investigated this association using intakes of whole grains...

  16. Radiological incidents in radiotherapy

    International Nuclear Information System (INIS)

    Hobzova, L.; Novotny, J.

    2008-01-01

    In many countries a reporting system of radiological incidents to national regulatory body exists and providers of radiotherapy treatment are obliged to report all major and/or in some countries all incidents occurring in institution. State Office for Nuclear Safety (SONS) is providing a systematic guidance for radiotherapy departments from 1997 by requiring inclusion of radiation safety problems into Quality assurance manual, which is the basic document for obtaining a license of SONS for handling with sources of ionizing radiation. For that purpose SONS also issued the recommendation 'Introduction of QA system for important sources in radiotherapy-radiological incidents' in which the radiological incidents are defined and the basic guidance for their classification (category A, B, C, D), investigation and reporting are given. At regular periods the SONS in co-operation with radiotherapy centers is making a survey of all radiological incidents occurring in institutions and it is presenting obtained information in synoptic communication (2003 Motolske dny, 2005 Novy Jicin). This presentation is another summary report of radiological incidents that occurred in our radiotherapy institutions during last 3 years. Emphasis is given not only to survey and statistics, but also to analysis of reasons of the radiological incidents and to their detection and prevention. Analyses of incidents in radiotherapy have led to a much broader understanding of incident causation. Information about the error should be shared as early as possible during or after investigation by all radiotherapy centers. Learning from incidents, errors and near misses should be a part of improvement of the QA system in institutions. Generally, it is recommended that all radiotherapy facilities should participate in the reporting, analyzing and learning system to facilitate the dissemination of knowledge throughout the whole country to prevent errors in radiotherapy.(authors)

  17. Review of methodologies for analysis of safety incidents at NPPs. Final report of a co-ordinated research project 1998-2001

    International Nuclear Information System (INIS)

    2002-03-01

    The safe operation of nuclear power plants around the world and the prevention of incidents in these installations remain key concerns for the nuclear community. In this connection, the feedback of operating experience plays a major role: every nuclear power plant or nuclear utility needs to have a system in place for collecting information on unusual events, whether these are incidents or merely deviations from normal operation. Reporting to the regulatory body of important events and lessons learned is normally carried out through the national reporting schemes based on regulatory reporting requirements. The most important lessons learned are further shared internationally, through, for example, the Joint IAEA/NEA Incident Reporting System (IRS) or the event information exchange of the World Association of Nuclear Operators (WANO). In order to properly assess the event, an adequate event investigation methodology has to be applied, which leads to the identification of correct root causes. Once these root causes have been ascertained, appropriate corrective actions can be established and corresponding lessons can be drawn. The overall goal of root cause analysis is the prevention of events or their recurrence and thus the overall improvement in plant safety. In 1998, the IAEA established a co-ordinated research project with the objective of exploring root cause methodologies and techniques currently in use in Member States, evaluating their strengths and limitations and developing criteria for appropriate event investigation methodologies. This report is the outcome of four years of co-ordinated research which involved 15 national and international research organizations

  18. Detailed semantic analyses of human error incidents occurring at nuclear power plant in USA (interim report). Characteristics of human error incidents occurring in the period from 1992 to 1996

    International Nuclear Information System (INIS)

    Hirotsu, Yuko; Tsuge, Tadashi; Sano, Toshiaki; Takano, Kenichi; Gouda, Hidenori

    2001-01-01

    CRIEPI has been conducting detailed analyses of all human error incidents at domestic nuclear power plants (NPPs) collected from Japanese Licensee Event Reports (LERs) using J-HPES (Japanese version of HPES) as an analysis method. Results obtained by the analyses have been stored in J-HPES database. Since 1999, human error incidents have been selected from U.S. LERs, and they are analyzed using J-HPES. In this report, the results, which classified error action, cause, and preventive measure, are summarized for U.S. human error cases occurring in the period from 1992 to 1996. It was suggested as a result of classification that the categories of error action were almost the same as those of Japanese human error cases. Therefore, problems in the process of error action and checkpoints for preventing errors will be extracted by analyzing both U.S. and domestic human error cases. It was also suggested that the interrelations between error actions, causes, and organizational factors could be identified. While taking these suggestions into consideration, we will continue to analyze U.S. human error cases. (author)

  19. Can the surgical checklist reduce the risk of wrong site surgery in orthopaedics? - can the checklist help? Supporting evidence from analysis of a national patient incident reporting system

    Directory of Open Access Journals (Sweden)

    Cleary Kevin

    2011-04-01

    Full Text Available Abstract Background Surgical procedures are now very common, with estimates ranging from 4% of the general population having an operation per annum in economically-developing countries; this rising to 8% in economically-developed countries. Whilst these surgical procedures typically result in considerable improvements to health outcomes, it is increasingly appreciated that surgery is a high risk industry. Tools developed in the aviation industry are beginning to be used to minimise the risk of errors in surgery. One such tool is the World Health Organization's (WHO surgery checklist. The National Patient Safety Agency (NPSA manages the largest database of patient safety incidents (PSIs in the world, already having received over three million reports of episodes of care that could or did result in iatrogenic harm. The aim of this study was to estimate how many incidents of wrong site surgery in orthopaedics that have been reported to the NPSA could have been prevented by the WHO surgical checklist. Methods The National Reporting and Learning Service (NRLS database was searched between 1st January 2008- 31st December 2008 to identify all incidents classified as wrong site surgery in orthopaedics. These incidents were broken down into the different types of wrong site surgery. A Likert-scale from 1-5 was used to assess the preventability of these cases if the checklist was used. Results 133/316 (42% incidents satisfied the inclusion criteria. A large proportion of cases, 183/316 were misclassified. Furthermore, there were fewer cases of actual harm [9% (12/133] versus 'near-misses' [121/133 (91%]. Subsequent analysis revealed a smaller proportion of 'near-misses' being prevented by the checklist than the proportion of incidents that resulted in actual harm; 18/121 [14.9% (95% CI 8.5 - 21.2%] versus 10/12 [83.3% (95%CI 62.2 - 104.4%] respectively. Summatively, the checklist could have been prevented 28/133 [21.1% (95%CI 14.1 - 28.0%] patient safety

  20. Police Incident Blotter (Archive)

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Police Blotter Archive contains crime incident data after it has been validated and processed to meet Uniform Crime Reporting (UCR) standards, published on a...

  1. Incidence, puberty, and fertility in 45,X/47,XXX mosaicism: Report of a patient and a literature review.

    Science.gov (United States)

    Lim, Han Hyuk; Kil, Hong Ryang; Koo, Sun Hoe

    2017-05-09

    Turner syndrome (TS), characterized by short stature and premature ovarian failure, is caused by chromosomal aberrations with total or partial loss of one of the two X chromosomes. Spontaneous puberty, menarche, and pregnancy occur in some patients depending on the abnormality of the X. Moreover, spontaneous pregnancy is uncommon (XXX karyotype is extremely rare. Previous reports have demonstrated that TS with 45,X/47,XXX is less severe than common TS due to higher occurrence of puberty (83%), menarche (57-67%), and fertility (14%) and lower occurrence of congenital anomalies (XXX mosaicism who presented with short stature. She showed mild TS phenotype including short stature but had spontaneous puberty. Based on our case and previous reports, we expect that girls with 45,X/47,XXX mosaicism may progress through puberty normally, without estrogen therapy. Therefore, it is necessary to consider specific guidelines for clinical decisions surrounding pubertal development and fertility in TS with 45,X/47,XXX karyotype. © 2017 Wiley Periodicals, Inc.

  2. A Meta-Analysis of the Incidence of Patient-Reported Dysphagia After Anterior Cervical Decompression and Fusion with the Zero-Profile Implant System.

    Science.gov (United States)

    Yang, Yi; Ma, Litai; Liu, Hao; Xu, MangMang

    2016-04-01

    Dysphagia is a well-known complication following anterior cervical surgery. It has been reported that the Zero-profile Implant System can decrease the incidence of dysphagia following surgery, however, dysphagia after anterior cervical decompression and fusion (ACDF) with the Zero-profile Implant System remains controversial. Previous studies only focus on small sample sizes. The objective of this study was to determine the incidence of dysphagia after ACDF with the Zero-profile Implant System. Studies were collected from PubMed, EMBASE, the Cochrane library and the China Knowledge Resource Integrated Database using the keywords "Zero-profile OR Zero-p) AND (dysphagia OR [swallowing dysfunction]". The software STATA (Version 13.0) was used for statistical analysis. Statistical heterogeneity across the various trials, a test of publication bias and sensitivity analysis was performed. 30 studies with a total of 1062 patients were included in this meta-analysis. The occurrence of post-operative transient dysphagia ranged from 0 to 76 % whilst the pooled incidence was 15.6 % (95 % CI, 12.6, 18.5 %). 23 studies reported no persistent dysphagia whilst seven studies reported persistent dysphagia ranging from 1 to 7 %). In summary, the present study observed a low incidence of both transient and persistent dysphagia after ACDF using the Zero-profile Implant System. Most of the dysphagia was mild and gradually decreased during the following months. Moderate or severe dysphagia was uncommon. Future randomized controlled multi-center studies and those focusing on the mechanisms of dysphagia and methods to reduce its incidence are required.

  3. Characteristics and outcomes of e-cigarette exposure incidents reported to 10 European Poison Centers: a retrospective data analysis

    Directory of Open Access Journals (Sweden)

    Constantine I. Vardavas

    2017-08-01

    Our study highlighted parameters related to e-cigarette exposure incidents in 10 EU MS, the results of which indicate that consideration should be given to the design features which may mitigate risks, thereby protecting users, non-users and especially children.

  4. Global Incidence and Mortality for Prostate Cancer: Analysis of Temporal Patterns and Trends in 36 Countries.

    Science.gov (United States)

    Wong, Martin C S; Goggins, William B; Wang, Harry H X; Fung, Franklin D H; Leung, Colette; Wong, Samuel Y S; Ng, Chi Fai; Sung, Joseph J Y

    2016-11-01

    Prostate cancer (PCa) is a leading cause of mortality and morbidity globally, but its specific geographic patterns and temporal trends are under-researched. To test the hypotheses that PCa incidence is higher and PCa mortality is lower in countries with higher socioeconomic development, and that temporal trends for PCa incidence have increased while mortality has decreased over time. Data on age-standardized incidence and mortality rates in 2012 were retrieved from the GLOBOCAN database. Temporal patterns were assessed for 36 countries using data obtained from Cancer incidence in five continents volumes I-X and the World Health Organization mortality database. Correlations between incidence or mortality rates and socioeconomic indicators (human development index [HDI] and gross domestic product [GDP]) were evaluated. The average annual percent change in PCa incidence and mortality in the most recent 10 yr according to join-point regression. Reported PCa incidence rates varied more than 25-fold worldwide in 2012, with the highest incidence rates observed in Micronesia/Polynesia, the USA, and European countries. Mortality rates paralleled the incidence rates except for Africa, where PCa mortality rates were the highest. Countries with higher HDI (r=0.58) and per capita GDP (r=0.62) reported greater incidence rates. According to the most recent 10-yr temporal data available, most countries experienced increases in incidence, with sharp rises in incidence rates in Asia and Northern and Western Europe. A substantial reduction in mortality rates was reported in most countries, except in some Asian countries and Eastern Europe, where mortality increased. Data in regional registries could be underestimated. PCa incidence has increased while PCa mortality has decreased in most countries. The reported incidence was higher in countries with higher socioeconomic development. The incidence of prostate cancer has shown high variations geographically and over time, with smaller

  5. Cancer incidence among waiters

    DEFF Research Database (Denmark)

    Reijula, Jere; Kjaerheim, Kristina; Lynge, Elsebeth

    2015-01-01

    AIMS: To study cancer risk patterns among waiters in the Nordic countries. METHODS: We identified a cohort of 16,134 male and 81,838 female waiters from Denmark, Finland, Iceland, Norway and Sweden. During the follow-up period from 1961 to 2005, we found that 19,388 incident cancer cases were...... diagnosed. Standardised incidence ratio (SIR) was defined as the observed number of cancer cases divided by the expected number, based on national age, time period and gender-specific cancer incidence rates in the general population. RESULTS: The SIR of all cancers in waiters, in the five countries combined...... INCIDENCE IN SOME CANCER SITES CAN LIKELY BE EXPLAINED BY HIGHER ALCOHOL CONSUMPTION, THE PREVALENCE OF SMOKING AND OCCUPATIONAL EXPOSURE TO TOBACCO SMOKE HOPEFULLY, THE INCIDENCE OF CANCER AMONG WAITERS WILL DECREASE IN THE FUTURE, DUE TO THE BANNING OF TOBACCO SMOKING IN RESTAURANTS AND BARS IN THE NORDIC...

  6. Report of the Two-Day National Seminar on New Directions in Higher Education, Organized by the Kerala State Higher Education Council on 12th and 13th July 2010

    Science.gov (United States)

    Praveen, C.

    2010-01-01

    This is a report of the Two-Day National Seminar on New Directions in Higher Education, organized by the Kerala State Higher Education Council on 12th and 13th July 2010. The objective of the seminar was to deliberate upon the reforms being undertaken by the Government of India in Higher Education. Reputed scholars from within and outside the…

  7. Improvement of the structure of reports of Ukrainian higher educational institutions in terms of deregulation and state authority decentralization

    Directory of Open Access Journals (Sweden)

    V.S. Ambarchian

    2015-09-01

    Full Text Available Improvement of the structure and content of financial and budgetary reports of domestic higher educational institutions, enhance of financial statements completeness in order to enable citizens to control a university activity. During the research both general scientific and specific scientific economic methods were implemented. The general methods include induction, deduction, analogy and comparison. Among specific methods of economic research grouping, table method, graphical method, method of informational and logical analysis were used. The paper characterizes legal documents which regulate the process of university financial statements preparation and presentation in different countries. Financial reports of Ukrainian, American and British universities are compared. The author determines the major directions of improvement of the structure and content of domestic university reports with the purpose of their completeness enhancing. As a result of the research performed the proper recommendations of improvement of domestic universities reporting are suggested. The author conforms the reporting information with the Managerial report which discloses the information about the reporting period achievements and the efficiency of budget resources expenditure.

  8. Age/race differences in HER2 testing and in incidence rates for breast cancer triple subtypes: a population-based study and first report.

    Science.gov (United States)

    Lund, Mary Jo; Butler, Ebonee N; Hair, Brionna Y; Ward, Kevin C; Andrews, Judy H; Oprea-Ilies, Gabriella; Bayakly, A Rana; O'Regan, Ruth M; Vertino, Paula M; Eley, J William

    2010-06-01

    Although US year 2000 guidelines recommended characterizing breast cancers by human epidermal growth factor receptor 2 (HER2), national cancer registries do not collect HER2, rendering a population-based understanding of HER2 and clinical "triple subtypes" (estrogen receptor [ER] / progesterone receptor [PR] / HER2) largely unknown. We document the population-based prevalence of HER2 testing / status, triple subtypes and present the first report of subtype incidence rates. Medical records were searched for HER2 on 1842 metropolitan Atlanta females diagnosed with breast cancer during 2003-2004. HER2 testing/status and triple subtypes were analyzed by age, race/ethnicity, tumor factors, socioeconomic status, and treatment. Age-adjusted incidence rates were calculated. Over 90% of cases received HER2 testing: 12.6% were positive, 71.7% negative, and 15.7% unknown. HER2 testing compliance was significantly better for women who were younger, of Caucasian or African-American descent, or diagnosed with early stage disease. Incidence rates (per 100,000) were 21.1 for HER2+ tumors and 27.8 for triple-negative tumors, the latter differing by race (36.3 and 19.4 for black and white women, respectively). HER2 recommendations are not uniformly adhered to. Incidence rates for breast cancer triple subtypes differ by age/race. As biologic knowledge is translated into the clinical setting eg, HER2 as a biomarker, it will be incumbent upon national cancer registries to report this information. Incidence rates cautiously extrapolate to an annual burden of 3000 and 17,000 HER2+ tumors for black and white women, respectively, and triple-negative tumors among 5000 and 16,000 respectively. Testing, rate, and burden variations warrant population-based in-depth exploration and clinical translation. (c) 2010 American Cancer Society.

  9. Librarian co-authors correlated with higher quality reported search strategies in general internal medicine systematic reviews.

    Science.gov (United States)

    Rethlefsen, Melissa L; Farrell, Ann M; Osterhaus Trzasko, Leah C; Brigham, Tara J

    2015-06-01

    To determine whether librarian and information specialist authorship was associated with better reported systematic review (SR) search quality. SRs from high-impact general internal medicine journals were reviewed for search quality characteristics and reporting quality by independent reviewers using three instruments, including a checklist of Institute of Medicine Recommended Standards for the Search Process and a scored modification of the Peer Review of Electronic Search Strategies instrument. The level of librarian and information specialist participation was significantly associated with search reproducibility from reported search strategies (Χ(2) = 23.5; P Librarian co-authored SRs had significantly higher odds of meeting 8 of 13 analyzed search standards than those with no librarian participation and six more than those with mentioned librarian participation. One-way ANOVA showed that differences in total search quality scores between all three groups were statistically significant (F2,267 = 10.1233; P librarian or information specialist co-authors are correlated with significantly higher quality reported search strategies. To minimize bias in SRs, authors and editors could encourage librarian engagement in SRs including authorship as a potential way to help improve documentation of the search strategy. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Total Quality Management in Higher Education: Clearing the Hurdles. A Survey on Strategies for Implementing Quality Management Practices in Higher Education. A GOAL/QPC Application Report.

    Science.gov (United States)

    Seymour, Daniel

    Based on a survey of Quality Management (QM) practitioners at 21 colleges, this study presents the 10 most difficult implementation hurdles to QM in higher education and a set of hurdle-clearing strategies. The hurdles are: (1) lack of time to implement QM; (2) perception that QM is something for janitorial and housing staffs but not applicable to…

  11. The Uses of Institutional Culture: Strengthening Identification and Building Brand Equity in Higher Education. ASHE Higher Education Report, Volume 31, Number 2

    Science.gov (United States)

    Toma, J. Douglas, Ed.; Dubrow, Greg, Ed.; Hartley, Matthew, Ed.

    2005-01-01

    Institutional culture matters in higher education, and universities and colleges commonly express the need to strengthen their culture. A strong culture is perceived, correctly so, to engender a needed sense of connectedness between and among the varied constituents associated with a campus. Linking organizational culture and social cohesion is…

  12. Increase of Prostate Cancer Incidence in Martinique

    Directory of Open Access Journals (Sweden)

    Dominique Belpomme

    2011-01-01

    Full Text Available Prostate cancer incidence is steadily increasing in many developed countries. Because insular populations present unique ethnic, geographical, and environmental characteristics, we analyzed the evolution of prostate cancer age-adjusted world standardized incidence rates in Martinique in comparison with that of metropolitan France. We also compared prostate cancer incidence rates, and lifestyle-related and socioeconomic markers such as life expectancy, dietary energy, and fat supply and consumption, with those in other Caribbean islands, France, UK, Sweden, and USA. The incidence rate of prostate cancer in Martinique is one of the highest reported worldwide; it is continuously growing since 1985 in an exponential mode, and despite a similar screening detection process and lifestyle-related behaviour, it is constantly at a higher level than in metropolitan France. However, Caribbean populations that are genetically close to that of Martinique have generally much lower incidence of prostate cancer. We found no correlation between prostate cancer incidence rates, life expectancy, and diet westernization. Since the Caribbean African descent-associated genetic susceptibility factor would have remained constant during the 1980–2005, we suggest that in Martinique some environmental change including the intensive use of carcinogenic organochlorine pesticides might have occurred as key determinant of the persisting highly growing incidence of prostate cancer.

  13. Self-reported whole-grain intake and plasma alkylresorcinol concentrations in combination in relation to the incidence of colorectal cancer.

    Science.gov (United States)

    Knudsen, Markus Dines; Kyrø, Cecilie; Olsen, Anja; Dragsted, Lars O; Skeie, Guri; Lund, Eiliv; Aman, Per; Nilsson, Lena M; Bueno-de-Mesquita, H B; Tjønneland, Anne; Landberg, Rikard

    2014-05-15

    Self-reported food frequency questionnaires (FFQs) have occasionally been used to investigate the association between whole-grain intake and the incidence of colorectal cancer, but the results from those studies have been inconsistent. We investigated this association using intakes of whole grains and whole-grain products measured via FFQs and plasma alkylresorcinol concentrations, a biomarker of whole-grain wheat and rye intake, both separately and in combination (Howe's score with ranks). We conducted a nested case-control study in a cohort from a research project on Nordic health and whole-grain consumption (HELGA, 1992-1998). Incidence rate ratios and 95% confidence intervals were calculated using conditional logistic regression. Plasma alkylresorcinol concentrations alone and Howe's score with ranks were inversely associated with the incidence of distal colon cancer when the highest quartile was compared with the lowest (for alkylresorcinol concentrations, incidence rate ratio = 0.34, 95% confidence interval: 0.13, 0.92; for Howe's score with ranks, incidence rate ratio = 0.35, 95% confidence interval: 0.15, 0.86). No association was observed between whole-grain intake and any colorectal cancer (colon, proximal, distal or rectum cancer) when using an FFQ as the measure/exposure variable for whole-grain intake. The results suggest that assessing whole-grain intake using a combination of FFQs and biomarkers slightly increases the precision in estimating the risk of colon or rectal cancer by reducing the impact of misclassification, thereby increasing the statistical power of the study.

  14. Seventy Years of Asthma in Italy: Age, Period and Cohort Effects on Incidence and Remission of Self-Reported Asthma from 1940 to 2010.

    Directory of Open Access Journals (Sweden)

    Giancarlo Pesce

    Full Text Available It is well known that asthma prevalence has been increasing all over the world in the last decades. However, few data are available on temporal trends of incidence and remission of asthma.To evaluate the rates of asthma incidence and remission in Italy from 1940 to 2010.The subjects were randomly sampled from the general Italian population between 1991 and 2010 in the three population-based multicentre studies: ECRHS, ISAYA, and GEIRD. Individual information on the history of asthma (age at onset, age at the last attack, use of drugs for asthma control, co-presence of hay-fever was collected on 35,495 subjects aged 20-84 and born between 1925-1989. Temporal changes in rates of asthma incidence and remission in relation to age, birth cohort and calendar period (APC were modelled using Poisson regression and APC models.The average yearly rate of asthma incidence was 2.6/1000 (3,297 new cases among 1,263,885 person-years. The incidence rates have been linearly increasing, with a percentage increase of +3.9% (95%CI: 3.1-4.5, from 1940 up to the year 1995, when the rates begun to level off. The stabilization of asthma incidence was mainly due to a decrease in the rates of atopic asthma after 1995, while non-atopic asthma has continued to increase. The overall rate of remission was 43.2/1000person-years, and it did not vary significantly across generations, but was associated with atopy, age at asthma onset and duration of the disease.After 50 years of a continuous upward trend, the rates of asthma incidence underwent a substantial stabilization in the late 90s. Despite remarkable improvements in the treatment of asthma, the rate of remission did not change significantly in the last seventy years. Some caveats are required in interpreting our results, given that our estimates are based on self-reported events that could be affected by the recall bias.

  15. Incidents analysis

    International Nuclear Information System (INIS)

    Francois, P.

    1996-01-01

    We undertook a study programme at the end of 1991. To start with, we performed some exploratory studies aimed at learning some preliminary lessons on this type of analysis: Assessment of the interest of probabilistic incident analysis; possibility of using PSA scenarios; skills and resources required. At the same time, EPN created a working group whose assignment was to define a new approach for analysis of incidents on NPPs. This working group gave thought to both aspects of Operating Feedback that EPN wished to improve: Analysis of significant incidents; analysis of potential consequences. We took part in the work of this group, and for the second aspects, we proposed a method based on an adaptation of the event-tree method in order to establish a link between existing PSA models and actual incidents. Since PSA provides an exhaustive database of accident scenarios applicable to the two most common types of units in France, they are obviously of interest for this sort of analysis. With this method we performed some incident analyses, and at the same time explores some methods employed abroad, particularly ASP (Accident Sequence Precursor, a method used by the NRC). Early in 1994 EDF began a systematic analysis programme. The first, transient phase will set up methods and an organizational structure. 7 figs

  16. Incidents analysis

    Energy Technology Data Exchange (ETDEWEB)

    Francois, P

    1997-12-31

    We undertook a study programme at the end of 1991. To start with, we performed some exploratory studies aimed at learning some preliminary lessons on this type of analysis: Assessment of the interest of probabilistic incident analysis; possibility of using PSA scenarios; skills and resources required. At the same time, EPN created a working group whose assignment was to define a new approach for analysis of incidents on NPPs. This working group gave thought to both aspects of Operating Feedback that EPN wished to improve: Analysis of significant incidents; analysis of potential consequences. We took part in the work of this group, and for the second aspects, we proposed a method based on an adaptation of the event-tree method in order to establish a link between existing PSA models and actual incidents. Since PSA provides an exhaustive database of accident scenarios applicable to the two most common types of units in France, they are obviously of interest for this sort of analysis. With this method we performed some incident analyses, and at the same time explores some methods employed abroad, particularly ASP (Accident Sequence Precursor, a method used by the NRC). Early in 1994 EDF began a systematic analysis programme. The first, transient phase will set up methods and an organizational structure. 7 figs.

  17. Modified A{sup ++}-standard refrigerator with 30% reduction of energy consumption. Higher efficiency by compressor modification - Final report

    Energy Technology Data Exchange (ETDEWEB)

    Siegrist, M.; Stahl, S.; Ganz, J.

    2010-06-15

    This final report for the Swiss Federal Office of Energy (SFOE) takes a look at how a modified refrigerator can be given a higher efficiency by modifying the compressor. The modified refrigerator was fitted with a variable-speed compressor. This compressor could be run at much lower speeds so that it was in operation for up to 90% of the time. It was shown that less electricity was consumed the more the compressor ran. The report discusses the aims of the work and presents details on the standard refrigerator used for the tests. The compressor normally used and the variable-speed compressor used in the test are described. Systems for temperature control and data acquisition during the tests are described. The results obtained are examined and the influence of various factors is discussed.

  18. Dietary intake of fiber, fruit and vegetables decreases the risk of incident kidney stones in women: A women's health initiative report

    OpenAIRE

    Sorensen, MD; Hsi, RS; Chi, T; Shara, N; Wactawski-Wende, J; Kahn, AJ; Wang, H; Hou, L; Stoller, ML

    2014-01-01

    © 2014 American Urological Association Education and Research, Inc. Results Mean age of the women was 64±7 years, 85% were white and 2,937 (3.5%) experienced a kidney stone in a median followup of 8 years. In women with no history of kidney stones higher total dietary fiber (6% to 26% decreased risk, p < 0.001), greater fruit intake (12% to 25% decreased risk, p < 0.001) and greater vegetable intake (9% to 22% decreased risk, p=0.002) were associated with a decreased risk of incident kidney...

  19. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State.

    Science.gov (United States)

    Kohler, Betsy A; Sherman, Recinda L; Howlader, Nadia; Jemal, Ahmedin; Ryerson, A Blythe; Henry, Kevin A; Boscoe, Francis P; Cronin, Kathleen A; Lake, Andrew; Noone, Anne-Michelle; Henley, S Jane; Eheman, Christie R; Anderson, Robert N; Penberthy, Lynne

    2015-06-01

    The American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and North American Association of Central Cancer Registries (NAACCR) collaborate annually to produce updated, national cancer statistics. This Annual Report includes a focus on breast cancer incidence by subtype using new, national-level data. Population-based cancer trends and breast cancer incidence by molecular subtype were calculated. Breast cancer subtypes were classified using tumor biomarkers for hormone receptor (HR) and human growth factor-neu receptor (HER2) expression. Overall cancer incidence decreased for men by 1.8% annually from 2007 to 2011 [corrected]. Rates for women were stable from 1998 to 2011. Within these trends there was racial/ethnic variation, and some sites have increasing rates. Among children, incidence rates continued to increase by 0.8% per year over the past decade while, like adults, mortality declined. HR+/HER2- breast cancers, the subtype with the best prognosis, were the most common for all races/ethnicities with highest rates among non-Hispanic white women, local stage cases, and low poverty areas (92.7, 63.51, and 98.69 per 100000 non-Hispanic white women, respectively). HR+/HER2- breast cancer incidence rates were strongly, positively correlated with mammography use, particularly for non-Hispanic white women (Pearson 0.57, two-sided P < .001). Triple-negative breast cancers, the subtype with the worst prognosis, were highest among non-Hispanic black women (27.2 per 100000 non-Hispanic black women), which is reflected in high rates in southeastern states. Progress continues in reducing the burden of cancer in the United States. There are unique racial/ethnic-specific incidence patterns for breast cancer subtypes; likely because of both biologic and social risk factors, including variation in mammography use. Breast cancer subtype analysis confirms the capacity of cancer registries to adjust national collection

  20. Evaluation of tuberculosis cases occurring in ten outlying cities and reported in the Entorno region of the state of Goiás and reported in the neighboring Federal District: analysis of the incidence of tuberculosis in those cites.

    Science.gov (United States)

    Moreira, Maria Auxiliadora Carmo; Bello, Aline Sampaio; Alves, Maristela dos Reis Luz; Silva, Miramar Vieira da; Lorusso, Vincenza

    2007-01-01

    To evaluate tuberculosis cases occurring in the greater metropolitan area of the Distrito Federal (MADF, encompassing the Federal District, i.e., the national capital of Brasília, located in the state of Goiás) but reported in Brasília itself and to analyze the influence that this has on the effectiveness of the tuberculosis control program, as well as on the collection of socioeconomic and demographic data related to tuberculosis incidence rates. Rates of tuberculosis incidence, cure, noncompliance, treatment failure, mortality, and referral, as well as socioeconomic and demographic data, were reviewed for patients from ten MADF cities. From 2000 to 2004, 714 new cases of tuberculosis were reported in the cities studied, 436 (61%) of which were treated in Brasília and were therefore not included in the Goiás database. Among patients treated only in the MADF cities studied, the mean incidence of tuberculosis ranged from 4.40 to 10.02/100,000 inhabitants. When those treated in Brasília were included, the incidence significantly increased, ranging from 15.16 to 20.54/100,000 inhabitants (p < 0.001). The rate at which contacts of tuberculosis patients were investigated was low, and treatment outcomes were unsatisfactory in the MADF cities studied and in Brasília. Socioeconomic and demographic data were consistent with the tuberculosis incidence. The number of tuberculosis patients treated in the city in which they resided was lower than expected. Treatment in another city might impair tuberculosis control. The recalculated tuberculosis incidence is consistent with the socioeconomic and demographic profile of the region. A federal surveillance system could be efficiently optimized, improving the control of this disease.

  1. A Decade of Child-Initiated Family Violence: Comparative Analysis of Child-Parent Violence and Parricide Examining Offender, Victim, and Event Characteristics in a National Sample of Reported Incidents, 1995-2005

    Science.gov (United States)

    Walsh, Jeffrey A.; Krienert, Jessie L.

    2009-01-01

    This article examines 11 years (1995-2005) of National Incident Based Reporting System data comparing victim, offender, and incident characteristics for two types of child-initiated family violence: child-parent violence (CPV) and parricide. The objective is to better understand the victim-offender relationship for CPV and parricide and to…

  2. Higher Education.

    Science.gov (United States)

    Hendrickson, Robert M.

    This chapter reports 1982 cases involving aspects of higher education. Interesting cases noted dealt with the federal government's authority to regulate state employees' retirement and raised the questions of whether Title IX covers employment, whether financial aid makes a college a program under Title IX, and whether sex segregated mortality…

  3. Acute cerebrovascular incident in a young woman: Venous or arterial stroke? – Comparative analysis based on two case reports

    International Nuclear Information System (INIS)

    Sleiman, Katarzyna; Zimny, Anna; Kowalczyk, Edyta; Sąsiadek, Marek

    2013-01-01

    Cerebrovascular diseases are the most common neurological disorders. Most of them are arterial strokes, mainly ischemic, less often of hemorrhagic origin. Changes in the course of cerebral venous thrombosis are less common causes of acute cerebrovascular events. Clinical and radiological presentation of arterial and venous strokes (especially in emergency head CT) may pose a diagnostic problem because of great resemblance. However, the distinction between arterial and venous stroke is important from a clinical point of view, as it carries implications for the treatment and determinates patient’s prognosis. In this article, we present cases of two young women (one with an acute venous infarction, the second with an arterial stroke) who presented with similar both clinical and radiological signs of acute vascular incident in the cerebral cortex. We present main similarities and differences between arterial and venous strokes regarding the etiology, clinical symptoms and radiological appearance in various imaging techniques. We emphasize that thorough analysis of CT (including cerebral vessels), knowledge of symptoms and additional clinical information (e.g. risk factors) may facilitate correct diagnosis and allow planning further diagnostic imaging studies. We also emphasize the importance of MRI, especially among young people, in the differential diagnosis of venous and arterial infarcts

  4. Cancer, coronary artery disease and smoking: a preliminary report on differences in incidence between Seventh-day Adventists and others.

    Science.gov (United States)

    WYNDER, E L; LEMON, F R

    1958-10-01

    A study was made of the incidence of certain types of disease among Seventh-day Adventists, a religious group of special interest because they refrain from smoking and drinking. Epidermoid cancer of the lung, previously shown to be related to smoking, was 10 times less common among Seventh-day Adventists than among the general population, even among those Seventh-day Adventists living in the Los Angeles area where all are exposed to smog. Similarly, cancers of the mouth, larynx, and esophagus, previously shown to be related not only to smoking but also to heavy drinking, were at least 10 times less common among Seventh-day Adventist men than among men of the general population. All other types of cancer, with the exception of cancer of the bladder and cervix, occurred among Seventh-day Adventists with the same frequency as in the general population. The latter occurred slightly less than in the general population. Myocardial infarction in Seventh-day Adventist males was less frequent and occurred at a later age than among males in the general population; while the age distribution of the disease among the Seventh-day Adventist females was similar to that of females in the general population.

  5. Tuberculosis incidence in prisons: a systematic review.

    Science.gov (United States)

    Baussano, Iacopo; Williams, Brian G; Nunn, Paul; Beggiato, Marta; Fedeli, Ugo; Scano, Fabio

    2010-12-21

    Transmission of tuberculosis (TB) in prisons has been reported worldwide to be much higher than that reported for the corresponding general population. A systematic review has been performed to assess the risk of incident latent tuberculosis infection (LTBI) and TB disease in prisons, as compared to the incidence in the corresponding local general population, and to estimate the fraction of TB in the general population attributable (PAF%) to transmission within prisons. Primary peer-reviewed studies have been searched to assess the incidence of LTBI and/or TB within prisons published until June 2010; both inmates and prison staff were considered. Studies, which were independently screened by two reviewers, were eligible for inclusion if they reported the incidence of LTBI and TB disease in prisons. Available data were collected from 23 studies out of 582 potentially relevant unique citations. Five studies from the US and one from Brazil were available to assess the incidence of LTBI in prisons, while 19 studies were available to assess the incidence of TB. The median estimated annual incidence rate ratio (IRR) for LTBI and TB were 26.4 (interquartile range [IQR]: 13.0-61.8) and 23.0 (IQR: 11.7-36.1), respectively. The median estimated fraction (PAF%) of tuberculosis in the general population attributable to the exposure in prisons for TB was 8.5% (IQR: 1.9%-17.9%) and 6.3% (IQR: 2.7%-17.2%) in high- and middle/low-income countries, respectively. The very high IRR and the substantial population attributable fraction show that much better TB control in prisons could potentially protect prisoners and staff from within-prison spread of TB and would significantly reduce the national burden of TB. Future studies should measure the impact of the conditions in prisons on TB transmission and assess the population attributable risk of prison-to-community spread. Please see later in the article for the Editors' Summary.

  6. Integrated Incident Management System (IIMS) web client application development, deployment and evaluation Staten Island (SI) demonstration project : final report.

    Science.gov (United States)

    2015-09-27

    This evaluation report provides background on the development and findings. The aim of the UTRC project was to develop and : deploy Portable IIMS based on Smartphone web applications. Previously, traditional IIMS was deployed in the field vehicles : ...

  7. Examining the Relationship between Economic Hardship and Child Maltreatment Using Data from the Ontario Incidence Study of Reported Child Abuse and Neglect-2013 (OIS-2013

    Directory of Open Access Journals (Sweden)

    Rachael Lefebvre

    2017-02-01

    Full Text Available There is strong evidence that poverty and economic disadvantage are associated with child maltreatment; however, research in this area is underdeveloped in Canada. The purpose of this paper is to examine the relationship between economic hardship and maltreatment for families and children identified to the Ontario child protection system for a maltreatment concern. Secondary analyses of the Ontario Incidence Study of Reported Child Abuse and Neglect-2013 (OIS-2013 were conducted. The OIS-2013 examines the incidence of reported maltreatment and the characteristics of children and families investigated by child welfare authorities in Ontario in 2013. Descriptive and bivariate chi-square analyses were conducted in addition to a logistic regression predicting the substantiation of maltreatment. In 9% of investigations, the household had run out of money for food, housing, and/or utilities in the past 6 months. Children in these households were more likely to have developmental concerns, academic difficulties, and caregivers with mental health concerns and substance use issues. Controlling for key clinical and case characteristics, children living in families facing economic hardship were almost 2 times more likely to be involved in a substantiated maltreatment investigation (OR = 1.91, p < 0.001. The implications in regard to future research and promoting resilience are discussed.

  8. Higher Drop in Speed during a Repeated Sprint Test in Soccer Players Reporting Former Hamstring Strain Injury

    Science.gov (United States)

    Røksund, Ola D.; Kristoffersen, Morten; Bogen, Bård E.; Wisnes, Alexander; Engeseth, Merete S.; Nilsen, Ann-Kristin; Iversen, Vegard V.; Mæland, Silje; Gundersen, Hilde

    2017-01-01

    Aim: Hamstring strain injury is common in soccer. The aim of this study was to evaluate the physical capacity of players who have and have not suffered from hamstring strain injury in a sample of semi-professional and professional Norwegian soccer players in order to evaluate characteristics and to identify possible indications of insufficient rehabilitation. Method: Seventy-five semi-professional and professional soccer players (19 ± 3 years) playing at the second and third level in the Norwegian league participated in the study. All players answered a questionnaire, including one question about hamstring strain injury (yes/no) during the previous 2 years. They also performed a 40 m maximal sprint test, a repeated sprint test (8 × 20 m), a countermovement jump, a maximal oxygen consumption (VO2max) test, strength tests and flexibility tests. Independent sample t-tests were used to evaluate differences in the physical capacity of the players who had suffered from hamstring strain injury and those who had not. Mixed between-within subject's analyses of variance was used to compare changes in speed during the repeated sprint test between groups. Results: Players who reported hamstring strain injury during the previous two years (16%) had a significantly higher drop in speed (0.07 vs. 0.02 s, p = 0.007) during the repeated sprint test, compared to players reporting no previous hamstring strain injury. In addition, there was a significant interaction (groups × time) (F = 3.22, p = 0.002), showing that speed in the two groups changed differently during the repeated sprint test. There were no significant differences in relations to age, weight, height, body fat, linear speed, countermovement jump height, leg strength, VO2max, or hamstring flexibility between the groups. Conclusion: Soccer players who reported hamstring strain injury during the previous 2 years showed significant higher drop in speed during the repeated sprint test compared to players with no hamstring

  9. Incidence rates and risk factors for owner-reported adverse events following vaccination of dogs that did or did not receive a Leptospira vaccine.

    Science.gov (United States)

    Yao, Peng Ju; Stephenson, Nicole; Foley, Janet E; Toussieng, Chuck R; Farver, Thomas B; Sykes, Jane E; Fleer, Katryna A

    2015-11-15

    To determine incidence rates (IRs) and potential risk factors for owner-reported adverse events (AEs) following vaccination of dogs that did or did not receive a Leptospira vaccine. Observational, retrospective cohort study. 130,557 dogs. Electronic records of mobile veterinary clinics from June 2012 to March 2013 were searched to identify dogs that received ≥ 1 vaccine in a given visit. Signalment data, vaccinations received, medications administered, and owner-reported clinical signs consistent with AEs that developed ≤ 5 days after vaccination were recorded. Associations between potential risk factors and owner-reported AEs were evaluated by logistic regression analysis. The IR/10,000 dogs for owner-reported postvaccination AEs was 26.3 (95% CI, 23.6 to 29.2), whereas that for dogs that received a Leptospira vaccine alone or with other vaccines was 53.0 (95% CI, 42.8 to 64.9). Significant factors for increasing or decreasing risk of AEs were as follows: receiving a Leptospira vaccine (adjusted OR, 2.13), age at vaccination 1 to dogs), and IRs for these events did not differ significantly between dogs vaccinated with or without a Leptospira component. The overall IR for owner-reported postvaccination AEs was low. Results suggested vaccination against Leptospira (an organism that can cause fatal disease) is safe in the majority of cases, slightly increasing the risk of owner-reported AEs but not associated with a significant increase in hypersensitivity reactions, compared with other vaccinations administered.

  10. Emergency preparedness incident response and radiation monitoring in Finland. Annual report 1998; Valmiustapahtumat ja valtakunnallinen saeteilyvalvonta. Vuosiraportti 1998

    Energy Technology Data Exchange (ETDEWEB)

    Ristonmaa, S. [ed.

    1999-03-01

    The Radiation and Nuclear Safety Authority (STUK) publishes annually a report about STUK's preparedness measures. The report describes notifications received by STUK's on duty system and further measures carried out after receiving a message. In addition, the emergence exercises STUK participated in during the year are described. The radiation situation in Finland is continuously monitored. STUK is the authority who carries out a wide range of environmental measurements, sampling and sensitive laboratory analyses. The measurement results are presented in the form of tables and graphically. (editor)

  11. Emergency preparedness incident response and radiation monitoring in Finland. Annual report 1999; Valmiustapahtumat ja saeteilyvalvonta. Vuosiraportti 1999

    Energy Technology Data Exchange (ETDEWEB)

    Ristonmaa, S. [ed.

    2000-04-01

    The Radiation and Nuclear Safety Authority (STUK) publishes annually a report about STUK's preparedness measures. The report describes notifications received by STUK's on duty system and further measures carried out after receiving a message. In addition, the emergence exercises STUK participated in during the year are described. The radiation situation in Finland is continuously monitored. STUK is the authority who carries out a wide range of environmental measurements, sampling and sensitive laboratory analyses. The measurement results are presented in the form of tables and graphically. (editor)

  12. Survey of reportable incidents in nuclear power plant in the Federal Republic of Germany. Period covered: 4th quarter 1992

    International Nuclear Information System (INIS)

    1993-01-01

    There was no radioactivity release exceeding the limits set by law, and there was no hazard to man or the environment in the period under review. 58 events reported belonged to the lowest reporting category, N (normal notification), one event to category E (immediate notification, and there was none belonging to category S (emergency) notification. According to the INES evaluation scale, 56 events belonged to category 0, (no safety or radiological impact), and there were 3 events of INES scale 1 (malfunction). (orig./HP) [de

  13. Comparison of the incidence of patient-reported post-operative dysphagia between ACDF with a traditional anterior plate and artificial cervical disc replacement.

    Science.gov (United States)

    Yang, Yi; Ma, Litai; Liu, Hao; Liu, Yilian; Hong, Ying; Wang, Beiyu; Ding, Chen; Deng, Yuxiao; Song, Yueming; Liu, Limin

    2016-09-01

    Compared with anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR) has provided satisfactory clinical results. The incidence of post-operative dysphagia between ACDF with a traditional anterior plate and CDR remains controversial. Considering the limited studies and knowledge in this area, a retrospective study focusing on post-operative dysphagia was conducted. The Bazaz grading system was used to assess the severity of dysphagia at post-operative intervals including 1 week, 1 month, 3 months, 6 months, 12 months and 24 months respectively. The Chi-square test, Student t-test, Mann-Whitney U tests and Ordinal Logistic regression were used for data analysis when appropriate. Statistical significance was accepted at a probability value of dysphagia in the CDR and plate group were 36.58% and 60.43% at one week, 29.27% and 38.85% at one month, 21.95% and 31.65% at three months, 6.83% and 17.99% at six months, 5.85% and 14.39% at 12 months, and 4.39% and 10.07% at the final follow-up respectively (All Pdysphagia (all Pdysphagia. Female patients, two-level surgery, C4/5 surgery and anterior cervical plating were associated with a higher incidence of dysphagia. Future prospective, randomized, controlled studies are needed to further validate these findings. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Prevalence of Skin Tears in Elderly Patients: A Retrospective Chart Review of Incidence Reports in 6 Long-term Care Facilities.

    Science.gov (United States)

    Hawk, Joyce; Shannon, Mary

    2018-04-01

    The incidence and prevalence of skin tears in long-term care (LTC) facilities has not been well established. To ascertain the point prevalence of reported skin tears, a retrospective review of incident reports was performed in 6 LTC facilities in western Pennsylvania from November 1, 2016 through December 31, 2016. Report data, including resident age; gender; mobility limitations; skin tear location, number, and cause (if known); occurrence time (7 am to 3 pm, 3 pm to 11 pm, or 11 pm to 7 am nursing shift); and history of previous skin tears, were abstracted. All data were entered into a statistical analysis program and analyzed using descriptive statistics. Period prevalence was used to determine prevalence rate; an independent t test was used to compare the presence of skin tears between genders. Differences between location and cause of skin tears were evaluated using a multinomial test of related proportions. A test of proportions was used to evaluate skin tear occurrence time (nursing shift) differences. The overall point prevalence rate was 9% (N = 1253 residents) ranging from 6 to 28 skin tears per facility. The average age of residents with a skin tear (n = 119) was 83.5 years. The majority (111, 93%) had mobility limitations. Falls accounted for 38 skin tears (31.9%), followed by propelling in a wheelchair (18, 15.1%; X2 =7.14; P = .008). Forearm skin tears (37, 31.1%) occurred significantly more frequently than lower leg skin tears (19, 16%; P = .016). Significantly more skin tears occurred during the 7 am to 3 pm shift (47, 39.5%) and 3 pm to 11 pm shift (49, 41.2%) than during the 11 pm to 7 am shift (23, 19.3%; X2 = 5.78; P skin tears are a significant problem among elderly residents in LTC, especially because the reported rate is likely lower than the actual rate. Research to further elucidate the incidence and prevalence of skin tears and associated risk factors is needed to help develop evidence-based risk assessment, classification systems

  15. Incidence of epilepsy in Ferrara, Italy.

    Science.gov (United States)

    Cesnik, Edward; Pedelini, Francesco; Faggioli, Raffaella; Monetti, Vincenza Cinzia; Granieri, Enrico; Casetta, Ilaria

    2013-12-01

    Few studies have been carried out in the same area at different times, allowing an assessment of the incidence of epilepsy (E.), including all ages, over time. The available data on temporal trend show a decrease in E. incidence in childhood and an increase in the elderly. We sought to update the incidence of E. in the province of Ferrara, where a previous study estimated an incidence rate of 33.1 per 100,000, 35.8, if standardized to the European population. Newly diagnosed patients aged up to 14 years were drawn from a community-based prospective multi-source registry, and adult onset E. cases were collected through multiple overlapping sources of case collection. Cases were included and classified according to ILAE recommendations. During the study period (2007-2008), 141 newly diagnosed cases (66 men and 75 women) living in the study area were identified. The crude incidence rate was 46.1 per 100,000 person-years (95 % CI 39.0-54.5), 35.5 (95 % CI 28.0-43.0) if adjusted to the European population. The incidence of childhood and adolescence epilepsy was 57.0 per 100,000 person-years (95 % CI 33.8-90.0), lower than that reported in our previous study, and it was 44.8 (95 % CI 37.4-53.6) for adult onset E., which is significantly higher as compared to our previous study. The overall incidence of E. in northern Italy is stable over time. We detected a significant decrease in incidence of childhood and adolescence E. and an increase in adult-onset E. The burden of epilepsy will increase as the population continues to age.

  16. Reduction of incidents in the report dosimetry using checklist; Reduccion de incidencias en el informe dosimetrico mediante checklist

    Energy Technology Data Exchange (ETDEWEB)

    Beltran Vilagrasa, M.; Saez Beltran, J.; Fa Asensio, X.; Seoane Ramallo, A.; Hermida Lopez, M.; Toribio Berruete, J.; Sanchez Hernandez, N.

    2011-07-01

    Treatment of patients with External radiation therapy is complex and composed of different stages where different professionals involved. In order to reduce the number of errors in the technical reports that the dosemeters dosimetry presented for approval to the physical, Physical Service Hospital Universitari Vail d'Hebron in Barcelona includes a checklist of clinical dosimetry. This paper describes this checklist, its effectiveness and acceptance of this by members of the team.

  17. A Rare Incidence of Breakage of tip of Micropituitary Forceps during Percutaneous Discectomy - How to Remove it: A Case Report

    Directory of Open Access Journals (Sweden)

    Sureisen M

    2015-11-01

    Full Text Available Breakage of the tip of the micropituitary forceps during spine surgery is a rare occurrence. Retrieval of the broken tip could be a challenge in minimally invasive surgeries due to limitation of access and retrieval instruments. We describe our experience in handling such a situation during percutaneous radiofrequency discectomy. The removal was attempted, without converting into open surgery, by utilising percutaneous endoscopic lumbar discectomy working cannula and guided by image intensifier. We were able to remove the fragment without any significant morbidity to the patient. This technique for removal has not been reported previously in the literature.

  18. Young adolescents who combine alcohol and energy drinks have a higher risk of reporting negative behavioural outcomes.

    Science.gov (United States)

    Holubcikova, Jana; Kolarcik, Peter; Madarasova Geckova, Andrea; Joppova, Eva; van Dijk, Jitse P; Reijneveld, Sijmen A

    2017-04-01

    To explore whether young adolescents consuming alcohol and energy drinks combined were more likely to report negative behavioural outcomes than their peers who drink only one type of these beverages or are abstinent. We analysed data on a representative sample of Slovak adolescents 8502 adolescents (mean age 13.21, 49.4 % boys) from the 2014 Health Behaviour in School-aged Children cross-sectional study. We assessed the associations of alcohol and energy drinks consumption with negative outcomes and their potential synergy, as measured by the synergy index (SI). Adolescents consuming both alcohol and energy drinks were at higher risk of negative behavioural outcomes than their peers who drank only alcohol or energy drinks or were non-consumers. Consumers of alcohol and energy drinks were highly prone to be involved in fighting-the joint association of alcohol and energy drinks consumption was greater than sum of its associations separately in relation to fighting (SI 1.49; 95 % confidence interval 1.03-2.16). Preventive strategies should aim at increasing awareness of negative behavioural outcomes-especially aggressive behaviour associated with alcohol and energy drinks consumption among young adolescents.

  19. Progress report on the influence of higher interpass temperatures on the integrity of austenitic stainless steel welded joints

    Energy Technology Data Exchange (ETDEWEB)

    Yarmuch, M.; Choi, L. [Alberta Research Council, Edmonton, AB (Canada); Armstrong, K.; Radu, I. [PCL Industrial Constructors Inc., Nisku, AB (Canada)

    2008-07-01

    This report discussed the progress of the Welding Productivity Group (TWPG) interpass temperature assessment project (ITAP). The project was initiated to evaluate the influence of interpass temperatures on the metallurgical, corrosive, and mechanical properties of austenitic stainless steel, carbon steel, and low-alloy pressure weldments. To date, the project has conducted experiments to determine if interpass temperatures in austenitic stainless steel weldments are higher than temperatures recommended by API requirements. Elevated interpass temperatures for various base materials have been evaluated. Preliminary metallurgical, mechanical, and laboratory corrosion data from 3 experiments with 304/304L and 316/316L stainless steel weldment test specimens has shown that no significant changes occur as a result of elevated interpass temperatures. Results from side bend specimens have demonstrated that elevated interpass temperatures produce acceptable weldment ductility. No intergranular cracking was observed during oxalic acid etch tests conducted for the 316/316L samples. Huey tests performed on the 304/304L specimens indicated that elevated interpass temperatures did not adversely affect the intergranular corrosion resistance of weldments with less than 3 weld passes. Huey tests performed on the 316 specimens showed a marked increase in corrosion rates and normalized weight losses. It was concluded that rates of attack correlate with the maximum interpass temperature and not the average weld metal ferrite number. 22 refs., 11 tabs., 12 figs.

  20. Higher plasma soluble Receptor for Advanced Glycation End Products (sRAGE) levels are associated with incident cardiovascular disease and all-cause mortality in type 1 diabetes: a 12-year follow-up study

    DEFF Research Database (Denmark)

    Nin, Johanna W M; Jorsal, Anders; Merces Ferreira, Isabel Maria

    2010-01-01

    To investigate the associations of plasma levels of soluble receptor for advanced glycation end products (sRAGE) with incident cardiovascular disease (CVD) and all-cause mortality in type 1 diabetes and the extent to which any such associations could be explained by endothelial and renal dysfunct......To investigate the associations of plasma levels of soluble receptor for advanced glycation end products (sRAGE) with incident cardiovascular disease (CVD) and all-cause mortality in type 1 diabetes and the extent to which any such associations could be explained by endothelial and renal...

  1. [Usefulness of local health reports to link the incidence rate of diarrhea with the quality of drinking water].

    Science.gov (United States)

    Rodriguez-Alvarez, María S; Moraña, Liliana B; Salusso, María M; Gil, José; Seghezzo, Lucas

    2018-03-20

    In this study, we analyzed the reports of the health care center located in Vaqueros (Salta, Argentina) over an 8-month period. Moreover, we determined the concentration of Escherichia coli and Giardia spp. cysts in samples from four different drinking water sources. A statistical relationship between water quality and cases of diarrhea could not be found. However, using an odds ratio calculation, it was possible to determine that one of the studied drinking water systems acts as a protection factor in cases of diarrhea. The present work provides useful information for planning preventive measures by the local health system. Copyright © 2018 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Correlates of joint child protection and police child sexual abuse investigations: results from the Canadian Incidence Study of Reported Child Abuse and Neglect-2008

    Directory of Open Access Journals (Sweden)

    L. Tonmyr

    2015-01-01

    Full Text Available Introduction: Our study examines the frequency of joint investigations by child protection workers and the police in sexual abuse investigations compared to other maltreatment types and the association of child-, caregiver-, maltreatment- and investigation-related characteristics in joint investigations, focussing specifically on investigations involving sexual abuse. Methods: We analyzed data from the Canadian Incidence Study of Reported Child Abuse and Neglect-2008 using logistic regression. Results: The data suggest that sexual abuse (55%, and then physical abuse, neglect and emotional maltreatment, are most often co-investigated. Substantiation of maltreatment, severity of maltreatment, placement in out-of-home care, child welfare court involvement and referral of a family member to specialized services was more likely when the police were involved in an investigation. Conclusion: This study adds to the limited information on correlates of joint child protection agency and police investigations. Further research is needed to determine the effectiveness of these joint investigations.

  3. Incidence of Gastric Cancer in Marrakech and Casablanca, Morocco

    International Nuclear Information System (INIS)

    Smith, B. L.; Watkins, K.; Soliman, A. S.

    2015-01-01

    Gastric cancer is the fifth most common cancer globally with over 70% of new cases occurring in developing countries. In Morocco, oncologists in Marrakech suspected higher frequency of gastric cancer compared to Casablanca, a city 150 kilometers away. This study calculated age-specific, sex-specific, and total incidence rates of gastric cancer in Marrakech and was compared to the Casablanca population-based cancer registry. Using medical records from Center Hospital University Mohammad VI and reports from 4 main private pathology laboratories in Marrakech, we identified 774 patients for the period 2008-2012. Comparison of rates showed higher age-specific incidence in Marrakech in nearly all age groups for both genders. A higher total incidence in Marrakech than in Casablanca was found with rates of 5.50 and 3.23 per 100,000, respectively. Incidence was significantly higher among males in Marrakech than males in Casablanca (7.19 and 3.91 per 100,000, resp.) and females in Marrakech compared to females in Casablanca (3.87 and 2.58 per 100,000, resp.). Future studies should address possible underestimation of gastric cancer in Marrakech, estimate incidence in other regions of Morocco, and investigate possible risk factors to explain the difference in rates.Gastric cancer is the fifth most common cancer globally with over 70% of new cases occurring in developing countries. In Morocco, oncologists in Marrakech suspected higher frequency of gastric cancer compared to Casablanca, a city 150 kilometers away. This study calculated age-specific, sex-specific, and total incidence rates of gastric cancer in Marrakech and was compared to the Casablanca population-based cancer registry. Using medical records from Center Hospital University Mohammad VI and reports from 4 main private pathology laboratories in Marrakech, we identified 774 patients for the period 2008-2012. Comparison of rates showed higher age-specific incidence in Marrakech in nearly all age groups for both

  4. Hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real‐time record review may all have a place

    Science.gov (United States)

    Olsen, Sisse; Neale, Graham; Schwab, Kat; Psaila, Beth; Patel, Tejal; Chapman, E Jane; Vincent, Charles

    2007-01-01

    Background Over the past five years, in most hospitals in England and Wales, incident reporting has become well established but it remains unclear how well reports match clinical adverse events. International epidemiological studies of adverse events are based on retrospective, multi‐hospital case record review. In this paper the authors describe the use of incident reporting, pharmacist surveillance and local real‐time record review for the recognition of clinical risks associated with hospital inpatient care. Methodology Data on adverse events were collected prospectively on 288 patients discharged from adult acute medical and surgical units in an NHS district general hospital using incident reports, active surveillance of prescription charts by pharmacists and record review at time of discharge. Results Record review detected 26 adverse events (AEs) and 40 potential adverse events (PAEs) occurring during the index admission. In contrast, in the same patient group, incident reporting detected 11 PAEs and no AEs. Pharmacy surveillance found 10 medication errors all of which were PAEs. There was little overlap in the nature of events detected by the three methods. Conclusion The findings suggest that incident reporting does not provide an adequate assessment of clinical adverse events and that this method needs to be supplemented with other more systematic forms of data collection. Structured record review, carried out by clinicians, provides an important component of an integrated approach to identifying risk in the context of developing a safety and quality improvement programme. PMID:17301203

  5. Environmental effects of ash recycling on the incidence of 137Cs in vegetation and soil. Final report

    International Nuclear Information System (INIS)

    Hoegbom, Lars; Nohrstedt, Hans-Oerjan

    2000-08-01

    Recycling of wood-ash from combustion of bio-fuel could in the future become a common practice in Swedish forestry. As a consequence of the Chernobyl radioactive fallout in 1986 large areas in central Sweden became contaminated. There is a risk that addition of wood-ash originating from these contaminated areas will increase the activity of 137 Cs in a forests if added to a non-contaminated area. We report here of measurements of 137 Cs activity in different coniferous forest compartments from seven field experiments. The activity measurements were made 5-8 years after wood-ash application. The field experiments, in a north-south transect in Sweden, have received a background activity ranging 0 - 40 kBq m -2 as a consequence of the Chernobyl fallout. The applied wood-ash had an activity ranging between 0 - 4.8 kBq kg -1 depending on origin. Samples of the various compartments, taken in autumn 1999, included samples of soil, field vegetation, needles and wood (both twigs and stem wood). The soil and the field-vegetation were analysed using a NaI detector while the samples obtained from the trees were analysed on a GeLi detector. In addition, the soil samples were also analysed for K, by extraction with 1M ammonium lactate. The highest 137 Cs activity concentration was, by far, found in the soil, the activity found in the field-layer and the trees was in general lower. At six of seven sites there were no statistically significant effects of the wood-ash application on radiation, despite the fact that the wood-ash had, at least theoretically, in one case doubled the activity. However, at one site (Vindeln), with an intermediate 137 Cs deposition (10-20 kBq m -2 ) from Chernobyl, there was a statistically significant decrease in 137 Cs activity in the soil as well as in needles and twigs at the wood-ash amended plots. This occurred despite that the wood-ash had added a considerable activity (0.63 kBq m -2 ) to the site. The same ash applied to another site also

  6. Measuring the Contribution of Higher Education to Innovation Capacity in the EU. Executive Summary of the Final Report

    Science.gov (United States)

    European Commission, 2017

    2017-01-01

    This current study is part of the actions taken aiming to analyse the links between the operations and effects of higher-education institutions on the capacity to innovate in the economies in Europe. Providing insights into the contribution of higher education to the innovative capacity of the EU economies is crucial for policy making and the…

  7. Leptospirosis in Ireland: annual incidence and exposures associated with infection.

    LENUS (Irish Health Repository)

    Garvey, P

    2013-08-05

    SUMMARY Human leptospirosis is found throughout the world, albeit with a higher incidence in tropical regions. In temperate regions it is associated with certain occupational and recreational activities. This paper reports both on the incidence of human leptospirosis in Ireland and on possible associated exposures, using leptospirosis case notification, enhanced surveillance, hospital discharge data and death registrations. Based on official notification data, there was a threefold increase in the reported incidence of leptospirosis in Ireland between 1995-1999 and 2004-2009, which appears partially to be due to improved reporting. The exposures most associated with infection were those involving contact with livestock or water-based recreational sports, in particular kayaking. Advice on prevention should continue to be targeted in the first instance at these groups. The variety of potential transmission routes reported should inform clinicians to consider leptospirosis in individuals with a compatible clinical profile who were not from occupational groups historically considered at risk.

  8. Precursor incident program at EDF

    International Nuclear Information System (INIS)

    Fourest, B.; Maliverney, B.; Rozenholc, M.; Piovesan, C.

    1998-01-01

    The precursor program was started by EDF in 1994, after an investigation of the US NRC's Accident Sequence Precursor Program. Since then, reported operational events identified as Safety Outstanding Events have been analyzed whenever possible using probabilistic methods based on PSAs. Analysis provides an estimate of the remaining protection against core damage at the time the incident occurred. Measuring the incidents' severity enables to detect incidents important regarding safety. Moreover, the most efficient feedback actions can be derived from the main accident sequences identified through the analysis. Therefore, incident probabilistic analysis provides a way to assess priorities in terms of treatment and resource allocation, and so, to implement countermeasures preventing further occurrence and development of the most significant incidents. As some incidents cannot be analyzed using this method, probabilistic analysis can only be one among the methods used to assess the nuclear power plants' safety level. Nevertheless, it provides an interesting complement to classical methods of deterministic studies. (author)

  9. Contaminated Mexican steel incident

    International Nuclear Information System (INIS)

    1985-01-01

    This report documents the circumstances contributing to the inadvertent melting of cobalt 60 (Co-60) contaminated scrap metal in two Mexican steel foundries and the subsequent distribution of contaminated steel products into the United States. The report addresses mainly those actions taken by US Federal and state agencies to protect the US population from radiation risks associated with the incident. Mexico had much more serious radiation exposure and contamination problems to manage. The United States Government maintained a standing offer to provide technical and medical assistance to the Mexican Government. The report covers the tracing of the source to its origin, response actions to recover radioactive steel in the United States, and return of the contaminated materials to Mexico. The incident resulted in significant radiation exposures within Mexico, but no known significant exposure within the United States. Response to the incident required the combined efforts of the Nuclear Regulatory Commission (NRC), Department of Energy, Department of Transportation, Department of State, and US Customs Service (Department of Treasury) personnel at the Federal level and representatives of all 50 State Radiation Control Programs and, in some instances, local and county government personnel. The response also required a diplomatic interface with the Mexican Government and cooperation of numerous commercial establishments and members of the general public. The report describes the factual information associated with the event and may serve as information for subsequent recommendations and actions by the NRC. 8 figures

  10. Poster - 27: Incident Learning Practices in Ontario

    Energy Technology Data Exchange (ETDEWEB)

    Angers, Crystal; Medlam, Gaylene; Liszewski, Brian; Simniceanu, Carina [The Ottawa Hospital Cancer Centre, Mississauga Halton/Central West Regional Cancer Center, Odette Cancer Centre, Cancer Care Ontario (Canada)

    2016-08-15

    Purpose: The Radiation Incident and Safety Committee (RISC), established and supported by Cancer Care Ontario (CCO), is responsible for advising the Provincial Head of the Radiation Treatment program on matters relating to provincial reporting of radiation incidents with the goal of improved risk mitigation. Methods: The committee is made up of Radiation Incident Leads (RILs) with representation from each of the 14 radiation medicine programs in the province. RISC routinely meets to review recent critical incidents and to discuss provincial reporting processes and future directions of the committee. Regular face to face meetings have provided an excellent venue for sharing incident learning practices. A summary of the incident learning practices across Ontario has been compiled. Results: Almost all programs in Ontario employ an incident learning committee to review incidents and identify corrective actions or process improvements. Tools used for incident reporting include: paper based reporting, a number of different commercial products and software solutions developed in-house. A wide range of classification schema (data taxonomies) are employed, although most have been influenced by national guidance documents. The majority of clinics perform root cause analyses but utilized methodologies vary significantly. Conclusions: Most programs in Ontario employ a committee approach to incident learning. However, the reporting tools and taxonomies in use vary greatly which represents a significant challenge to provincial reporting. RISC is preparing to adopt the National System for Incident Reporting – Radiation Therapy (NSIR-RT) which will standardize incident reporting and facilitate data analyses aimed at identifying targeted improvement initiatives.

  11. Poster - 27: Incident Learning Practices in Ontario

    International Nuclear Information System (INIS)

    Angers, Crystal; Medlam, Gaylene; Liszewski, Brian; Simniceanu, Carina

    2016-01-01

    Purpose: The Radiation Incident and Safety Committee (RISC), established and supported by Cancer Care Ontario (CCO), is responsible for advising the Provincial Head of the Radiation Treatment program on matters relating to provincial reporting of radiation incidents with the goal of improved risk mitigation. Methods: The committee is made up of Radiation Incident Leads (RILs) with representation from each of the 14 radiation medicine programs in the province. RISC routinely meets to review recent critical incidents and to discuss provincial reporting processes and future directions of the committee. Regular face to face meetings have provided an excellent venue for sharing incident learning practices. A summary of the incident learning practices across Ontario has been compiled. Results: Almost all programs in Ontario employ an incident learning committee to review incidents and identify corrective actions or process improvements. Tools used for incident reporting include: paper based reporting, a number of different commercial products and software solutions developed in-house. A wide range of classification schema (data taxonomies) are employed, although most have been influenced by national guidance documents. The majority of clinics perform root cause analyses but utilized methodologies vary significantly. Conclusions: Most programs in Ontario employ a committee approach to incident learning. However, the reporting tools and taxonomies in use vary greatly which represents a significant challenge to provincial reporting. RISC is preparing to adopt the National System for Incident Reporting – Radiation Therapy (NSIR-RT) which will standardize incident reporting and facilitate data analyses aimed at identifying targeted improvement initiatives.

  12. Self-reported vision impairment and incident prefrailty and frailty in English community-dwelling older adults: findings from a 4-year follow-up study.

    Science.gov (United States)

    Liljas, Ann E M; Carvalho, Livia A; Papachristou, Efstathios; De Oliveira, Cesar; Wannamethee, S Goya; Ramsay, Sheena E; Walters, Kate R

    2017-11-01

    Little is known about vision impairment and frailty in older age. We investigated the relationship of poor vision and incident prefrailty and frailty. Cross-sectional and longitudinal analyses with 4-year follow-up of 2836 English community-dwellers aged ≥60 years. Vision impairment was defined as poor self-reported vision. A score of 0 out of the 5 Fried phenotype components was defined as non-frail, 1-2 prefrail and ≥3 as frail. Participants non-frail at baseline were followed-up for incident prefrailty and frailty. Participants prefrail at baseline were followed-up for incident frailty. 49% of participants (n=1396) were non-frail, 42% (n=1178) prefrail and 9% (n=262) frail. At follow-up, there were 367 new cases of prefrailty and frailty among those non-frail at baseline, and 133 new cases of frailty among those prefrail at baseline. In cross-sectional analysis, vision impairment was associated with frailty (age-adjustedandsex-adjusted OR 2.53, 95% CI 1.95 to 3.30). The association remained after further adjustment for wealth, education, cardiovascular disease, diabetes, falls, cognition and depression. In longitudinal analysis, compared with non-frail participants with no vision impairment, non-frail participants with vision impairment had twofold increased risks of prefrailty or frailty at follow-up (OR 2.07, 95% CI 1.32 to 3.24). The association remained after further adjustment. Prefrail participants with vision impairment did not have greater risks of becoming frail at follow-up. Non-frail older adults who experience poor vision have increased risks of becoming prefrail and frail over 4 years. This is of public health importance as both vision impairment and frailty affect a large number of older adults. © 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.

  13. Adult health study report 7. noncancer disease incidence in the atomic-bomb survivors, 1958-86 (examination cycles 1-14)

    International Nuclear Information System (INIS)

    Wong F, Lennie; Yamada, Michiko; Sasaki, Hideo; Kodama, Kazunori; Akiba, Suminori; Shimaoka, Katsutaro; Hosoda, Yutaka.

    1993-08-01

    Using the longitudinal data of the Adult Health Study (AHS) cohort collected during 1958-86, we examined for the first time the relationship between exposure to ionizing radiation and the incidence of 19 selected nonmalignant disorders. Diagnoses of the diseases were based on general laboratory tests, physical examinations, and histories taken during the biennial AHS examinations. The outcomes were encoded as three-digit International Classification of Diseases codes in the AHS data base, which served as the basis for case ascertainment. Statistically significant excess risk was detected for myoma uteri, chronic hepatitis and liver cirrhosis, and thyroid disease, defined broadly as the presence of one or more of certain noncancerous thyroid conditions. The finding for myoma uteri might be additional evidence indicating that benign tumor growths are possible effects of radiation exposure. An age-at-exposure effect was detected in nonmalignant thyroid disease, with increased risk for those exposed at ages ≤ 20 yr, but not for older persons. Thus, the AHS data also suggest that the thyroid gland in young persons is more radiosensitive not only to the development of thyroid malignancies, as shown in the most recent LSS report on cancer incidence, but also possibly to the development of nonmalignant disorders. Our findings hold independent of the dose effects observed for thyroid malignancies. No significant dose-response relationships were detected in any of our cardiovascular disease endpoints. Our analysis also suggests that new occurrences of lens opacity during 1958-86 are not increased with radiation dose among the AHS participants. Our results emphasize the utility and importance of the AHS in searching for the effects of acute exposure to ionizing radiation in noncancer diseases. (J.P.N.)

  14.  Patient safety in orthopedic surgery: prioritizing key areas of iatrogenic harm through an analysis of 48,095 incidents reported to a national database of errors

    Directory of Open Access Journals (Sweden)

    Panesar SS

    2013-03-01

    Full Text Available  Sukhmeet S Panesar,1 Andrew Carson-Stevens,2 Sarah A Salvilla,1 Bhavesh Patel,3 Saqeb B Mirza,4 Bhupinder Mann51Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK; 2Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; 3National Patient Safety Agency, London, UK; 4Department of Trauma and Orthopaedic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, Hampshire, UK; 5Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury, UKBackground: With scientific and technological advances, the practice of orthopedic surgery has transformed the lives of millions worldwide. Such successes however have a downside; not only is the provision of comprehensive orthopedic care becoming a fiscal challenge to policy-makers and funders, concerns are also being raised about the extent of the associated iatrogenic harm. The National Reporting and Learning System (NRLS in England and Wales is an underused resource which collects intelligence from reports about health care error.Methods: Using methods akin to case-control methodology, we have identified a method of prioritizing the areas of a national database of errors that have the greatest propensity for harm. Our findings are presented using odds ratios (ORs and 95% confidence intervals (CIs.Results: The largest proportion of surgical patient safety incidents reported to the NRLS was from the trauma and orthopedics specialty, 48,095/163,595 (29.4%. Of those, 14,482/48,095 (30.1% resulted in iatrogenic harm to the patient and 71/48,095 (0.15% resulted in death. The leading types of errors associated with harm involved the implementation of care and on-going monitoring (OR 5.94, 95% CI 5.53, 6.38; self-harming behavior of patients in hospitals (OR 2.14, 95% CI 1.45, 3.18; and infection control (OR 1.91, 95% CI 1.69, 2.17. We analyze these data to quantify the extent and type of iatrogenic

  15. Lightning incidents in Mongolia

    Directory of Open Access Journals (Sweden)

    Myagmar Doljinsuren

    2015-11-01

    Full Text Available This is one of the first studies that has been conducted in Mongolia on the distribution of lightning incidents. The study covers a 10-year period from 2004 to 2013. The country records a human death rate of 15.4 deaths per 10 million people per year, which is much higher than that of many countries with similar isokeraunic level. The reason may be the low-grown vegetation observed in most rural areas of Mongolia, a surface topography, typical to steppe climate. We suggest modifications to Gomes–Kadir equation for such countries, as it predicts a much lower annual death rate for Mongolia. The lightning incidents spread over the period from May to August with the peak of the number of incidents occurring in July. The worst lightning affected region in the country is the central part. Compared with impacts of other convective disasters such as squalls, thunderstorms and hail, lightning stands as the second highest in the number of incidents, human deaths and animal deaths. Economic losses due to lightning is only about 1% of the total losses due to the four extreme weather phenomena. However, unless precautionary measures are not promoted among the public, this figure of losses may significantly increase with time as the country is undergoing rapid industrialization at present.

  16. [Incidence of haematological neoplasms in Castilla y León, Spain].

    Science.gov (United States)

    Rodríguez-García, José Antonio; Vázquez, Lourdes; Ramos, Fernando; Cuevas, Beatriz; Martín, Alejandro; Smucler, Alicia; Guerola, Dulce Nombre; Cantalapiedra, Alberto; Alonso, José María; Fernández, Silvia; Díez, Eva; Rodríguez, María Jesús; Calmuntia, María José; Aguilar, Carlos; Sierra, Magdalena; Gracia, José Antonio; Cebeira, María José; Cantalejo, Rosa

    2015-06-08

    We aimed to assess the incidence of haematological neoplasms (HNs) in Castilla y León (2,5 million inhabitants) and its distribution by age, gender and histological type. The epidemiological profile based on the described variables of the 10,943 HNs diagnosed during a 10-years period was analyzed, compared with other studies. The overall age-adjusted incidence was 29.4 cases/10(5) inhabitants-year, with some geographical differences. The mean age was 67.3 years, with a turning point between the 6th-7th decades of life from which there was a very significant increase of incidence. Two relevant facts where simultaneous with advancing age: decreased lymphoid neoplasms incidence and increased low degree neoplasms incidence. Lymphoid low degree neoplasms accounted for half of the registered processes, showed the greatest preference for male and reached the mode before the rest of neoplasms. Myeloid neoplasms incidence (9.5) was higher than that reported in other European registries, specially compared to southern European countries, opposite to lymphoid neoplasms incidence (20.0). A higher myeloid neoplasms incidence and lower lymphoid one than expected was observed. The turning point of incidence is between the 6th-7th decades of life, with a preference for male that decreases with age. There is an increased incidence of HNs in the area where a higher density of potentially polluting facilities is concentrated. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  17. USFA NFIRS 2013 Fire Incident & Cause Data

    Data.gov (United States)

    Department of Homeland Security — The 2013 Fire Causes & Incident data was provided by the U.S. Fire Administration’s (USFA) National Fire Data Center’s (NFDC’s) National Fire Incident Reporting...

  18. Police Incident Blotter (30 Day)

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The 30 Day Police Blotter contains the most recent initial crime incident data, updated on a nightly basis. All data is reported at the block/intersection level,...

  19. Incidence of carpal tunnel syndrome in the US military population.

    Science.gov (United States)

    Wolf, Jennifer Moriatis; Mountcastle, Sally; Owens, Brett D

    2009-09-01

    Carpal tunnel syndrome (CTS) is a common disease. Its epidemiology has been evaluated previously, mostly in regional populations or in working groups, with an incidence between 1.5 and 3.5 per 1,000 person-years. We studied this diagnosis in the US military population, with the hypothesis that this young population would have a lower incidence of CTS than previously reported in general populations. The Defense Medical Epidemiology Database notes all medical encounters for all US military personnel and maintains the number of all personnel on active duty each year. We queried the database using the International Classification of Diseases, ninth revision, code 354.0 (CTS) and analyzed the personnel presenting for initial visits for the years 1998-2006. Multivariate Poisson analysis was performed, controlling for rank, gender, age, and race. The raw incidence of CTS in the US military was 3.98 per 1,000 person-years, in a population of 12,298,088 person-years. Females had a significantly higher incidence of CTS than males, with an adjusted incidence rate ratio of 3.29. CTS incidence increased by age, with the age group > or = 40 years having a significantly higher incidence. Additionally, military rank was found to be an independent risk factor for CTS, with rates higher in senior officer and enlisted groups. This suggests that occupational requirements have an effect on CTS within the military. We showed a comparable incidence of CTS between the US military and general population, with a significantly higher female cohort with a diagnosis of CTS. Increased age and advanced rank were risk factors for CTS.

  20. Injury incidence in hip hop dance.

    Science.gov (United States)

    Ojofeitimi, S; Bronner, S; Woo, H

    2012-06-01

    Hip hop dance has rapidly become a popular international art form. There is limited information on injury patterns in this population. The purpose of this study was to determine injury incidence and patterns among three groups of hip hop dancers. Three hundred and twelve intermediate, advanced, and expert hip hop dancers were recruited at battles, dance conferences, clubs, and on dance related web sites within the United States and internationally. A Web-based survey was conducted over a 6-month period. Inclusion criteria included intermediate and advanced level dancers over the age of 13. Dancers were divided into three main categories: Breakers, Popper/Lockers, and New Schoolers. Separate analysis of variances were used to compare injury pattern differences between groups. Two hundred and thirty-two dancers reported a total of 738 injuries. Five hundred and six of these (sustained by 205 dancers) were time-loss (TL) injuries. Annual injury incidence was 237% (162% involving TL). Lower extremity injuries were 52% and upper extremity injuries 32% of total injuries. Breakers had a higher injury incidence compared with Popper/Lockers, and New Schoolers. Hip hop dancers report injury rates that are higher than other dance forms but similar to gymnastics. These dancers should be educated concerning injury prevention, biomechanics, and use of protective equipment. © 2010 John Wiley & Sons A/S.

  1. Perspectives on and obstacles to the internal reporting reform at higher education institutions – Case of Bosnia and Herzegovina, Croatia and Slovenia

    Directory of Open Access Journals (Sweden)

    Martina Dragija Kostić

    2017-01-01

    Full Text Available Higher education institutions are going through a different reform processes that differ from country to country. However, the common challenge of higher education institutions is to assure the financial sustainability and only those institutions that have stable financial structure will be able to fulfil their missions and goals in conditions of limited financial resources. One of very important preconditions for assuring financial sustainability is a high quality reporting system, providing comprehensive and detailed information about all aspects of the activities, performed by an institution of higher education and, especially, its full costs. The objective of the paper is two-fold. On the one hand, its aim is to address reform processes regarding reporting systems at higher education institutions in selected countries; Bosnia and Herzegovina, Croatia and Slovenia, and on the other hand, to highlight most important obstacles for development of efficient internal reporting systems. The empirical research was conducted in 2016 and data collection was based on the survey method. The questionnaires were sent to all public higher education institutions in Bosnia and Herzegovina, Croatia and Slovenia. The results of research have shown that, even though there is a positive perception regarding the need to improve existing internal reporting systems, there are significant differences in obstacles for development of efficient internal reporting systems in observed countries.

  2. Communication report regarding the incident on the residual heat removal system at the nuclear power plant of Civaux May 12, 1998

    International Nuclear Information System (INIS)

    Chadeyron, Philippe

    1999-01-01

    The RRA (Residual Heat Removal System) of unit I had a leak of 280 m 3 while the reactor was shutdown for a period of 5 days, for normal start up tests. The leak was caused by a crack in a weld on a pipe of 25 cm in diameter. The liquid was completely contained within the Reactor Building containment; absolutely nothing leaked outside of the Reactor Building. This incident was classified level 2 on the INES scale. The Communication Immediately following the Incident showed that the efforts towards transparency were rewarding. A few months after the incident, hindsight helps, we can say that the media management of the RRA incident on, May 12th was in the image of its technical management, that is to say well mastered, and outside of the incident itself close to perfect. Obviously, the work we did during crisis exercises reaped its rewards. What is missing to advance to the next level? Maybe a bit of psychology, to attempt to surmise what a leak of radioactive water could represent in the public's eyes as well as the Media's who ignore the 'safety culture' (back-up trains etc.) and who still have fresh in their memories the Chernobyl accident. The vital Experience Feedback we collected and that of the Nuclear Industry since it exists incident after incident, even if immeasurable progress has been made (Civaux is a good example) our technical culture remains a hinderence towards a good estimation of the emotional level that such an incident can cause. Otherwise said, we still have progress to make on measuring the impact of an incident, not on the technical consequences nor the seriousness, but on the psychological impact it may have on the public. Beyond the crisis, this incident also showed how essential it is to dare talking about incidents and Safety Culture before intervening. The intimate enemy of Nuclear Energy is above all the relative ignorance in which the population finds itself. We still have work to do

  3. Predicting Student Engagement by Disability Type at Four-Year Baccalaureate Higher Education Institutions Using Self-Reported Data

    Science.gov (United States)

    Ziswiler, Korrin M.

    2014-01-01

    The number of students with disabilities accessing higher education continues to increase, yet persistence and graduation rates for this population of students are considerably lower than those of students without disabilities. Previous research suggests that a key factor in improving post-secondary outcomes is increasing the level with which…

  4. Considering Teaching Excellence in Higher Education: 2007-2013. A Literature Review since the CHERI Report 2007. HEA Research Series

    Science.gov (United States)

    Gunn, Vicky; Fisk, Anna

    2014-01-01

    This research review explores both the research and the grey literature on university teaching excellence with a specific remit to update an earlier review, "Excellence in Teaching and Learning: a review of literature for the Higher Education Academy". Little, B., et al (2007) The two main aims are: (1) to suggest further areas of…

  5. Efficiency and Effectiveness in Higher Education: A Report by the Universities UK Efficiency and Modernisation Task Group

    Science.gov (United States)

    Universities UK, 2011

    2011-01-01

    Effectiveness, efficiency and value for money are central concerns for the higher education sector. In England, decisions made by the current Government will effect a radical change in the funding for teaching. Institutions will be managing a reduction in public funding for teaching and the transition to the new system of graduate contributions,…

  6. Incidence of and survival after subsequent cancers in carriers of pathogenic MMR variants with previous cancer : a report from the prospective Lynch syndrome database

    NARCIS (Netherlands)

    Møller, Pål; Seppälä, Toni; Bernstein, Inge; Holinski-Feder, Elke; Sala, Paola; Evans, D Gareth; Lindblom, Annika; Macrae, Finlay; Blanco, Ignacio; Sijmons, Rolf; Jeffries, Jacqueline; Vasen, Hans; Burn, John; Nakken, Sigve; Hovig, Eivind; Rødland, Einar Andreas; Tharmaratnam, Kukatharmini; de Vos Tot Nederveen Cappel, Wouter H; Hill, James; Wijnen, Juul; Jenkins, Mark; Green, Kate; Lalloo, Fiona; Sunde, Lone; Mints, Miriam; Bertario, Lucio; Pineda, Marta; Navarro, Matilde; Morak, Monika; Renkonen-Sinisalo, Laura; Frayling, Ian M; Plazzer, John-Paul; Pylvanainen, Kirsi; Genuardi, Maurizio; Mecklin, Jukka-Pekka; Möslein, Gabriela; Sampson, Julian R; Capella, Gabriel

    2016-01-01

    Objective Today most patients with Lynch syndrome (LS) survive their first cancer. There is limited information on the incidences and outcome of subsequent cancers. The present study addresses three questions: (i) what is the cumulative incidence of a subsequent cancer; (ii) in which organs do

  7. A cellular automata approach to estimate incident-related travel time on Interstate 66 in near real time : final contract report.

    Science.gov (United States)

    2010-03-01

    Incidents account for a large portion of all congestion and a need clearly exists for tools to predict and estimate incident effects. This study examined (1) congestion back propagation to estimate the length of the queue and travel time from upstrea...

  8. Association between isotretinoin use and central retinal vein occlusion in an adolescent with minor predisposition for thrombotic incidents: a case report

    Directory of Open Access Journals (Sweden)

    Labiris Georgios

    2009-02-01

    Full Text Available Abstract Introduction We report an adolescent boy with minimal pre-existing risk for thromboses who suffered central retinal vein occlusion associated with isotretinoin use for acne. To the best of our knowledge, this is the first well documented case of this association. Case presentation An otherwise healthy 17-year-old white man who was treated with systemic isotretinoin for recalcitrant acne was referred with central retinal vein occlusion in one eye. Although a detailed investigation was negative, DNA testing revealed that the patient was a heterozygous carrier of the G20210A mutation of the prothrombin gene. Despite the fact that this particular mutation is thought to represent only a minor risk factor for thromboses, it is probable that isotretinoin treatment greatly increased the risk of a vaso-occlusive incident in this patient. Conclusion Isotretinoin use may be associated with sight- and life-threatening thrombotic adverse effects even in young patients with otherwise minimal thrombophilic risk. Physicians should be aware of such potential dangers.

  9. The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system.

    Science.gov (United States)

    Mortaro, Alberto; Pascu, Diana; Zerman, Tamara; Vallaperta, Enrico; Schönsberg, Alberto; Tardivo, Stefano; Pancheri, Serena; Romano, Gabriele; Moretti, Francesca

    2015-07-01

    The role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives. An ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010. During the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population. Despite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a "learning organization" and improve both efficacy and safety of first aid care.

  10. Interim report of the DOE [Department of Energy] Type B Investigation Group: Appendix C, Oral statements about the RSI [Radiation Sterilizers, Inc.] incident

    International Nuclear Information System (INIS)

    Hultgren, R.O.

    1990-07-01

    Sometime between April 28, 1988, and June 5, 1988, a 22-inch long by 2.625-inch diameter doubly encapsulated cesium-137 irradiation source began leaking in the RSI-Decatur, Georgia, irradiation facility. By November 1988 when the source was isolated, between 7 and 8 curies (0.4 grams) leaked. This source was one of 1576 produced at Hanford to isolate the highly radioactive elements of wastes stored in single-walled tanks there. The capsule was designed for long term storage in a benign controlled pool environment on the Hanford reservation. An investigation was conducted to evaluate the cause of the incident, the management and administrative matters including leasing and licensing, the capsule design and manufacture, and the capsule qualification process. This Appendix presents transcripts of oral testimony taken during this investigation and is include as an integral part of the factual data upon which the Findings of this report are based. The transcriptions in every case were made available to the individuals involved for correction of factual misstatements and to be cleaned of verbal idiosyncrasies that detract from the meaning of the text

  11. Sex Differences in Suicide Incident Characteristics and Circumstances among Older Adults: Surveillance Data from the National Violent Death Reporting System—17 U.S. States, 2007–2009

    Directory of Open Access Journals (Sweden)

    Debra Karch

    2011-08-01

    Full Text Available Each year in the U.S. more than 7,000 adults aged 60 years and older die of suicide and as the population ages, these numbers are expected to increase. While sex is an important predictor of older adult suicide, differences between males and females are often overlooked due to low occurrence, particularly among women. The National Violent Death Reporting System (NVDRS bridges this gap by providing detailed information on older adult suicide by sex in 17 US states (covering approximately 26% of the U.S. population. NVDRS data for 2007–2009 were used to characterize male (n = 5,004 and female (n = 1,123 suicide decedents aged 60 years and older, including incident characteristics and circumstances precipitating suicide. Stratification of NVDRS data by sex shows significant differences with regard to the presence of antidepressants (19% and 45% respectively, opiates (18%, 37%, and 14 precipitating circumstances concerning mental health, interpersonal problems, life stressors and a history of suicide attempts. No differences were found for alcohol problems, suicide/other death of family or friends, non-criminal legal problems, financial problems, or disclosure of intent to take their own life. The findings of this study demonstrate the value of using comprehensive surveillance data to understand sex-specific suicide circumstances so that opportunities for targeted prevention strategies may be considered.

  12. Patient safety in primary allied health care: what can we learn from incidents in a Dutch exploratory cohort study?

    Science.gov (United States)

    van Dulmen, Simone A; Tacken, Margot A J B; Staal, J Bart; Gaal, Sander; Wensing, Michel; Nijhuis-van der Sanden, Maria W G

    2011-12-01

    Research on patient safety in allied healthcare is scarce. Our aim was to document patient safety in primary allied healthcare in the Netherlands and to identify factors associated with incidents. DESIGN AND SUBJECT: A retrospective study of 1000 patient records in a representative sample of 20 allied healthcare practices was combined with a prospective incident-reporting study. All records were reviewed by trained researchers to identify patient safety incidents. The incidents were classified and analyzed, using the Prevention and Recovery Information System for Monitoring and Analysis method. Factors associated with incidents were examined in a logistic regression analysis. In 18 out of 1000 (1.8%; 95% confidence interval: 1.0-2.6) records an incident was detected. The main causes of incidents were related to errors in clinical decisions (89%), communication with other healthcare providers (67%), and monitoring (56%). The probability of incidents was higher if more care providers had been involved and if patient records were incomplete (37% of the records). No incidents were reported in the prospective study. The absolute number of incidents was low, which could imply a low risk of harm in Dutch primary allied healthcare. Nevertheless, incompleteness of the patient records and the fact that incidents were mainly caused through human actions suggest that a focus on clinical reasoning and record keeping is needed to further enhance patient safety. Improvements in record keeping will be necessary before accurate incident reporting will be feasible and valid.

  13. Incidence of Gastric Cancer in Marrakech and Casablanca, Morocco

    Directory of Open Access Journals (Sweden)

    Brittney L. Smith

    2015-01-01

    Full Text Available Gastric cancer is the fifth most common cancer globally with over 70% of new cases occurring in developing countries. In Morocco, oncologists in Marrakech suspected higher frequency of gastric cancer compared to Casablanca, a city 150 kilometers away. This study calculated age-specific, sex-specific, and total incidence rates of gastric cancer in Marrakech and was compared to the Casablanca population-based cancer registry. Using medical records from Center Hospital University Mohammad VI and reports from 4 main private pathology laboratories in Marrakech, we identified 774 patients for the period 2008–2012. Comparison of rates showed higher age-specific incidence in Marrakech in nearly all age groups for both genders. A higher total incidence in Marrakech than in Casablanca was found with rates of 5.50 and 3.23 per 100,000, respectively. Incidence was significantly higher among males in Marrakech than males in Casablanca (7.19 and 3.91 per 100,000, resp. and females in Marrakech compared to females in Casablanca (3.87 and 2.58 per 100,000, resp.. Future studies should address possible underestimation of gastric cancer in Marrakech, estimate incidence in other regions of Morocco, and investigate possible risk factors to explain the difference in rates.

  14. Analyzing of the self reported ICT literacy level of Slovakian and Serbian Students in the higher education

    Directory of Open Access Journals (Sweden)

    Kiss Gabor

    2017-01-01

    Full Text Available The students generally use technology for communication in the European Union and outside of the Union. First of all we have to see in this research the ICT knowledge level of the students in the higher education to make decision about the application and retraining methods. It is important to know can we find any difference in ICT literacy between the Slovakian and the Serbian students to see how long is the way to finish the ICT revolution in these countries. On the other hand is it important to see which topic need more attention from the teachers in the high school to give a good knowledge for the student before they go in the higher education. We measured the ICT literacy level with a tool consisting of 15 items (Likert scaled. The data analysis was performed with SPSS software using descriptive statistics and Mann-Whitney test.

  15. Listening to victims: use of a Critical Incident Reporting System to enable adult victims of childhood sexual abuse to participate in a political reappraisal process in Germany.

    Science.gov (United States)

    Rassenhofer, Miriam; Spröber, Nina; Schneider, Thekla; Fegert, Jörg M

    2013-09-01

    Recent revelations about the scope and severity of past child sexual abuse in German institutions set off a broad public debate on this issue, and led to the establishment of a politically appointed Round Table committee and an Independent Commissioner whose mandates were to reappraise the issue and develop recommendations for future policies. A media campaign was launched to publicize the establishment of a Critical Incident Reporting System (CIRS) whereby now-adult victims of past abuse could anonymously provide testimonials and let policy makers know what issues were important to them. Respondents could either call a hotline number or communicate by mail or email. The information collected was documented and analyzed by a research team, and the results of interim reports were included in the recommendations of the Independent Commissioner and the Round Table committee. Most of the respondents described severe and repeated occurrences of childhood sexual abuse. For many, priorities were improvements in therapy and counseling services, the abolishment of the statute of limitations on prosecuting offenders, and financial compensation. Based on the recommendations of the Round Table and the Independent Commissioner, two new laws were adopted as well as an action plan and some guidelines. In addition to rules for recompensation of victims in an institutional context a fund for victims of sexual abuse in intrafamilial context was established by the Federal Government. Another effect of this process was raising societal sensitivity to the problem of child sexual abuse. The use of a CIRS enabled those directly affected by childhood sexual abuse to have some input into a political process designed to address this issue. Such an approach could have applicability in other countries or in other domains of public health and other forms of societal conflict as well. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Staff in Higher Education Salary Report: Key Findings, Trends, and Comprehensive Tables for the 2016-17 Academic Year. Overview

    Science.gov (United States)

    Bichsel, Jacqueline; McChesney, Jasper

    2017-01-01

    This year is a momentous one for College and University Professional Association for Human Resources (CUPA-HR) research. As they celebrate their 50th anniversary of collecting salary data, they are also celebrating transformations in the way data are collected for all salary surveys and in the ways these data are reported. Rather than contributing…

  17. Malaysia and the Knowledge Economy: Building a World-Class Higher Education System. Human Development Sector Reports

    Science.gov (United States)

    Regel, Omporn; Salmi, Jamil; Watkins, Alfred; Tan, Hong; Dawkins, John; Saroyan, Alenoush; Vestergaard, Jakob

    2007-01-01

    This report was prepared at the request of the Government of Malaysia (GOM) as a contribution to the long term development objectives for the university sector under the Ninth Malaysia Plan. The GOM is considering new policy directions to make the country a more competitive player in the world economy. Such a strategy will require bold innovations…

  18. Size Constancy Is Preserved but Afterimages Are Prolonged in Typical Individuals with Higher Degrees of Self-Reported Autistic Traits

    Science.gov (United States)

    Sperandio, Irene; Unwin, Katy L.; Landry, Oriane; Chouinard, Philippe A.

    2017-01-01

    Deficits in perceptual constancies from early infancy have been proposed to contribute to autism and exacerbate its symptoms (Hellendoorn et al., "Frontiers in Psychology" 6:1-16, 2015). Here, we examined size constancy in adults from the general population (N = 106) with different levels of self-reported autistic traits using an…

  19. Young adolescents who combine alcohol and energy drinks have a higher risk of reporting negative behavioural outcomes

    NARCIS (Netherlands)

    Holubcikova, Jana; Kolarcik, Peter; Geckova, Andrea Madarasova; Joppova, Eva; van Dijk, Jitse P.; Reijneveld, Sijmen A.

    To explore whether young adolescents consuming alcohol and energy drinks combined were more likely to report negative behavioural outcomes than their peers who drink only one type of these beverages or are abstinent. We analysed data on a representative sample of Slovak adolescents 8502 adolescents

  20. On the Brink: How the Recession of 2009 Will Affect Post-Secondary Education. Canadian Higher Education Report Series

    Science.gov (United States)

    Usher, Alex; Dunn, Ryan

    2009-01-01

    With the global recession in full effect, post-secondary education in Canada is about to face some very significant challenges. The purpose of this report is to outline the likely main effects of this global recession on the Canadian post-secondary education (PSE) sector, as well as suggest a series of measures that governments can take to help…

  1. Weight patterns in children with higher risk ALL: A report from the Children's Oncology Group (COG) for CCG 1961.

    Science.gov (United States)

    Withycombe, Janice S; Post-White, Janice E; Meza, Jane L; Hawks, Ria G; Smith, Lynette M; Sacks, Nancy; Seibel, Nita L

    2009-12-15

    This retrospective analysis defined and described patterns and predictors of weight change during treatment in children with acute lymphocytic leukemia (ALL) with high-risk features who received treatment on Children's Cancer Group protocol CCG 1961. Patients (1,638) were enrolled in CCG 1961 from November 1996 to May 2002. Weight was measured as BMI percent (%), specific for age and gender, and defined as 100 x ln(BMI/median BMI). By the end of treatment, 23% of children were obese (BMI >or=95%), compared with 14% at diagnosis. Children who received post-induction intensified therapy (arms C, D, SER with Doxorubicin or Idarubicin) had higher gastrointestinal toxicities and lower BMI% from consolidation through interim maintenance 1. BMI% then increased for all arms between delayed intensification and maintenance 1 or 2. Children who were of Black or Hispanic race, obese at diagnosis, or who had grade 3 or 4 pancreatitis/glucose toxicities during induction had higher BMI% throughout treatment. Children were more likely to be obese at the end of the study if they were aged 5-9 years at diagnosis or female gender. Cranial radiation was not a predictor of obesity. Successful treatment of higher risk childhood ALL was associated with obesity, independent of cranial irradiation. The beginning of maintenance therapy may be the best time to intervene with nutritional and behavioral interventions, particularly for children who are obese or aged 5-9 years at diagnosis, female, Black or Hispanic, or those with metabolic toxicities during induction. (c) 2009 Wiley-Liss, Inc.

  2. Real-time incident detection using social media data.

    Science.gov (United States)

    2016-05-09

    The effectiveness of traditional incident detection is often limited by sparse sensor coverage, and reporting incidents to emergency response systems : is labor-intensive. This research project mines tweet texts to extract incident information on bot...

  3. Invasive cancer incidence - Puerto Rico, 2007-2011.

    Science.gov (United States)

    O'Neil, Mary Elizabeth; Henley, S Jane; Singh, Simple D; Wilson, Reda J; Ortiz-Ortiz, Karen J; Ríos, Naydi Pérez; Torres Cintrón, Carlos R; Luna, Guillermo Tortolero; Zavala Zegarra, Diego E; Ryerson, A Blythe

    2015-04-17

    Cancer is a leading cause of morbidity and death in Puerto Rico. To set a baseline for identifying new trends and patterns of cancer incidence, Puerto Rico Central Cancer Registry staff and CDC analyzed data from Puerto Rico included in U.S. Cancer Statistics (USCS) for 2007-2011, the most recent data available. This is the first report of invasive cancer incidence rates for 2007-2011 among Puerto Rican residents by sex, age, cancer site, and municipality. Cancer incidence rates in Puerto Rico were compared with those in the U.S. population for 2011. A total of 68,312 invasive cancers were diagnosed and reported in Puerto Rico during 2007-2011. The average annual incidence rate was 330 cases per 100,000 persons. The cancer sites with the highest cancer incidence rates included prostate (152), female breast (84), and colon and rectum (43). Cancer incidence rates varied by municipality, particularly for prostate, lung and bronchus, and colon and rectum cancers. In 2011, cancer incidence rates in Puerto Rico were lower for all cancer sites and lung and bronchus, but higher for prostate and thyroid cancers, compared with rates within the U.S. Identifying these variations can aid evaluation of factors associated with high incidence, such as cancer screening practices, and development of targeted cancer prevention and control efforts. Public health professionals can monitor cancer incidence trends and use these findings to evaluate the impact of prevention efforts, such as legislation prohibiting tobacco use in the workplace and public places and the Puerto Rico Cessation Quitline in decreasing lung and other tobacco-related cancers.

  4. The Relationship between Reports of Psychological Capital and Reports of Job Satisfaction among Administrative Personnel at a Private Institution of Higher Education

    Science.gov (United States)

    Mello, James A.

    2012-01-01

    The purpose of this single-site case study was to investigate the relationship between administrative personnel's reports of psychological capital (Luthans, Youssef, & Avolio, 2007) and their reports of job satisfaction (Hackman & Oldham, 1980). Specifically, two surveys, the Psychological Capital Questionnaire (Luthans, Youssef, &…

  5. Student Retention Indicators Benchmark Report for Four-Year and Two-Year Institutions, 2013. Noel-Levitz Report on Undergraduate Trends in Enrollment Management. Higher Ed Benchmarks

    Science.gov (United States)

    Noel-Levitz, Inc., 2013

    2013-01-01

    This biennial report from Noel-Levitz assists colleges and universities with raising the bar on student retention and degree completion subgoals by benchmarking key predictive indicators such as term-to-term persistence and the ratio of credit hours completed vs. credit hours attempted. The report is based on a Web-based poll of campus officials…

  6. The reported incidence of man-machine interface issues in Army aviators using the Aviator's Night Vision System (ANVIS) in a combat theatre

    Science.gov (United States)

    Hiatt, Keith L.; Rash, Clarence E.

    2011-06-01

    Background: Army Aviators rely on the ANVIS for night operations. Human factors literature notes that the ANVIS man-machine interface results in reports of visual and spinal complaints. This is the first study that has looked at these issues in the much harsher combat environment. Last year, the authors reported on the statistically significant (pEnduring Freedom (OEF). Results: 82 Aircrew (representing an aggregate of >89,000 flight hours of which >22,000 were with ANVIS) participated. Analysis demonstrated high complaints of almost all levels of back and neck pain. Additionally, the use of body armor and other Aviation Life Support Equipment (ALSE) caused significant ergonomic complaints when used with ANVIS. Conclusions: ANVIS use in a combat environment resulted in higher and different types of reports of spinal symptoms and other man-machine interface issues over what was previously reported. Data from this study may be more operationally relevant than that of the peacetime literature as it is derived from actual combat and not from training flights, and it may have important implications about making combat predictions based on performance in training scenarios. Notably, Aircrew remarked that they could not execute the mission without ANVIS and ALSE and accepted the degraded ergonomic environment.

  7. The incidence of cancer and leukaemia in young people in the vicinity of the Sellafield site, West Cumbria. Further studies and an update of the situation since the publication of the report of the Black Advisory Group in 1984

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    The report discusses the incidence of cancer and leukaemia among young people living in the vicinity of Sellafield. Possible radiation effects of paternal preconception irradiation in cancer development as well as the risk involved by the general population is considered. Recommendations are provided to improve occupational safety and public health

  8. Relational stressors as predictors for repeat aggressive and self-harming incidents in child and adolescent psychiatric inpatient settings.

    Science.gov (United States)

    Ulke, Christine; Klein, Annette M; von Klitzing, Kai

    2014-01-01

    This study examined whether relational stressors such as psychosocial stressors, the therapist's absence and a change of therapist are associated with repeat aggressive or self-harming incidents in child and adolescent psychiatric inpatient care. The study data were derived from critical incident reports and chart reviews of 107 inpatients. In multinomial regression analysis, patients with repeat aggressive or self-harming incidents were compared with patients with single incidents. Results suggested that a higher number of psychosocial stressors and a change of therapist, but not the therapist's absence are predictors for repeat aggressive and self-harming incidents. There was a high prevalence of therapist's absence during both, single and repeat, incidents. Repeat aggressive incidents were common in male children and adolescents with disruptive behavior disorders. Repeat self-harming incidents were common in adolescent females with trauma-related disorders. Patients with repeat aggressive or self-harming incidents had a higher number of abnormal intrafamilial relationships and acute life events than patients with single incidents. Interventions to reduce a change of therapist should in particular target children and adolescents with a higher number of psychosocial stressors and/or a known history of traumatic relational experiences. After a first incident, patients should have a psychosocial assessment to evaluate whether additional relational support is needed.

  9. Implications of Self-Deception for Self-Reported Intrinsic and Extrinsic Motivational Dispositions and Actual Learning Performance: A Higher Order Structural Model

    Science.gov (United States)

    Hirschfeld, Robert R.; Thomas, Christopher H.; McNatt, D. Brian

    2008-01-01

    The authors explored implications of individuals' self-deception (a trait) for their self-reported intrinsic and extrinsic motivational dispositions and their actual learning performance. In doing so, a higher order structural model was developed and tested in which intrinsic and extrinsic motivational dispositions were underlying factors that…

  10. Equal Educational Opportunity Scoreboard: The Status of Black Americans in Higher Education, 1970-1979. Fourth ISEP Status Report, Part I.

    Science.gov (United States)

    Morris, Lorenzo; And Others

    This fourth report of the Institute for the Study of Educational Policy examines the status of black Americans in higher education from 1970 to 1979, with special consideration to a discussion of a basis of parity which takes into account the rapid growth of the black population and to enrollment patterns in traditionally black institutions of…

  11. Brief Report: Parent-Adolescent Informant Discrepancies of Social Skill Importance and Social Skill Engagement for Higher-Functioning Adolescents with Autism Spectrum Disorder

    Science.gov (United States)

    McMahon, Camilla M.; Solomon, Marjorie

    2015-01-01

    Parent- and adolescent-report of social skill importance and social skill engagement on the Social Skills Rating System (Gresham and Elliott in The social skills rating system, American Guidance Service, Circle Pines, 1990) were assessed in higher-functioning adolescents with Autism Spectrum Disorder (ASD). Compared to parents, adolescents…

  12. A Digest of Reports of the Carnegie Commission on Higher Education. With an Index to Recommendations and Suggested Assignments of Responsibility for Action.

    Science.gov (United States)

    Carnegie Commission on Higher Education , Berkeley, CA.

    In 21 reports issued over the span of almost six years, the Carnegie Commission on Higher Education has made available a massive resource of information for policymakers in colleges and universities, government agencies, and philanthropic and business organizations. The Commission has also offered nearly 300 individual recommendations for…

  13. The Federal Role in Meeting the Education Needs of Chicanos and Puerto Ricans with Special Emphasis on Higher Education. Final Report.

    Science.gov (United States)

    Miranda (L.) and Associates, Bethesda, MD.

    Federal efforts to meet higher educational needs of Chicanos and Puerto Ricans are analyzed in this report. As part of a study conducted by L. Miranda and Associates, 15 Federal agencies were surveyed to determine their programs and their financial commitment to Hispanic postsecondary education, and the participation of Hispanics in each agency's…

  14. Integrated Incident Management System (IIMS) web client application development, deployment and evaluation: an evaluation of a potential IIMS deployment in Western New York : final report.

    Science.gov (United States)

    2015-09-30

    Incident Management (IM) is an area of transportation management that can significantly decrease the congestion and increase the : efficiency of transportation networks in non-ideal conditions. In this study, the existing state of the Integrated Inci...

  15. Self-reported leadership styles of deans of baccalaureate and higher degree nursing programs in the United States.

    Science.gov (United States)

    Broome, Marion E

    2013-01-01

    Over the past decade there has been a lack of attention in the discipline paid to developing strong academic leaders. It is widely acknowledged that the role of the dean has shifted dramatically over the past two decades, with an increasing emphasis on interaction with and accountability to external constituencies at the university, community, and national levels. The overall purpose of this study was to investigate the self-reported leadership styles, behaviors, and experiences of deans of schools of nursing in the United States. The Multifactor Leadership Questionnaire (MLQ) was sent to 655 deans who were members of the American Association of Colleges of Nursing; 344 returned completed surveys for a return rate of 52.5%. Scores on the transformational scale (n = 321; 20 items) ranged from 2.75 to 4.0, with a mean of 3.79; transactional scores ranged from 1.3 to 4.0, with a mean of 3.3 and mode of 3.5. The passive leadership component was lowest, with a range of 0 to 3.75, mean of 1.1, and mode of 1.0. The highest scores for each dean were then examined and compared across the three components. Seventy-seven percent of the deans' highest scores fell on the transformational, 21% on the transactional, and 2% on the passive-avoidant scale. There were no significant differences in the most commonly reported leadership behaviors by gender, ethnicity, or terminal degree. Deans of nursing, compared with over 3,000 other leaders who have completed the MLQ, ranked in the 80th percentile for self-reported transformative behaviors and outcomes effectiveness. The findings from this sample, who were predominantly female, are congruent with previous research on women leaders. Recommendations for future research leadership development programs are presented. © 2013.

  16. Cyber Incidents Involving Control Systems

    Energy Technology Data Exchange (ETDEWEB)

    Robert J. Turk

    2005-10-01

    The Analysis Function of the US-CERT Control Systems Security Center (CSSC) at the Idaho National Laboratory (INL) has prepared this report to document cyber security incidents for use by the CSSC. The description and analysis of incidents reported herein support three CSSC tasks: establishing a business case; increasing security awareness and private and corporate participation related to enhanced cyber security of control systems; and providing informational material to support model development and prioritize activities for CSSC. The stated mission of CSSC is to reduce vulnerability of critical infrastructure to cyber attack on control systems. As stated in the Incident Management Tool Requirements (August 2005) ''Vulnerability reduction is promoted by risk analysis that tracks actual risk, emphasizes high risk, determines risk reduction as a function of countermeasures, tracks increase of risk due to external influence, and measures success of the vulnerability reduction program''. Process control and Supervisory Control and Data Acquisition (SCADA) systems, with their reliance on proprietary networks and hardware, have long been considered immune to the network attacks that have wreaked so much havoc on corporate information systems. New research indicates this confidence is misplaced--the move to open standards such as Ethernet, Transmission Control Protocol/Internet Protocol, and Web technologies is allowing hackers to take advantage of the control industry's unawareness. Much of the available information about cyber incidents represents a characterization as opposed to an analysis of events. The lack of good analyses reflects an overall weakness in reporting requirements as well as the fact that to date there have been very few serious cyber attacks on control systems. Most companies prefer not to share cyber attack incident data because of potential financial repercussions. Uniform reporting requirements will do much to make this

  17. Psychosocial encounters correlates with higher patient-reported functional quality of life in gynecological cancer patients receiving radiotherapy

    International Nuclear Information System (INIS)

    Fang, Penny; Tan, Kay See; Grover, Surbhi; McFadien, Mary K; Troxel, Andrea B; Lin, Lilie

    2015-01-01

    Our objective was to assess longitudinal health-related quality of life (HRQoL) in patients treated with radiotherapy for gynecologic malignancy and assess the relationship of psychosocial encounters on HRQoL. Women with gynecologic malignancy were prospectively enrolled and HRQoL assessed before, during, and after radiotherapy treatment using validated measures. Treatment and demographic information were reviewed. Mixed-effects models were used to assess changes in quality of life (QoL) over time and association of psychologist and social worker encounters with overall QoL as well as subdomains of QoL. Fifty-two women were enrolled and 41 completed at least one assessment. Fatigue (p = 0.008), nausea (p = 0.001), feeling ill (p = 0.007), and being bothered by side effects (p < 0.001) worsened on treatment with subsequent improvement. By follow-up, patients reported increased functional well-being (FWB) with significant decrease in worry (p = 0.003), increase in enjoyment of things usually done for fun (p = 0.003) and increase in contentment (p = 0.047). Twenty-three patients had at least one interaction with a social worker or psychologist during treatment. Each additional interaction was associated with a 2.12 increase in FWB score from before to after treatment (p = 0.002), and 1.74 increase from on to after treatment (p = 0.011). Additional interactions were not significantly associated with changes in overall FACT score (p = 0.056) or SWB (p = 0.305). Patient-reported HRQoL significantly worsened during radiotherapy treatment with subsequent improvement, affirming transiency of treatment-induced toxicities. Our preliminary study suggests that clinically-recommended psychological and social work interventions have potential value with respect to improving patient QoL during radiotherapy. Larger studies are needed to validate our findings

  18. Emergency department patients self-report higher patient inertia, hopelessness, and harmful lifestyle choices than community counterparts.

    Science.gov (United States)

    Joyner, JaNae; Moore, Ashley R; Mount, David L; Simmons, Debra R; Ferrario, Carlos M; Cline, David M

    2012-12-01

    Patient inertia is defined as an individual's failure to take responsibility for proactive lifestyle change and health conditions including hypertension. Generalized and hypertension-specific patient inertia factors were compared in 110 patients (48% women; 52% African American) from a Forsyth County, NC, emergency department (ED) and 104 community members (79% women; 70% African American) using the patient inertia-facilitated survey Patient Inertia-36. Statistically, more ED than community participants added salt to food at the table and consumed fast foods 5 to 7 days a week. ED patients agreed less often with health literacy questions about salt and BP. Hypertension associated Patient inertia questions asked of 45 ED and 40 community participants with a personal history of hypertension revealed a statistically higher sense of hopelessness surrounding blood pressure management in ED participants. Past BP control experiences of family members had statistically greater impact on community participants regarding their own BP control. Using a logistic regression model, advancing age and being surveyed in the ED were correlated with hopelessness towards BP control. ED patients make unhealthier diet choices and possess heightened generalized and hypertension-specific patient inertia including hopelessness towards controlling their BP that increases with age. These factors may contribute to this population's poor BP control, particularly self-efficacy barriers. © 2012 Wiley Periodicals, Inc.

  19. Review, analysis and report on the radiological consequences resulting from accidents and incidents involving radioactive materials during transport in the period 1975-1986 by and within member states of the european communities

    International Nuclear Information System (INIS)

    Lombard, J.; Ringot, C.; Tomachevsky, E.; Hughes, J.S.; Shaw, K.B.

    1990-01-01

    Radioactive materials are routinely transported throughout the European Communities, by all modes of transport. These shipments occur in accordance with comprehensive regulations and the vast majority of these shipments are made without incident. Occasionally however accidents and other incidents have occurred at various stages of transport operations and the purpose of this study was to examine the available information on events that occurred within the Communities during the years 1975 to 1986. The information was gathered from Member States' Competent Authorities and other organisations, using a questionnaire. Most of the detailed information came from the two countries carrying out the study, the UK and France. The information gathered covered many different types of event involving a wide range of materials: it is concluded that under-reporting is a major source of uncertainty in the results. Therefore, it is emphasised that care should be used in comparisons between the results for different types of transport operations, since accidents and incidents involving certain types of transport are more fully reported than others. Consequently, the authors stress the need for improved reporting and recording procedures. No evidence was found of any major health consequences resulting from the accidents and incidents studied. However, there were instances of high doses having been received by workers, mainly as a result of inadequate preparation of packages prior to despatch. These events point to the need to maintain high standards of quality assurance at all stages of transport operations

  20. Higher Childhood Peer Reports of Social Preference Mediates the Impact of the Good Behavior Game on Suicide Attempt.

    Science.gov (United States)

    Newcomer, Alison R; Roth, Kimberly B; Kellam, Sheppard G; Wang, Wei; Ialongo, Nicholas S; Hart, Shelley R; Wagner, Barry M; Wilcox, Holly C

    2016-02-01

    The Good Behavior Game (GBG) is a universal classroom-based preventive intervention directed at reducing early aggressive, disruptive behavior and improving children's social adaptation into the classroom. The GBG is one of the few universal preventive interventions delivered in early elementary school that has been shown to reduce the risk for future suicide attempts. This paper addresses one potential mechanism by which the GBG lowers the risk of later suicide attempt. In this study, we tested whether the GBG, by facilitating social adaptation into the classroom early on, including the level of social preference by classmates, thereby lowers future risk of suicide attempts. The measure of social adaptation is based on first and second grade peer reports of social preference ("which children do you like best?"; "which children don't you like?"). As part of the hypothesized meditational model, we examined the longitudinal association between childhood peer social preference and the risk of future suicide attempt, which has not previously been examined. Data were from an epidemiologically based randomized prevention trial, which tested the GBG among two consecutive cohorts of first grade children in 19 public schools and 41 classrooms. Results indicated that peer social preference partially mediated the relationship between the GBG and the associated reduction of risk for later suicide attempts by adulthood, specifically among children characterized by their first grade teacher as highly aggressive, disruptive. These results suggest that positive childhood peer relations may partially explain the GBG-associated reduction of risk for suicide attempts and may be an important and malleable protective factor for future suicide attempt.