Critical incident technique: a user's guide for nurse researchers.
Schluter, Jessica; Seaton, Philippa; Chaboyer, Wendy
2008-01-01
This paper is a description of the development and processes of the critical incident technique and its applicability to nursing research, using a recently-conducted study of the Australian nursing workforce as an exemplar. Issues are raised for consideration prior to the technique being put into practice. Since 1954, the critical incident technique has been used to study people's activities in a variety of professions. This five-step technique can be modified for specific settings and research questions. The fruitfulness of a study using the technique relies on gaining three important pieces of information. First, participants' complete and rich descriptions of the situation or event to be explored; secondly, the specific actions of the person/s involved in the event to aid understanding of why certain decisions were made; thirdly, the outcome of the event, to ascertain the effectiveness of the behaviour. As in other qualitative methodologies, an inductive analysis process can be used with the critical incident technique. Rich contextual information can be obtained using this technique. It generates information and uncovers tacit knowledge through assisting participants to describe their thought processes and actions during the event. Use of probing questions that determine how participants take part in certain events, or act in the ways they do, greatly enhances the outcome. A full interpretation of the event can only occur when all its aspects are provided. The critical incident technique is a practical method that allows researchers to understand complexities of the nursing role and function, and the interactions between nurses and other clinicians.
ERIC Educational Resources Information Center
Brunton, Margaret Ann; Jeffrey, Lynn Maud
2010-01-01
This paper presents the findings from research using the critical incident technique to identify the use of key competencies for communication management practitioners. Qualitative data was generated from 202 critical incidents reported by 710 respondents. We also present a brief summary of the quantitative data, which identified two superordinate…
Body image of patients with burns sequellae: evaluation through the critical incident technique.
Bergamasco, E C; Rossi, L A; da C G Amancio, A; de Carvalho, E C
2002-02-01
The present investigation is a descriptive study, with a retrospective, ex-post facto, design. The objectives of this study were to characterize the body image changes in patients with burn sequellae, through the critical incident technique and to identify and categorize critical incidents, comparing them to the characteristics defined by the Taxonomy of the North American Nursing Diagnoses Association (NANDA) for the body image disturbance nursing diagnosis. Thirty-five patients were interviewed. Two types of critical incidents were identified: 'facing the mirror'--the moment the patient looks at himself/herself and notices the changes in his/her body, and 'facing other people'--the moment the patient becomes aware that he/she calls the attention of others. Associated with the perceptions of changes in their bodies, the patients reported feelings of fear (19), rebellion (18) and shame (12). They also presented coping mechanisms of denial (12), rationalization (7), minimization (7) and repression (2). NANDA's body image disturbance diagnosis was identified in all patients.
ERIC Educational Resources Information Center
Hanson, James H.; Brophy, Patrick D.
2012-01-01
Not all knowledge and skills that educators want to pass to students exists yet in textbooks. Some still resides only in the experiences of practicing engineers (e.g., how engineers create new products, how designers identify errors in calculations). The critical incident technique, CIT, is an established method for cognitive task analysis. It is…
Using the critical incident technique in community-based participatory research: a case study.
Belkora, Jeffrey; Stupar, Lauren; O'Donnell, Sara
2011-01-01
Successful community-based participatory research involves the community partner in every step of the research process. The primary study for this paper took place in rural, Northern California. Collaborative partners included an academic researcher and two community based resource centers that provide supportive services to people diagnosed with cancer. This paper describes our use of the Critical Incident Technique (CIT) to conduct Community-based Participatory Research. We ask: Did the CIT facilitate or impede the active engagement of the community in all steps of the study process? We identified factors about the Critical Incident Technique that were either barriers or facilitators to involving the community partner in every step of the research process. Facilitators included the CIT's ability to accommodate involvement from a large spectrum of the community, its flexible design, and its personal approach. Barriers to community engagement included training required to conduct interviews, depth of interview probes, and time required. Overall, our academic-community partners felt that our use of the CIT facilitated community involvement in our Community-Based Participatory Research Project, where we used it to formally document the forces promoting and inhibiting successful achievement of community aims.
Critical Incidents of Student Satisfaction at German Universities
ERIC Educational Resources Information Center
Vianden, Jörg; Yakaboski, Tamara
2017-01-01
Purpose: The purpose of this paper is to advance a classification of satisfactory and unsatisfactory critical incidents of student-university relationships at German universities. Design/methodology/approach: Using the Critical Incident Technique (CIT), this paper reports the results of an exploratory study of 15 tertiary education students at…
Strömberg, A; Broström, A; Dahlström, U; Fridlund, B
1999-01-01
The aim of this study was to identify factors influencing compliance with prescribed treatment in patients with chronic heart failure. A qualitative design with a critical incident technique was used. Incidents were collected through interviews with 25 patients with heart failure strategically selected from a primary health care clinic, a medical ward, and a specialist clinic. Two hundred sixty critical incidents were identified in the interviews and 2 main areas emerged in the analysis: inward factors and outward factors. The inward factors described how compliance was influenced by the personality of the patient, the disease, and the treatment. The outward factors described how compliance was influenced by social activities, social relationships, and health care professionals. By identifying the inward and outward factors influencing patients with chronic heart failure, health care professionals can assess whether intervention is needed to increase compliance.
Norman, I J; Redfern, S J; Tomalin, D A; Oliver, S
1992-05-01
This paper discusses a development of Flanagan's critical incident technique (CIT) to elicit indicators of high and low quality nursing from patients and their nurses on medical, surgical and elderly care wards. Stages in undertaking the CIT are identified and presuppositions held by most researchers about the nature of the technique are identified. The paper describes how the authors moved to a different set of presuppositions during the course of the study. Preliminary analysis of interview transcripts revealed that critical incidents need not always be demarcated scenes with a clear beginning and end, but may arise from respondents summarizing their overall experience within their description of one incident. Characteristically respondents were unable to give a detailed account of such incidents but validity may be established by the fact that respondents appear to recount what actually happened as they saw it, and what they said was clearly important to them. The researchers found that the most appropriate basic unit of analysis was not the incident itself but 'happenings' revealed by incidents that are 'critical' by virtue of being important to respondents with respect to the quality of nursing care. The importance of CIT researchers achieving an understanding of the 'meaning' of critical happenings to respondents is emphasized. Analysis of the interview transcripts is facilitated by the use of INGRES, a relational database computer program which should enable a 'personal theory' of quality nursing for each respondent, both patients and nurses, to be described. The study suggests that the CIT is a flexible technique which may be adapted to meet the demands of nursing research. If carefully applied, the CIT seems capable of capitalizing on respondents' own stories and avoids the loss of information which occurs when complex narratives are reduced to simple descriptive categories. Patients and nurses have unique perspectives on nursing and their views are of
The Critical Incident Interview and Ethnoracial Identity.
ERIC Educational Resources Information Center
Montalvo, Frank F.
1999-01-01
Describes the critical-incident interview, a cross-cultural training technique that helps social work students assess clients' ethnic- and racial-identity development. Uses examples from student interviews to present the steps involved in teaching the technique. Includes guidelines for selecting and interviewing informants, and gives three scales…
[Patient satisfaction in hospital: critical incident technique or standardised questionnaire?].
Eckhardt-Abdulla, R; Bock, M; Bauer, M
2008-03-01
Questionnaires are usually used for the measurement of patient satisfaction, however, it is increasingly being recognized that the critical incident technique (CIT) also provides valuable insight. Questionnaires of the "Hamburger questionnaire on hospital stay" were distributed to 650 consecutive patients before discharge. Additionally 103 interviews were conducted in which the patients were asked to describe positive and negative incidents during their hospital stay. The results of both methods were then compared. A total of 369 patients returned the questionnaire and 103 patients participated in the interviews. The duration of a single interview was between 5 and 45 min with a mean of 12.7 min+/-10.1 min standard deviation (SD). Cronbach's alpha of the questionnaire was 0.9. A total of 424 incidents were reported, 301 of them were negative compared to 123 positive events. The questionnaires and interviews yielded partly similar and partly different results at category and subcategory levels concerning the areas of weaknesses and strengths in quality performance. The CIT was more concrete but did not give results for all aspects of quality. The CIT, but not the questionnaire, was able to detect 40/56 (71%) of the positive and 33/75 (44%) of the negative reports regarding medical performance and 25/42 (60%) of the positive and 15/51 (29.4%) of the negative reports of the performance of the nurses were revealed by the CIT and not by the questionnaires. The CIT gives valuable insights into the patient's perspective of strengths and weaknesses in hospital care, which might be overlooked by the questionnaire alone. However, the CIT is probably not suited for routine use because it is very time-consuming.
Students' Responses to the Critical Incident Technique: A Qualitative Perspective
ERIC Educational Resources Information Center
Ali, Mohamed A.; Zengaro, Sally; Zengaro, Franco
2016-01-01
This qualitative research reports findings on whether students' reflective writings during the course of one semester produced qualitative differences in several courses offered online and on-ground at two different universities. Eighty-six students from two universities responded to Brookfield's (1995, 1998) critical incident questionnaire.…
Altmaier, E M; From, R P; Pearson, K S; Gorbatenko-Roth, K G; Ugolini, K A
1997-12-01
To develop categories of behavior that define an applicant's aptitude for anesthesia, and to attempt to determine the relative importance of these behaviors to successful residency performance. Prospective open study. Anesthesia residencies at three midwest university teaching hospitals. Using a structured interview format known as the critical incident technique, faculty anesthesiologists were asked to describe examples of effective and ineffective behaviors observed among anesthesia residents during the twelve months prior to the interview. Interviews initially held with 34 anesthesiologists generated 172 incidents. These incidents formed the basis for a categorization analysis performed by two anesthesiologists. Six categories were developed: preparedness, interpersonal skills, response to teaching, data monitoring, technical skills, and emergency situations. Validation of these categories was confirmed with three subsequent interviews, in which 92 anesthesiologists generated 475 incidents. Most incidents were found to conform to the previously defined categories using a reallocation index with a range of 0.70 to 0.80. The category "technical skills" fell below the defined range. Over 60 percent of the incidents involved noncognitive personal attributes: preparedness, interpersonal skills, and response to teaching. Effective behavior in six categories identifies an applicant's aptitude for anesthesia. Selection of residents may be enhanced by routinely assessing noncognitive characteristics.
Robb, Meigan
2014-01-11
Engaging nursing students in the classroom environment positively influences their ability to learn and apply course content to clinical practice. Students are motivated to engage in learning if their learning preferences are being met. The methods nurse educators have used with previous students in the classroom may not address the educational needs of Millennials. This manuscript presents the findings of a pilot study that used the Critical Incident Technique. The purpose of this study was to gain insight into the teaching methods that help the Millennial generation of nursing students feel engaged in the learning process. Students' perceptions of effective instructional approaches are presented in three themes. Implications for nurse educators are discussed.
ERIC Educational Resources Information Center
Kalahar, Kory G.
2011-01-01
Student failure is a prominent issue in many comprehensive secondary schools nationwide. Researchers studying error, reliability, and performance in organizations have developed and employed a method known as critical incident technique (CIT) for investigating failure. Adopting an action research model, this study involved gathering and analyzing…
ERIC Educational Resources Information Center
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…
Unplanned extubations in an intensive care unit: Findings from a critical incident technique.
Danielis, Matteo; Chiaruttini, Simona; Palese, Alvisa
2018-05-15
Patients on mechanical ventilation are at risk of experiencing a potentially life-threatening unplanned extubation in the intensive care unit, which can lead to arrhythmias, bronchial aspiration, difficulty in reintubation or even sudden cardiac arrest. Although incidence and outcomes of the phenomenon have been documented in several quantitative studies, no studies have investigated the antecedents as experienced by critical care nurses. To gain a greater understanding of the antecedents of unplanned extubations. A qualitative study design involving the critical-incident technique. A total of 10 registered nurses who reported one or more episodes of unplanned extubations were involved in an in-depth interview. According to the nurses' experience, episodes of unplanned extubations are determined by predisposing, precipitating and mediating factors. The predisposing factors have been recognised in the (a) weaning programme (expected/unexpected decreased sedation) and in the (b) patient factors (increased needs due to discomfort, restlessness and desire to communicate). The precipitating factors have been divided into (a) organisational (failures in multi-professional communication), (b) environmental (excessive environmental chaos and barriers preventing direct surveillance) and (c) nursing care factors (ensuring privacy by creating barriers, avoiding disturbing other patients and poor nurse-to-patient ratio). Among the mediating factors, which are affected by the precipitating factors, decreased surveillance and mechanical restraints' use have been identified. Identifying risk factors of unplanned extubation, specifically those that are modifiable, such as increasing interprofessional communication, reducing excessive environment chaos, implementing strategies aimed at overcoming barriers threatening direct surveillance and ensuring appropriate nurse-to-patient ratio, can prevent the occurrence of these events. Copyright © 2018 Elsevier Ltd. All rights reserved.
Scheidegger, D
2005-03-01
In medicine real severe mishaps are rare. On the other hand critical incidents are frequent. Anonymous critical incident reporting systems allow us to learn from these mishaps. This learning process will make our daily clinical work safer Unfortunately, before these systems can be used efficiently our professional culture has to be changed. Everyone in medicine has to admit that errors do occur to see the need for an open discussion. If we really want to learn from errors, we cannot punish the individual, who reported his or her mistake. The interest is primarily in what has happened and why it has happened and not who has committed this mistake. The cause for critical incidents in medicine is in over 80% the human factor Poor communication, work under enormous stress, conflicts and hierarchies are the main cause. This has been known for many years, therefore have already 15 years ago high-tech industries, like e.g. aviation, started to invest in special courses on team training. Medicine is a typical profession were until now only the individual performance decided about the professional career Communication, conflict management, stress management, decision making, risk management, team and team resource management were subjects that have never been taught during our preor postgraduate education. These points are the most important ones for an optimal teamwork. A multimodular course designed together with Swissair (Human Aspect Development medical, HADmedical) helps to cover, as in aviation, the soft factor and behavioural education in medicine and to prepare professionals in health care to work as a real team.
Critical incidents influencing students' selection of elective science
NASA Astrophysics Data System (ADS)
Essary, Danny Ray
Purpose of the study. The purpose of the study was to investigate the critical incidents that determined high school students' self selection into and out of elective science classes. The Critical Incident Technique was used to gather data. Procedure. Subjects for study were 436 students attending five high schools within the geographical boundaries of a Northeast Texas County. Each student was enrolled in a senior level government/economics course during the spring semester of 1997. Students enrolled and in attendance during data collection procedures were subjects of the study. The subjects recorded 712 usable critical incidents. Incidents were categorized by examiners and a total of eleven incident categories emerged for analysis purposes. Incident frequencies were categorized by sample population, selectors, and nonselectors; subdivided by gender. Findings. The following categories emerged for study; (A) Mentored, (B) Requirements, (C) Personal Interest(s), (D) Level of Difficulty, (E) Time Restraints, (F) Future Concerns, (G) Grades, (H) Teacher, (I) Peer Influence, (J) Challenge, (K) Other Academic Experiences. Data were analyzed qualitatively to answer research questions and quantitatively to test hypotheses. There was an emergence of ten incident categories for nonselectors and an emergence of eleven incident categories for selectors. Of the twelve hypotheses, four failed to be rejected and eight were rejected. Conclusions. Nonselectors and selectors of elective science were influenced by various external factors. Requirements were influential for nonselectors. Nonselectors chose to select the minimum number of science classes necessary for graduation. Selectors were influenced by curriculum requirements, future concerns and mentors. Special programs that required extra science classes were influential in students' decisions to enroll in elective science. Gender differences were not influential for selectors or nonselectors of elective science.
A critical incident reporting system in anaesthesia.
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
Ekblad, Helena; Malm, Dan; Fridlund, Bengt; Conlon, Lisa; Rönning, Helén
2014-01-01
Background: The well-being of relatives of patients having chronic heart diseases (CHD) has been found to be negatively affected by the patient’s condition. Studies examining relatives of patients with atrial fibrillation (AF) indicate that their well-being may be affected in a similar manner, but further research is needed. Aim: To explore and describe critical incidents in which relatives of patients experience how AF affects their well-being and what actions they take to handle these situations. Design and method: An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 19 relatives (14 women and five men) of patients hospitalised in southern Sweden due to acute symptoms of the AF. Results: The well-being of relatives was found to be affected by their worries (patient-related health), as well as the sacri-ficing of their own needs (self-related health). In handling their own well-being, these relatives adjusted to and supported the patient (practical involvement), along with adjusting their own feelings and responding to the mood of the patients (emotional involvement). Conclusion: The well-being of relatives of patients with AF was affected depending on the patients’ well-being. In their attempt to handle their own well-being, the relatives adjusted to and supported the patients. Further research is needed in order to evaluate the effects of support to relatives and patients respectively and together. PMID:25419253
78 FR 38878 - Critical Incident Stress Plans
Federal Register 2010, 2011, 2012, 2013, 2014
2013-06-28
...-0131, Notice No. 1] RIN 2130-AC00 Critical Incident Stress Plans AGENCY: Federal Railroad... incident stress plans that provide for appropriate support services to be offered to their employees who... railroad's critical incident stress plan, the type of employees to be covered by the plan, a requirement...
Eriksson, Kerstin; Wikström, Lotta; Fridlund, Bengt; Årestedt, Kristofer; Broström, Anders
2016-04-01
Postoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients' experiences and actions could help healthcare professionals to improve pain management and could increase patients' participation in pain assessments. The aim of this study was, through an examination of critical incidents, to describe patients' experiences and actions when needing to describe pain after surgery. An explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined. Pain experiences were described according to two main areas: "Patients' resources when in need of pain assessment" and "Ward resources for performing pain assessments". Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients' ability to describe pain. Two main areas regarding actions emerged: "Patients used active strategies when needing to describe pain" and "Patients used passive strategies when needing to describe pain". Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals
Surgery resident selection and evaluation. A critical incident study.
Edwards, J C; Currie, M L; Wade, T P; Kaminski, D L
1993-03-01
This article reports a study of the process of selecting and evaluating general surgery residents. In personnel psychology terms, a job analysis of general surgery was conducted using the Critical Incident Technique (CIT). The researchers collected 235 critical incidents through structured interviews with 10 general surgery faculty members and four senior residents. The researchers then directed the surgeons in a two-step process of sorting the incidents into categories and naming the categories. The final essential categories of behavior to define surgical competence were derived through discussion among the surgeons until a consensus was formed. Those categories are knowledge/self-education, clinical performance, diagnostic skills, surgical skills, communication skills, reliability, integrity, compassion, organization skills, motivation, emotional control, and personal appearance. These categories were then used to develop an interview evaluation form for selection purposes and a performance evaluation form to be used throughout residency training. Thus a continuum of evaluation was established. The categories and critical incidents were also used to structure the interview process, which has demonstrated increased interview validity and reliability in many other studies. A handbook for structuring the interviews faculty members conduct with applicants was written, and an interview training session was held with the faculty. The process of implementation of the structured selection interviews is being documented currently through qualitative research.
Vyawahare, S; Banda, N R; Choubey, S; Parvekar, P; Barodiya, A; Dutta, S
2013-01-01
In pediatric dentistry, the experiences of dental students may help dental educators better prepare graduates to treat the children. Research suggests that student's perceptions should be considered in any discussion of their education, but there has been no systematic examination of India's undergraduate dental students learning experiences. This qualitative investigation aimed to gather and analyze information about experiences in pediatric dentistry from the students' viewpoint using critical incident technique (CIT). The sample group for this investigation came from all 240 3rd and 4th year dental students from all the four dental colleges in Indore. Using CIT, participants were asked to describe at least one positive and one negative experience in detail. They described 308 positive and 359 negative experiences related to the pediatric dentistry clinic. Analysis of the data resulted in the identification of four key factors related to their experiences: 1) The instructor; 2) the patient; 3) the learning process; and 4) the learning environment. The CIT is a useful data collection and analysis technique that provides rich, useful data and has many potential uses in dental education.
Giibinenimidizomin: Owning Ourselves--Critical Incidents in the Attainment of Aboriginal Identity
ERIC Educational Resources Information Center
Goodwill, Alanaise O.; McCormick, Rod
2012-01-01
This research explored the facilitation and hindrance of Aboriginal identity attainment and developed a scheme of categories to describe what facilitates and hinders cultural identity among Canadian Aboriginal adults living in British Columbia. Twelve individuals, interviewed using the critical incident technique, were asked to describe observable…
ERIC Educational Resources Information Center
Rutherford, R. Stanley
This paper discusses the concept of the critical incidents technique, traces its early development in the training of airplane pilots during World War II, sketches the requirements of the typical steps, notes the few studies in communication using this technique, provides an evaluation, and briefly describes a study concerning department chairmen.…
Noticing Critical Incidents in a Mathematics Classroom
ERIC Educational Resources Information Center
Choy, Ban Heng
2014-01-01
What teachers attend to, how they make sense of, and respond to critical incidents in the classroom are important for improving teaching. However, seeing and understanding important features of critical incidents can be difficult. In this paper, I propose a notion of productive noticing, which I used to analyse a case study of what teachers…
Factors influencing nurse supervisor competence: a critical incident analysis study.
Arvidsson, Barbro; Fridlund, Bengt
2005-05-01
The aim of the study was to identify factors related to critical incidents that influence the competence of nurse supervisors. Nurse supervisors require considerable competence in order to help supervisees to reflect on their clinical work and to interpret the needs of the patient. A qualitative approach involving the critical incident technique was used. Critical incidents were collected by means of self-reports from 25 nurse supervisors. Two main areas emerged: a professional and a personal stance. The professional stance described the nurse supervisors' awareness of the importance of creating a secure learning environment and facilitating reflection. The supervisors structured the material and created awareness of fundamental nursing values. The second main area, personal stance, described the nurse supervisors' behaviour when they gave the participating nurses the opportunity to work through the experiences gained in the daily provision of nursing care. Although they experienced lack of self-assurance during the supervision session, they also expressed security regarding their own performance as nurse supervisors. Nurse supervisors need to include more nursing theory and focus on the nursing process as well as being aware of their own shortcomings and resources. One way for the supervisor to scrutinize his/her actions is to discuss and examine them with a more experienced nurse supervisor colleague.
What Matters in College to Students: Critical Incidents in the Undergraduate Experience
ERIC Educational Resources Information Center
Vianden, Jörg
2015-01-01
This article advances that undergraduates are partners to higher education institutions in establishing the educational enterprise. Leaning on student relationship management as a theoretical construct and the critical incident technique as method, the study found 58 undergraduates' interpersonal interactions with faculty, staff, and peers…
49 CFR 272.101 - Content of a critical incident stress plan.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 49 Transportation 4 2014-10-01 2014-10-01 false Content of a critical incident stress plan. 272... RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CRITICAL INCIDENT STRESS PLANS Plan Components and Approval Process § 272.101 Content of a critical incident stress plan. Each critical incident stress plan...
49 CFR 272.7 - Coverage of a critical incident stress plan.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 49 Transportation 4 2014-10-01 2014-10-01 false Coverage of a critical incident stress plan. 272.7... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CRITICAL INCIDENT STRESS PLANS General § 272.7 Coverage of a critical incident stress plan. The critical incident stress plan of a railroad subject to this part shall...
Victoroff, Kristin Zakariasen; Hogan, Sarah
2006-02-01
Students' views of their educational experience can be an important source of information for curriculum assessment. Although quantitative methods, particularly surveys, are frequently used to gather such data, fewer studies have employed qualitative methods to examine students' dental education experiences. The purpose of this study is to explore characteristics of effective learning experiences in dental school using a qualitative method. All third-year (seventy) and fourth-year (seventy) dental students enrolled in one midwestern dental school were invited to participate. Fifty-three dental students (thirty-five male and eighteen female; thirty-two third-year and twenty-one fourth-year) were interviewed using a critical incident interview technique. Each student was asked to describe a specific, particularly effective learning incident that he or she had experienced in dental school and a specific, particularly ineffective learning incident, for comparison. Each interview was audiotaped. Students were assured that only the interviewer and one additional researcher would have access to the tapes. Data analysis resulted in identification of key themes in the data describing characteristics of effective learning experiences. The following characteristics of effective learning experiences were identified: 1) instructor characteristics (personal qualities, "checking-in" with students, and an interactive style); 2) characteristics of the learning process (focus on the "big picture," modeling and demonstrations, opportunities to apply new knowledge, high-quality feedback, focus, specificity and relevance, and peer interactions); and 3) learning environment (culture of the learning environment, technology). Common themes emerged across a wide variety of learning incidents. Although additional research is needed, the characteristics of effective learning experiences identified in this study may have implications for individual course design and for the dental school
A Critical-Incident Stress Debriefing Program for Hospital-Based Health Care Personnel.
ERIC Educational Resources Information Center
Spitzer, William J.; Burke, Laurie
1993-01-01
Reviews individual and institutional effects of critical-incident stress on health care delivery and use of stress education, defusings, and debriefings as effective interventions with health care personnel. Presents successful efforts of social work department using these techniques in major university hospital system as model for replication in…
Critical incidents in nursing academics: discovering a new identity.
Aguayo-González, Mariela; Castelló-Badía, Montserrat; Monereo-Font, Carles
2015-01-01
a qualitative study that followed the principles of the grounded theory in order to analyze the professional identity of nursing academics through the analysis of the most disturbing critical incidents. semi-structured interviews were conducted with seven nurses who worked as professors and researchers in a private university in Barcelona. the resulting empirical material was organized into two categories: characterization of critical incidents and responsiveness to the incident. the professional identity of nurses regarding the academic area is still under construction and inexperience is the major obstacle in the management of critical incidents in the teaching career.
From novice to proficient general practitioner: a critical incident study.
Sim, M G; Kamien, M; Diamond, M R
1996-09-01
To obtain information about any change in the performance or perceptions of doctors undertaking the Royal Australian College of General Practitioners (RACGP) Training Program, with advancing general practice experience. The critical incident technique' was used, which is a comparative qualitative analysis. It involved interviews at 12 to 18 months after the basic term interview. Eighteen Western Australian doctors, who had been interviewed in 1992, at the end of their first 6 months of general practice training and were now completing their advanced or mentor terms in the RACGP Training Program took part in the study. Doctors reported an average of 4.4 critical incidents in their first interview and 5.0 in their second interview. The major areas of positive change included relationships with patients and other health care professionals, including supervisors; paediatrics and orthopaedics skills; the skills of developing a therapeutic relationship to enhance patient compliance and the ability to manage complex cardiovascular and psychiatric problems without reliance on specialist referral; attitudes of responsibility for and enjoyment of long term care of patients and families; and reduced levels of anxiety over difficult problems. New or continuing areas of difficulty were found in gynaecology; pharmacotherapy and dermatology; the diagnosis of common complaints with uncommon presentations; the skill of managing difficult or angry patients; the organisation for the follow-up of patients with potentially severe disorders; and in managing feelings of guilt over missed diagnoses or poor management. An analysis of commonly occurring positive and negative critical incidents shows that RACGP Training Program doctors develop competence, confidence and reduced levels of performance anxiety with advancing experience. All but one doctor found the Training Program helpful in achieving these proficiencies. However, many ongoing areas of difficulty remain. The Critical Incident
Hohenstein, Christian; Rupp, Peter; Fleischmann, Thomas
2011-02-01
We wanted to identify incidents that led or could have led to patient harm during prehospital cardiopulmonary resuscitation. A nationwide anonymous and Internet-based critical incident reporting system gave the data. During a 4-year period we received 548 reports of which 74 occurred during cardiopulmonary resuscitation. Human error was responsible for 85% of the incidents, whereas equipment failure contributed to 15% of the reports. Equipment failure was considered to be preventable in 61% of all the cases, whereas incidents because of human error could have been prevented in almost all the cases. In most cases, prevention can be accomplished by simple strategies with the Poka-Yoke technique. Insufficient training of emergency medical service physicians in Germany requires special attention. The critical incident reports raise concerns regarding the level of expertize provided by emergency medical service doctors.
Attachment Theory in Supervision: A Critical Incident Experience
ERIC Educational Resources Information Center
Pistole, M. Carole; Fitch, Jenelle C.
2008-01-01
Critical incident experiences are a powerful source of counselor development (T. M. Skovholt & P. R. McCarthy, 1988a, 1988b) and are relevant to attachment issues. An attachment theory perspective of supervision is presented and applied to a critical incident case scenario. By focusing on the behavioral systems (i.e., attachment, caregiving, and…
Exploring the Development of Critical Incident Response Teams
ERIC Educational Resources Information Center
Lockhart, Charlotte Fiona; Woods, Kevin
2017-01-01
Critical incidents, such as human or natural disasters, can have profound effects upon children and young people, and upon the adults who work with and care for them. Educational psychologists have contributed to and led the development of critical incident response teams to support those affected. This study sought to develop understanding of the…
A critical incident study of general practice trainees in their basic general practice term.
Diamond, M R; Kamien, M; Sim, M G; Davis, J
1995-03-20
To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.
Mantram repetition for stress management in veterans and employees: a critical incident study.
Bormann, Jill E; Oman, Doug; Kemppainen, Jeanne K; Becker, Sheryl; Gershwin, Madeline; Kelly, Ann
2006-03-01
This paper reports a study assessing the usefulness of a mantram repetition programme. Complementary/alternative therapies are becoming commonplace, but more research is needed to assess their benefits. A 5-week programme teaching a 'mind-body-spiritual' technique of silently repeating a mantram - a word or phrase with spiritual meaning - to manage stress was developed. A mantram was chosen by individuals, who were taught to repeat it silently throughout the day or night to interrupt unwanted thoughts and elicit the relaxation response. Participants who attended a 5-week course were invited to participate in the study. Of those who consented, a randomly selected subset (n = 66) was contacted approximately 3 months after the course for a telephone interview using the critical incident interviewing technique. Participants were asked whether the intervention was helpful or not, and if helpful, to identify situations where it was applied. Interviews were transcribed and incidents were identified and categorized to create a taxonomy of uses. The data were collected in 2001-2002. Participants included 30 veterans, mostly males (97%), and 36 hospital employees, mostly females (86%). Mean age was 56 years (sd = 12.94). Fifty-five participants (83.3%) practiced the technique and reported 147 incidents where the programme was helpful. Outcomes were organized into a taxonomy of incidents using four major categories that included managing: (a) emotions other than stress (51%); (b) stress (23.8%); (c) insomnia (12.9%); and (d) unwanted thoughts (12.3%). A group of raters reviewed the categories for inter-rater reliability. The majority of participants from two distinct samples reported that the mantram programme was helpful in a variety of situations. The critical incident interviewing method was found to be practical, efficient, and thorough in collecting and analyzing data. Such qualitative methods contribute to understanding the benefits of mind-body complementary therapies.
Broström, Anders; Strömberg, Anna; Dahlström, Ulf; Fridlund, Bengt
2003-03-01
Sleep related breathing disorders are common as well as a poor prognostic sign associated with higher mortality in patients with congestive heart failure (CHF). These patients often have a shorter total duration of sleep, disturbed sleep structure and increased daytime sleepiness, which can negatively affect all dimensions of the life situation. The spouse has an important role in supporting the patient in relation to sleep disorders, but this role may be adversely affected by the sleep situation of the couple. The aim of this study was to describe decisive situations that influence spouses' support to patients with CHF in relation to the couple's sleep situation. A qualitative descriptive design using critical incident technique was employed. Incidents were collected by means of interviews with 25 spouses of patients with CHF, strategically selected from two hospital-based specialist clinics in southern Sweden. Two main areas emerged in the analysis: support stimulating situations and support inhibiting situations. Support stimulating situations described how spouses' support was positively affected by their own adaptation in psychosocial or practical situations, and receiving help from others. Support inhibiting situations described how the spouses' support was negatively affected by sleep disturbances as a result of the patient's symptoms, anxiety in relation to the disease, limitations as a result of the sleeping habits, dissatisfaction with care related to the sleep situation, and being left to cope alone with the problems. An increased understanding of the stimulating and inhibiting situations influencing spouses' support for patients with CHF can guide health care personnel in deciding if an intervention is needed to improve the sleep situation for patient and spouse.
Reflections on the Use of Critical Incident Stress Debriefing in Schools
ERIC Educational Resources Information Center
Aucott, Clare; Soni, Anita
2016-01-01
Providing support to schools following a critical incident has become an established part of service delivery for many Educational Psychology Services (EPSs) in the UK. This article offers reflections on the use of Critical Incident Stress Debriefing (CISD) in schools. A review of the literature on critical incidents, trauma, resilience and…
Pourin, C; Daucourt, V; Barberger-Gateau, P
2001-06-01
Health care centers will have to set up a regular survey of their patients' satisfaction, in addition to the discharge questionnaire. Few instruments for measuring satisfaction are at present available. A working group associating 10 psychiatric hospitals in Aquitaine conducted a study on the specificity of this measure in psychiatry. To record the patient's perception on the stay in order to identify areas of satisfaction and dissatisfaction as perceived and reported by himself, using a qualitative approach. The critical incident technique was used in 3 volunteer hospitals, in patients hospitalised in psychiatric wards selected by their doctor. Interview using a semi-structured questionnaire were conducted by an investigator external to the departments. Data were analysed in a qualitative way. 32 interviews could be analysed, and 215 events were extracted. These events were classified in 12 themes. The events identified from these interviews have allowed identification of new areas of patient satisfaction, which could be used to build additional items centered on patients' preoccupations.
Automatic Analysis of Critical Incident Reports: Requirements and Use Cases.
Denecke, Kerstin
2016-01-01
Increasingly, critical incident reports are used as a means to increase patient safety and quality of care. The entire potential of these sources of experiential knowledge remains often unconsidered since retrieval and analysis is difficult and time-consuming, and the reporting systems often do not provide support for these tasks. The objective of this paper is to identify potential use cases for automatic methods that analyse critical incident reports. In more detail, we will describe how faceted search could offer an intuitive retrieval of critical incident reports and how text mining could support in analysing relations among events. To realise an automated analysis, natural language processing needs to be applied. Therefore, we analyse the language of critical incident reports and derive requirements towards automatic processing methods. We learned that there is a huge potential for an automatic analysis of incident reports, but there are still challenges to be solved.
[Critical incidents and quality of life among rescue workers].
Prati, G; Pietrantoni, L
2009-01-01
Fire-fighters, paramedics and civil protection volunteers routinely confront potentially traumatic events in the course of their jobs. The frequency of exposure to critical incidents and the relationship between critical incident exposure and quality of life (Professional Quality of Life Scale, PROQOL, Stamm, 2005) A sample of 586 Italian emergency workers. The data indicated that the most frequent critical incidents were incidents involving multiple casualties (65% three or more times), prolonged extrication of trapped victim with life-threatening injuries (64% three or more times), verbal or physical threat by public while on duty (41% three or more times), and victims known to fire-emergency worker (40% three or more times). Infrequent events included serious line of duty injury to self (76% never) and colleagues and line of duty risk of injury or death to self (53% never) and colleagues (47% never). Emergency health workers were more exposed to critical incidents in comparison to fire-fighters. Result from non-parametric correlation analyses indicated that the more infrequent events showed the strong association with compassion fatigue and burnout while failed mission after extensive effort was the event most strongly associated with most associated with compassion satisfaction.
Sundling, Catherine
2015-11-18
Accessibility of travel may be better understood if psychological factors underlying change in travel behavior are known. This paper examines older (65+) travelers' motives for changing their travel behavior. These changes are grounded in critical incidents earlier encountered in public-transport travel. A scientific framework is developed based on cognitive and behavioral theory. In 29 individual interviews, travelers' critical reactions (i.e., cognitive, emotional, and/or behavioral) to 77 critical incidents were examined. By applying critical incident technique (CIT), five reaction themes were identified that had generated travel-behavior change: firm restrictions, unpredictability, unfair treatment, complicated trips, and earlier adverse experiences. To improve older travelers' access to public transport, key findings were: (a) service must be designed so as to strengthen the feeling of being in control throughout the journey; (b) extended personal service would increase predictability in the travel chain and decrease travel complexity; consequently, (c) when designing new services and making effective accessibility interventions, policy makers should consider and utilize underlying psychological factors that could direct traveler behavior.
Sundling, Catherine
2015-01-01
Accessibility of travel may be better understood if psychological factors underlying change in travel behavior are known. This paper examines older (65+) travelers’ motives for changing their travel behavior. These changes are grounded in critical incidents earlier encountered in public-transport travel. A scientific framework is developed based on cognitive and behavioral theory. In 29 individual interviews, travelers’ critical reactions (i.e., cognitive, emotional, and/or behavioral) to 77 critical incidents were examined. By applying critical incident technique (CIT), five reaction themes were identified that had generated travel-behavior change: firm restrictions, unpredictability, unfair treatment, complicated trips, and earlier adverse experiences. To improve older travelers’ access to public transport, key findings were: (a) service must be designed so as to strengthen the feeling of being in control throughout the journey; (b) extended personal service would increase predictability in the travel chain and decrease travel complexity; consequently, (c) when designing new services and making effective accessibility interventions, policy makers should consider and utilize underlying psychological factors that could direct traveler behavior. PMID:26593935
Redfern, S; Norman, I
1999-07-01
The aims of the study were to identify indicators of quality of nursing care from the perceptions of patients and nurses, and to determine the congruence between patients' and nurses' perceptions. The paper is presented in two parts. Part 1 includes the background and methods to the study and the findings from the comparison of patients' and nurses' perceptions. Part 2 describes the perceptions of patients and nurses, and the conclusions drawn from the study as a whole. Patients and nurses in hospital wards were interviewed using the critical incident technique. We grouped 4546 indicators of high and low quality nursing care generated from the interview transcripts into 316 subcategories, 68 categories and 31 themes. Congruence between patients' and nurses' perceptions of quality was high and significant, although there was some difference of emphasis.
Bond, Susan; Cooper, Simon
2006-08-01
To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. Systematic literature review with critical incident reflection. Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996-2004) followed by the 'snowball method'. Studies were selected in accordance with preset criteria. A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making (Fig. 2). Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety.
Teachers' Critical Incidents: Ethical Dilemmas in Teaching Practice
ERIC Educational Resources Information Center
Shapira-Lishchinsky, Orly
2011-01-01
The aim of this study is to explore ethical dilemmas in critical incidents and the emerged responses that these incidents elicit. Most teachers try to suppress these incidences because of the unpleasant feelings they evoke. Fifty teachers participated in the study. A three-stage coding process derived from grounded theory was utilized. A taxonomy…
49 CFR 272.105 - Requirement to file critical incident stress plan electronically.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 49 Transportation 4 2014-10-01 2014-10-01 false Requirement to file critical incident stress plan...) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CRITICAL INCIDENT STRESS PLANS Plan Components and Approval Process § 272.105 Requirement to file critical incident stress plan electronically...
Clark, Maria; Lewis, Alison; Bradshaw, Sally; Bradbury-Jones, Caroline
2018-06-13
Globally, the potentially harmful effects of using cell phone technology for 'sexting' among young people, is a public health concern. The background literature indicates that sexting might have adverse psychosocial consequences for some young people who share partially nude images ('selfies'). Public health nurses (PHNs) could offer guidance to children and young people on digital safety, yet little is known about their role in this regard. This study explored PHNs' knowledge and confidence in addressing the issue among young people. A qualitative study was undertaken using the Critical Incident Technique. The study took place in 2016. Eighteen semi-structured interviews were conducted with PHNs in a region of England. Data were analysed through thematic analysis, and managed through the use of NViVo 11 software. From the entire data set, thirteen critical incidents were identified of which nine were deemed relevant for reporting in this paper. PHNs regarded sexting as a contemporary 'normalised' practice that takes place in what young people consider to be trusting relationships. PHNs' knowledge was informed by media reports that supported their beliefs about young peoples' vulnerability to risk-taking sexual behaviour. They were not confident about discussing sexting with young people, even though some PHNs had done so in light of concerns about potential child sexual exploitation. PHNs have a role to play in advising young people on digital safety, but findings of the study show that their role is not fully realised. They have some knowledge of sexting as a possible signifier of abusive behaviour. However, they are not always confident in dealing with the issue. Improving PHNs ability to promote digital safety through better understanding of technology use among young people is good safeguarding practice. This may, in turn, better define this important nursing contribution to public health.
Cultural differences in dealing with critical incidents.
Leonhardt, Jörg; Vogt, Joachim
2009-01-01
This article discusses the cultural aspects of High Reliability Organizations (HROs), such as air navigation services. HROs must maintain a highly professional safety culture and constantly be prepared to handle crises. The article begins with a general discussion of the concept of organizational culture. The special characteristics of HROs and their safety culture is then described. Finally the article illustrates how Critical Incident Stress Management (CISM) is becoming an ingrained feature of the organizational culture in air traffic control systems. Critical Incident Stress Management is a prevention program that can successfully guard against the negative effects of critical incidents. The CISM program of DFS (Deutsche Flugsicherung) was recently evaluated by the University of Copenhagen. This evaluation not only confirmed the successful prevention of negative effects at the operation's employee level (especially air traffic controllers), but also showed a sustained improvement of its safety culture and its overall organizational performance. The special aspects of cross-cultural crisis intervention and the challenges it faces, as well as the importance of prevention programs, such as CISM, are illustrated using the examples of two aircraft accidents: the crash landing of a calibration aircraft and the Lake Constance air disaster.
Implementation of a critical incident reporting system in a neurosurgical department.
Kantelhardt, P; Müller, M; Giese, A; Rohde, V; Kantelhardt, S R
2011-02-01
Critical incident monitoring is an important tool for quality improvement and the maintenance of high safety standards. It was developed for aviation safety and is now widely accepted as a useful tool to reduce medical care-related morbidity and mortality. Despite this widespread acceptance, the literature has no reports on any neurosurgical applications of critical incident monitoring. We describe the introduction of a mono-institutional critical incident reporting system in a neurosurgical department. Furthermore, we have developed a formula to assess possible counterstrategies. All staff members of a neurosurgical department were advised to report critical incidents. The anonymous reporting form contained a box for the description of the incident, several multiple-choice questions on specific risk factors, place and reason for occurrence of the incident, severity of the consequences and suggested counterstrategies. The incident data was entered into an online documentation system (ADKA DokuPik) and evaluated by an external specialist. For data analysis we applied a modified assessment scheme initially designed for flight safety. Data collection was started in September 2008. The average number of reported incidents was 18 per month (currently 216 in total). Most incidents occurred on the neurosurgical ward (64%). Human error was involved in 86% of the reported incidents. The largest group of incidents consisted of medication-related problems. Accordingly, counterstrategies were developed, resulting in a decrease in the relative number of reported medication-related incidents from 42% (March 09) to 30% (September 09). Implementation of the critical incident reporting system presented no technical problems. The reporting rate was high compared to that reported in the current literature. The formulation, evaluation and introduction of specific counterstrategies to guard against selected groups of incidents may improve patient safety in neurosurgical departments.
Audits and critical incident reporting in paediatric anaesthesia: lessons from 75,331 anaesthetics.
Wan, Sharon; Siow, Yew Nam; Lee, Su Min; Ng, Agnes
2013-02-01
This study reports our experience of audit and critical incidents observed by paediatric anaesthetics from 2000 to 2010 at a paediatric teaching hospital in Singapore. Data pertaining to patient demographics, practices and critical incidents during anaesthesia and in the perioperative period were prospectively collected via an audit form and retrospectively analysed thereafter. A total of 2,519 incidents were noted at the 75,331 anaesthetics performed during the study period. There were nine deaths reported. The majority of incidents reported were respiratory critical incidents (n = 1,757, 69.8%), followed by cardiovascular incidents (n = 238, 9.5%). Risk factors for critical incidents included age less than one year, and preterm and former preterm children. Critical incident reporting has value, as it provides insights into the system and helps to identify active and system errors, thus enabling the formulation of effective preventive strategies. By creating and maintaining an environment that encourages reporting, we have maintained a high and consistent reporting rate through the years. The teaching of analysis of critical incidents should be regarded by all clinicians as an important tool for improving patient safety.
Laws, T
2001-05-01
The object of this study was to determine if critical care nurses' emotional responses to having performed cardiopulmonary resuscitation were indicative of critical incident stress. A descriptive approach was employed using a survey questionnaire of 31 critical care nurses, with supportive interview data from 18 of those participants. Analysis of the data generated from the questionnaire indicated that the respondents experienced thought intrusion and avoidance behaviour. A majority of those interviewed disclosed that they had experienced a wide range of emotional stressors and physical manifestations in response to having performed the procedure. The findings from both questionnaire and interview data were congruent with signs of critical incident stress, as described in the literature. This has been found to be detrimental to employees' mental health status and, for this reason, employers have a duty of care to minimise the risk of its occurrence and to manage problems as they arise.
Using the critical incident survey to assess hospital service quality.
Longo, B; Connor, G; Barnhart, T
1993-01-01
This survey was designed to determine "standards of excellence" in hospital services as defined by (a) former patients, (b) physicians, (c) hospital employees, and (d) corporate insurance subscribers. One hundred forty-seven (147) patients, 188 employees, and 20 corporate subscribers were interviewed by telephone, and 52 physicians were interviewed in their offices. The interview consisted of a single question: "Can you think of a time when, as a patient/employee/employer/physician, you had a particularly satisfying or dissatisfying experience with a local hospital?" Reported incidents were reviewed, and 239 "critical incidents" were identified. These incidents were classified into 12 descriptive categories relating to the underlying factors in the incident reports. Six focus groups were later held with participants segregated by the population pool they represented. These groups were asked to develop definitions of "excellence" in hospital service quality and standards for service which would "exceed expectations." The focus groups created 122 standards of excellence, which were classified into 43 categories. Overall, the largest percentages of corporate, physician, and employee critical incidents were classified as "Administrative Policy" issues. Patients most often reported "Nurturing" incidents as critical to their perceptions of hospital service quality.
Supporting staff recovery and reintegration after a critical incident resulting in infant death.
Roesler, Roberta; Ward, Debra; Short, Mary
2009-08-01
A critical incident is described as any sudden unexpected event that has the power to overwhelm the usual effective coping skills of an individual or a group and can cause significant psychological distress in usually healthy persons. A Just Culture model to deal with critical incidents is an approach that seeks to identify and balance system events and personal accountability. This article reports a critical incident that occurred at the Neonatal Intensive Care Unit, Methodist Hospital of Indianapolis, when 5 infants received an overdose of heparin that resulted in the death of 3 infants. Although care of the family after the critical incident was the immediate priority, the focus of this article was on the recovery and reintegration of the NICU staff after a critical incident based on the Just Culture philosophy.
Palese, Alvisa; Lesa, Lucia; Stroppolo, Giulia; Lupieri, Giulia; Tardivo, Stefano; Brusaferro, Silvio
2017-04-01
To elucidate factors, other than those clinical, precipitating the risk of aspiration in hospitalized patients. The Critical Incident Technique was adopted for this study in 2015. Three departments located in two academic hospitals in the northeast of Italy, equipped with 800 and 1500 beds, respectively. A purposeful sample of 12 registered nurses (RN), all of whom (i) had reported one or more episodes of aspiration during the longitudinal survey, (ii) had worked ≥3 years in the department, and (iii) were willing to participate, were included. Antecedent factors involved in episodes of aspiration as experienced by RNs were collected through an open-ended interview, and qualitatively analysed. In addition to clinical factors, other factors interacting with each other may precipitate the risk of aspiration episodes during hospitalization: at the nursing care level (misclassifying patients, transferring tasks to other healthcare professionals and standardizing processes to remove potential threats); at the family level (misclassifying patients, dealing with the cultural relevance of eating) and at the environmental level (positioning the patient, managing time pressures, distracting patient while eating, dealing with food consistency and irritating oral medication). At the hospital level, an adequate nursing workforce and models of care delivery, as well as time for initial and continuing patient and family assessment are required. At the unit level, patient-centred models of care aimed at reducing care standardization are also recommended; in addition, nursing, family and environmental factors should be recorded in the incident reports documenting episodes of aspiration. © The Author 2016. 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
Analysing Users' Satisfaction with E-Learning Using a Negative Critical Incidents Approach
ERIC Educational Resources Information Center
Chen, Nian-Shing; Lin, Kan-Min; Kinshuk
2008-01-01
One critical success factor for e-learning is learners' satisfaction with it. This is affected by both positive and negative experiences in a learning process. This paper examines the impact of such critical incidents on learners' satisfaction in e-learning. In particular, frequent occurrence of negative critical incidents has significant…
Critical incidents connected to nurses' leadership in Intensive Care Units.
Lima, Elaine Cantarella; Bernardes, Andrea; Baldo, Priscila Lapaz; Maziero, Vanessa Gomes; Camelo, Silvia Helena Henriques; Balsanelli, Alexandre Pazetto
2017-01-01
The goal of this study is to analyze nurses' leadership in intensive care units at hospitals in the state of São Paulo, Brazil, in the face of positive and negative critical incidents. Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. Results were grouped into 61 critical incidents distributed into categories. Researchers came to the conclusion that leadership-related situations interfere with IC nurses' behaviors. Among these situations they found: difficulty in the communication process; conflicts in the daily exercise of nurses' activities; people management; and the setting of high quality care targets. Researchers identified a mixed leadership model, leading them to the conclusion that nurses' knowledge and practice of contemporary leadership theories/styles are crucial because they facilitate the communication process, focusing on behavioral aspects and beliefs, in addition to valuing flexibility. This positively impacts the organization's results. Analisar a liderança do enfermeiro em Centros de Terapia Intensiva de hospitais localizados no interior do estado de São Paulo, diante de incidentes críticos positivos e negativos. Estudo exploratório, descritivo, realizado com 24 enfermeiros, que utilizou a Técnica do Incidente Crítico como referencial metodológico. Os resultados foram agrupados em 61 incidentes críticos distribuídos em categorias. Identificou-se que situações relacionadas à liderança interferem no comportamento do enfermeiro de Terapia Intensiva, dentre elas: dificuldade no processo de comunicação, conflitos existentes no dia a dia do exercício profissional, gerenciamento de pessoas e estabelecimento de metas para o alcance da assistência qualificada. Encontrou-se um modelo misto de liderança, o que permite concluir que o conhecimento e a prática dos enfermeiros acerca de teorias/estilos contemporâneos de liderança tornam-se fundamentais, pois
DeFraia, Gary S
2013-01-01
Central to the field of trauma psychology is assessment of the impact of critical incidents on individuals, as measured by individual symptoms of stress. Accordingly, the trauma literature reflects a proliferation of clinical impact of event scales. Workplace incidents however, affect not only individual employees, but also work organizations, requiring a multi-level response. Critical incident stress management (CISM) is the most prevalent multi-level incident response strategy utilized by organizations, often through specialized CISM units operating within their employee assistance programs (EAPs). While EAP-based CISM units seeks to support both individuals and organizations, studies focused on individual stress dominate the literature, mirroring assessment scales that tend to emphasize clinical as opposed to organizational practice. This research contributes to less-prevalent studies exploring incident characteristics as disruptive to organizations, rather than clinical symptoms as disruptive to individuals. To measure incident disruption, an EAP-based CISM unit developed a critical incident severity scale. By analyzing this unit's extensive practice database, this exploratory study examines how critical incident severity level varies among various types of incidents. Employing the methodology of clinical data mining, this practice-based research generates evidence-informed practice recommendations in the areas of EAP-based CISM intake assessment, organizational consultation and incident response planning.
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.
Biagetti, Chiara; Naspi, Giulia; Catassi, Carlo
2013-11-12
Celiac Disease (CD) is a chronic autoimmune disease triggered by dietary gluten. Gluten avoidance, which is the only available treatment for CD, could impact on quality of life of children with CD. We present the results of a qualitative study on the emotional impact of gluten free diet (GFD) on the everyday life of children affected with CD. We investigated 76 celiac patients aged 2-18 years (average age: 9.5 years). By using the Critical Incident Technique (CIT), we defined emotions related to difficulties and awkward situations experienced by the patients. Written answers to open-ended questions from either children (older than 8 years) and parents (children younger than 8 years) were analyzed qualitatively. We found 80 dilemmas experienced in three different arenas (food situations at school, meals at home, meals outside) and characterized lived experiences of children with CD in everyday life (specific emotions, difficulties in relationships and in management of daily life). Children with CD experience strong emotions related to the GFD, permeating several aspects of everyday life. These dilemmas may be missed by a conventional, questionnaire-based approach to the psycho-social consequences of CD treatment.
Hofmeister, Erik H; Reed, Rachel A; Barletta, Michele; Shepard, Molly; Quandt, Jane
2018-05-01
To apply the critical incident technique (CIT) methodology to a series of perianesthetic cardiac arrest events at a university teaching hospital to describe the factors that contributed to cardiac arrest. CIT qualitative analysis of a case series. A group of 16 dogs and cats that suffered a perioperative cardiac arrest between November 2013 and November 2016. If an arrest occurred, the event was discussed among the anesthesiologists. The discussion included a description of the case, a description of the sequence of events leading up to the arrest and a discussion of what could have been done to affect the outcome. A written description of the case and the event including animal signalment and a timeline of events was provided by the supervising anesthesiologist following discussion among the anesthesiologists. Only dogs or cats were included. After the data collection period, information from the medical record was collected. A qualitative document analysis was performed on the summaries provided about each case by the supervising anesthesiologist, the medical record and any supporting documents. Each case was then classified into one or more of the following: animal, human, equipment, drug and procedural factors for cardiac arrest. The most common factor was animal (n=14), followed by human (n=12), procedural (n=4), drugs (n=1) and equipment (n=1). The majority (n=11) of animals had multiple factors identified. Cardiac arrests during anesthesia at a referral teaching hospital were primarily a result of animal and human factors. Arrests because of procedural, drug and equipment factors were uncommon. Most animals experienced more than one factor and two animals arrested after a change in recumbency. Future work should focus on root cause analysis and interventions designed to minimize all factors, particularly human ones. Copyright © 2018 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd
Guenthner, Daniel H
2012-01-01
A literature review was performed on critical incident stress after September 11th, 2001 (9/11), and Hurricanes Katrina and Rita, which focused on the need to implement a holistic critical incident stress management programme for first responders and business organisations. Critical incident stress management is required to handle acute stress and other distress in the face of natural or man-made disasters, including terrorist attacks. A holistic approach to community resilience through a well-planned and implemented critical incident stress management programme has been shown in the literature to promote self-help and self-efficacy of individuals and organisations. The interventions and programme elements defined clearly show how a number of different intervention and prevention strategies will promote business and community resilience and also self-efficacy in a culturally-diverse community and organisation. Implementing a critical incident stress management programme within a responding business organisation is critical because of the fact that first responders are the most susceptible every day to exposure to critical incidents that will affect their mental health; and business employees will suffer some of the same maladies as first responders in the event of a disaster or crisis. Utilising the framework provided, a holistic critical incident stress management programme can be implemented to help reduce the effects of burnout, absenteeism, acute stress, post-traumatic stress, substance use and traumatic stress, and to work to promote community resilience and toughen individuals against the effects of stress. Taking care of the needs of the employees of a business organisation, and of those of first responders, is clearly required.
ERIC Educational Resources Information Center
McGarr, Oliver; McCormack, Orla
2016-01-01
This study explores reflective practice through the lens of counterfactual thinking and examines its role in encouraging student teachers to reflect on negative "critical incidents". The study posits that reflections on critical incidents are often not "critical" in nature. They more frequently result in counterfactual thinking…
Redfern, S; Norman, I
1999-07-01
The aims of the study were to identify indicators of quality of nursing care from the perceptions of patients and nurses, and to determine the congruence between patients' and nurses' perceptions. The paper is presented in two parts. Part 1 included the background and methods to the study and the findings from the comparison of patients' and nurses' perceptions. Part 2 describes the perceptions of patients and nurses, and draws conclusions drawn from the study as a whole. Patients and nurses in hospital wards were interviewed using the critical incident technique. We grouped 4546 indicators of high and low quality nursing care generated from the interview transcripts into 316 subcategories, 68 categories and 31 themes. The themes were grouped into eight clusters: therapeutic context for care, attitudes and sensitivity, teaching and leadership, motivation to nurse, monitoring and informing, high-dependency care, efficiency and thoroughness, reflection and anticipation. As shown in Part 1 of the paper, congruence between patients' and nurses' perceptions of quality was high and significant, although there was some difference of emphasis. The findings support an emerging theory of interpersonal competence and quality in nursing care.
When Things Go Wrong: Managing Critical Incidents in Children's Services.
ERIC Educational Resources Information Center
Legg, Chris
2001-01-01
Critical incidents particular to an individual or family (such as parental divorce or death of a family member) and incidents of national or international significance (such as wars or terrorist attacks) effect those involved in children's services and can result in some children, families, or staff suffering long-term psychological effects. This…
English Teaching, Intercultural Competence, and Critical Incident Exercises
ERIC Educational Resources Information Center
Snow, Don
2015-01-01
Critical incident exercises (CIEs) are increasingly used in English courses, and there seems little doubt that in addition to providing English practice opportunities CIEs also help learners build intercultural competence. The question is: What precise aspects of intercultural competence do CIEs help learners build? This article introduces an…
Homeland security: sharing and managing critical incident information
NASA Astrophysics Data System (ADS)
Ashley, W. R., III
2003-09-01
Effective critical incident response for homeland security requires access to real-time information from many organizations. Command and control, as well as basic situational awareness, are all dependant on quickly communicating a dynamically changing picture to a variety of decision makers. For the most part, critical information management is not unfamiliar or new to the public safety community. However, new challenges present themselves when that information needs to be seamlessly shared across multiple organizations at the local, state and federal level in real-time. The homeland security problem does not lend itself to the traditional military joint forces planning model where activities shift from a deliberate planning process to a crisis action planning process. Rather, the homeland security problem is more similar to a traditional public safety model where the current activity state moves from complete inactivity or low-level attention to immediate crisis action planning. More often than not the escalation occurs with no warning or baseline information. This paper addresses the challenges of sharing critical incident information and the impacts new technologies will have on this problem. The value of current and proposed approaches will be critiqued for operational value and areas will be identified for further development.
A self-report critical incident assessment tool for army night vision goggle helicopter operations.
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.
The Provision of Critical Incident Stress Debriefing Services by EAPs: A Case Study.
ERIC Educational Resources Information Center
McWhirter, Ellen Hawley; Linzer, Marc
1994-01-01
Provides a description of critical incident stress debriefing (CISD) strategies used after a bank robbery-hostage incident. Intervention intended to reduce the effects of the incident on the employees' morale, health, and productivity. Knowledge of CISD procedures will enable counselors to respond effectively to traumatic incidents in the…
Westbrook, Johanna I; Coiera, Enrico W; Braithwaite, Jeffrey
2005-01-01
Online evidence retrieval systems are one potential tool in supporting evidence-based practice. We have undertaken a program of research to investigate how hospital-based clinicians (doctors, nurses and allied health professionals) use these systems, factors influencing use and their impact on decision-making and health care delivery. A central component of this work has been the development and testing of a broad range of evaluation techniques. This paper provides an overview of the results obtained from three stages of this evaluation and details the results derived from the final stage which sought to test two methods for assessing the integration of an online evidence system and its impact on decision making and patient care. The critical incident and journey mapping techniques were applied. Semi-structured interviews were conducted with 29 clinicians who were experienced users of the online evidence system. Clinicians were asked to described recent instances in which the information obtained using the online evidence system was especially helpful with their work. A grounded approach to data analysis was taken producing three categories of impact. The journey mapping technique was adapted as a method to describe and quantify clinicians' integration of CIAP into their practice and the impact of this on patient care. The analogy of a journey is used to capture the many stages in this integration process, from introduction to the system to full integration into everyday clinical practice with measurable outcomes. Transcribed interview accounts of system use were mapped against the journey stages and scored. Clinicians generated 85 critical incidents and one quarter of these provided specific examples of system use leading to improvements in patient care. The journey mapping technique proved to be a useful method for providing a quantification of the ways and extent to which clincians had integrated system use into practice, and insights into how information
Yonas, Michael A.; Aronson, Robert; Schaal, Jennifer; Eng, Eugenia; Hardy, Christina; Jones, Nora
2013-01-01
Disproportionate and persistent inequities in quality of healthcare have been observed among persons of color in the United States. To understand and ultimately eliminate such inequities, several public health institutions have issued calls for innovative methods and approaches that examine determinants from the social, organizational and public policy contexts to inform the design of systems change interventions. The authors, including academic and community research partners in a community-based participatory research (CBPR) study, reflected together on the use and value of the critical incident technique (CIT) for exploring racial disparities in healthcare for women with breast cancer. Academic and community partners used initial large group discussion involving a large partnership of 35 academic and community researchers guided by principles of CBPR, followed by the efforts of a smaller interdisciplinary manuscript team of academic and community researchers to reflect, document summarize and translate this participatory research process, lessons learned and value added from using the CIT with principles of CBPR and Undoing Racism. The finding of this article is a discussion of the process, strengths and challenges of utilizing CIT with CBPR. The participation of community members at all levels of the research process including development, collection of the data and analysis of the data was enhanced by the CIT process. As the field of CBPR continues to mature, innovative processes which combine the expertise of community and academic partners can enhance the success of such partnerships. This report contributes to existing literature by illustrating a unique and participatory research application of CIT with principles of CBPR and Undoing Racism. Findings highlight the collaborative process used to identify and implement this novel method and the adaptability of this technique in the interdisciplinary exploration of system-level changes to understand and
Code of Federal Regulations, 2014 CFR
2014-10-01
... 49 Transportation 4 2014-10-01 2014-10-01 false Submission of critical incident stress plan for... CRITICAL INCIDENT STRESS PLANS Plan Components and Approval Process § 272.103 Submission of critical incident stress plan for approval by the Federal Railroad Administration. (a) Each railroad subject to this...
Wang, Jen-Huang; Hsieh, Shiu-Ying; Huang, Shian-Che
2017-01-01
Background Increased incidence of intraoperative awareness was reported in critically ill patients during major operations, particularly under total intravenous (TIVA) or endotracheal general anesthesia (ETGA). However, the incidence and effect of anesthesia techniques on awareness in generally healthy, non-critically ill patients during operations have yet to receive significant attention. Methods and results This retrospective matched case-control study was conducted between January 2009 to December 2014. Surgical patients (ASA physical status I-III) whom reported intraoperative awareness during this study period were interviewed and their medical records were reviewed. The potential risk factors for awareness were compared with the non-case matched controls, who were randomly selected from the database. A total of 61436 patients were included and 16 definite cases of intraoperative awareness were identified. Patients who received ETGA and TIVA had significantly higher incidence of developing awareness compared to those who were anesthetized using laryngeal masks (LMA) (P = 0.03). Compared with the matched controls (n = 80), longer anesthesia time was associated with increased incidence of awareness (odds ratio 2.04; 95% CI 1.30–3.20, per hour increase). Perioperative use of muscle relaxant was also associated with increased incidence of awareness, while significantly lower incidence of awareness was found in patients who were anesthetized with volatile anesthetics. Conclusions The overall incidence of awareness was 0.023% in the ASA≤ III surgical patients who received general anesthesia. Anesthesia with a laryngeal mask under spontaneous ventilation and supplemented with volatile anesthetics may be the preferred anesthesia technique in generally healthy patients in order to provide a lower risk of intraoperative awareness. PMID:29073151
Taylor, Julie; Bradbury-Jones, Caroline; Kroll, Thilo; Duncan, Fiona
2013-09-01
Domestic abuse is increasingly recognised as a serious, worldwide public health concern. There is a significant body of literature regarding domestic abuse, but little is known about health professionals' beliefs about domestic abuse disclosure. In addition, the intersection between health professionals' beliefs and abused women's views remains uninvestigated. We report on a two-phase, qualitative study using Critical Incident Technique (CIT) that aimed to explore community health professionals' beliefs about domestic abuse and the issue of disclosure. We investigated this from the perspectives of both health professionals and abused women. The study took place in Scotland during 2011. The study was informed theoretically by the Common Sense Model of Self-Regulation of Health and Illness (CSM). This model is typically used in disease-orientated research. In our innovative use, however, CSM was used to study the social phenomenon, domestic abuse. The study involved semi-structured, individual CIT interviews with health professionals and focus groups with women who had experienced domestic abuse. Twenty-nine health professionals (Midwives, Health Visitors and General Practitioners) participated in the first phase of the study. In the second phase, three focus groups were conducted with a total of 14 women. Data were analysed using a combination of an inductive classification and framework analysis. Findings highlight the points of convergence and divergence between abused women's and health professionals' beliefs about abuse. Although there was some agreement, they do not always share the same views. For example, women want to be asked about abuse, but many health professionals do not feel confident or comfortable discussing the issue. Overall, the study shows the dynamic interaction between women's and health professionals' beliefs about domestic abuse and readiness to discuss and respond to it. Understanding these complex dynamics assists in the employment of
ERIC Educational Resources Information Center
Kellogg, Angela H.; Liddell, Debora L.
2012-01-01
This qualitative study explored how critical incidents shape multiracial students' understanding of race and identity at predominantly White institutions. Participants included 14 multiracial undergraduate students from two institutions in the Midwest. Four categories of critical incidents were identified from the data: (a) confronting race and…
Stressful Encounters with Social Work Clients: A Descriptive Account Based on Critical Incidents
ERIC Educational Resources Information Center
Savaya, Riki; Gardner, Fiona; Stange, Dorit
2011-01-01
This article presents the findings of an analysis of 130 critical incidents reported by social workers in Israel. Almost all the incidents turned out to be upsetting events that caused the writers a great deal of pain, frustration, and self-doubt. Content analysis yielded four main categories of incidents or events: (1) client hostility and…
Diversity Management in Preschools Using a Critical Incident Approach
ERIC Educational Resources Information Center
Stier, Jonas; Tryggvason, Marja-Terttu; Sandstrom, Margareta; Sandberg, Anette
2012-01-01
Using the critical incident approach, preschool teachers at 10 preschools in Sweden were asked to describe their work with respect to ethnic and cultural diversity. The study attempted to provide insights that go beyond commonly used models of intercultural sensitivity and intercultural competence (e.g. Gudykunst and Kim; Landis, Bennett, and…
Müller-Leonhardt, Alice; Mitchell, Shannon G; Vogt, Joachim; Schürmann, Tim
2014-07-01
In complex systems, such as hospitals or air traffic control operations, critical incidents (CIs) are unavoidable. These incidents can not only become critical for victims but also for professionals working at the "sharp end" who may have to deal with critical incident stress (CIS) reactions that may be severe and impede emotional, physical, cognitive and social functioning. These CIS reactions may occur not only under exceptional conditions but also during every-day work and become an important safety issue. In contrast to air traffic management (ATM) operations in Europe, which have readily adopted critical incident stress management (CISM), most hospitals have not yet implemented comprehensive peer support programs. This survey was conducted in 2010 at the only European general hospital setting which implemented CISM program since 2004. The aim of the article is to describe possible contribution of CISM in hospital settings framed from the perspective of organizational safety and individual health for healthcare professionals. Findings affirm that daily work related incidents also can become critical for healthcare professionals. Program efficiency appears to be influenced by the professional culture, as well as organizational structure and policies. Overall, findings demonstrate that the adaptation of the CISM program in general hospitals takes time but, once established, it may serve as a mechanism for changing professional culture, thereby permitting the framing of even small incidents or near misses as an opportunity to provide valuable feedback to the system. Copyright © 2014 Elsevier Ltd. All rights reserved.
Concept-Based Retrieval from Critical Incident Reports.
Denecke, Kerstin
2017-01-01
Critical incident reporting systems (CIRS) are used as a means to collect anonymously entered information of incidents that occurred for example in a hospital. Analyzing this information helps to identify among others problems in the workflow, in the infrastructure or in processes. The entire potential of these sources of experiential knowledge remains often unconsidered since retrieval of relevant reports and their analysis is difficult and time-consuming, and the reporting systems often do not provide support for these tasks. The objective of this work is to develop a method for retrieving reports from the CIRS related to a specific user query. atural language processing (NLP) and information retrieval (IR) methods are exploited for realizing the retrieval. We compare standard retrieval methods that rely upon frequency of words with an approach that includes a semantic mapping of natural language to concepts of a medical ontology. By an evaluation, we demonstrate the feasibility of semantic document enrichment to improve recall in incident reporting retrieval. It is shown that a combination of standard keyword-based retrieval with semantic search results in highly satisfactory recall values. In future work, the evaluation should be repeated on a larger data set and real-time user evaluation need to be performed to assess user satisfactory with the system and results.
Vachon, Brigitte; LeBlanc, Jeannette
2011-09-01
Critical incident analysis (CIA) is one of the strategies frequently used to facilitate reflective learning. It involves the thorough description and analysis of an authentic and experienced event within its specific context. However, CIA has also been described as having the potential to expose vulnerabilities, threaten learners' coping mechanisms and increase rather than reduce their anxiety levels. The aim of this study was to compare the analysis of current critical incidents with that of past critical incidents, and to further explore why and how the former is more conducive to reflective learning and practice change than the latter. A collaborative research study was conducted. Eight occupational therapists were recruited to participate in a reflective learning group that convened for 12 meetings held over a 15-month period. The group facilitator planned and adapted the learning strategies to be used to promote reflective learning and guided the group process. Critical incident analysis represented the main activity carried out in the group discussions. The data collected were analysed using the grounded theory method. Three phenomena were found to differentiate between the learning contexts created by the analysis of, respectively, past and current critical incidents: attitudinal disposition; legitimacy of purpose, and the availability of opportunities for experimentation. Analysis of current clinical events was found to improve participants' motivation to self-evaluate, to increase their self-efficacy, and to help them transfer learning into action and to progressively self-regulate. The results of this collaborative research study suggest that the analysis of current clinical events in order to promote reflection offers a safer and more constructive learning environment than does the analysis of incidents that have occurred in the past. This learning strategy is directly grounded in health professional practice. The remaining challenge for continuing
[Second victim : Critical incident stress management in clinical medicine].
Schiechtl, B; Hunger, M S; Schwappach, D L; Schmidt, C E; Padosch, S A
2013-09-01
Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.
Critical Incidents of Transnational Student-Teachers in Central Mexico
ERIC Educational Resources Information Center
Serna-Gutiérrez, José Irineo Omar; Mora-Pablo, Irasema
2018-01-01
This study is an exploration of the life-changing decisions and changes which the participants underwent, and which led them to pursue an education in English language teaching (or languages). The foremost objective of this study was to highlight the critical incidents from the past, present, and teaching practice of transnational students in a BA…
Health and productivity of commuter railroad employees involved in critical incidents.
DOT National Transportation Integrated Search
2011-02-15
ABSTRACTThe effects of accidentstermed Critical Incidentson the health and productivity of rail transit workers have not been fully investigated. Anecdotal evidence suggests lasting effects of these incidents. Surveys were obtained from 363 com...
Skin bank development and critical incident response.
Hamilton, Kellie T; Herson, Marisa R
2011-05-01
The Donor Tissue Bank of Victoria (DTBV), situated in Melbourne, Australia developed a skin banking program in 1994. It remains Australia's only operational skin bank, processing cryopreserved human cadaveric skin for the treatment of burns. The demand for allograft skin in Australia has steadily increased since the development of the program. The bank has been involved in the provision of skin for a number of critical incidences or disasters both in Australia and overseas. Demand always exceeds supply, and in the absence of other local skin banks, the DTBV has needed to develop strategies to enable increased provision of allograft skin nationally.
Critical incident reporting in emergency medicine: results of the prehospital reports.
Hohenstein, Christian; Hempel, Dorothea; Schultheis, Kerstin; Lotter, Oliver; Fleischmann, Thomas
2014-05-01
Medical errors frequently contribute to morbidity and mortality. Prehospital emergency medicine is prone to incidents that can lead to immediate deadly consequences. Critical incident reporting can identify typical problems and be the basis for structured risk management in order to reduce and mitigate these incidents. We set up a free access internet website for German-speaking countries, with an anonymous reporting system for emergency medical services personnel. After a 7-year study period, an expert team analysed and classified the incidents into staff related, equipment related, organisation and tactics, or other. 845 reports were entered in the study period. Physicians reported 44% of incidents, paramedics 42%. Most patients were in a life-threatening or potentially life-threatening situation (82%), and only 53% of all incidents had no influence on the outcome of the patient. Staff-related problems were responsible for 56% of the incidents, when it came to harm, 78% of these incidents were staff related. Incident reporting in prehospital emergency medicine can identify system weaknesses. Most of the incidents were reported during care of patients in life-threatening conditions with a high impact on patient outcome. Staff-related problems contributed to the most frequent and most severe incidents. 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.
Critical Incidents in the Lives of Gifted Female Finnish Scientists.
ERIC Educational Resources Information Center
Tirri, Kirsi; Koro-Ljungberg, Mirka
2002-01-01
A study investigated critical incidents in the professional and personal lives of 11 gifted Finnish female scientists. All made important life choices that promoted their talent and career development. The majority have also made some compromises related to their scientific interests and careers, as well as personal compromises. (Contains…
Coining and defining novel nursing terminology. Part 2: critical incident nursing intervention.
Wong, Elizabeth
2008-01-01
In the second of a three-part series, a novel nursing terminology is introduced and proposed for inclusion in the Nursing Interventions Classification (NIC): Critical incident nursing intervention (CINI), defined as any indirect or direct care registered nurse-initiated treatment, based upon clinical judgment and knowledge that a registered nurse performs in response to a critical incident nursing diagnosis (CIND). A CIND is defined as recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication. The literature, research studies, meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article. The current nursing interventions in the NIC are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations. Coining and defining novel nursing terminology, CINI, for patient care during life-threatening situations is important and fills the gap in the current standardized nursing terminology. Refining the NIC will permit nursing researchers, among others, to conduct studies on nursing interventions in conjunction with the proposed novel nursing terminology, CINI. The first article in this series (Part 1) introduced the novel nursing terminology: CIND; the present article (Part 2) introduces the novel nursing terminology: CINI; and the third article in this series (Part 3) will introduce the novel nursing terminology: critical incident control.
Education for Ethically Sensitive Teaching in Critical Incidents at School
ERIC Educational Resources Information Center
Hanhimaki, Eija; Tirri, Kirsi
2009-01-01
The purpose of the present study was to identify and investigate critical incidents at school that require ethically sensitive teaching. This kind of knowledge is needed in teacher education to prepare future teachers for their profession. The data included narrative interviews with 12 teachers from four urban schools in Finland. Critical…
Legal decision-making by people with aphasia: critical incidents for speech pathologists.
Ferguson, Alison; Duffield, Gemma; Worrall, Linda
2010-01-01
The assessment and management of a person with aphasia for whom decision-making capacity is queried represents a highly complex clinical issue. In addition, there are few published guidelines and even fewer published accounts of empirical research to assist. The research presented in this paper aimed to identify the main issues for speech pathologists when decision-making capacity for legal and related matters arose for their clients with aphasia, and to describe qualitatively the nature of these issues and the practices of the speech pathologists in these situations. The methodology was informed by the qualitative research paradigm and made use of the semi-structured interview methods developed for the Critical Incident Technique. Nine speech pathologists, with a range of clinical experience between three and 27 years, were interviewed by telephone, with verbatim notes being taken on-line by the interviewer. The speech pathologists described a total of 21 clients (15 male, six female) with acquired neurological communication disorders (including cerebral vascular accident, traumatic brain injury, and tumour) whose care had raised critical incidents for the speech pathologist in relation to legal and related matters. These verbatim notes were qualitatively analysed using NVivo qualitative analysis software. The main incidents related to legal decisions (for example, power of attorney, will-making), as well as decisions involving consent for medical treatment, discharge, accommodation, and business/financial decisions. In all but one of the incidents recounted, the issues centred on a situation of conflict between the person with aphasia and their family, friends or with the multidisciplinary team. The roles taken by the speech pathologists ranged from those expected within a speech pathology scope of practice, such as that of assessor and consultant, to those which arguably present dilemmas and conflict of interest, for example, interpreter, advocate. The
Advanced grazing-incidence techniques for modern soft-matter materials analysis
Hexemer, Alexander; Müller-Buschbaum, Peter
2015-01-01
The complex nano-morphology of modern soft-matter materials is successfully probed with advanced grazing-incidence techniques. Based on grazing-incidence small- and wide-angle X-ray and neutron scattering (GISAXS, GIWAXS, GISANS and GIWANS), new possibilities arise which are discussed with selected examples. Due to instrumental progress, highly interesting possibilities for local structure analysis in this material class arise from the use of micro- and nanometer-sized X-ray beams in micro- or nanofocused GISAXS and GIWAXS experiments. The feasibility of very short data acquisition times down to milliseconds creates exciting possibilities forin situandin operandoGISAXS and GIWAXS studies. Tuning the energy of GISAXS and GIWAXS in themore » soft X-ray regime and in time-of flight GISANS allows the tailoring of contrast conditions and thereby the probing of more complex morphologies. In addition, recent progress in software packages, useful for data analysis for advanced grazing-incidence techniques, is discussed.« less
Advanced grazing-incidence techniques for modern soft-matter materials analysis
Hexemer, Alexander; Müller-Buschbaum, Peter
2015-01-01
The complex nano-morphology of modern soft-matter materials is successfully probed with advanced grazing-incidence techniques. Based on grazing-incidence small- and wide-angle X-ray and neutron scattering (GISAXS, GIWAXS, GISANS and GIWANS), new possibilities arise which are discussed with selected examples. Due to instrumental progress, highly interesting possibilities for local structure analysis in this material class arise from the use of micro- and nanometer-sized X-ray beams in micro- or nanofocused GISAXS and GIWAXS experiments. The feasibility of very short data acquisition times down to milliseconds creates exciting possibilities for in situ and in operando GISAXS and GIWAXS studies. Tuning the energy of GISAXS and GIWAXS in the soft X-ray regime and in time-of flight GISANS allows the tailoring of contrast conditions and thereby the probing of more complex morphologies. In addition, recent progress in software packages, useful for data analysis for advanced grazing-incidence techniques, is discussed. PMID:25610632
[Analysis of an incident notification system and register in a critical care unit].
Murillo-Pérez, M A; García-Iglesias, M; Palomino-Sánchez, I; Cano Ruiz, G; Cuenca Solanas, M; Alted López, E
2016-01-01
To analyse the incident communicated through a notification system and register in a critical care unit. A cross-sectional descriptive study was conducted by performing an analysis of the records of incidents communicated anonymously and voluntarily from January 2007 to December 2013 in a critical care unit of adult patients with severe trauma. incident type and class, professional reports, and suggestions for improvement measures. A descriptive analysis was performed on the variables. Out of a total of 275 incidents reported, 58.5% of them were adverse events. Incident distributed by classes: medication, 33.7%; vascular access-drainage-catheter-sensor, 19.6%; devices-equipment, 13.3%, procedures, 11.5%; airway tract and mechanical ventilation, 10%; nursing care, 4.1%; inter-professional communication, 3%; diagnostic test, 3%; patient identification, 1.1%, and transfusion 0.7%. In the medication group, administrative errors accounted for a total of 62%; in vascular access-drainage-catheter-sensor group, central venous lines, a total of 27%; in devices and equipment group, respirators, a total of 46.9%; in airway self-extubations, a total of 32.1%. As regards to medication errors, 62% were incidents without damage. Incident notification by profession: doctors, 43%, residents, 5.6%, nurses, 51%, and technical assistants, 0.4%. Adverse events are the most communicated incidents. The events related to medication administration are the most frequent, although most of them were without damage. Nurses and doctors communicate the incidents with the same frequency. In order to highlight the low incident notification despite it being an anonymous and volunteer system, therefore, it is suggested to study measurements to increase the level of communication. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Interferometry On Grazing Incidence Optics
NASA Astrophysics Data System (ADS)
Geary, Joseph; Maeda, Riki
1988-08-01
A preliminary interferometric procedure is described showing potential for obtaining surface figure error maps of grazing incidence optics at normal incidence. The latter are found in some laser resonator configurations, and in Wolter type X-ray optics. The procedure makes use of cylindrical wavefronts and error subtraction techniques over subapertures. The surface error maps obtained will provide critical information to opticians in the fabrication process.
Interferometry on grazing incidence optics
NASA Astrophysics Data System (ADS)
Geary, Joseph M.; Maeda, Riki
1987-12-01
An interfeormetric procedure is described that shows potential for obtaining surface figure error maps of grazing incidence optics at normal incidence. Such optics are found in some laser resonator configurations and in Wolter-type X-ray optics. The procedure makes use of cylindrical wavefronts and error subtraction techniques over subapertures. The surface error maps obtained will provide critical information to opticians for the fabrication process.
Travel behaviour change in old age: the role of critical incidents in public transport.
Sundling, Catherine; Nilsson, Mats E; Hellqvist, Sara; Pendrill, Leslie R; Emardson, Ragne; Berglund, Birgitta
Older people's travel behaviour is affected by negative or positive critical incidents in the public transport environment. With the objective of identifying such incidents during whole trips and examining how travel behaviour had changed, we have conducted in-depth interviews with 30 participants aged 65-91 years in the County of Stockholm, Sweden. Out of 469 incidents identified, 77 were reported to have resulted in travel behaviour change, 67 of them in a negative way. Most critical incidents were encountered in the physical environment on-board vehicles and at stations/stops as well as in pricing/ticketing. The findings show that more personal assistance, better driving behaviour, and swift maintenance of elevators and escalators are key facilitators that would improve predictability in travelling and enhance vulnerable older travellers' feeling of security. The results demonstrate the benefit of involving different groups of end users in future planning and design, such that transport systems would meet the various needs of its end users.
Ward, C L; Lombard, C J; Gwebushe, N
2006-01-01
Objectives To assess critical incident exposure among prehospital emergency services personnel in the developing world context of South Africa; and to assess associated mental health consequences. Methods We recruited a representative sample from emergency services in the Western Cape Province, South Africa, to participate in this cross sectional epidemiological study. Questionnaires covered critical incident exposure, general psychopathology, risky alcohol use, symptoms of post‐traumatic stress disorder (PTSD), and psychological and physical aggression between co‐workers. Open ended questions addressed additional stressors. Results Critical incident exposure and rates of general psychopathology were higher than in studies in the developed world. Exposure to critical incidents was associated with general psychopathology, symptoms of PTSD, and with aggression between co‐workers, but not with alcohol use. Ambulance, fire, and sea rescue services had lower general psychopathology scores than traffic police. The sea rescue service also scored lower than traffic police on PTSD and psychological aggression. The defence force had higher rates of exposure to physical assault, and in ambulance services, younger staff were more vulnerable to assault. Women had higher rates of general psychopathology and of exposure to psychological aggression. Other stressors identified included death notification, working conditions, and organisational problems. Conclusions Service organisations should be alert to the possibility that their personnel are experiencing work ‐related mental health and behavioural problems, and should provide appropriate support. Attention should also be given to organisational issues that may add to the stress of incidents. Workplace programmes should support vulnerable groups, and address death notification and appropriate expression of anger. PMID:16498167
Emotion in Leadership: Secondary School Administrators' Perceptions of Critical Incidents
ERIC Educational Resources Information Center
Yamamoto, Julie K.; Gardiner, Mary E.; Tenuto, Penny L.
2014-01-01
This article contributes to an emergent literature of empirical studies on how emotion impacts leadership. The purpose of the study was to examine how secondary school administrators derived meaning from critical incidents of significant emotional events retrospectively, and how the understanding impacted leadership. A conceptual framework of…
Critical Incident Effects on Principals: Using School Closure as the Context
ERIC Educational Resources Information Center
Lenarduzzi, Grant P.
2015-01-01
The effect of critical incidents on school principals has been marginally investigated. Principal leadership has many pleasures, but it is often replete with problematic circumstances. The skilled school-based leader requires rationality and diplomacy to manage conflict successfully. This study examined the perceived effects of a critical…
van der Togt, Remko; van Lieshout, Erik Jan; Hensbroek, Reinout; Beinat, E; Binnekade, J M; Bakker, P J M
2008-06-25
Health care applications of autoidentification technologies, such as radio frequency identification (RFID), have been proposed to improve patient safety and also the tracking and tracing of medical equipment. However, electromagnetic interference (EMI) by RFID on medical devices has never been reported. To assess and classify incidents of EMI by RFID on critical care equipment. Without a patient being connected, EMI by 2 RFID systems (active 125 kHz and passive 868 MHz) was assessed under controlled conditions during May 2006, in the proximity of 41 medical devices (in 17 categories, 22 different manufacturers) at the Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. Assessment took place according to an international test protocol. Incidents of EMI were classified according to a critical care adverse events scale as hazardous, significant, or light. In 123 EMI tests (3 per medical device), RFID induced 34 EMI incidents: 22 were classified as hazardous, 2 as significant, and 10 as light. The passive 868-MHz RFID signal induced a higher number of incidents (26 incidents in 41 EMI tests; 63%) compared with the active 125-kHz RFID signal (8 incidents in 41 EMI tests; 20%); difference 44% (95% confidence interval, 27%-53%; P < .001). The passive 868-MHz RFID signal induced EMI in 26 medical devices, including 8 that were also affected by the active 125-kHz RFID signal (26 in 41 devices; 63%). The median distance between the RFID reader and the medical device in all EMI incidents was 30 cm (range, 0.1-600 cm). In a controlled nonclinical setting, RFID induced potentially hazardous incidents in medical devices. Implementation of RFID in the critical care environment should require on-site EMI tests and updates of international standards.
Pilot Critical Incident Reports as a Means to Identify Human Factors of Remotely Piloted Aircraft
NASA Technical Reports Server (NTRS)
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
A Kolsky tension bar technique using a hollow incident tube
NASA Astrophysics Data System (ADS)
Guzman, O.; Frew, D. J.; Chen, W.
2011-04-01
Load control of the incident pulse profiles in compression Kolsky bar experiments has been widely used to subject the specimen to optimal testing conditions. Tension Kolsky bars have been used to determine dynamic material behavior since the 1960s with limited capability to shape the loading pulses due to the pulse-generating mechanisms. We developed a modified Kolsky tension bar where a hollow incident tube is used to carry the incident stress waves. The incident tube also acts as a gas gun barrel that houses the striker for impact. The main advantage of this new design is that the striker impacts on an impact cap of the incident tube. Compression pulse shapers can be attached to the impact cap, thus fully utilizing the predictive compression pulse-shaping capability in tension experiments. Using this new testing technique, the dynamic tensile material behavior for Al 6061-T6511 and TRIP 800 (transformation-induced plasticity) steel has been obtained.
Critical incident reporting and learning.
Mahajan, R P
2010-07-01
The success of incident reporting in improving safety, although obvious in aviation and other high-risk industries, is yet to be seen in health-care systems. An incident reporting system which would improve patient safety would allow front-end clinicians to have easy access for reporting an incident with an understanding that their report will be handled in a non-punitive manner, and that it will lead to enhanced learning regarding the causation of the incident and systemic changes which will prevent it from recurring. At present, significant problems remain with local and national incident reporting systems. These include fear of punitive action, poor safety culture in an organization, lack of understanding among clinicians about what should be reported, lack of awareness of how the reported incidents will be analysed, and how will the reports ultimately lead to changes which will improve patient safety. In particular, lack of systematic analysis of the reports and feedback directly to the clinicians are seen as major barriers to clinical engagement. In this review, robust systematic methodology of analysing incidents is discussed. This methodology is based on human factors model, and the learning paradigm which emphasizes significant shift from traditional judicial approach to understanding how 'latent errors' may play a role in a chain of events which can set up an 'active error' to occur. Feedback directly to the clinicians is extremely important for keeping them 'in the loop' for their continued engagement, and it should target different levels of analyses. In addition to high-level information on the types of incidents, the feedback should incorporate results of the analyses of active and latent factors. Finally, it should inform what actions, and at what level/stage, have been taken in response to the reported incidents. For this, local and national systems will be required to work in close cooperation, so that the lessons can be learnt and actions taken
Unpacking In-Service EFL Teachers' Critical Incidents: The Case of Iran
ERIC Educational Resources Information Center
Atai, Mahmood Reza; Nejadghanbar, Hassan
2016-01-01
Despite the importance of reflection on critical incidents (CIs), there are only a few studies in ELT literature addressing English language teachers' CIs (Farrell, 2008). Accordingly, this study was conducted to explore and discuss how six in-service EFL teachers reflected on and reported their CIs. In so doing, the participant teachers reflected…
Critical incidents and mortality reporting in pediatric anesthesia: the Australian experience.
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.
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. PMID:29310496
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.
Development of a radiology faculty appraisal instrument by using critical incident interviewing.
Collins, J; Albanese, M A; Thakor, S K; Propeck, P A; Scanlan, K A
1997-12-01
To develop a valid and reliable radiology faculty appraisal instrument based on scientific methods. Fifteen radiology residents participated in critical incident interviewing. During a 1-hour interview, a resident was asked to describe five incidents each of effective and ineffective faculty behavior. Two investigators independently listened to the tape-recorded interviews, and two different investigators sorted the incidents into broad categories. A faculty appraisal instrument was developed by listing similar incidents under broad categories. A five-point rating scale was applied to each item. Content validity was assessed by resident and faculty critique of the appraisal instrument. A total of 168 incidents of faculty behavior were generated. The frequency with which similar incidents were reported was recorded. The most common behaviors reported were related to staff expertise and teaching. Interjudge reliability was good, as determined by computing K indices of agreement (overall K = 0.59). There was good agreement regarding instrument content validity among residents but not among faculty. Residents supported the use of the new appraisal instrument, but further tests of validity and reliability and faculty acceptance of the instrument will determine its usefulness as a tool for monitoring faculty teaching performance and making decisions regarding faculty promotion.
Critical Incident Stress Debriefing as a Trauma Intervention in First Nation Communities
ERIC Educational Resources Information Center
Hughes, Megan L.
2006-01-01
This study examines the appropriateness of a cross-cultural application of Critical Incident Stress Debriefing (CISD). Participant/observations were made of CISD workshops conducted for First Nations participants. The facilitator and five participants were interviewed using narrative methodology. Observations and interview data were examined using…
[Critical infusion incident caused by incorrect use of a patient-controlled analgesia pump].
Steffen, M; von Hintzenstern, U; Obermayer, A
2002-01-01
We report on the case of a 17-year-old male patient who received a PCA pump after nephrectomy for postoperative analgesia. The syringe of the PCA pump was filled with 50 mg morphine and positioned about 25 cm above the heart. Since the piston of the syringe was not bolted while the pump was switched off, an unnoticed accidental evacuation of the whole content of the syringe into the intravenous line of the patient occurred because of gravity. This problem exists not only with PCA pumps, but can happen with syringe pumps in general. The incident, which can only be explained by strongly reduced venous pressure, was detected by chance. No harm resulted for the patient, but under different conditions it could have been lethal. This critical incident was caused by various factors: incorrect application in combination with insufficient experience or training, stress, inadequate handing-over of the patient and a lack of arrangements and instructions for procedures in routine situations. Suggestions for preventing such dangerous critical incidents are made and discussed. In particular, an algorithm for the correct procedure when inserting or changing the syringe of a syringe pump is presented.
New Teaching Techniques to Improve Critical Thinking. The Diaprove Methodology
ERIC Educational Resources Information Center
Saiz, Carlos; Rivas, Silvia F.
2016-01-01
The objective of this research is to ascertain whether new instructional techniques can improve critical thinking. To achieve this goal, two different instruction techniques (ARDESOS--group 1--and DIAPROVE--group 2--) were studied and a pre-post assessment of critical thinking in various dimensions such as argumentation, inductive reasoning,…
Critical evaluation of sample pretreatment techniques.
Hyötyläinen, Tuulia
2009-06-01
Sample preparation before chromatographic separation is the most time-consuming and error-prone part of the analytical procedure. Therefore, selecting and optimizing an appropriate sample preparation scheme is a key factor in the final success of the analysis, and the judicious choice of an appropriate procedure greatly influences the reliability and accuracy of a given analysis. The main objective of this review is to critically evaluate the applicability, disadvantages, and advantages of various sample preparation techniques. Particular emphasis is placed on extraction techniques suitable for both liquid and solid samples.
Plasmapheresis and other extracorporeal filtration techniques in critical patients.
Daga Ruiz, D; Fonseca San Miguel, F; González de Molina, F J; Úbeda-Iglesias, A; Navas Pérez, A; Jannone Forés, R
2017-04-01
Plasmapheresis is an extracorporeal technique that eliminates macromolecules involved in pathological processes from plasma. A review is made of the technical aspects, main indications in critical care and potential complications of plasmapheresis, as well as of other extracorporeal filtration techniques such as endotoxin-removal columns and other devices designed to eliminate cytokines or modulate the inflammatory immune response in critical patients. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Introduction of a prehospital critical incident monitoring system--pilot project results.
Stella, Julian; Davis, Anna; Jennings, Paul; Bartley, Bruce
2008-01-01
trend/further observation and analysis responses (5.2%; CI = 4.9-5.5%). The pilot project demonstrates successful implementation of an incident monitoring system within a regional, prehospital environment. The combination of incident detecting techniques has a high yield with potential to capture different error types. The large proportion of incidents in the "near miss" category allows analysis of incidents without patient harm. The majority of incidents were system related and many were mitigated by circumstance. The model used is appropriate for ongoing incident monitoring in this setting.
Garcia, Evangeline; Horton, Denise A
2003-02-01
The purpose of this article was to document the efforts of two military installations in facilitating Critical Incident Stress Management teams for Federal Emergency Management Agency Rescue and Recovery Units following the attacks on the World Trade Center on September 11, 2001. McGuire Air Force Base accepted the mission to support the rotating task forces with emotional support, and Fort Dix offered temporary lodging while the teams were in-bound and out-bound to the "Ground Zero" site. A team, comprised of staff from both installations due to the configuration of professional and support staffs, does the Critical Incident Stress Management work. Both installations are within commuting distance of New York City and could provide adequate safety, security, and logistics to the teams. The classic crisis management models were not called into play, as that service was not asked for; however, it was clear to the McGuire Air Force Base/Fort Dix Critical Incident Stress Management team members that the rescue and recovery teams needed their physical presence. Many rescue organizations have their own "debriefing teams," yet it is believed that "outside teams" may be helpful as interim measures to demonstrate the universality of the process of coping with traumatic stress and grief management. It is hoped that this article honors the workers who came together to help in a very difficult time for our country. This article documents the interim measures that were taken for a group of people moving through crisis.
The Role of the Critical Incident Stress Debriefing (CISD) Process in Disaster Counseling.
ERIC Educational Resources Information Center
Everly, George S., Jr.
1995-01-01
Posttraumatic stress is an occupational hazard for certain high-risk groups such as personnel in emergency services, public safety, and disaster response. Critical Incident Stress Debriefing (CISD) represents a structured group intervention designed for the mitigation of posttraumatic stress. Provides an introduction to and an overview of the CISD…
ERIC Educational Resources Information Center
Phelan, Liam
2012-01-01
This article discusses whether the very act of accessing online students' experiences of teaching may itself foster students' sense of belonging to a learning community. The article reports and reflects on the application of Brookfield's critical incident questionnaire (CIQ) in postgraduate courses delivered online in 2008-2010 through the…
ERIC Educational Resources Information Center
Brenner, Eliot; Freundlich, Madelyn
2006-01-01
The Adoption and Safe Families Act of 1997 has made child safety an explicit focus in child welfare. The authors describe an automated critical incident reporting program designed for use in foster care and family-support programs. The program, which is based in Lotus Notes and uses e-mail to route incident reports from direct service staff to…
de Boer, Jacoba; Lok, Anja; Van't Verlaat, Ellen; Duivenvoorden, Hugo J; Bakker, Arnold B; Smit, Bert J
2011-07-01
This meta-analysis reviewed existing data on the impact of work-related critical incidents in hospital-based health care professionals. Work-related critical incidents may induce post-traumatic stress symptoms or even post-traumatic stress disorder (PTSD), anxiety, and depression and may negatively affect health care practitioners' behaviors toward patients. Nurses and doctors often cope by working part time or switching jobs. Hospital administrators and health care practitioners themselves may underestimate the effects of work-related critical incidents. Relevant online databases were searched for original research published from inception to 2009 and manual searches of the Journal of Traumatic Stress, reference lists, and the European Traumatic Stress Research Database were conducted. Two researchers independently decided on inclusion and study quality. Effect sizes were estimated using standardized mean differences with 95% confidence intervals. Consistency was evaluated, using the I(2)-statistic. Meta-analysis was performed using the random effects model. Eleven studies, which included 3866 participants, evaluated the relationship between work-related critical incidents and post-traumatic stress symptoms. Six of these studies, which included 1695 participants, also reported on the relationship between work-related critical incidents and symptoms of anxiety and depression. Heterogeneity among studies was high and could not be accounted for by study quality, character of the incident, or timing of data collection. Pooled effect sizes for the impact of work-related critical incidents on post-traumatic stress symptoms, anxiety, and depression were small to medium. Remarkably, the effect was more pronounced in the longer than in the shorter term. In conclusion, this meta-analysis supports the hypothesis that work-related critical incidents are positively related to post-traumatic stress symptoms, anxiety, and depression in hospital-based health care professionals
Leichtweis, Gustavo Elias; Andriolo, Luiza; Delevatti, Yasmim A.; Jorge, Amaury C.; Fumagalli, Andreia C.; Santos, Luiz Claudio; Miura, Cecilia K.; Saito, Sergio K.
2017-01-01
Background Acute Atrial Fibrillation (AF) is common in critically ill patients, with significant morbidity and mortality; however, its incidence and severity in Intensive Care Units (ICUs) from low-income countries are poorly studied. Additionally, impact of vasoactive drugs on its incidence and severity is still not understood. This study aimed to assess epidemiology and risk factors for acute new-onset AF in critically ill adult patients and the role of vasoactive drugs. Method Cohort performed in seven general ICUs (including cardiac surgery) in three cities in Paraná State (southern Brazil) for 45 days. Patients were followed until hospital discharge. Results Among 430 patients evaluated, the incidence of acute new-onset AF was 11.2%. Patients with AF had higher ICU and hospital mortality. Vasoactive drugs use (norepinephrine and dobutamine) was correlated with higher incidence of AF and higher mortality in patients with AF; vasopressin (though used in few patients) had no effect on development of AF. Conclusions In general ICU patients, incidence of new-onset AF was 11.2% with a high impact on morbidity and mortality, particularly associated with the presence of Acute Renal Failure. The use of vasoactive drugs (norepinephrine and dobutamine) could lead to a higher incidence of new-onset AF-associated morbidity and mortality. PMID:28702263
Duarte, Péricles A D; Leichtweis, Gustavo Elias; Andriolo, Luiza; Delevatti, Yasmim A; Jorge, Amaury C; Fumagalli, Andreia C; Santos, Luiz Claudio; Miura, Cecilia K; Saito, Sergio K
2017-01-01
Acute Atrial Fibrillation (AF) is common in critically ill patients, with significant morbidity and mortality; however, its incidence and severity in Intensive Care Units (ICUs) from low-income countries are poorly studied. Additionally, impact of vasoactive drugs on its incidence and severity is still not understood. This study aimed to assess epidemiology and risk factors for acute new-onset AF in critically ill adult patients and the role of vasoactive drugs. Cohort performed in seven general ICUs (including cardiac surgery) in three cities in Paraná State (southern Brazil) for 45 days. Patients were followed until hospital discharge. Among 430 patients evaluated, the incidence of acute new-onset AF was 11.2%. Patients with AF had higher ICU and hospital mortality. Vasoactive drugs use (norepinephrine and dobutamine) was correlated with higher incidence of AF and higher mortality in patients with AF; vasopressin (though used in few patients) had no effect on development of AF. In general ICU patients, incidence of new-onset AF was 11.2% with a high impact on morbidity and mortality, particularly associated with the presence of Acute Renal Failure. The use of vasoactive drugs (norepinephrine and dobutamine) could lead to a higher incidence of new-onset AF-associated morbidity and mortality.
Transactional Space: Feedback, Critical Thinking, and Learning Dance Technique
ERIC Educational Resources Information Center
Akinleye, Adesola; Payne, Rose
2016-01-01
This article explores attitudes about feedback and critical thinking in dance technique classes. The authors discuss an expansion of their teaching practices to include feedback as bidirectional (transactional) and a part of developing critical thinking skills in student dancers. The article was written after the authors undertook research…
Effects of Proactive and Prosocial Behaviors on Critical Incidents of Schoolers from Lima
ERIC Educational Resources Information Center
Holguin Alvarez, Jhon A.
2017-01-01
The study focuses on the theoretical approaches of proactive and prosocial behavior of Covey (1996), Xifra (2009) and Roche-Olivar (2004), with the objective of analyzing the significant differences in the reduction of critical incidents in students from public and private schools in the district of San Juan de Lurigancho. To this end, two…
Critical fiber length technique for composite manufacturing processes
DOE Office of Scientific and Technical Information (OSTI.GOV)
Sivley, G.N.; Vandiver, T.L.; Dougherty, N.S.
1996-12-31
An improved injection technique for composite structures has been cooperatively developed by the U.S. Army Missile Command (MICOM) and Rockwell International (RI). This process simultaneously injects chopped fiberglass fibers and an epoxy resin matrix into a mold. Four injection techniques: (1){open_quotes}Little Willie{close_quotes} RTM system, (2) Pressure Vat system, (3) Pressure Vat system with vacuum assistance, and (4) Injection gun system, were investigated for use with a 304.8 mm x 304.8 mm x 5.08 mm (12 in x 12 in x 0.2 in) flat plaque mold. The driving factors in the process optimization included: fiber length, fiber weight, matrix viscosity, injectionmore » pressure, flow rate, and tool design. At fiber weights higher than 30 percent, the injection gun appears to have advantages over the other systems investigated. Results of an experimental investigation are reviewed in this paper. The investigation of injection techniques is the initial part of the research involved in a developing process, {open_quotes}Critical Fiber Length Technique{close_quotes}. This process will use the data collected in injection experiment along with mechanical properties derived from coupon test data to be incorporated into a composite material design code. The {open_quotes}Critical Fiber Length Technique{close_quotes} is part of a Cooperative Research and Development Agreement (CRADA) established in 1994 between MICOM and RI.« less
ERIC Educational Resources Information Center
Badia, Antoni; Becerril, Lorena
2016-01-01
This study approaches teacher learning from a dialogical viewpoint where lecturers' voices used in a training course context reflect how lecturers generated new professional discourse. The design of the training course considered the analysis of several critical incidents (CIs) in online teaching. An analytical framework based on lecturers'…
ERIC Educational Resources Information Center
Mwaba, Kelvin; Pedersen, Paul
1990-01-01
Investigated the relative importance of multicultural counselors' experience or training in their choice of intercultural, interpersonal, or psychopathological attributions when interpreting 20 brief multicultural critical incidents. An inverse correlation was found between experience or training and emphasis on intercultural, as opposed to…
Panzica, M; Krettek, C; Cartes, M
2011-09-01
The probability that an inpatient will be harmed by a medical procedure is at least 3% of all patients. As a consequence, hospital risk management has become a central management task in the health care sector. The critical incident reporting system (CIRS) as a voluntary instrument for reporting (near) incidents plays a key role in the implementation of a risk management system. The goal of the CIRS is to register system errors without assigning guilt or meting out punishment and at the same time increasing the number of voluntary reports.
Hauck, Yvonne L; Blixt, Ingrid; Hildingsson, Ingegerd; Gallagher, Louise; Rubertsson, Christine; Thomson, Brooke; Lewis, Lucy
2016-10-10
Breastfeeding initiation rates in some developed countries are high (98 % in Sweden and 96 % in Australia) whereas in others, they are not as favourable (46 % to 55 % in Ireland). Although the World Health Organization recommends exclusively breastfeeding for six months, 15 % of Australian women, 11 % of Swedish women and less than 7 % of Irish women achieve this goal. Awareness of what women in different countries perceive as essential breastfeeding support is a gap in our knowledge. Our aim was to explore Australian, Irish and Swedish women's perceptions of what assisted them to continue breastfeeding for six months. An exploratory design using critical incident techniques was used. Recruitment occurred through advertisements in local newspapers and on social networking platforms. Initial sampling was purposive, followed by snowball sampling. Telephone interviews were conducted with 64 Irish, 139 Swedish and 153 Australian women who responded to one question "what has assisted you to continue breastfeeding for at least six months?" Content analysis was conducted and common categories determined to allow comparison of frequencies and priority ranking. Categories reflected the individual mother, her inner social network, her outer social network (informal support either face to face or online), and societal support (health professionals, work environment and breastfeeding being regarded as the cultural norm). Categories ranked in the top five across the three countries were 'informal face to face support' and 'maternal determination'. Swedish and Australian women ranked "health professional support" higher (first and third respectively) than Irish women who ranked 'informal online support' as second compared to ninth and tenth for Swedish and Australian women. The support required to assist breastfeeding women is complex and multi-faceted. Although common international categories were revealed, the ranking of these supportive categories varied. We must
Veyler, R V; Musaeva, T S; Trembach, N V; Zabolotskikh, I B
2016-09-01
to determine patterns during combined anesthesia andfrequency ofcritical incidents, depending on the initial level of wakefulness and patient age. 158 patients of planning operated under combined anesthesia for colon tumors were divided into two groups of elderly patients (n= 79) and old (n= 79). Each group was divided into 3 subgroups, depending on level of wakefulness, the estimatedfor level of direct current potential: low, optimum and high levels ofwakefulness. Relations of age and level ofwakefulness with afrequency of critical incidents. In the number of registered incidents included hemodynamic incidents: hypotension, hypertension, bradycardia, arrhythmia and tachycardia; respiratory incidents: hypoxemia, hypercapnia, the needfor prolonged postoperative mechanical ventilation; metabolic incidents: hypothermia, slow recovery of neuromuscular conduction, slow postoperative awakening has been studied. The most frequent incidents in our study were hemodynamic incidents, which prevailed in the structure of hypotension and hypertension. Among of the respiratory incidents dominated by hypoxia and hypercapnia. In the group of elderly patients the most incidents occurred in the subgroup with low level of wakefulness, while in the oldest patients statistically group significant differences between the groups were not found Conclusion. Frequency of critical incidents does not only depend from the age but also from a preoperative level of wakefulness; frequency was lower in elderly patients with an optimum level of wakefulness, and the low level of wakefulness - was high regardless of age.
DOT National Transportation Integrated Search
2014-04-01
This independent report presents work conducted regarding project FR-RDD-0024-11-01 to advise and support the formulation of : regulations and supporting materials concerning critical incident response plans for rail carriers covered by the Rai...
ERIC Educational Resources Information Center
O'Brien, Patrick; Mills, Katrina; Fraser, Amanda; Andersson, John
2011-01-01
This article proposes that consideration could be given to an invitational intervention rather than an expectational intervention when support personnel respond to a critical incident in schools. Intuitively many practitioners know that it is necessary for guidance/counselling personnel to intervene in schools in and following times of trauma.…
ERIC Educational Resources Information Center
Griffin, Maureen L.; Scherr, Tracey G.
2010-01-01
This longitudinal project consisted of exploring the usefulness of Critical Incident Reporting (CIR) as an instructional tool (Griffin, 2003) to first increase objectivity and self-knowledge among practicum students and then to guide practices when those students became interns the following academic year. Analysis included 120 CIRs written by 15…
Increased Incidence of Critical Illness in Psoriasis.
Marrie, Ruth Ann; Bernstein, Charles N; Peschken, Christine A; Hitchon, Carol A; Chen, Hui; Garland, Allan
Psoriasis is associated with an increased risk of comorbid disease. Despite the recognition of increased morbidity in psoriasis, the effects on health care utilisation remain incompletely understood. Little is known about the risk of intensive care unit (ICU) admission in persons with psoriasis. To compare the incidence of ICU admission and post-ICU mortality rates in a psoriasis population compared with a matched population without psoriasis. Using population-based administrative data from Manitoba, Canada, we identified 40 930 prevalent cases of psoriasis and an age-, sex-, and geographically matched cohort from the general population (n = 150 210). We compared the incidence of ICU admission between populations using incidence rates and Cox regression models adjusted for age, sex, socioeconomic status, and comorbidity and compared mortality after ICU admission. Among incident psoriasis cases (n = 30 150), the cumulative 10-year incidence of ICU admission was 5.6% (95% confidence interval [CI], 5.3%-5.8%), 21% higher than in the matched cohort (incidence rate ratio, 1.21; 95% CI, 1.15-1.27). In the prevalent psoriasis cohort, crude mortality in the ICU was 11.5% (95% CI, 9.9%-13.0%), 32% higher than observed in the matched population admitted to the ICU (8.7%; 95% CI, 8.3%-9.1%). Mortality rates after ICU admission remained elevated at all time points in the psoriasis cohort compared with the matched cohort. Psoriasis is associated with an increased risk for ICU admission and with an increased risk of mortality post-ICU admission.
Arora, V; Johnson, J; Lovinger, D; Humphrey, H J; Meltzer, D O
2005-12-01
The transfer of care for hospitalized patients between inpatient physicians is routinely mediated through written and verbal communication or "sign-out". This study aims to describe how communication failures during this process can lead to patient harm. In interviews employing critical incident technique, first year resident physicians (interns) described (1) any adverse events or near misses due to suboptimal preceding patient sign-out; (2) the worst event due to suboptimal sign-out in which they were involved; and (3) suggestions to improve sign-out. All data were analyzed and categorized using the constant comparative method with independent review by three researchers. Twenty six interns caring for 82 patients were interviewed after receiving sign-out from another intern. Twenty five discrete incidents, all the result of communication failures during the preceding patient sign-out, and 21 worst events were described. Inter-rater agreement for categorization was high (kappa 0.78-1.00). Omitted content (such as medications, active problems, pending tests) or failure-prone communication processes (such as lack of face-to-face discussion) emerged as major categories of failed communication. In nearly all cases these failures led to uncertainty during decisions on patient care. Uncertainty may result in inefficient or suboptimal care such as repeat or unnecessary tests. Interns desired thorough but relevant face-to-face verbal sign-outs that reviewed anticipated issues. They preferred legible, accurate, updated, written sign-out sheets that included standard patient content such as code status or active and anticipated medical problems. Communication failures during sign-out often lead to uncertainty in decisions on patient care. These may result in inefficient or suboptimal care leading to patient harm.
Techniques of Punishment and the Development of Self-Criticism
ERIC Educational Resources Information Center
Grusec, Joan E.; Ezrin, Sharyn A.
1972-01-01
The results of this study indicate that induction combined with withdrawal of love is no more effective as a punishment technique for the development of at least one aspect of conscience--self-criticism--than withdrawal of material reward. (Authors)
Risk of incident mental health conditions among critical care air transport team members.
Tvaryanas, Anthony P; Maupin, Genny M
2014-01-01
This study investigated whether Critical Care Air Transport Team (CCATT) members are at increased risk for incident post-deployment mental health conditions. We conducted a retrospective cohort study of 604 U.S. Air Force medical personnel without preexisting mental health conditions who had at least one deployment as a CCATT member during 2003-2012 as compared to a control group of 604 medical personnel, frequency matched based on job role, with at least one deployment during the same period, but without CCATT experience. Electronic health record data were used to ascertain the diagnosis of a mental health condition. The incidence of post-deployment mental health conditions was 2.1 per 1000 mo for the CCATT group versus 2.2 per 1000 mo for the control group. The six most frequent diagnoses were the same in both groups: adjustment reaction not including posttraumatic stress disorder (PTSD), anxiety, major depressive disorder, specific disorders of sleep of nonorganic origin, PTSD, and depressive disorder not elsewhere classified. Women were at marginally increased risk and nurses and technicians were at twice the risk of physicians. The distribution of the time interval from end of the most recent deployment to diagnosis of incident mental health condition was positively skewed with a median greater than 6 mo. CCATT members were at no increased risk for incident post-deployment mental health conditions as compared to non-CCATT medical service members. Nearly two-thirds of incident post-deployment mental health conditions were diagnosed outside the standard 6-mo medical surveillance period, a finding warranting further study.
Multi-intelligence critical rating assessment of fusion techniques (MiCRAFT)
NASA Astrophysics Data System (ADS)
Blasch, Erik
2015-06-01
Assessment of multi-intelligence fusion techniques includes credibility of algorithm performance, quality of results against mission needs, and usability in a work-domain context. Situation awareness (SAW) brings together low-level information fusion (tracking and identification), high-level information fusion (threat and scenario-based assessment), and information fusion level 5 user refinement (physical, cognitive, and information tasks). To measure SAW, we discuss the SAGAT (Situational Awareness Global Assessment Technique) technique for a multi-intelligence fusion (MIF) system assessment that focuses on the advantages of MIF against single intelligence sources. Building on the NASA TLX (Task Load Index), SAGAT probes, SART (Situational Awareness Rating Technique) questionnaires, and CDM (Critical Decision Method) decision points; we highlight these tools for use in a Multi-Intelligence Critical Rating Assessment of Fusion Techniques (MiCRAFT). The focus is to measure user refinement of a situation over the information fusion quality of service (QoS) metrics: timeliness, accuracy, confidence, workload (cost), and attention (throughput). A key component of any user analysis includes correlation, association, and summarization of data; so we also seek measures of product quality and QuEST of information. Building a notion of product quality from multi-intelligence tools is typically subjective which needs to be aligned with objective machine metrics.
Masuyama, Tomoyuki; Sanui, Masamitsu; Yoshida, Naoto; Iizuka, Yusuke; Ogi, Kunio; Yagihashi, Satoko; Nagatomo, Kanae; Sasabuchi, Yusuke; Lefor, Alan K
2018-02-08
Benzodiazepine use is a risk factor for the development of delirium in adult intensive care unit (ICU) patients. Suvorexant is an alternative to benzodiazepines to induce sleep, but the incidence of delirium in critically ill patients is unknown. We undertook this retrospective study to investigate the incidence of delirium in patients who receive suvorexant in the ICU. This retrospective cohort study was conducted in a closed 12-bed ICU at a tertiary teaching hospital. Patients admitted to the ICU for 72 h or longer between January and June 2015 were evaluated for delirium using the Confusion Assessment Method for the Intensive Care Unit tool. We evaluated the incidence of delirium in patients who received suvorexant and those who did not. To adjust for confounding factors, multivariable logistic regression analysis was conducted. Study subjects included 118 patients, with a median age of 72 years and a median Acute Physiology and Chronic Health Evaluation II score of 18 points. Eighty-two patients (69.5%) were admitted after cardiovascular surgery. In the suvorexant group, there were fewer post-cardiovascular surgical patients and more medical patients. The duration of mechanical ventilation during ICU stay was longer in the suvorexant group, and sedatives and sleep inducers other than suvorexant were used more frequently in the suvorexant group. The incidence of delirium was 43.8% in the suvorexant group and 58.8% in the non-suvorexant group (P = 0.149). After adjustment for risk factors using multivariable logistic regression analysis, suvorexant was associated with a lower incidence of delirium (odds ratio = 0.23, 95% confidence interval: 0.07-0.73; P = 0.012). Suvorexant was associated with decreased odds of transitioning to delirium in critically ill patients. The use of suvorexant may lower the incidence of delirium in ICU patients. Future prospective studies are warranted. © 2018 Japanese Psychogeriatric Society.
Professional monitoring and critical incident reporting using personal digital assistants.
Bent, Paul D; Bolsin, Stephen N; Creati, Bernie J; Patrick, Andrew J; Colson, Mark E
2002-11-04
To assess the practicality of using personal digital assistants (PDAs) for the collection of logbook data, procedural performance data and critical incident reports in anaesthetic trainees. Pilot study. Two tertiary referral centres (in Victoria and New Zealand) and a large district hospital in Queensland. Six accredited Australian and New Zealand College of Anaesthetists (ANZCA) registrars and their ANZCA training supervisors. Registrars and supervisors underwent initial training for one hour, and supervisors were provided with ongoing support. Reliable use of the program, average time for data entry and number of procedures logged. ANZCA trainees reliably enter data into PDAs. The data can be transferred to a central database, where they can be remotely analysed before results are fed back to trainees. This technology can be used to monitor professional performance in ANZCA trainees.
Frozen moments: flashback memories of critical incidents in emergency personnel.
Kleim, Birgit; Bingisser, Martina-Barbara; Westphal, Maren; Bingisser, Roland
2015-07-01
Emergency Department personnel regularly face highly stressful situations or critical incidents (CIs) that may subsequently be recalled as unbidden intrusive memories. In their most extreme form, such memories are reexperienced as if they were happening again in the present, as flashbacks. This study examined (1) which CIs are associated with flashback memories; (2) candidate person and work-related features that predict flashback memories; and (3) the association between flashback memories and anxiety, depression, and emotional exhaustion. Emergency nurses (N = 91; 80.2% female) were recruited from two urban teaching hospitals and filled in self-report questionnaires. A majority (n = 59, 65%) experienced intrusive memories; almost half of the sample reported that their memories had flashback character. Those involved in resuscitations in the past week were at a fourfold risk for experiencing flashbacks. Having worked more consecutive days without taking time off was associated with a somewhat lower incidence of flashbacks. Moreover, older individuals who reported more work-related conflicts were at greater risk for experiencing flashback memories than their younger colleagues with heightened work conflict and flashback memory scores, respectively. Flashback memories were associated with heightened symptoms of anxiety, depression, and emotional exhaustion. The present findings have implications for evidence-based health promotion in emergency personnel and other individuals regularly exposed to CIs.
Differential Deposition Technique for Figure Corrections in Grazing Incidence X-ray Optics
NASA Technical Reports Server (NTRS)
Kilaru, Kiranmayee; Ramsey, Brian D.; Gubarev, Mikhail
2009-01-01
A differential deposition technique is being developed to correct the low- and mid-spatial-frequency deviations in the axial figure profile of Wolter type grazing incidence X-ray optics. These deviations arise due to various factors in the fabrication process and they degrade the performance of the optics by limiting the achievable angular resolution. In the differential deposition technique, material of varying thickness is selectively deposited along the length of the optic to minimize these deviations, thereby improving the overall figure. High resolution focusing optics being developed at MSFC for small animal radionuclide imaging are being coated to test the differential deposition technique. The required spatial resolution for these optics is 100 m. This base resolution is achievable with the regular electroform-nickel-replication fabrication technique used at MSFC. However, by improving the figure quality of the optics through differential deposition, we aim at significantly improving the resolution beyond this value.
Incidence and predictors of critical events during urgent air–medical transport
Singh, Jeffrey M.; MacDonald, Russell D.; Bronskill, Susan E.; Schull, Michael J.
2009-01-01
Background Little is known about the risks of urgent air–medical transport used in regionalized health care systems. We sought to determine the incidence of intransit critical events and identify factors associated with these events. Methods We conducted a population-based, retrospective cohort study using clinical and administrative data. We included all adults undergoing urgent air–medical transport in the Canadian province of Ontario between Jan. 1, 2004, and May 31, 2006. The primary outcome was in-transit critical events, which we defined as death, major resuscitative procedure, hemodynamic deterioration, or inadvertent extubation or respiratory arrest. Results We identified 19 228 patients who underwent air–medical transport during the study period. In-transit critical events were observed in 5.1% of all transports, for a rate of 1 event per 12.6 hours of transit time. Events consisted primarily of new hypotension or airway management procedures. Independent predictors of critical events included female sex (adjusted odds ratio [OR] 1.3, 95% confidence interval [CI] 1.1–1.5), assisted ventilation before transport (adjusted OR 3.0, 95% CI 2.3–3.7), hemodynamic instability before transport (adjusted OR 3.2, 95% CI 2.5–4.1), transport in a fixed-wing aircraft (adjusted OR 1.5, 95% CI 1.2–1.8), increased duration of transport (adjusted OR 1.02 per 10-minute increment, 95% CI 1.01–1.03), on-scene calls (adjusted OR 1.7, 95% CI 1.4–2.1) and type of crew (adjusted OR 0.6 for advanced care paramedics v. critical care paramedics, 95% CI 0.5–0.7). Interpretation Critical events occurred in about 1 in every 20 air–medical transports and were associated with multiple risk factors at the patient, transport and system levels. These findings have implications for the refinement of training of paramedic transport crews and processes for triage and transport. PMID:19752105
Gouweloos-Trines, Juul; Tyler, Mark P; Giummarra, Melita J; Kassam-Adams, Nancy; Landolt, Markus A; Kleber, Rolf J; Alisic, Eva
2017-12-01
Prehospital providers are at increased risk for psychological distress. Support at work after critical incidents is believed to be important for providers, but current guidelines are in need of more scientific evidence. This study aimed to investigate: (1) to what extent prehospital providers experience support at work; (2) whether support at work is directly associated with lower distress and (3) whether availability of a formal peer support system is related to lower distress via perceived colleague support. This cross-sectional study surveyed prehospital providers from eight western industrialised countries between June and November 2014. A supportive work environment was operationalised as perceived management and colleague support (Job Content Questionnaire), availability of a formal peer support system and having enough time to recover after critical incidents. The outcome variable was psychological distress (Kessler 10). We conducted multiple linear regression analyses and mediation analysis. Of the 813 respondents, more than half (56.2%) were at moderate to high risk of psychological distress. Participants did not consistently report support at work (eg, 39.4% were not aware of formal peer support). Perceived management support (b (unstandardised regression coefficient)=-0.01, 95% CI -0.01 to 0.00), having enough time to recover after critical incidents (b=-0.07, 95% CI -0.09 to -0.04) and perceived colleague support (b=-0.01, 95% CI -0.01 to 0.00) were related to lower distress. Availability of formal peer support was indirectly related to lower distress via increased perceived colleague support (β=-0.04, 95% CI -0.02 to -0.01). Prehospital providers at risk of psychological distress may benefit from support from colleagues and management and from having time to recover after critical incidents. Formal peer support may assist providers by increasing their sense of support from colleagues. These findings need to be verified in a longitudinal design
Habre, Walid; Disma, Nicola; Virag, Katalin; Becke, Karin; Hansen, Tom G; Jöhr, Martin; Leva, Brigitte; Morton, Neil S; Vermeulen, Petronella M; Zielinska, Marzena; Boda, Krisztina; Veyckemans, Francis
2017-05-01
Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0-5·5) with an incidence of respiratory critical events of 3·1% (2·9-3·3). Cardiovascular instability occurred in 1·9% (1·7-2·1), with an immediate poor outcome in 5·4% (3·7-7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86-0·90; p<0·0001), medical history, and physical condition (1·60, 1·40-1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981-0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97-0·99; p=0
Keyboarding Instruction at NABTE Institutions: Are We Teaching Techniques to Reduce CTD Incidence?
ERIC Educational Resources Information Center
Blaszczynski, Carol; Joyce, Marguerite Shane
1996-01-01
Responses from 157 of 193 business teachers who teach keyboarding indicated that 78.7% were aware of cumulative trauma disorder and 22% had experienced it. Only 13% of classrooms were equipped with wrist rests. About 53% teach techniques to reduce incidence, but 20% did not know whether they taught preventive measures. (SK)
Gluck, S; Headdon, W G; Tang, Dws; Bastian, I B; Goggin, M J; Deane, A M
2015-11-01
Despite a paucity of data regarding both the incidence of ocular candidiasis and the utility of ophthalmic examination in critically ill patients, routine ophthalmic examination is recommended for critically ill patients with candidaemia. The objectives were to estimate the incidence of ocular candidiasis and evaluate whether ophthalmic examination influenced subsequent management of these patients. We conducted a ten-year retrospective observational study. Data were extracted for all ICU patients who were blood culture positive for fungal infection. Risk factors for candidaemia and eye involvement were quantified and details regarding ophthalmic examination were reviewed. Candida species were cultured in 93 patients. Risk factors for ocular candidiasis were present in 57% of patients. Forty-one percent of patients died prior to ophthalmology examination and 2% of patients were discharged before candidaemia was identified. During examination, signs of ocular candidiasis were only present in one (2.9%) patient, who had a risk factor for ocular candidiasis. Based on these findings, the duration of antifungal treatment for this patient was increased. Ocular candidiasis occurs rarely in critically ill patients with candidaemia, but because treatment regimens may be altered when diagnosed, routine ophthalmic examination is still indicated.
DOE Office of Scientific and Technical Information (OSTI.GOV)
Denise Baclawski
2010-03-08
The University of Nevada, Reno Fire Science Academy (FSA) applied for grant funding to develop and deliver programs for municipal, rural, and volunteer firefighters. The FSA specializes in preparing responders for a variety of emergency events, including flammable liquid fires resulting from accidents, intentional acts, or natural disasters. Live fire training on full scale burnable props is the hallmark of FSA training, allowing responders to practice critical skills in a realistic, yet safe environment. Unfortunately, flammable liquid live fire training is often not accessible to municipal, rural, or volunteer firefighters due to limited department training budgets, even though most departmentmore » personnel will be exposed to flammable liquid fire incidents during the course of their careers. In response to this training need, the FSA developed a course during the first year of the grant (Year One), Responding to Terrorist Incidents in Your Community: Flammable-Liquid Fire Fighting Techniques for Municipal and Rural Firefighters. During the three years of the grant, a total of 2,029 emergency responders received this training. In Year Three, two new courses, a train-the-trainer for Responding to Terrorist Incidents in Your Community and Management of Large-Scale Disasters for Public Officials were developed and pilot tested during the Real-World Disaster Management Conference held at the FSA in June of 2007. Two research projects were conducted during Years Two and Three. The first, conducted over a two year period, evaluated student surveys regarding the value of the flammable liquids training received. The second was a needs assessment conducted for rural Nevada. Both projects provided important feedback and a basis for curricula development and improvements.« less
Critical incidents in a French department of paediatric anaesthesia.
Kupersztych-Hagege, Elisa; Duracher-Gout, Caroline; Ortego, Rocio; Carli, Pierre; Orliaguet, Gilles
2017-04-01
Several studies have highlighted the importance of critical incident (CI) reporting in order to enhance patient safety. We have implemented an anonymous procedure for CI reporting in our department of paediatric anaesthesia. This study aims at analysing those CIs so as to improve patient care and risk management. CIs were reported by the anaesthetic team using the World Health Organization classification and analysed using the ORION methodology. CIs were classified according to type, surgery and complications. Risk factors and consequences for patients and for the institution were analysed. Risk factors with high degree of harm for the patient were identified using a univariate analysis and odds ratios (OR). Over an 18-month period, 114 CIs were reported for 103 patients (median age: 7.0 years [95% CI: 3.6-9.8]). We found that 29.9% of reported CIs had consequences for the patients and 76.3% were considered preventable. The two main types of CI were "respiratory" (28.8%) and "drug-related" (22.8%) incidents. The main risk factor was 'human error' (42.3%). Several consequences for the patient and the hospital were identified. An ASA score≥3 (OR: 2.52; [95% CI: 1.10-5.78]) was an independent risk factor for a high degree of patient harm. Improving quality of care must be a priority for paediatric anaesthesiologists as most of the CIs observed are preventable and have consequences for the patient and the institution. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
Song, Dawei; Meng, Bin; Gan, Minfeng; Niu, Junjie; Li, Shiyan; Chen, Hao; Yuan, Chenxi; Yang, Huilin
2015-08-01
Percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) are minimally invasive and effective vertebral augmentation techniques for managing osteoporotic vertebral compression fractures (OVCFs). Recent meta-analyses have compared the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques or conservative treatment; however, the inclusions were not thorough and rigorous enough, and the effects of each technique on the incidence of secondary vertebral fractures remain unclear. To perform an updated systematic review and meta-analysis of the studies with more rigorous inclusion criteria on the effects of vertebral augmentation techniques and conservative treatment for OVCF on the incidence of secondary vertebral fractures. PubMed, MEDLINE, EMBASE, SpringerLink, Web of Science, and the Cochrane Library database were searched for relevant original articles comparing the incidence of secondary vertebral fractures between vertebral augmentation techniques and conservative treatment for patients with OVCFs. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (NRCTs) were identified. The methodological qualities of the studies were evaluated, relevant data were extracted and recorded, and an appropriate meta-analysis was conducted. A total of 13 articles were included. The pooled results from included studies showed no statistically significant differences in the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques and conservative treatment. Subgroup analysis comparing different study designs, durations of symptoms, follow-up times, races of patients, and techniques were conducted, and no significant differences in the incidence of secondary fractures were identified (P > 0.05). No obvious publication bias was detected by either Begg's test (P = 0.360 > 0.05) or Egger's test (P = 0.373 > 0.05). Despite current thinking in the
Delsignore, Ann Marie; Petrova, Elena; Harper, Amney; Stowe, Angela M; Mu'min, Ameena S; Middleton, Renée A
2010-07-01
An exploratory qualitative analysis of the critical incidents and assistance-seeking behaviors of White mental health psychologists and professional counselors was performed in an effort to examine a theoretical supposition presented within a Person(al)-as-Profession(al) transtheoretical framework (P-A-P). A concurrent nested strategy was used in which both quantitative and qualitative data were collected simultaneously (Creswell, 2003). In this nested strategy, qualitative data was embedded in a predominant (quantitative) method of analysis from an earlier study (see Middleton et al., 2005). Critical incidents categorized as informal (i.e., personal) experiences were cited more often than those characterized as formal (i.e., professional) experiences as influencing the professional perspectives of White mental health practitioners regarding multicultural diversity. Implications for the counseling and psychology professions are discussed.
An exploration of GPs' use of MRI: a critical incident study.
Robling, M; Kinnersley, P; Houston, H; Hourihan, M; Cohen, D; Hale, J
1998-06-01
Direct access to Magnetic Resonance Imaging (MRI) is becoming available to GPs in the UK, offering major benefits for the improved diagnosis and management of certain clinical conditions. Variations in usage of this service may be large, and effective locally produced guidelines are not currently available. The Department of General Practice is conducting a research programme to develop and evaluate methods to optimize MRI use by GPs. We aimed to describe the current use of MRI by GPs in South Glamorgan; to summarize their reasons for requesting MRI; and to produce criteria to assess the appropriateness of magnetic resonance (MR) scan requests. Using the critical incident technique, 25 GPs were interviewed about recent scans requested for patients with knee and lumbar spine complaints. A local panel of primary and secondary care doctors was convened to develop criteria for assessing MR scan requests. Sixty-two scan requests were discussed. Doctors' reasons for requesting MR scans were identified and classified. Reasons for requests included personal, contextual and biomedical variables. Fifteen patients (24%) were managed in primary care following MRI when otherwise they would have been referred. When referrals were made, GPs felt able to reinforce the request and occasionally to direct the patient somewhere more appropriate. The panel reviewed the interview data to produce objective criteria to assess scan requests. The criteria reflect the relative importance of non-biomedical variables in the decision to request MRI. The study identified those reasons which are important to GPs when requesting MR scans and the impact of this new technology upon patient management. Interview data have been used to inform locally developed consensus criteria, which will be made available as practice guidelines as the research programme progresses.
ERIC Educational Resources Information Center
Sugar, William A.; Luterbach, Kenneth J.
2016-01-01
Through consideration of critical incidents, this study analyzed 106 effective, ineffective and extraordinary instructional design and multimedia production (MP) activities discussed by 36 instructional design professionals. This evaluation provided insights into these professionals' best and not so best practices during the past 6 months.…
ERIC Educational Resources Information Center
Holligan, Chris; Wilson, Michael
2015-01-01
Drawing on insights from phenomenological sociology and various strands of socio-cultural theory, this paper reports the findings of a qualitative investigation into critical incidents as formative influences in the research orientation and research cultivation of 22 academics working in research-intensive university education departments. The…
Hamui-Sutton, Alicia; Vives-Varela, Tania; Gutiérrez-Barreto, Samuel; Leenen, Iwin; Sánchez-Mendiola, Melchor
2015-11-04
Medical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied. We carried out a mixed-methods study, consisting of a qualitative and a quantitative phase. For the qualitative study, 128 residents reported critical incidents in their clinical practice and described how they coped with the uncertainty in the situation. Each critical incident was analyzed and the most salient situations, 45 in total, were retained. In the quantitative phase, a distinct group of 120 medical residents indicated for each of these situations whether they have been involved in the described situations and, if so, which coping strategy they applied. The analysis examines the relation between characteristics of the situation and the coping strategies. From the qualitative study, a new typology of uncertainty was derived which distinguishes between technical, conceptual, communicational, systemic, and ethical uncertainty. The quantitative analysis showed that, independently of the type of uncertainty, critical incidents are most frequently resolved by consulting senior physicians (49 % overall), which underscores the importance of the hierarchical relationships in the hospital. The insights gained by this study are combined into an integrative model of uncertainty in medical residencies, which combines the type and perceived level of uncertainty, the strategies employed to deal with it, and context elements such as the actors present in the situation. The model considers the final resolution at each of three levels: the patient, the health system, and the physician's personal level. This study gives insight into how medical residents make decisions under different types of uncertainty
Does the Use of Clean or Sterile Dressing Technique Affect the Incidence of Wound Infection?
Kent, Dea J; Scardillo, Jody N; Dale, Barbara; Pike, Caitlin
The purpose of this article is to examine the evidence and provide recommendations for the use of clean or sterile dressing technique with dressing application to prevent wound infection. In all persons with acute or chronic wounds, does the use of clean or sterile dressing technique affect incidence of wound infection? A search of the literature was performed by a trained university librarian, which resulted in 473 articles that examined any age group that dealt with application of a wound dressing using either sterile or nonsterile technique. A systematic approach was used to review titles, abstracts, and text, yielding 4 studies that met inclusion criteria. Strength of the evidence was rated using rating methodology from Essential Evidence Plus: Levels of Evidence and Oxford Center for Evidence-Based Medicine, adapted by Gray and colleagues. Johns Hopkins Nursing Evidence-Based Practice Nursing Research Appraisal Tool was used to rate the quality of the evidence. All 4 studies reported no significant difference in the rate of wound infection when using either clean or sterile technique with dressing application. The strength of the evidence for the identified studies was identified as level 2 (1 level A, 3 level B). The study sizes were variable, and the wounds included do not represent the continuum of wounds clinically encountered across the board. Evidence indicates that the use of clean technique for acute wound care is a clinically effective intervention that does not affect the incidence of infection. There is no recommendation that can be made regarding type of dressing technique for a chronic wound due to the lack of evidence in the literature.
Incidence loss for fan turbine rotor blade in two-dimensional cascade
NASA Technical Reports Server (NTRS)
Kline, J. F.; Moffitt, T. P.; Stabe, R. G.
1983-01-01
The effect of incidence angle on the aerodynamic performance of a fan turbine rotor blade was investigated experimentally in a two dimensional cascade. The test covered a range of incidence angles from -15 deg to 10 deg and exit ideal critical velocity ratios from 0.75 to 0.95. The principal measurements were blade-surface static pressures and cross-channel survey of exit total pressure, static pressure, and flow angle. Flow adjacent to surfaces was examined using a visualization technique. The results of the investigation include blade-surface velocity distribution and overall kinetic energy loss coefficients for the incidence angles and exit velocity ratios tested. The measured losses are compared with those from a reference core turbine rotor blade and also with two common analytical methods of predicting incidence loss.
Strand, Russell; Felices, Karina; Williams, Kenneth
2010-01-01
On November 5, 2009, an individual entered the Fort Hood Soldier Readiness Processing (SRP) site and opened fire with a handgun. The result of the shooting was a total of 13 people killed and 31 wounded. A two-person critical incident peer support (CIPS) team from the United States Army Military Police School (USAMPS) provided critical incident stress management (CISM) in the forms of critical incident stress debriefings (CISD) and one-on-one crisis intervention for investigators and their spouses. This article provides a summary and discussion of the results of the interventions that were conducted. Key results for successful CISM were accessibility of CIPS team, the credibility of trained peers and the development of supportive relationships, the reduction of stigma by requiring attendance at interventions, and the commitment of the CIPS team to the principles of CISM (e.g., homogenous groups, utilizing a multicomponent approach, and facilitating the normalization of emotional reactions to the crisis). Recommendations include mandating critical incident peer support cells for Criminal Investigation Division (CID) units, Director of Emergency Services (DES) on military installations, and Military Police units; providing a pool of trained peers in the above-mentioned organizations; providing permanent funding for USAMPS' CIPS Course; and recognition of CIPS/CISMas an essential element of Comprehensive Soldier Fitness and Army Human Capital in promoting Soldier Family, and Civilian well-being and resiliency. This article would benefit leaders, chaplains, mental health professionals, and emergency services personnel in investigative, operational, and U.S. Army Garrison units.
ERIC Educational Resources Information Center
Vaughan, Karen; Kear, Andrew; MacKenzie, Heath
2014-01-01
This article examines a critical incident during research investigating a new assessment system for on-job learning in carpentry. The system was designed to establish clear relationships between supportive learning environments and purposeful, professional assessment of learners' progress through "naturally occurring evidence" on…
Pharmacy student decision making in over-the-counter medicine supply: A critical incident study.
McMillan, Sara S; Thangarajah, Thachaayini; Anderson, Claire; Kelly, Fiona
2017-09-28
Various factors influence decision making in over-the-counter (OTC) medicine consultations, yet limited studies have focused, in-depth, on the thought process of pharmacy staff. This includes pharmacy students as pharmacists-in-training. To explore the factors that influence pharmacy students' decisions in relation to OTC consultations and choice of OTC medicine/s. Semi-structured interviews using the critical incident technique were undertaken with ten pharmacy students in Australia, who also worked as part-time pharmacy staff. Nine key themes were identified to influence pharmacy student decision making in OTC consultations, including customer response, confidence and scope of practice. Product requests were reported as more challenging due to customer expectations and experiences in other pharmacies, states or countries. Although negative customer response influenced some students to supply medicines in contradiction of evidence, an overarching concern for safety meant that a medicine was only supplied if unlikely to cause harm. Students reported developing confidence in OTC decision making more from real-life practice than university training; greater confidence was identified for inquiries more frequently experienced in the pharmacy. Students perceived that customers had assumptions around support staff, and were happier to talk to students than assistants. This study further identified that OTC decision making is a complex process for pharmacy students. Additional opportunities for experiential learning within this area are suggested, such as work-based placements or in-class activities such as role-plays with simulated patients. Copyright © 2017 Elsevier Inc. All rights reserved.
Hensing, Gunnel K E; Sverker, Annette M; Leijon, Göran S
2007-06-01
Neuropathic pain is a disabling chronic condition with limited therapeutic options. Few studies have addressed patient's experience and strategies. The aim of this study was to explore dilemmas experienced in order to improve care and rehabilitation. An interview study with 39 patients suffering from neuropathic pain of different origin was performed. We used the critical incident technique to collect data. Questions on occasions when patients had been hindered by or reminded of their neuropathic pain were included, and the self-perceived consequences and management of such occasions. The interviews were transcribed verbatim and analysed qualitatively. A broad range of experiences categorised into dilemmas, disturbances, consequences and managements from most parts of everyday life was identified. The dilemmas were 'housework', 'sitting', 'physical activity', 'personal hygiene', 'sleeping difficulties', 'hypersensitivity to external stimuli', 'social relationships', 'transportation' and 'leisure time'. Disturbances were 'failures', 'inabilities' and 'restrictions'. Consequences were 'increased pain', 'psychological reactions' and 'physical symptoms'. The majority of the patients used activity-oriented strategies to manage their pain such as alternative ways of performing the task, a cognitive approach or simply ignoring the pain. This is one of the first studies presenting detailed data on everyday dilemmas, disturbances and consequences of patients with chronic neuropathic pain. Such information is important in clinical settings to improve care and rehabilitation.
Clinical supervision in the emergency department: a critical incident study
Kilroy, D A
2006-01-01
Objectives To identify the key features of effective clinical supervision in the emergency department (ED) from the perspectives of enthusiastic consultants and specialist registrars. To highlight the importance of clinical supervision within emergency medicine, and identify obstructions to its occurrence in everyday practice. Methods A critical incident study was undertaken consisting of structured interviews, conducted by telephone or in person, with 18 consultants and higher level trainees selected for their interest in supervision. Results Direct clinical supervision of key practical skills and patient management steps was considered to be of paramount importance in providing quality patient care and significantly enhancing professional confidence. The adequacy of supervision varied depending upon patient presentation. Trainees were concerned with the competence and skills of their supervisor; consultants were concerned with wider systemic constraints upon the provision of adequate supervision to juniors. Conclusions The value of supervision extends to all patient presentations in the ED. The study raised questions concerning the appropriate attitudes and qualifications for supervisors. Protected supervisory time for those with trainees is mandatory, and must be incorporated within ED consultant job planning. PMID:16439737
Neurodiagnostic techniques in neonatal critical care.
Chang, Taeun; du Plessis, Adre
2012-04-01
This article reviews recent advances in the neurodiagnostic tools available to clinicians practicing in neonatal critical care. The advent of induced mild hypothermia for acute neonatal hypoxic-ischemic encephalopathy in 2005 has been responsible for renewed urgency in the development of precise and reliable neonatal neurodiagnostic techniques. Traditional evaluations of bedside head ultrasounds, head computed tomography scans, and routine electroencephalograms (EEGs) have been upgraded in most tertiary pediatric centers to incorporate protocols for MRI, continuous EEG monitoring with remote bedside access, amplitude-integrated EEG, and near-infrared spectroscopy. Meanwhile, recent studies supporting the association between placental pathology and neonatal brain injury highlight the need for closer examination of the placenta in the neurodiagnostic evaluation of the acutely ill newborn. As the pursuit of more effective neuroprotection moves into the "hypothermia plus" era, the identification, evaluation, and treatment of the neurologically affected newborn in the neonatal intensive care unit has increasing significance.
Malcom, Daniel R; Hibbs, Jennifer L
2012-09-10
To design, implement, and measure the effectiveness of a critical care elective course for second-year students in a 3-year accelerated doctor of pharmacy (PharmD) program. A critical care elective course was developed that used active-learning techniques, including cooperative learning and group presentations, to deliver content on critical care topics. Group presentations had to include a disease state overview, practice guidelines, and clinical recommendations, and were evaluated by course faculty members and peers. Students' mean scores on a 20-question critical-care competency assessment administered before and after the course improved by 11% (p < 0.05). Course evaluations and comments were positive. A critical care elective course resulted in significantly improved competency in critical care and was well-received by students.
How do general practice registrars learn from their clinical experience? A critical incident study.
Holmwood, C
1997-01-01
This preliminary study of RACGP registrars in the period of subsequent general practice experience examines the types of clinical experiences from which registrars learn, what they learn from the experiences and the process of learning from such experiences. A critical incident method was used on a semi structured interview process. Registrars were asked to recall clinical incidents where they had learnt something of importance. Data were sorted and categorised manually. Nine registrars were interviewed before new categories of data ceased to develop. Registrars learnt from the opportunity to follow up patients. An emotional response to the interaction was an important part of the learning process. Learning from such experiences is haphazard and unstructured. Registrars accessed human resources in response to their clinical difficulties rather than text or electronic based information sources. Registrars should be aware of their emotional responses to interactions with patients; these emotional responses often indicate important learning opportunities. Clinical interactions and resultant learning could be made less haphazard by structuring consultations with patients with specific problems. These learning opportunities should be augmented by the promotion of follow up of patients.
Compassion satisfaction, compassion fatigue, and critical incident stress management.
Wee, David; Myers, Diane
2003-01-01
This study examines the potential for compassion satisfaction, compassion fatigue, and burnout in a sample of persons attending a workshop on Prevention of Compassion Fatigue at an international conference of providers of Critical Incident Stress Management (CISM) services. In the study, more than half (58%) of the respondents reported experiencing psychological reactions after providing CISM services, including an array of behavioral, emotional, cognitive, and physical symptoms of psychological stress. Forty percent of respondents were found to have moderate, high, or extremely high risk for compassion fatigue. At the same time, 89% of respondents were found to have a good, high, or extremely high potential for compassion satisfaction, and 87% were found to be at extremely low risk for burnout. The results appear to indicate that, while the CISM practitioners recognize the stress associated with their work (as reflected in the reported symptoms), the work provides significant rewards (as measured by compassion satisfaction) that outweigh the stress and mitigate against burnout. Likewise, while 40% tested positive for compassion fatigue (or secondary traumatic stress) as a result of their empathy with CISM recipients, the rewards of the work again appear to mitigate the negative effects of the work. Implications for future research and practice are presented.
Wu, Ningling; Christenbury, Joseph G; Dishler, Jon G; Bozkurt, Tahir Kansu; Duel, Daniel; Zhang, Lijun; Hamilton, D Rex
2017-09-01
To identify risk factors for opaque bubble layer (OBL) formation and compare the incidence of OBL using a cone modification technique versus the original technique for LASIK flap creation using the VisuMax laser (Carl Zeiss Meditec, Jena, Germany). This retrospective study examined videos of flap creation using the VisuMax laser to identify OBL occurrence. Eyes were divided into three groups: eyes where OBL occurred using the original technique (OBL group), eyes where OBL did not occur using the original technique (no OBL group), and eyes in which the cone modification technique was used for LASIK flap creation (larger flap diameter) (cone modification technique group). Preoperative measurements including simulated keratometry (flat and steep) values, white-to-white distance (WTW), pachymetry, patient age and gender, amount of correction, flap parameters, energy setting, corneal hysteresis, and corneal resistance factor were analyzed to identify parameters with statistical difference between the OBL and no OBL groups. Incidence of OBL was compared between the original and cone modification techniques. OBL incidence was significantly lower with the cone modification technique (7.6%; 7 of 92 eyes) than with the original technique (28.8%; 34 of 118 eyes) (Fisher's exact test, P = .0009). Factors identified with a significant difference between eyes with and without OBL using the original technique were: corneal thickness (OBL: 561.2 μm, no OBL: 549.6 μm, P = .0132), WTW diameter (OBL: 11.6 mm, no OBL: 11.9 mm, P = .0048), corneal resistance factor (OBL: 10.4 mm Hg, no OBL: 9.6 mm Hg, P = 0.0329), and corneal astigmatism (OBL: 0.80 diopter, no OBL: 1.00 diopter, P = .0472) CONCLUSIONS: Less astigmatic, thicker, denser, and smaller corneas increased the risk of OBL using the original technique for flap creation. The cone modification technique was associated with lower risk of OBL formation, even in eyes with significant risk factors for OBL using the original
Novel Hybrid Scheduling Technique for Sensor Nodes with Mixed Criticality Tasks.
Micea, Mihai-Victor; Stangaciu, Cristina-Sorina; Stangaciu, Valentin; Curiac, Daniel-Ioan
2017-06-26
Sensor networks become increasingly a key technology for complex control applications. Their potential use in safety- and time-critical domains has raised the need for task scheduling mechanisms specially adapted to sensor node specific requirements, often materialized in predictable jitter-less execution of tasks characterized by different criticality levels. This paper offers an efficient scheduling solution, named Hybrid Hard Real-Time Scheduling (H²RTS), which combines a static, clock driven method with a dynamic, event driven scheduling technique, in order to provide high execution predictability, while keeping a high node Central Processing Unit (CPU) utilization factor. From the detailed, integrated schedulability analysis of the H²RTS, a set of sufficiency tests are introduced and demonstrated based on the processor demand and linear upper bound metrics. The performance and correct behavior of the proposed hybrid scheduling technique have been extensively evaluated and validated both on a simulator and on a sensor mote equipped with ARM7 microcontroller.
Novel Hybrid Scheduling Technique for Sensor Nodes with Mixed Criticality Tasks
Micea, Mihai-Victor; Stangaciu, Cristina-Sorina; Stangaciu, Valentin; Curiac, Daniel-Ioan
2017-01-01
Sensor networks become increasingly a key technology for complex control applications. Their potential use in safety- and time-critical domains has raised the need for task scheduling mechanisms specially adapted to sensor node specific requirements, often materialized in predictable jitter-less execution of tasks characterized by different criticality levels. This paper offers an efficient scheduling solution, named Hybrid Hard Real-Time Scheduling (H2RTS), which combines a static, clock driven method with a dynamic, event driven scheduling technique, in order to provide high execution predictability, while keeping a high node Central Processing Unit (CPU) utilization factor. From the detailed, integrated schedulability analysis of the H2RTS, a set of sufficiency tests are introduced and demonstrated based on the processor demand and linear upper bound metrics. The performance and correct behavior of the proposed hybrid scheduling technique have been extensively evaluated and validated both on a simulator and on a sensor mote equipped with ARM7 microcontroller. PMID:28672856
Using Combined SFTA and SFMECA Techniques for Space Critical Software
NASA Astrophysics Data System (ADS)
Nicodemos, F. G.; Lahoz, C. H. N.; Abdala, M. A. D.; Saotome, O.
2012-01-01
This work addresses the combined Software Fault Tree Analysis (SFTA) and Software Failure Modes, Effects and Criticality Analysis (SFMECA) techniques applied to space critical software of satellite launch vehicles. The combined approach is under research as part of the Verification and Validation (V&V) efforts to increase software dependability and as future application in other projects under development at Instituto de Aeronáutica e Espaço (IAE). The applicability of such approach was conducted on system software specification and applied to a case study based on the Brazilian Satellite Launcher (VLS). The main goal is to identify possible failure causes and obtain compensating provisions that lead to inclusion of new functional and non-functional system software requirements.
Sanders, Robert D; Gaskell, Amy; Raz, Aeyal; Winders, Joel; Stevanovic, Ana; Rossaint, Rolf; Boncyk, Christina; Defresne, Aline; Tran, Gabriel; Tasbihgou, Seth; Meier, Sascha; Vlisides, Phillip E; Fardous, Hussein; Hess, Aaron; Bauer, Rebecca M; Absalom, Anthony; Mashour, George A; Bonhomme, Vincent; Coburn, Mark; Sleigh, Jamie
2017-02-01
The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice. Two hundred sixty adult patients were recruited at six sites into a prospective cohort study of the isolated forearm technique after intubation. Demographic, anesthetic, and intubation data, plus postoperative questionnaires, were collected. Univariate statistics, followed by bivariate logistic regression models for age plus variable, were conducted. The incidence of isolated forearm technique responsiveness after intubation was 4.6% (12/260); 5 of 12 responders reported pain through a second hand squeeze. Responders were younger than nonresponders (39 ± 17 vs. 51 ± 16 yr old; P = 0.01) with more frequent signs of sympathetic activation (50% vs. 2.4%; P = 0.03). No participant had explicit recall of intraoperative events when questioned after surgery (n = 253). Across groups, depth of anesthesia monitoring values showed a wide range; however, values were higher for responders before (54 ± 20 vs. 42 ± 14; P = 0.02) and after (52 ± 16 vs. 43 ± 16; P = 0.02) intubation. In patients not receiving total intravenous anesthesia, exposure to volatile anesthetics before intubation reduced the odds of responding (odds ratio, 0.2 [0.1 to 0.8]; P = 0.02) after adjustment for age. Intraoperative connected consciousness occurred frequently, although the rate is up to 10-times lower than anticipated. This should be considered a conservative estimate of intraoperative connected consciousness.
Tarchala, Magdalena; Harvey, Edward J; Barralet, Jake
2016-03-01
Critical-sized bone defects present a significant burden to the medical community due to their challenging treatment. However, a successful limb-salvaging technique, the Masquelet Technique (MT), has significantly improved the prognosis of many segmental bone defects in helping to restore form and function. Although the Masquelet Technique has proven to be clinically effective, the physiology of the healing it induces is not well understood. Multiple modifiable factors have been implicated by various surgical and research teams, but no single factor has been proven to be critical to the success of the Masquelet Technique. In this review the most recent clinical and experimental evidence that supports and helps to decipher the traditional Masquelet, as well as the modifiable factors and their effect on the success of the technique are discussed. In addition, future developments for the integration of the traditional Masquelet Technique with the use of alternative biomaterials to increase the effectiveness and expand the clinical applicability of the Masquelet Technique are reviewed. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
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.
Krüger, A; Gillmann, B; Hardt, C; Döring, R; Beckers, S K; Rossaint, R
2009-06-01
Physicians have to demonstrate non-technical skills, such as communication and team leading skills, while coping with critical incidents. These skills are not taught during medical education. A crisis resource management (CRM) training was established for 4th to 6th year medical students using a full-scale simulator mannikin (Emergency Care Simulator, ECS, METI). The learning objectives of the course were defined according to the key points of Gaba's CRM concept. The training consisted of theoretical and practical parts (3 simulation scenarios with debriefing). Students' self-assessment before and after the training provided the data for evaluation of the training outcome. A total of 65 students took part in the training. The course was well received in terms of overall course quality, debriefings and didactic presentation, the mean overall mark being 1.4 (1: best, 6: worst). After the course students felt significantly more confident when facing incidents in clinical practice. The main learning objectives were achieved. The effectiveness of applying the widely used ECS full-scale simulator in interdisciplinary teaching has been demonstrated. The training exposes students to crisis resource management issues and motivates them to develop non-technical skills.
McIntosh, Tania
2006-01-01
Experience suggests that effective and appropriate responses of an organization's management after a traumatic incident can help mitigate the reactions of primary, secondary, and tertiary victims. This commentary addresses the managerial response of Southwest Airlines to the trauma induced by September 11. It highlights the effectiveness of the unity between the company, the unions, and the Critical Incident Response Team, as well as the types of interventions that were highly regarded by flight attendants and pilots who received such services. This commentary also defines the phenomenon known as fear of flight.
The Taped Monologue as Narrative Technique for Reflective Practice
ERIC Educational Resources Information Center
Ford, Keith
2016-01-01
In this article, I describe how an EFL teacher engaged in a process of reflective practice. As she looked back on her teaching career, she explored the critical incidents, principles, and practices that have informed her present teaching identity. I focus on how a taped monologue narrative technique was used, and on the rationale, practice, and…
Schulz, Christian M; Schneider, Erich; Kohlbecher, Stefan; Hapfelmeier, Alexander; Heuser, Fabian; Wagner, Klaus J; Kochs, Eberhard F; Schneider, Gerhard
2014-10-01
Development of accurate Situation Awareness (SA) depends on experience and may be impaired during excessive workload. In order to gain adequate SA for decision making and performance, anaesthetists need to distribute visual attention effectively. Therefore, we hypothesized that in more experienced anaesthetists performance is better and increase of physiological workload is less during critical incidents. Additionally, we investigated the relation between physiological workload indicators and distribution of visual attention. In fifteen anaesthetists, the increase of pupil size and heart rate was assessed in course of a simulated critical incident. Simulator log files were used for performance assessment. An eye-tracking device (EyeSeeCam) provided data about the anaesthetists' distribution of visual attention. Performance was assessed as time until definitive treatment. T tests and multivariate generalized linear models (MANOVA) were used for retrospective statistical analysis. Mean pupil diameter increase was 8.1% (SD ± 4.3) in the less experienced and 15.8% (±10.4) in the more experienced subjects (p = 0.191). Mean heart rate increase was 10.2% (±6.7) and 10.5% (±8.3, p = 0.956), respectively. Performance did not depend on experience. Pupil diameter and heart rate increases were associated with a shift of visual attention from monitoring towards manual tasks (not significant). For the first time, the following four variables were assessed simultaneously: physiological workload indicators, performance, experience, and distribution of visual attention between "monitoring" and "manual" tasks. However, we were unable to detect significant interactions between these variables. This experimental model could prove valuable in the investigation of gaining and maintaining SA in the operation theatre.
USDA-ARS?s Scientific Manuscript database
Predisposing conditions incite chalkbrood disease (Ascosphaera apis) in honey bee colonies either by cooling or warming brood and correspond to an abundance of mummies where temperatures fluctuate widely. This Chapter describes a novel technique for estimating the temperature where the incidence of...
Delphi Technique Used in Laser Incident Surveillance
2004-01-01
Registry (LAIR), and the Food and Drug Administration’s (FDA) Center for Devices and Radiological Health ( CDRH ) [10]. Other databases were consulted...for collecting laser incident reports such as training (RLI), reporting equipment problems ( CDRH ), or for research and accident prevention (LAIR
ERIC Educational Resources Information Center
Epperly, Anna C.
2017-01-01
This qualitative, collective case study documented the development of the self-efficacy beliefs of special education preservice candidates during one semester of a course-embedded field experience in a small, private, faith-based university in the Midwest. Interviews of candidates regarding critical incidents in field experiences as documented by…
Keers, Richard N; Williams, Steven D; Cooke, Jonathan; Ashcroft, Darren M
2015-01-01
Objectives To investigate the underlying causes of intravenous medication administration errors (MAEs) in National Health Service (NHS) hospitals. Setting Two NHS teaching hospitals in the North West of England. Participants Twenty nurses working in a range of inpatient clinical environments were identified and recruited using purposive sampling at each study site. Primary outcome measures Semistructured interviews were conducted with nurse participants using the critical incident technique, where they were asked to discuss perceived causes of intravenous MAEs that they had been directly involved with. Transcribed interviews were analysed using the Framework approach and emerging themes were categorised according to Reason's model of accident causation. Results In total, 21 intravenous MAEs were discussed containing 23 individual active failures which included slips and lapses (n=11), mistakes (n=8) and deliberate violations of policy (n=4). Each active failure was associated with a range of error and violation provoking conditions. The working environment was implicated when nurses lacked healthcare team support and/or were exposed to a perceived increased workload during ward rounds, shift changes or emergencies. Nurses frequently reported that the quality of intravenous dose-checking activities was compromised due to high perceived workload and working relationships. Nurses described using approaches such as subconscious functioning and prioritising to manage their duties, which at times contributed to errors. Conclusions Complex interactions between active and latent failures can lead to intravenous MAEs in hospitals. Future interventions may need to be multimodal in design in order to mitigate these risks and reduce the burden of intravenous MAEs. PMID:25770226
Dempsey, Owen P; Bekker, Hilary L
2002-12-01
Acute hospital Trusts' inability to cope with the numbers of emergency admissions has led to the production of guidelines by the Department of Health aimed at reducing inappropriate admissions by GPs. There is a paucity of research describing GPs' decisions to (not) admit patients and it is unclear how effective these guidelines are in changing these practices. To describe GPs' decision-making about referrals for emergency hospital admissions. Observational design using the critical incident technique to elicit data. Eight GPs in West Yorkshire recorded details of memorable emergency admission decisions, both prospective and retrospective consultations. The transcript data were classified by theme using NUD*IST. Forty prospective and 8 retrospective consultations were analysed. Factors affecting GPs' decisions were:Identification of all consequences for all stakeholders in the decision. Emotional impact on the GP of managing these conflicting needs. 'Peer review' of the GP's professionalism about the decision. Contextual pressures limiting effectiveness of GPs' decision-making. Referral decisions require the evaluation of several conflicting consequences for many stakeholders in time-pressured and peer-reviewed situations. These factors encourage the use of heuristics, i.e. GPs' judgements will be influenced more by the social context of the choice than information about the patient's condition. Emergency referral guidelines provide more information to evaluate from another stakeholder; introducing guidelines is likely to increase GPs' use of heuristics and the making of less optimal decisions.
Meyer-Massetti, Carla; Krummenacher, Evelyne; Hedinger-Grogg, Barbara; Luterbacher, Stephan; Hersberger, Kurt E
2016-09-01
Background: While drug-related problems are among the most frequent adverse events in health care, little is known about their type and prevalence in home care in the current literature. The use of a Critical Incident Reporting System (CIRS), known as an economic and efficient tool to record medication errors for subsequent analysis, is widely implemented in inpatient care, but less established in ambulatory care. Recommendations on a possible format are scarce. A manual CIRS was developed based on the literature and subsequently piloted and implemented in a Swiss home care organization. Aim: The aim of this work was to implement a critical incident reporting system specifically for medication safety in home care. Results: The final CIRS form was well accepted among staff. Requiring limited resources, it allowed preliminary identification and trending of medication errors in home care. The most frequent error reports addressed medication preparation at the patients’ home, encompassing the following errors: omission (30 %), wrong dose (17.5 %) and wrong time (15 %). The most frequent underlying causes were related to working conditions (37.9 %), lacking attention (68.2 %), time pressure (22.7 %) and interruptions by patients (9.1 %). Conclusions: A manual CIRS allowed efficient data collection and subsequent analysis of medication errors in order to plan future interventions for improvement of medication safety. The development of an electronic CIRS would allow a reduction of the expenditure of time regarding data collection and analysis. In addition, it would favour the development of a national CIRS network among home care institutions.
Kurakawa, Takuto; Miyamoto, Hiroshi; Kaneyama, Shuichi; Sumi, Masatoshi; Uno, Koki
2016-07-01
It has been reported that the incidence of post-operative segmental nerve palsy, such as C5 palsy, is higher in posterior reconstruction surgery than in conventional laminoplasty. Correction of kyphosis may be related to such a complication. The aim of this study was to elucidate the risk factors of the incidence of post-operative C5 palsy, and the critical range of sagittal realignment in posterior instrumentation surgery. Eighty-eight patients (mean age 64.0 years) were involved. The types of the disease were; 33 spondylosis with kyphosis, 27 rheumatoid arthritis, 17 athetoid cerebral palsy and 11 others. The patients were divided into two groups; Group P: patients with post-operative C5 palsy, and Group NP: patients without C5 palsy. The correction angle of kyphosis, and pre-operative diameter of C4/5 foramen on CT were evaluated between the two groups. Multivariate logistic regression analysis was used to determine the critical range of realignment and the risk factors affecting the incidence of post-operative C5 palsy. Seventeen (19.3 %) of the 88 patients developed C5 palsy. The correction angle of kyphosis in Group P (15.7°) was significantly larger than that in Group NP (4.5°). In Group P, pre-operative diameters of intervertebral foramen at C4/5 (3.2 mm) were significantly smaller than those in Group NP (4.1 mm). The multivariate analysis demonstrated that the risk factors were the correction angle and pre-operative diameter of the C4/5 intervertebral foramen. The logistic regression model showed a correction angle exceeding 20° was critical for developing the palsy when C4/5 foraminal diameter reaches 4.1 mm, and there is a higher risk when the C4/5 foraminal diameter is less than 2.7 mm regardless of any correction. This study has indicated the risk factors of post-operative C5 palsy and the critical range of realignment of the cervical spine after posterior instrumented surgery.
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.
Critical Counseling Behavior in Rehabilitation Settings.
ERIC Educational Resources Information Center
Jaques, Marceline E.
This study investigates rehabilitation counseling to determine critical job requirements, training needs, and differences in counselor perception of critical incidents as a function of academic preparation. A questionnaire requesting one effective and one ineffective counseling incident was distributed to 404 counselors and supervisors from…
ERIC Educational Resources Information Center
Swaine, Cynthia Wright
Encouraging librarians to incorporate critical thinking skills and active learning techniques in their course instruction requires more than talking about it in a department meeting or distributing articles on the topic. At Old Dominion University (Virginia), librarians have tried conducting workshops, had readily-accessible binders of articles…
ERIC Educational Resources Information Center
Chien, Chin-Wen
2018-01-01
Language teachers can uncover new understanding of the teaching and learning process through reflecting on critical incidents [Richard, J.C., and T.S.C. Farrell. 2005. "Professional Development for Language Teachers." New York, NY: Cambridge University Press]. Based on the data analysis of workshop handouts, observation notes, and…
ERIC Educational Resources Information Center
Johnson, Brian
2013-01-01
Emotional intelligence is a relatively new academic discipline that began forming in the early 1990s. Currently, emotional intelligence is used in academia and in business as a new intelligence quotient. This research study investigates how Senior Student Affairs Officers' use their emotional intelligence ability during critical incidents. The…
ERIC Educational Resources Information Center
Heinrichs, Karin; Jäcklin, Benjamin
2017-01-01
During the post-formation phase, young ventures are often in danger of sliding into bankruptcy. The entrepreneur has to deal with a multitude of complex problems, decisions have to be made under time pressure or uncertainty, and upcoming crises have to be perceived in time. This paper presents seven critical incidents that are (1) realistic,…
Terrorism in Australia: factors associated with perceived threat and incident-critical behaviours.
Stevens, Garry; Agho, Kingsley; Taylor, Melanie; Barr, Margo; Raphael, Beverley; Jorm, Louisa
2009-03-27
To help improve incident preparedness this study assessed socio-demographic and socio-economic predictors of perceived risk of terrorism within Australia and willingness to comply with public safety directives during such incidents. The terrorism perception question module was incorporated into the New South Wales Population Health Survey and was completed by a representative sample of 2,081 respondents in early 2007. Responses were weighted against the New South Wales population. Multivariate analyses indicated that those with no formal educational qualifications were significantly more likely (OR = 2.10, 95%CI:1.32-3.35, p < 0.001) to think that a terrorist attack is very or extremely likely to occur in Australia and also more likely (OR = 3.62, 95%CI:2.25-5.83, p < 0.001) to be very or extremely concerned that they or a family member would be directly affected, compared to those with a university-level qualification. Speaking a language other than English at home predicted high concern (very/extremely) that self or family would be directly affected (OR = 3.02, 95%CI:2.02-4.53, p < 0.001) and was the strongest predictor of having made associated changes in living (OR = 3.27, 95%CI:2.17-4.93, p < 0.001). Being female predicted willingness to evacuate from public facilities. Speaking a language other than English at home predicted low willingness to evacuate. Low education level is a risk factor for high terrorism risk perception and concerns regarding potential impacts. The pattern of concern and response among those of migrant background may reflect secondary social impacts associated with heightened community threat, rather than the direct threat of terrorism itself. These findings highlight the need for terrorism risk communication and related strategies to address the specific concerns of these sub-groups as a critical underpinning of population-level preparedness.
Knowledge based systems: A critical survey of major concepts, issues and techniques. Visuals
NASA Technical Reports Server (NTRS)
Dominick, Wayne D. (Editor); Kavi, Srinu
1984-01-01
This Working Paper Series entry represents a collection of presentation visuals associated with the companion report entitled, Knowledge Based Systems: A Critical Survey of Major Concepts, Issues, and Techniques, USL/DBMS NASA/RECON Working Paper Series report number DBMS.NASA/RECON-9. The objectives of the report are to: examine various techniques used to build the KBS; to examine at least one KBS in detail, i.e., a case study; to list and identify limitations and problems with the KBS; to suggest future areas of research; and to provide extensive reference materials.
2013-11-01
THE INCIDENCE OF FEVER IN US CRITICAL CARE AIR TRANSPORT TEAM COMBAT TRAUMA PATIENTS EVACUATED FROM THE THEATER BETWEEN MARCH 2009 AND MARCH 2010...Critical Care Air Transport Teams (CCATTs). Fever after trauma is correlated with surgical complications and infection. The purposes of this study are...248 trauma patients met the inclusion criteria, and 101 trauma patients (40%) had fever . The mean age was 28 years, and 98% of patients were men. The
Russ, Alissa L; Militello, Laura G; Glassman, Peter A; Arthur, Karen J; Zillich, Alan J; Weiner, Michael
2017-05-03
Cognitive task analysis (CTA) can yield valuable insights into healthcare professionals' cognition and inform system design to promote safe, quality care. Our objective was to adapt CTA-the critical decision method, specifically-to investigate patient safety incidents, overcome barriers to implementing this method, and facilitate more widespread use of cognitive task analysis in healthcare. We adapted CTA to facilitate recruitment of healthcare professionals and developed a data collection tool to capture incidents as they occurred. We also leveraged the electronic health record (EHR) to expand data capture and used EHR-stimulated recall to aid reconstruction of safety incidents. We investigated 3 categories of medication-related incidents: adverse drug reactions, drug-drug interactions, and drug-disease interactions. Healthcare professionals submitted incidents, and a subset of incidents was selected for CTA. We analyzed several outcomes to characterize incident capture and completed CTA interviews. We captured 101 incidents. Eighty incidents (79%) met eligibility criteria. We completed 60 CTA interviews, 20 for each incident category. Capturing incidents before interviews allowed us to shorten the interview duration and reduced reliance on healthcare professionals' recall. Incorporating the EHR into CTA enriched data collection. The adapted CTA technique was successful in capturing specific categories of safety incidents. Our approach may be especially useful for investigating safety incidents that healthcare professionals "fix and forget." Our innovations to CTA are expected to expand the application of this method in healthcare and inform a wide range of studies on clinical decision making and patient safety.
In-situ verification techniques for fast critical assembly cores
DOE Office of Scientific and Technical Information (OSTI.GOV)
Brumbach, S.B.; Amundson, P.I.; Roche, C.T.
1979-01-01
Active and passive autoradiographic techniques were used to obtain piece counts of fuel plates in fast critical assembly drawers and to verify the assembly loading pattern. Active autoradiography using prompt-fission and fission-product radiation was more successful with uranium fuel while passive autoradiography was more successful with plutonium fuel. A source multiplication technique was used to measure changes in reactivity when small quantities (2-2.5 kg) of fissile material were removed from a subcritical reference core of the Zero Power Plutonium Reactor. Efforts to compensate for unsuccessful. Some compensation was achieved by replacing U-238 with polyethylene. The sensitivity for detection of partiallymore » compensated fuel removed from minimum worth regions was approximately 2.5 kg (fissile) for a core containing 2600 kg (fissile). Substitution of polyethylene was detected with a spectral index which was the ratio of the rate of the In-115 (n,..gamma..) reaction to the rate of the In-115 (n,n') reaction. This spectral index was sensitive to the presence of an 0.64-cm-thick, 5.08-cm-high polyethylene column 10-15 cm away from the indium foil. The reactivity worth of Pu-239 was also obtained as a function of location in the reactor core with the use of an inverse kinetics technique. Reactivity worths for Pu-239 varied from a maximum of 58.67 Ih/kg near the core center to a minimum of 14.86 Ih/kg at the core edge.« less
Malinowski, Andrzej; Mołas, Justyna; Maciołek-Blewniewska, Grazyna; Cieślak, Jarosław
2006-02-01
Vault haematoma is one of the most common complication of vaginal hysterectomy. The aim of this work was to analyse the effects of a modification of incision and closure technique of the vaginal vault on the incidence of vault haematoma after vaginal hysterectomy. The study group consisted of 333 women of whom 49 (group A) underwent vaginal hysterectomy traditional technique of incision and closure of the vaginal vault, an 284 (group B) modified technique. Following parameters were evaluated: number of vault haematomas, blood loss, postoperative fever, required antibiotics, length of hospital stay. The risk of vault haematoma was significantly lower in the group B (1,06% vs 12,4%). Loss of blood was higher in group A (310 ml vs 206 ml). Incidence of postoperative fever was in 12,2% patients from group A, and 1,4% from group B. The length of hospitalization was lower for women in group B (4,3 days compared with 7,3 days). The modification of incision and closure technique of the vaginal vault during vaginal hysterectomy is recommended to minimise intra- and postoperative complications.
Critical Information at Critical Moments
ERIC Educational Resources Information Center
Fierman, Ben; Thrower, Raymond H., Jr.
2011-01-01
On a daily basis, administrators are reminded of the potential, perhaps the likelihood, of violence or natural crises on their campuses. Comprehensive studies have been conducted and point to recommendations and best practices for planning, preparing, responding to, and recovering from critical incidents. The International Association of Campus…
Critical incident stress debriefing (CISD) in a shipping company.
Saarni, H; Saari, S; Häkkinen, U
1999-01-01
Critical incident stress debriefing (CISD) is a method used successfully to reduce suffering from stress-related ailments such as insomnia, depression, anger, headaches etc. The resources of the shipping company are very limited and, thus, networking with existing organizations and specialists is necessary to carry out CISD effectively. The present company model has been adopted to take into account various situations and levels of disaster. The model has been adopted at three levels of events:Level 1. Serious accidents on shore, sudden deaths, severe events and threats. Events involving one or only few persons. Level 2. Life-threatening occupational accidents on board ship, suicide of a workmate, sudden death and fire on board ship. Events involving one person or limited group of persons. Level 3. Disasters at sea. Severe events involving all or nearly all persons on board ship. Actions at different levels: Level 1: A leaflet describing CISD, situations where it would be appropriate and where it is available, is given to each sailor. The victim is encouraged to seek CISD from public health care centres, most of which have their own services in Finland. Level 2. Training of about 8 hours is carried out by an experienced crisis psychologist for supervisors and officers on board ship. After the training they are able to identify stressful situations. At each harbour, the shipping company has made agreements with experienced crisis psychologists to act as specialists and contact persons on shore. These nominated psychologists will initiate CISD actions when necessary. If they need extra manpower they will turn to other psychologists. Level 3. In such serious accidents, the company's own resources alone are insufficient to provide effective CISD. All available public and private resources will he needed (health care organizations, Red Cross, Church etc.).
NASA Astrophysics Data System (ADS)
Brown, M. G. L.; He, T.; Liang, S.
2016-12-01
Satellite-derived estimates of incident photosynthetically active radiation (PAR) can be used to monitor global change, are required by most terrestrial ecosystem models, and can be used to estimate primary production according to the theory of light use efficiency. Compared with parametric approaches, non-parametric techniques that include an artificial neural network (ANN), support vector machine regression (SVM), an artificial bee colony (ABC), and a look-up table (LUT) do not require many ancillary data as inputs for the estimation of PAR from satellite data. In this study, a selection of machine learning methods to estimate PAR from MODIS top of atmosphere (TOA) radiances are compared to a LUT approach to determine which techniques might best handle the nonlinear relationship between TOA radiance and incident PAR. Evaluation of these methods (ANN, SVM, and LUT) is performed with ground measurements at seven SURFRAD sites. Due to the design of the ANN, it can handle the nonlinear relationship between TOA radiance and PAR better than linearly interpolating between the values in the LUT; however, training the ANN has to be carried out on an angular-bin basis, which results in a LUT of ANNs. The SVM model may be better for incorporating multiple viewing angles than the ANN; however, both techniques require a large amount of training data, which may introduce a regional bias based on where the most training and validation data are available. Based on the literature, the ABC is a promising alternative to an ANN, SVM regression and a LUT, but further development for this application is required before concrete conclusions can be drawn. For now, the LUT method outperforms the machine-learning techniques, but future work should be directed at developing and testing the ABC method. A simple, robust method to estimate direct and diffuse incident PAR, with minimal inputs and a priori knowledge, would be very useful for monitoring global change of primary production
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.
Working relationships between obstetric care staff and their managers: a critical incident analysis.
Chipeta, Effie; Bradley, Susan; Chimwaza-Manda, Wanangwa; McAuliffe, Eilish
2016-08-26
Malawi continues to experience critical shortages of key health technical cadres that can adequately respond to Malawi's disease burden. Difficult working conditions contribute to low morale and frustration among health care workers. We aimed to understand how obstetric care staff perceive their working relationships with managers. A qualitative exploratory study was conducted in health facilities in Malawi between October and December 2008. Critical Incident Analysis interviews were done in government district hospitals, faith-based health facilities, and a sample of health centres' providing emergency obstetric care. A total of 84 service providers were interviewed. Data were analyzed using NVivo 8 software. Poor leadership styles affected working relationships between obstetric care staff and their managers. Main concerns were managers' lack of support for staff welfare and staff performance, lack of mentorship for new staff and junior colleagues, as well as inadequate supportive supervision. All this led to frustrations, diminished motivation, lack of interest in their job and withdrawal from work, including staff seriously considering leaving their post. Positive working relationships between obstetric care staff and their managers are essential for promoting staff motivation and positive work performance. However, this study revealed that staff were demotivated and undermined by transactional leadership styles and behavior, evidenced by management by exception and lack of feedback or recognition. A shift to transformational leadership in nurse-manager relationships is essential to establish good working relationships with staff. Improved providers' job satisfaction and staff retentionare crucial to the provision of high quality care and will also ensure efficiency in health care delivery in Malawi.
Improving Freight Crash Incident Management : Research Project Capsule
DOT National Transportation Integrated Search
2012-10-01
Excessive delay, cost, : and adverse public : safety result from : major incidents that : occur along critical : segments of the : interstate system. : There is a high likelihood these types of incidents involve a commercial : vehicle. Several recent...
ERIC Educational Resources Information Center
Gervey, Robert; Drout, Mary O'Connor; Wang, Chia-Chiang
2009-01-01
The educational setting, in particular the college classroom, is a natural training ground for fostering critical thinking skills for the 21st century worker. In this study, debate is explored as a technique to help students attain mastery of content and critical thinking skills considered key to working in the field of rehabilitation counseling.…
Terrorism in Australia: factors associated with perceived threat and incident-critical behaviours
Stevens, Garry; Agho, Kingsley; Taylor, Melanie; Barr, Margo; Raphael, Beverley; Jorm, Louisa
2009-01-01
Background To help improve incident preparedness this study assessed socio-demographic and socio-economic predictors of perceived risk of terrorism within Australia and willingness to comply with public safety directives during such incidents. Methods The terrorism perception question module was incorporated into the New South Wales Population Health Survey and was completed by a representative sample of 2,081 respondents in early 2007. Responses were weighted against the New South Wales population. Results Multivariate analyses indicated that those with no formal educational qualifications were significantly more likely (OR = 2.10, 95%CI:1.32–3.35, p < 0.001) to think that a terrorist attack is very or extremely likely to occur in Australia and also more likely (OR = 3.62, 95%CI:2.25–5.83, p < 0.001) to be very or extremely concerned that they or a family member would be directly affected, compared to those with a university-level qualification. Speaking a language other than English at home predicted high concern (very/extremely) that self or family would be directly affected (OR = 3.02, 95%CI:2.02–4.53, p < 0.001) and was the strongest predictor of having made associated changes in living (OR = 3.27, 95%CI:2.17–4.93, p < 0.001). Being female predicted willingness to evacuate from public facilities. Speaking a language other than English at home predicted low willingness to evacuate. Conclusion Low education level is a risk factor for high terrorism risk perception and concerns regarding potential impacts. The pattern of concern and response among those of migrant background may reflect secondary social impacts associated with heightened community threat, rather than the direct threat of terrorism itself. These findings highlight the need for terrorism risk communication and related strategies to address the specific concerns of these sub-groups as a critical underpinning of population-level preparedness. PMID:19323842
Measurement Techniques for Respiratory Tract Deposition of Airborne Nanoparticles: A Critical Review
Möller, Winfried; Pagels, Joakim H.; Kreyling, Wolfgang G.; Swietlicki, Erik; Schmid, Otmar
2014-01-01
Abstract Determination of the respiratory tract deposition of airborne particles is critical for risk assessment of air pollution, inhaled drug delivery, and understanding of respiratory disease. With the advent of nanotechnology, there has been an increasing interest in the measurement of pulmonary deposition of nanoparticles because of their unique properties in inhalation toxicology and medicine. Over the last century, around 50 studies have presented experimental data on lung deposition of nanoparticles (typical diameter≤100 nm, but here≤300 nm). These data show a considerable variability, partly due to differences in the applied methodologies. In this study, we review the experimental techniques for measuring respiratory tract deposition of nano-sized particles, analyze critical experimental design aspects causing measurement uncertainties, and suggest methodologies for future studies. It is shown that, although particle detection techniques have developed with time, the overall methodology in respiratory tract deposition experiments has not seen similar progress. Available experience from previous research has often not been incorporated, and some methodological design aspects that were overlooked in 30–70% of all studies may have biased the experimental data. This has contributed to a significant uncertainty on the absolute value of the lung deposition fraction of nanoparticles. We estimate the impact of the design aspects on obtained data, discuss solutions to minimize errors, and highlight gaps in the available experimental set of data. PMID:24151837
Illig, Kurt R.
2015-01-01
Undergraduate neuroscience courses typically involve highly interdisciplinary material, and it is often necessary to use class time to review how principles of chemistry, math and biology apply to neuroscience. Lecturing and Socratic discussion can work well to deliver information to students, but these techniques can lead students to feel more like spectators than participants in a class, and do not actively engage students in the critical analysis and application of experimental evidence. If one goal of undergraduate neuroscience education is to foster critical thinking skills, then the classroom should be a place where students and instructors can work together to develop them. Students learn how to think critically by directly engaging with course material, and by discussing evidence with their peers, but taking classroom time for these activities requires that an instructor find a way to provide course materials outside of class. Using technology as an on-demand provider of course materials can give instructors the freedom to restructure classroom time, allowing students to work together in small groups and to have discussions that foster critical thinking, and allowing the instructor to model these skills. In this paper, I provide a rationale for reducing the use of traditional lectures in favor of more student-centered activities, I present several methods that can be used to deliver course materials outside of class and discuss their use, and I provide a few examples of how these techniques and technologies can help improve learning outcomes. PMID:26240525
Illig, Kurt R
2015-01-01
Undergraduate neuroscience courses typically involve highly interdisciplinary material, and it is often necessary to use class time to review how principles of chemistry, math and biology apply to neuroscience. Lecturing and Socratic discussion can work well to deliver information to students, but these techniques can lead students to feel more like spectators than participants in a class, and do not actively engage students in the critical analysis and application of experimental evidence. If one goal of undergraduate neuroscience education is to foster critical thinking skills, then the classroom should be a place where students and instructors can work together to develop them. Students learn how to think critically by directly engaging with course material, and by discussing evidence with their peers, but taking classroom time for these activities requires that an instructor find a way to provide course materials outside of class. Using technology as an on-demand provider of course materials can give instructors the freedom to restructure classroom time, allowing students to work together in small groups and to have discussions that foster critical thinking, and allowing the instructor to model these skills. In this paper, I provide a rationale for reducing the use of traditional lectures in favor of more student-centered activities, I present several methods that can be used to deliver course materials outside of class and discuss their use, and I provide a few examples of how these techniques and technologies can help improve learning outcomes.
Challenges faced by nurses in managing pain in a critical care setting.
Subramanian, Pathmawathi; Allcock, Nick; James, Veronica; Lathlean, Judith
2012-05-01
To explore nurses' challenges in managing pain among ill patients in critical care. Pain can lead to many adverse medical consequences and providing pain relief is central to caring for ill patients. Effective pain management is vital since studies show patients admitted to critical care units still suffer from significant levels of acute pain. The effective delivery of care in clinical areas remains a challenge for nurses involved with care which is dynamic and constantly changing in critically ill. Qualitative prospective exploratory design. This study employed semi structured interviews with nurses, using critical incident technique. Twenty-one nurses were selected from critical care settings from a large acute teaching health care trust in the UK. A critical incident interview guide was constructed from the literature and used to elicit responses. Framework analysis showed that nurses perceived four main challenges in managing pain namely lack of clinical guidelines, lack of structured pain assessment tool, limited autonomy in decision making and the patient's condition itself. Nurses' decision making and pain management can influence the quality of care given to critically ill patients. It is important to overcome the clinical problems that are faced when dealing with pain experience. There is a need for nursing education on pain management. Providing up to date and practical strategies may help to reduce nurses' challenges in managing pain among critically ill patients. Broader autonomy and effective decision making can be seen as beneficial for the nurses besides having a clearer and structured pain management guidelines. © 2011 Blackwell Publishing Ltd.
Schmidbauer, M; Schäfer, P; Besedin, S; Grigoriev, D; Köhler, R; Hanke, M
2008-11-01
A new scattering technique in grazing-incidence X-ray diffraction geometry is described which enables three-dimensional mapping of reciprocal space by a single rocking scan of the sample. This is achieved by using a two-dimensional detector. The new set-up is discussed in terms of angular resolution and dynamic range of scattered intensity. As an example the diffuse scattering from a strained multilayer of self-assembled (In,Ga)As quantum dots grown on GaAs substrate is presented.
Challenges for Early Responders to a Nuclear / Radiological Terrorism Incident
DOE Office of Scientific and Technical Information (OSTI.GOV)
Wells, M.A.; Stearns, L.J.; Davie, A.D.
2007-07-01
Even in the best of circumstances, most municipalities would face severe challenges in providing effective incident response to a large scale radiation release caused by nuclear terrorism or accident. Compounding obvious complexities, the effectiveness of first and early responders to a radiological emergency may also be hampered by an insufficient distribution of radiation detection and monitoring equipment, local policies concerning triage and field decontamination of critical victims, malfunctioning communications, inadequate inter-agency agility, and the psychological 'fear' impact on early responders. This paper examines several issues impeding the early response to nuclear terrorism incidents with specific consideration given to the on-goingmore » and forward-thinking preparedness efforts currently being developed in the Sacramento, California region. Specific recommendations are provided addressing hot zone protocols, radiation detection and monitoring equipment, hasty patient packaging techniques, vertically and horizontally integrated pre-event training, mitigating psychological fear, and protocols for the effective 'hand-off' from first responders to subsequent early response-recovery teams. (authors)« less
Techniques for Intravascular Foreign Body Retrieval
DOE Office of Scientific and Technical Information (OSTI.GOV)
Woodhouse, Joe B.; Uberoi, Raman, E-mail: raman.uberoi@orh.nhs.uk
2013-08-01
As endovascular therapies increase in frequency, the incidence of lost or embolized foreign bodies is increasing. The presence of an intravascular foreign body (IFB) is well recognized to have the potential to cause serious complications. IFB can embolize and impact critical sites such as the heart, with subsequent significant morbidity or mortality. Intravascular foreign bodies most commonly result from embolized central line fragments, but they can originate from many sources, both iatrogenic and noniatrogenic. The percutaneous approach in removing an IFB is widely perceived as the best way to retrieve endovascular foreign bodies. This minimally invasive approach has a highmore » success rate with a low associated morbidity, and it avoids the complications related to open surgical approaches. We examined the characteristics, causes, and incidence of endovascular embolizations and reviewed the various described techniques that have been used to facilitate subsequent explantation of such materials.« less
Cury, Marcus Vinícius Martins; Matielo, Marcelo Fernando; Brochado Neto, Francisco Cardoso; Soares, Rafael de Athayde; Adami, Vinícius Lopes; Morais, Jalíese Dantas Fernandes; Futigami, Aline Yoshimi; Sacilotto, Roberto
2018-01-01
Intra-arterial digital subtraction angiography (DSA) is commonly used for the diagnosis and treatment of patients with critical limb ischemia (CLI). The aim of this study was to analyze the incidence of contrast-induced nephropathy (CIN) in patients with CLI and to assess their outcomes. Between May 2013 and May 2014, a prospective and observational study was conducted with 107 patients admitted exclusively for CLI treatment. The main outcomes included hemodialysis independence (HI) and overall survival (OS), as assessed by Kaplan-Meier curves. Overall, there was a predominance of males (57%), with a mean age of 70.5 (10.7) years. The incidence of CIN was 35.5%, and chronic kidney failure was the only factor associated with elevated risk of this condition (relative risk [RR] = 1.9; 95% confidence interval = 1.17-3.09; P = .017). The median follow-up was 645 days, and in 720-day analyses, patients who experienced CIN had worse HI (81.2% vs 96.3%; P = .0107) and OS (49.5% vs 66.3%; P = .0463). The current study found a high incidence of CIN in patients with CLI after DSA. This renal impairment was associated with a worse prognosis in terms of survival.
Irita, Kazuo; Tsuzaki, Koichi; Sawa, Tomohiro; Sanuki, Michiyoshi; Nakatsuka, Hideki; Makita, Koshi; Morita, Kiyoshi
2007-01-01
The Japanese Society of Anesthesiologists (JSA) survey of critical incidents in the operating room and other reports have shown that pediatric patients undergoing anesthesia are at an increased risk. Purpose was to examine the state of pediatric anesthesia in Japan. This might clarify the role of children's hospitals for pediatric anesthesia, and the relationship between critical incidents and volume of pediatric anesthetic procedures. The JSA has conducted annual surveys of critical incidents in the operating room by sending to and collecting confidential questionnaires from all JSA Certified Training Hospitals. From 1999 to 2003, 342,840 pediatric (0-5 yr) anesthetic procedures were registered. During this period, only 15 cardiac arrests and 3 deaths within 7 postoperative days totally attributable to anesthetic management were reported. Therefore, we analyzed cardiac arrests and deaths due to all etiologies. The hospitals were classified as children's hospitals, university hospitals, and other hospitals, and the incidence of cardiac arrest, the recovery rate from cardiac arrest without any sequelae, and the mortality rate were compared according to types of the hospitals. The relationship between death due to intraoperative critical incidents and the volume of pediatric anesthetic procedures was examined using data from the 2003 survey, the recovery rate of which was 85.7%. In 2003, 739 JSA Certified Training Hospitals responded to the survey: 7 children's hospitals, 109 university hospitals, and 623 other hospitals. Among these hospitals, 707 and 270 hospitals conducted pediatric and newborn (<1 mo) anesthesia, respectively. In 2003, 4,630 newborn, 17,890 infant (<1 yr), and 60,524 child (1-5 yr) anesthetic procedures were registered. Odds ratios were determined to compare the risks among the hospital groups, and the 95% confidential interval (CI) was shown. The Chi square test was used to compare the background of patients with cardiac arrest. P values less
Simms-Ellis, R; Madill, A
2001-01-01
This study investigates financial services employees' experience of critical incident stress debriefing (CISD) and their views about peers and clinicians as facilitators. Semi-structured interview accounts of four participants who had experienced both peer-led and clinician-led CISD were analyzed using grounded theory. A core category, ambivalence, permeated each interview and divided into two poles: pathologizing and normalizing. The most frequently occurring sub-category was a dislike of professionalism. Participants preferred the peer debriefer who was perceived to have more personal involvement and with whom they felt more empowered and understood. The findings suggest that the status of the debriefer as 'peer' or 'clinician' may be a crucial variable in the effectiveness of CISD and should be considered when reviewing the outcome literature.
Critical analysis of radiologist-patient interaction.
Morris, K J; Tarico, V S; Smith, W L; Altmaier, E M; Franken, E A
1987-05-01
A critical incident interview technique was used to identify features of radiologist-patient interactions considered effective and ineffective by patients. During structured interviews with 35 radiology patients and five patients' parents, three general categories of physician behavior were described: attention to patient comfort, explanation of procedure and results, and interpersonal sensitivity. The findings indicated that patients are sensitive to physicians' interpersonal styles and that they want physicians to explain procedures and results in an understandable manner and to monitor their well-being during procedures. The sample size of the study is small; thus further confirmation is needed. However, the implications for training residents and practicing radiologists in these behaviors are important in the current competitive medical milieu.
Identification of Human Factors in Unmanned Aviation Via Pilot Incident Reports
NASA Technical Reports Server (NTRS)
Hobbs, Alan; Cardoza, Colleen; Null, Cynthia
2015-01-01
There is a need for incident data relevant to the operation of civilian unmanned aircraft systems (UAS) in the National Air Space (NAS). Currently, very limited incident and accident data are available from military sources, and the tightly-restricted civilian UAS industry has produced very few incident reports that could shed light on design issues relevant to human factors. An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from UAS pilots, and using the information to identify areas where human factors guidelines will be of assistance. Experienced UAS pilots are participating in small focus groups in which they are prompted to describe critical incidents that either reveal a system flaw, or highlight a case where the human operator contributed to system resilience or mission success. The de-identified incidents are being analyzed to identify contributing factors, with a focus on design issues that either hindered or assisted the pilot in dealing with the incident. Preliminary findings will be described.
Dealing with aggressive methadone patients in community pharmacy: a critical incident study.
Irwin, Amy; Laing, Christianne; Mearns, Kathryn
2012-01-01
Community pharmacists are an important link between methadone patients and the health service in the United Kingdom. However, many pharmacists feel ill prepared to deal with methadone patients, with aggressive behavior a particular concern. To assess the perceived impact of methadone patient aggression on pharmacy practice. Sixteen registered pharmacists with a minimum of 3 years' work experience were recruited from within 3 Scottish health boards. Critical incident interviews were conducted to assess pharmacist behavior during an interaction with an aggressive methadone patient. Factors considered by pharmacists to have a negative impact on an interaction with an aggressive methadone patient included intoxication of the patient, the presence of a new or an inexperienced pharmacist, and a restricted time frame for dispensing methadone. Positive factors when dealing with aggressive patients were authoritative behavior by the pharmacist, a separate dispensing area for methadone patients, or a solid counter and a positive relationship between pharmacist and patient. Aggression from methadone patients is a risk when dispensing methadone. However, action can be taken by the pharmacist to minimize the impact of that aggression on pharmacy practice. The provision of further training and support, particularly to inexperienced pharmacists, could further reduce the negative impact of patient aggression. The present study indicates that such training could be based on nontechnical skills to strengthen current leadership and teamwork behaviors. Copyright © 2012 Elsevier Inc. All rights reserved.
DeFraia, G S
2015-07-01
Psychologically traumatic workplace events (known as critical incidents) occur within various work environments, with workgroups in certain industries vulnerable to multiple incidents. With the increasing prevalence of incidents in the USA, incident response is a growing practice area within occupational medicine, industrial psychology, occupational social work and other occupational health professions. To analyze a measure of incident severity based on level of disruption to the workplace and explore whether incident severity varied among different industry settings or between workgroups experiencing multiple vs single traumatic incidents. Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring incident severity level varied among industry settings or between workgroups impacted by multiple vs isolated events. Incident severity level differed among various industry settings. Banks, retail stores and fast food restaurants accounted for the most severe incidents, while industrial and manufacturing sites reported less severe incidents. Workgroups experiencing multiple incidents reported more severe incidents than workgroups experiencing a single incident. Occupational health practitioners should be alert to industry differences in several areas: pre-incident resiliency training, the content of business recovery plans, assessing worker characteristics, strategies to assist continuous operations and assisting workgroups impacted by multiple or severe incidents.
NASA Astrophysics Data System (ADS)
Grammatikos, S. A.; Kordatos, E. Z.; Aggelis, D. G.; Matikas, T. E.; Paipetis, A. S.
2012-04-01
Infrared Thermography (IrT) has been shown to be capable of detecting and monitoring service induced damage of repair composite structures. Full-field imaging, along with portability are the primary benefits of the thermographic technique. On-line lock-in thermography has been reported to successfully monitor damage propagation or/and stress concentration in composite coupons, as mechanical stresses in structures induce heat concentration phenomena around flaws. During mechanical fatigue, cyclic loading plays the role of the heating source and this allows for critical and subcritical damage identification and monitoring using thermography. The Electrical Potential Change Technique (EPCT) is a new method for damage identification and monitoring during loading. The measurement of electrical potential changes at specific points of Carbon Fiber Reinforced Polymers (CFRPs) under load are reported to enable the monitoring of strain or/and damage accumulation. Along with the aforementioned techniques Finally, Acoustic Emission (AE) method is well known to provide information about the location and type of damage. Damage accumulation due to cyclic loading imposes differentiation of certain parameters of AE like duration and energy. Within the scope of this study, infrared thermography is employed along with AE and EPCT methods in order to assess the integrity of bonded repair patches on composite substrates and to monitor critical and subcritical damage induced by the mechanical loading. The combined methodologies were effective in identifying damage initiation and propagation of bonded composite repairs.
Critical infrastructure protection.
Deitz, Kim M
2012-01-01
Current government policies for protecting the nation's critical infrastructure are described in this article which focuses on hospital disaster planning and incident management and the significant role of Security in infrastructure protection
Mouledoux, Jessica H; Walsh, William F
2013-10-01
Screening for critical congenital heart disease (CCHD) using pulse oximetry has been endorsed by the American Academy of Pediatrics and the American Heart Association. We sought to determine the incidence of undetected CCHD in Tennessee and the diagnostic gap of CCHD in Middle Tennessee prior to screening implementation. The Tennessee Initiative for Perinatal Quality Care (TIPQC) Undetected CCHD Registry is a quality improvement initiative established to identify neonates discharged from the nursery with undetected CCHD. The TIPQC database was queried and a simultaneous review of all neonates with CCHD in the Middle Tennessee region was performed to define the incidence and identify the pre-screen diagnostic gap of undetected CCHD at the time of hospital discharge. In 2011, of 79,462 live births in Tennessee, 12 newborns had undiagnosed CCHD (incidence 15 per 100,000; 95 % CI 9-26 per 100,000). Nine of 12 (75 %) had coarctation of the aorta (CoA). There were no deaths due to undiagnosed CCHD. In the Middle Tennessee region, 6 of 45 neonates with CCHD were missed, for a diagnostic gap of 13 % (95 % CI 6-26 %). Prior to implementation of CCHD screening using pulse oximetry, 12 Tennessee neonates with CCHD were missed by prenatal ultrasound and newborn examination. CoA was the most common lesion missed and is also the CCHD most likely to be missed despite addition of screening using pulse oximetry. Continued evaluation of the diagnostic gap with particular attention to missed diagnoses of CoA should accompany institution of CCHD screening programs.
NASA Astrophysics Data System (ADS)
Carrick, T. L.; Miller, K. C.; Levine, R.; Martinez-Sussmann, C.; Velasco, A. A.
2011-12-01
Anecdotally, it is often stated that the majority of students that enter the geosciences usually do so sometime after their initial entrance into college. With the objective of providing concrete and useful information for individuals developing programs for inspiring interest in the Geosciences amongst pre-college students and trying to increase the number of freshman Geoscience majors, we conducted a critical incident study. Twenty-two students, who were undergraduate or graduate Geoscience majors, were asked, "Why did you decide to major in the Geosciences?" in a series of interviews. Their responses were then used to identify over 100 critical incidents, each of which described a specific behavior that was causally responsible for a student's choice to major in Geoscience. Using these critical incidents, we developed a preliminary taxonomy that is comprised of three major categories: Informal Exposure to the Geosciences (e.g., outdoor experiences, family involvement), Formal Exposure to the Geosciences (e.g., academic experiences, program participation) and a Combined Informal and Formal Exposure (e.g., media exposure). Within these three main categories we identified thirteen subcategories. These categories and subcategories, describe, classify, and provide concrete examples of strategies that were responsible for geosciences career choices. As a whole, the taxonomy is valuable as a new, data-based guide for designing geosciences recruitment programs for the pre-college student population.
C2-Related Incidents Reported by UAS Pilots
NASA Technical Reports Server (NTRS)
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. This presentation focuses on incidents that involved the management of the command and control (C2) link. The identified issues include loss of link, interference from undesired transmissions, voice latency, accidental control transfer, and the use of the lost link timer, or lost link OK features.
Incident Management in Academic Information System using ITIL Framework
NASA Astrophysics Data System (ADS)
Palilingan, V. R.; Batmetan, J. R.
2018-02-01
Incident management is very important in order to ensure the continuity of a system. Information systems require incident management to ensure information systems can provide maximum service according to the service provided. Many of the problems that arise in academic information systems come from incidents that are not properly handled. The objective of this study aims to find the appropriate way of incident management. The incident can be managed so it will not be a big problem. This research uses the ITIL framework to solve incident problems. The technique used in this study is a technique adopted and developed from the service operations section of the ITIL framework. The results of this research found that 84.5% of incidents appearing in academic information systems can be handled quickly and appropriately. 15.5% incidents can be escalated so as to not cause any new problems. The model of incident management applied to make academic information system can run quickly in providing academic service in a good and efficient. The incident management model implemented in this research is able to manage resources appropriately so as to quickly and easily manage incidents.
Gathright, Molly M; Thrush, Carol; Guise, J Benjamin; Krain, Lewis; Clardy, James
2016-04-01
In order to better understand the professional development of medical students during their psychiatry clerkship, this study identifies common themes and characteristics of students' critical incident narratives which are designed to capture a recount of clerkship experiences they perceived as meaningful. A total of 205 narratives submitted by psychiatry clerkship students in 2010-2011 were subjected to a thematic analysis using a methodological approach and adaptation of categories derived from prior similar research. Descriptive content analysis was also carried out to assess the valence of the narrative content, characters involved, and whether there was evidence that the experience changed students' perspectives in some way. Narratives contained a variety of positive (19%) and negative content (24%) and many contained a hybrid of both (57%). The most common theme (29%) concerned issues of respect and disrespect in patient, clinical, and coworker interactions. In general, the majority (68%) of students' meaningful experience narratives reflected a change in their perspective (e.g., I learned that...). Narratives containing positive and hybrid content were associated with a change in students' perspective (χ(2) = 10.61, df = 2, p < 0.005). Medical students are keenly aware of the learning environment. Positive and hybrid critical incident narratives were associated with a stated change in their beliefs, attitudes, or behaviors due to the experience. Understanding the events that are meaningful to students can also provide rich feedback to medical educators regarding the ways in which students perceive clinical learning environments and how to best foster their professional development.
Lakhal, Karim; Ehrmann, Stephan; Chaari, Anis; Laissy, Jean-Pierre; Régnier, Bernard; Wolff, Michel; Pajot, Olivier
2011-12-01
Contrast-induced nephropathy (CIN) has been extensively studied in the ward but only scarcely in intensive care unit (ICU) patients, even if they may be particularly prone to develop or to worsen acute kidney insufficiency. We aimed to measure the incidence of CIN in a large ICU population using the Acute Kidney Injury Network (AKIN) definition and to investigate its impact on patients' outcome. In this 3-year retrospective study, we included all patients undergoing, during their stay in our medical ICU, a contrast media-enhanced computed tomographic scan. Change in serum creatinine between baseline (24 hours before to 12 hours after contrast media injection) and its maximum value over the 96 hours after contrast media injection was recorded. Contrast-induced nephropathy was defined as a 44.2-μmol/L absolute or a 25% relative minimal increase in serum creatinine over 48, 72, or 96 hours and according to the stage 1 of the AKIN classification (at least 26.4 μmol/L or 50% increase over 48 hours). A total of 398 contrast-enhanced computed tomographic scans performed among 299 patients were analyzed. Incidence of CIN was 14% according to the AKIN definition and ranged from 8% (48-hour absolute definition) to 23% (96-hour relative definition). The need for renal replacement therapy and ICU mortality were significantly higher in case of CIN. After adjusting for other variables associated with ICU mortality, the occurrence of at least 1 CIN episode during the ICU stay (AKIN criteria) was independently associated with ICU mortality (odds ratio, 3.85; 95% confidence interval, 1.85-8.00). Even if incidence varied greatly depending on the definition, CIN appeared frequent in our critically ill patients. The AKIN definition, independently associated with ICU mortality, may allow unifying diagnostic criteria to further evaluate this condition that impacts morbidity and mortality. Copyright © 2011 Elsevier Inc. All rights reserved.
Human Factors of Remotely Piloted Aircraft Systems: Lessons from Incident Reports
NASA Technical Reports Server (NTRS)
Hobbs, Alan; Null, Cynthia
2016-01-01
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. 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.
Defibrillation and external pacing in flight: incidence and implications.
Daly, Stuart; Milne, Helen J; Holmes, Dan P; Corfield, Alasdair R
2014-01-01
Emergency electrical intervention for patients in the form of defibrillation, cardioversion and external cardiac pacing can be life saving. Advances in medical technology have enabled electrical intervention to be delivered from small, portable devices. With the rising use of air transport for patients, electrical intervention during aeromedical transfer has an increasing incidence. Our aim was to describe the incidence of electrical intervention in a cohort of critically ill patients undergoing aeromedical transfer and review the risks associated with electrical intervention. All secondary retrievals undertaken by a national aeromedical critical care retrieval service were reviewed over a 48-month period. In a mixed medical and trauma critical care population, 11 of 967 (1.1%) secondary retrievals required electrical intervention during aeromedical critical care retrieval. The median age of these patients was 77 years (range 32-86) and the median transport time was 70 min (range 40-100 min). All of these patients had an underlying primary cardiac condition and had been identified as high risk for developing an arrhythmia. Electrical intervention in a transport environment brings unique challenges, particularly during aeromedical transport. Our study in a European model shows that there is a small but significant incidence of electrical intervention required during aeromedical flight for critically ill patients. There are potential safety issues with electrical intervention in aeromedical flight; therefore, any service involved in the transport of critically ill patients needs to have a robust procedure in place to deliver this safely.
Influence of crack opening and incident wave angle on second harmonic generation of Lamb waves
NASA Astrophysics Data System (ADS)
Yang, Yi; Ng, Ching-Tai; Kotousov, Andrei
2018-05-01
Techniques utilising second harmonic generation (SHG) have proven their great potential in detecting contact-type damage. However, the gap between the practical applications and laboratory studies is still quite large. The current work is aimed to bridge this gap by investigating the effects of the applied load and incident wave angle on the detectability of fatigue cracks at various lengths. Both effects are critical for practical implementations of these techniques. The present experimental study supported by three-dimensional (3D) finite element (FE) modelling has demonstrated that the applied load, which changes the crack opening and, subsequently, the contact nonlinearity, significantly affects the amplitude of the second harmonic generated by the fundamental symmetric mode (S0) of Lamb wave. This amplitude is also dependent on the length of the fatigue crack as well as the incident wave angle. The experimental and FE results correlate well, so the modelling approach can be implemented for practical design of damage monitoring systems as well as for the evaluation of the severity of the fatigue cracks.
Risk-based Classification of Incidents
NASA Technical Reports Server (NTRS)
Greenwell, William S.; Knight, John C.; Strunk, Elisabeth A.
2003-01-01
As the penetration of software into safety-critical systems progresses, accidents and incidents involving software will inevitably become more frequent. Identifying lessons from these occurrences and applying them to existing and future systems is essential if recurrences are to be prevented. Unfortunately, investigative agencies do not have the resources to fully investigate every incident under their jurisdictions and domains of expertise and thus must prioritize certain occurrences when allocating investigative resources. In the aviation community, most investigative agencies prioritize occurrences based on the severity of their associated losses, allocating more resources to accidents resulting in injury to passengers or extensive aircraft damage. We argue that this scheme is inappropriate because it undervalues incidents whose recurrence could have a high potential for loss while overvaluing fairly straightforward accidents involving accepted risks. We then suggest a new strategy for prioritizing occurrences based on the risk arising from incident recurrence.
Studies of EGRET sources with a novel image restoration technique
DOE Office of Scientific and Technical Information (OSTI.GOV)
Tajima, Hiroyasu; Cohen-Tanugi, Johann; Kamae, Tuneyoshi
2007-07-12
We have developed an image restoration technique based on the Richardson-Lucy algorithm optimized for GLAST-LAT image analysis. Our algorithm is original since it utilizes the PSF (point spread function) that is calculated for each event. This is critical for EGRET and GLAST-LAT image analysis since the PSF depends on the energy and angle of incident gamma-rays and varies by more than one order of magnitude. EGRET and GLAST-LAT image analysis also faces Poisson noise due to low photon statistics. Our technique incorporates wavelet filtering to minimize noise effects. We present studies of EGRET sources using this novel image restoration techniquemore » for possible identification of extended gamma-ray sources.« less
Souto, Antonio; Bione, Camila B. C.; Bastos, Monique; Bezerra, Bruna M.; Fragaszy, Dorothy; Schiel, Nicola
2011-01-01
We report the spontaneous modification and use of sticks to fish for termites, above the ground, in wild blonde capuchins (Cebus flavius). These critically endangered Neotropical primates inhabit remnants of the Atlantic Forest. They used two previously undescribed techniques to enhance their termite capture success: nest tapping and stick rotation. The current ecologically based explanation for tool use in wild capuchins (i.e. terrestrial habits and bipedalism) must be viewed cautiously. Instead, remarkable manual skills linked to a varied diet seem important in promoting tool use in different contexts. The repertoire of tool-using techniques employed by wild capuchins has been expanded, highlighting the behavioural versatility in this genus. PMID:21389018
Decision modeling for fire incident analysis
Donald G. MacGregor; Armando González-Cabán
2009-01-01
This paper reports on methods for representing and modeling fire incidents based on concepts and models from the decision and risk sciences. A set of modeling techniques are used to characterize key fire management decision processes and provide a basis for incident analysis. The results of these methods can be used to provide insights into the structure of fire...
Evidence-based guides in tracheostomy use in critical patients.
Raimondi, N; Vial, M R; Calleja, J; Quintero, A; Cortés Alban, A; Celis, E; Pacheco, C; Ugarte, S; Añón, J M; Hernández, G; Vidal, E; Chiappero, G; Ríos, F; Castilleja, F; Matos, A; Rodriguez, E; Antoniazzi, P; Teles, J M; Dueñas, C; Sinclair, J; Martínez, L; Von der Osten, I; Vergara, J; Jiménez, E; Arroyo, M; Rodriguez, C; Torres, J; Fernandez-Bussy, S; Nates, J L
2017-03-01
Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Incidence of bruxism in TMD population.
Chandwani, Briesh; Ceneviz, Caroline; Mehta, Noshir; Scrivani, Steven
2011-01-01
The objective of the study presented here was to examine the incidence of bruxism in patients suffering from temporomandibular disorders. Two cohorts of patients suffering from temporomandibular disorders were evaluated. One group, composed of 163 patients, was asked specifically about the occurrence of bruxism, while the other group, composed of 200 patients, was not specifically asked about bruxism (self-reporting). The incidence of bruxism was only 20.5% for the group that only self-reported bruxism, while the incidence was 65% when asked specifically about bruxism. It is critical to ask specifically about bruxism. Patients are more likely to report bruxism when asked specifically about it. It is important to incorporate this as part of a TMD evaluation.
Linux Incident Response Volatile Data Analysis Framework
ERIC Educational Resources Information Center
McFadden, Matthew
2013-01-01
Cyber incident response is an emphasized subject area in cybersecurity in information technology with increased need for the protection of data. Due to ongoing threats, cybersecurity imposes many challenges and requires new investigative response techniques. In this study a Linux Incident Response Framework is designed for collecting volatile data…
Contact Sport Concussion Incidence
Tommasone, Beth A; Valovich McLeod, Tamara C
2006-01-01
, facial bone fracture, or soft tissue injuries; if they reported prevalence, rather than incidence, of concussion; if they addressed chronic TBI; if they comprised case reports or letters to the editor; or if they lacked a denominator to determine risk rates. Finally, relevant and unknown articles from the abstract screening were reviewed again for the inclusion and exclusion criteria by an independent, outside party. Data Extraction: A general methodologic criteria design was used to critically appraise all articles that met the inclusion and exclusion criteria. This design appraised 11 study design and reporting criteria. In order for an article to be accepted into the systematic review, it had to meet at least the 5 mandatory criteria: description of the source population, appropriate description of inclusion and exclusion criteria, verifiable results from the raw data, differentiation of the incidence of injury between practice and game settings, and adequately measured denominator of population or person-time at risk. For each individual study, the 5 mandatory criteria listed above were rated with regard to whether they were included or addressed in the paper ( yes), were missing from the paper ( no), or were included but not described fully or in a way characterized by sound quality ( substandard). If any of the 5 mandatory criteria were rated no, the article was not evaluated any further. Data taken from these articles included sex, types of sessions in which concussion occurred, and numbers defining incidence of concussion within a contact sport. In some studies, rates were recalculated from the raw data in order to check accuracy, or if they were not presented in the published material, rates were calculated. These rates were recalculated with the denominator presented in the original study, athletes at risk for injury or time at risk for injury. Athlete-exposure was not defined in the review but is commonly used as the denominator in epidemiologic studies and
Lewis, Rachel; Yarker, Joanna; Donaldson-Feilder, Emma; Flaxman, Paul; Munir, Fehmidah
2010-03-01
To identify the specific management behaviours associated with the effective management of stress in nursing; and to build a stress management competency framework that can be integrated and compared with nurse management frameworks. Workplace stress is a significant problem in healthcare, especially within nursing. While there is a reasonable consensus regarding the sources of stress and its impact on health and well-being, little is known about the specific line manager behaviours that are associated with the effective and ineffective management of stress. Semi-structured interviews using critical incident technique were conducted with 41 employees working within 5 National Health Service (NHS) trusts within the United Kingdom. Data were transcribed and analysed using content analysis. 19 competencies (or sets of behaviour) were identified in the management of stress in employees. The 3 most frequently reported competencies: managing workload and resources, individual consideration and participative approach, are discussed in detail with illustrative quotes. Managers are vital in the reduction and management of stress at work. Importantly, the 2 of the 3 dominant competencies, managing workload and resources and individual consideration, do not feature in the UK's NHS Knowledge and Skills Framework, suggesting there are important skills gaps with regard to managing workplace stress. The implications of this approach for training and development, performance appraisal and assessment are discussed. Interventions to support managers develop effective behaviours are required to help reduce and manage stress at work. Copyright 2009 Elsevier Ltd. All rights reserved.
A Robust Automatic Ionospheric O/X Mode Separation Technique for Vertical Incidence Sounders
NASA Astrophysics Data System (ADS)
Harris, T. J.; Pederick, L. H.
2017-12-01
The sounding of the ionosphere by a vertical incidence sounder (VIS) is the oldest and most common technique for determining the state of the ionosphere. The automatic extraction of relevant ionospheric parameters from the ionogram image, referred to as scaling, is important for the effective utilization of data from large ionospheric sounder networks. Due to the Earth's magnetic field, the ionosphere is birefringent at radio frequencies, so a VIS will typically see two distinct returns for each frequency. For the automatic scaling of ionograms, it is highly desirable to be able to separate the two modes. Defence Science and Technology Group has developed a new VIS solution which is based on direct digital receiver technology and includes an algorithm to separate the O and X modes. This algorithm can provide high-quality separation even in difficult ionospheric conditions. In this paper we describe the algorithm and demonstrate its consistency and reliability in successfully separating 99.4% of the ionograms during a 27 day experimental campaign under sometimes demanding ionospheric conditions.
Shao, Yu; Wang, Shumin
2016-12-01
The numerical simulation of acoustic scattering from elastic objects near a water-sand interface is critical to underwater target identification. Frequency-domain methods are computationally expensive, especially for large-scale broadband problems. A numerical technique is proposed to enable the efficient use of finite-difference time-domain method for broadband simulations. By incorporating a total-field/scattered-field boundary, the simulation domain is restricted inside a tightly bounded region. The incident field is further synthesized by the Fourier transform for both subcritical and supercritical incidences. Finally, the scattered far field is computed using a half-space Green's function. Numerical examples are further provided to demonstrate the accuracy and efficiency of the proposed technique.
Concept Mapping: A Critical Thinking Technique
ERIC Educational Resources Information Center
Harris, Charles M.; Zha, Shenghua
2013-01-01
Concept mapping, graphically depicting the structure of abstract concepts, is based on the observation that pictures and line drawings are often more easily comprehended than the words that represent an abstract concept. The efficacy of concept mapping for facilitating critical thinking was assessed in four sections of an introductory psychology…
DOE Office of Scientific and Technical Information (OSTI.GOV)
King, Alex
2013-01-09
Ames Laboratory Director Alex King talks about the goals of the Critical Materials Institute in diversifying the supply of critical materials, developing substitute materials, developing tools and techniques for recycling critical materials, and forecasting materials needs to avoid future shortages.
King, Alex
2017-12-22
Ames Laboratory Director Alex King talks about the goals of the Critical Materials Institute in diversifying the supply of critical materials, developing substitute materials, developing tools and techniques for recycling critical materials, and forecasting materials needs to avoid future shortages.
Analysis of mass incident diffusion in Weibo based on self-organization theory
NASA Astrophysics Data System (ADS)
Pan, Jun; Shen, Huizhang
2018-02-01
This study introduces some theories and methods of self-organization system to the research of the diffusion mechanism of mass incidents in Weibo (Chinese Twitter). Based on the analysis on massive Weibo data from Songjiang battery factory incident happened in 2013 and Jiiangsu Qidong OJI PAPER incident happened in 2012, we find out that diffusion system of mass incident in Weibo satisfies Power Law, Zipf's Law, 1/f noise and Self-similarity. It means this system is the self-organization criticality system and dissemination bursts can be understood as one kind of Self-organization behavior. As the consequence, self-organized criticality (SOC) theory can be used to explain the evolution of mass incident diffusion and people may come up with the right strategy to control such kind of diffusion if they can handle the key ingredients of Self-organization well. Such a study is of practical importance which can offer opportunities for policy makers to have good management on these events.
Evidence-based guidelines for the use of tracheostomy in critically ill patients.
Raimondi, Néstor; Vial, Macarena R; Calleja, José; Quintero, Agamenón; Cortés, Albán; Celis, Edgar; Pacheco, Clara; Ugarte, Sebastián; Añón, José M; Hernández, Gonzalo; Vidal, Erick; Chiappero, Guillermo; Ríos, Fernando; Castilleja, Fernando; Matos, Alfredo; Rodriguez, Enith; Antoniazzi, Paulo; Teles, José Mario; Dueñas, Carmelo; Sinclair, Jorge; Martínez, Lorenzo; von der Osten, Ingrid; Vergara, José; Jiménez, Edgar; Arroyo, Max; Rodríguez, Camilo; Torres, Javier; Fernandez-Bussy, Sebastián; Nates, Joseph L
2017-04-01
To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions. Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used. Copyright © 2016 Elsevier Inc. All rights reserved.
Safe Space Oddity: Revisiting Critical Pedagogy
ERIC Educational Resources Information Center
Redmond, Melissa
2010-01-01
Inspired by an incident in a social work graduate classroom in which she was a teaching assistant, the author reflects on her commitment to constructivist teaching methods, critical theory, and critical pedagogy. Exploring the educational utility of notions such as public space and safe space, the author employs this personal experience to examine…
DOE Office of Scientific and Technical Information (OSTI.GOV)
Shah, Chirag; Vicini, Frank A., E-mail: fvicini@beaumont.edu
As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially withmore » a range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.« less
Black, Joyce; Berke, Christine; Urzendowski, Gail
2012-01-01
The primary objective of this study was to compare facility-acquired pressure ulcer incidence and progression of pressure ulcers present on admission in critically ill patients, using 2 different support surfaces. We completed a comparison cohort study in a surgical intensive care unit (ICU). The study setting was a 12-bed cardiovascular ICU in a university-based hospital in the Midwestern United States. The sample comprised 52 critically ill patients; 31 were placed on low air loss weight-based pressure redistribution-microclimate management system beds and 21 were placed on integrated powered air pressure redistribution beds. Prior to the start of the study, 5 low airloss beds were placed in open rooms in the cardiovascular surgical ICU. Inclusion criteria were anticipated ICU stay of 3 days, and patients did not receive a speciality bed for pulmonary or wound issues. Initial assessment of the patients included risk assessment and prior events that would increase risk for pressure ulcer development such as extended time in operating room, along with skin assessment for existing pressure ulcers. Subjects in both groups had ongoing skin assessment every 3 to 4 days and a subjective evaluation of heel elevation and turning or repositioning by the researcher. Data were collected until the subjects were dismissed from the ICU. Patients admitted to the unit were assigned to open rooms following the usual protocols. The mean length of stay was 7.0 days, with an 8.1-day length of stay for subjects on "low air loss with microclimate management" beds (LAL-MCM) and 6.6 days on the integrated power pressure air redistribution (IP-AR) beds (P = NS). The incidence of pressure ulcers on the buttocks, sacrum, or coccyx was 0% (0/31) on the low air loss bed and 18% (4/21) on the IP-AR bed (P = .046). Five subjects had 6 pressure ulcers on admission. Two pressure ulcers on 2 patients worsened on the integrated power air redistribution beds, which required specialty bed rental
Fretheim, Atle; Odgaard-Jensen, Jan; Røttingen, John-Arne; Reinar, Liv Merete; Vangen, Siri; Tanbo, Tom
2013-10-22
To re-evaluate previously published findings from an uncontrolled before-after evaluation of an intervention programme to reduce the incidence of anal sphincter tears. A key component of the programme was the use of a hands-on technique where the birth attendant presses the neonate's head during the final stage of delivery while simultaneously supporting the woman's perineum with the other hand. Interrupted time-series analysis using segmented regression modelling. Obstetric departments of five Norwegian hospitals. All women giving births vaginally in the study hospitals, 2002-2008. The main data source was the Medical Birth Registry of Norway. We estimated the change in incidence of anal sphincter tears before and after implementation of the intervention in the five intervention hospitals, taking into account the trends in incidence before and after implementation. Incidence of anal sphincter tears and episiotomies. There were 75 543 registered births at the five included hospitals. We found a 2% absolute reduction in incidence of anal sphincter tears associated with the hospital intervention programme, representing almost a halving in the number of women experiencing serious anal sphincter tears. This is a substantially smaller estimate than previously reported. However, it does represent a highly significant decrease in anal sphincter injuries. The programme was also associated with a significant increase in episiotomies. The intervention programme was associated with a significant reduction in the incidence of obstetric anal sphincter tears. Still, the findings should be interpreted with caution as they seem to contradict the findings from randomised controlled studies of similar interventions.
Behavior Change Techniques Present in Wearable Activity Trackers: A Critical Analysis
Mercer, Kathryn; Li, Melissa; Giangregorio, Lora; Burns, Catherine
2016-01-01
Background Wearable activity trackers are promising as interventions that offer guidance and support for increasing physical activity and health-focused tracking. Most adults do not meet their recommended daily activity guidelines, and wearable fitness trackers are increasingly cited as having great potential to improve the physical activity levels of adults. Objective The objective of this study was to use the Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy to examine if the design of wearable activity trackers incorporates behavior change techniques (BCTs). A secondary objective was to critically analyze whether the BCTs present relate to known drivers of behavior change, such as self-efficacy, with the intention of extending applicability to older adults in addition to the overall population. Methods Wearing each device for a period of 1 week, two independent raters used CALO-RE taxonomy to code the BCTs of the seven wearable activity trackers available in Canada as of March 2014. These included Fitbit Flex, Misfit Shine, Withings Pulse, Jawbone UP24, Spark Activity Tracker by SparkPeople, Nike+ FuelBand SE, and Polar Loop. We calculated interrater reliability using Cohen's kappa. Results The average number of BCTs identified was 16.3/40. Withings Pulse had the highest number of BCTs and Misfit Shine had the lowest. Most techniques centered around self-monitoring and self-regulation, all of which have been associated with improved physical activity in older adults. Techniques related to planning and providing instructions were scarce. Conclusions Overall, wearable activity trackers contain several BCTs that have been shown to increase physical activity in older adults. Although more research and development must be done to fully understand the potential of wearables as health interventions, the current wearable trackers offer significant potential with regard to BCTs relevant to uptake by all populations, including older adults. PMID:27122452
Behavior Change Techniques Present in Wearable Activity Trackers: A Critical Analysis.
Mercer, Kathryn; Li, Melissa; Giangregorio, Lora; Burns, Catherine; Grindrod, Kelly
2016-04-27
Wearable activity trackers are promising as interventions that offer guidance and support for increasing physical activity and health-focused tracking. Most adults do not meet their recommended daily activity guidelines, and wearable fitness trackers are increasingly cited as having great potential to improve the physical activity levels of adults. The objective of this study was to use the Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy to examine if the design of wearable activity trackers incorporates behavior change techniques (BCTs). A secondary objective was to critically analyze whether the BCTs present relate to known drivers of behavior change, such as self-efficacy, with the intention of extending applicability to older adults in addition to the overall population. Wearing each device for a period of 1 week, two independent raters used CALO-RE taxonomy to code the BCTs of the seven wearable activity trackers available in Canada as of March 2014. These included Fitbit Flex, Misfit Shine, Withings Pulse, Jawbone UP24, Spark Activity Tracker by SparkPeople, Nike+ FuelBand SE, and Polar Loop. We calculated interrater reliability using Cohen's kappa. The average number of BCTs identified was 16.3/40. Withings Pulse had the highest number of BCTs and Misfit Shine had the lowest. Most techniques centered around self-monitoring and self-regulation, all of which have been associated with improved physical activity in older adults. Techniques related to planning and providing instructions were scarce. Overall, wearable activity trackers contain several BCTs that have been shown to increase physical activity in older adults. Although more research and development must be done to fully understand the potential of wearables as health interventions, the current wearable trackers offer significant potential with regard to BCTs relevant to uptake by all populations, including older adults.
Measurement of the absorption coefficient using the sound-intensity technique
NASA Technical Reports Server (NTRS)
Atwal, M.; Bernhard, R.
1984-01-01
The possibility of using the sound intensity technique to measure the absorption coefficient of a material is investigated. This technique measures the absorption coefficient by measuring the intensity incident on the sample and the net intensity reflected by the sample. Results obtained by this technique are compared with the standard techniques of measuring the change in the reverberation time and the standing wave ratio in a tube, thereby, calculating the random incident and the normal incident adsorption coefficient.
Lawless, Craig; Hubbard, Simon J.; Fan, Jun; Bessant, Conrad; Hermjakob, Henning; Jones, Andrew R.
2012-01-01
Abstract New methods for performing quantitative proteome analyses based on differential labeling protocols or label-free techniques are reported in the literature on an almost monthly basis. In parallel, a correspondingly vast number of software tools for the analysis of quantitative proteomics data has also been described in the literature and produced by private companies. In this article we focus on the review of some of the most popular techniques in the field and present a critical appraisal of several software packages available to process and analyze the data produced. We also describe the importance of community standards to support the wide range of software, which may assist researchers in the analysis of data using different platforms and protocols. It is intended that this review will serve bench scientists both as a useful reference and a guide to the selection and use of different pipelines to perform quantitative proteomics data analysis. We have produced a web-based tool (http://www.proteosuite.org/?q=other_resources) to help researchers find appropriate software for their local instrumentation, available file formats, and quantitative methodology. PMID:22804616
Interference by new-generation mobile phones on critical care medical equipment.
van Lieshout, Erik Jan; van der Veer, Sabine N; Hensbroek, Reinout; Korevaar, Johanna C; Vroom, Margreeth B; Schultz, Marcus J
2007-01-01
The aim of the study was to assess and classify incidents of electromagnetic interference (EMI) by second-generation and third-generation mobile phones on critical care medical equipment. EMI was assessed with two General Packet Radio Service (GPRS) signals (900 MHz, 2 W, two different time-slot occupations) and one Universal Mobile Telecommunications System (UMTS) signal (1,947.2 MHz, 0.2 W), corresponding to maximal transmit performance of mobile phones in daily practice, generated under controlled conditions in the proximity of 61 medical devices. Incidents of EMI were classified in accordance with an adjusted critical care event scale. A total of 61 medical devices in 17 categories (27 different manufacturers) were tested and demonstrated 48 incidents in 26 devices (43%); 16 (33%) were classified as hazardous, 20 (42%) as significant and 12 (25%) as light. The GPRS-1 signal induced the most EMI incidents (41%), the GRPS-2 signal induced fewer (25%) and the UMTS signal induced the least (13%; P < 0.001). The median distance between antenna and medical device for EMI incidents was 3 cm (range 0.1 to 500 cm). One hazardous incident occurred beyond 100 cm (in a ventilator with GRPS-1 signal at 300 cm). Critical care equipment is vulnerable to EMI by new-generation wireless telecommunication technologies with median distances of about 3 cm. The policy to keep mobile phones '1 meter' from the critical care bedside in combination with easily accessed areas of unrestricted use still seems warranted.
Poster - 27: Incident Learning Practices in Ontario
DOE Office of Scientific and Technical Information (OSTI.GOV)
Angers, Crystal; Medlam, Gaylene; Liszewski, Brian
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 sharingmore » 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.« less
Instantaneous polarization statistic property of EM waves incident on time-varying reentry plasma
NASA Astrophysics Data System (ADS)
Bai, Bowen; Liu, Yanming; Li, Xiaoping; Yao, Bo; Shi, Lei
2018-06-01
An analytical method is proposed in this paper to study the effect of time-varying reentry plasma sheath on the instantaneous polarization statistic property of electromagnetic (EM) waves. Based on the disturbance property of the hypersonic fluid, the spatial-temporal model of the time-varying reentry plasma sheath is established. An analytical technique referred to as transmission line analogy is developed to calculate the instantaneous transmission coefficient of EM wave propagation in time-varying plasma. Then, the instantaneous polarization statistic theory of EM wave propagation in the time-varying plasma sheath is developed. Taking the S-band telemetry right hand circularly polarized wave as an example, effects of incident angle and plasma parameters, including the electron density and the collision frequency on the EM wave's polarization statistic property are studied systematically. Statistical results indicate that the lower the collision frequency and the larger the electron density and incident angle is, the worse the deterioration of the polarization property is. Meanwhile, in conditions of critical parameters of certain electron density, collision frequency, and incident angle, the transmitted waves have both the right and left hand polarization mode, and the polarization mode will reverse. The calculation results could provide useful information for adaptive polarization receiving of the spacecraft's reentry communication.
Grazing incidence X-ray absorption characterization of amorphous Zn-Sn-O thin film
NASA Astrophysics Data System (ADS)
Moffitt, S. L.; Ma, Q.; Buchholz, D. B.; Chang, R. P. H.; Bedzyk, M. J.; Mason, T. O.
2016-05-01
We report a surface structure study of an amorphous Zn-Sn-O (a-ZTO) transparent conducting film using the grazing incidence X-ray absorption spectroscopy technique. By setting the measuring angles far below the critical angle at which the total external reflection occurs, the details of the surface structure of a film or bulk can be successfully accessed. The results show that unlike in the film where Zn is severely under coordinated (N < 4), it is fully coordinated (N = 4) near the surface while the coordination number around Sn is slightly smaller near the surface than in the film. Despite a 30% Zn doping, the local structure in the film is rutile-like.
The hydrodynamic design and critical techniques for 1m×1m water tunnel
NASA Astrophysics Data System (ADS)
Jiang, Yubiao; Gao, Chao; Geng, Zihai; Chen, Cheng
2018-04-01
China aerodynamics research and development Center has built 1m×1m water tunnel featured by good flow field quality and comprehensive experimental abilities for the researches on flow visualization and measurement. In detail, it has several advantages, such as low turbulence intensity, spatially homogeneous velocity field, stable flow velocity and convenience for use. The experimental section has low turbulence intensity and good quality of flow field over a wide range of flow velocity from 0.1m/s to 1m/s, implying that the hydrodynamic design method and critical techniques for the tunnel are worthy of popularization.
Flabouris, Arthas; Nocera, Antony; Garner, Alan
2004-01-01
Multiple casualty incidents (MCI) are infrequent events for medical systems. This renders audit and quality improvement of the medical responses difficult. Quality tools and use of such tools for improvement is necessary to ensure that the design of medical systems facilitates the best possible response to MCI. To describe the utility of incident reporting as a quality monitoring and improvement tool during the deployment of medical teams for mass gatherings and multiple casualty incidents. Voluntary and confidential reporting of incidents was provided by members of the disaster medical response teams during the period of disaster medical team deployment for the 2000 Sydney Olympic Games. Qualitative evaluations were conducted of reported incidents. The main outcome measures included the nature of incident and associated contributing factors, minimization factors, harm potential, and comparison with the post-deployment, cold debriefings. A total of 53 incidents were reported. Management-based decisions, poor or non-existent protocols, and equipment and communication-related issues were the principal contributing factors. Eighty nine percent of the incidents were considered preventable. A potential for harm to patients and/or team members was documented in 58% of reports, of which 76% were likely to cause at least significant harm. Of equipment incidents, personal protective equipment (33%), medical equipment (27%), provision of equipment (22%), and communication equipment (17%) predominated. Personal protective equipment (50%) was reported as the most frequent occupational health and safety incident followed by fatigue (25%). Pre-deployment planning was the most important factor for future incident impact minimization. Incident monitoring was efficacious as a quality tool in identifying incident contributing factors. Incident monitoring allowed for greater systems evaluation. Further evaluation of this quality tool within different disaster settings is required.
Comparison of prometaphase chromosome techniques with emphasis on the role of colcemid.
Wiley, J E; Sargent, L M; Inhorn, S L; Meisner, L F
1984-12-01
Six different techniques were evaluated to define better those technical factors that are most critical for obtaining prometaphase cells for banding analysis. Our results demonstrate: colcemid exposures of 30 min or less have no effect on increasing the yield of prometaphase cells, colcemid exposures of greater than 0.1 microgram/ml can be toxic, methotrexate depresses the mitotic index significantly and seems to increase the incidence of prometaphase cells only because it suppresses later forms; and (d) the optimum number of cytogenetically satisfactory prometaphase cells can be obtained with a 4-h exposure to a combination of low concentration actinomycin D (0.5 microgram/ml) and colcemid (0.1 microgram/ml). This technique inhibits chromosome condensation while permitting prometaphase cells to accumulate for 4 h.
Interference by new-generation mobile phones on critical care medical equipment
van Lieshout, Erik Jan; van der Veer, Sabine N; Hensbroek, Reinout; Korevaar, Johanna C; Vroom, Margreeth B; Schultz, Marcus J
2007-01-01
Introduction The aim of the study was to assess and classify incidents of electromagnetic interference (EMI) by second-generation and third-generation mobile phones on critical care medical equipment. Methods EMI was assessed with two General Packet Radio Service (GPRS) signals (900 MHz, 2 W, two different time-slot occupations) and one Universal Mobile Telecommunications System (UMTS) signal (1,947.2 MHz, 0.2 W), corresponding to maximal transmit performance of mobile phones in daily practice, generated under controlled conditions in the proximity of 61 medical devices. Incidents of EMI were classified in accordance with an adjusted critical care event scale. Results A total of 61 medical devices in 17 categories (27 different manufacturers) were tested and demonstrated 48 incidents in 26 devices (43%); 16 (33%) were classified as hazardous, 20 (42%) as significant and 12 (25%) as light. The GPRS-1 signal induced the most EMI incidents (41%), the GRPS-2 signal induced fewer (25%) and the UMTS signal induced the least (13%; P < 0.001). The median distance between antenna and medical device for EMI incidents was 3 cm (range 0.1 to 500 cm). One hazardous incident occurred beyond 100 cm (in a ventilator with GRPS-1 signal at 300 cm). Conclusion Critical care equipment is vulnerable to EMI by new-generation wireless telecommunication technologies with median distances of about 3 cm. The policy to keep mobile phones '1 meter' from the critical care bedside in combination with easily accessed areas of unrestricted use still seems warranted. PMID:17822524
Minnick, Joanne M; Bebarta, Vikhyat S; Stanton, Marietta; Lairet, Julio R; King, James; Torres, Pedro; Aden, James; Ramirez, Rosemarie
2013-11-01
Most critically ill injured patients are transported out of the theater by Critical Care Air Transport Teams (CCATTs). Fever after trauma is correlated with surgical complications and infection. The purposes of this study are to identify the incidence of elevated temperature in patients managed in the CCATT environment and to describe the complications reported and the treatments used in these patients. We performed a retrospective review of available records of trauma patients from the combat theater between March 1, 2009, and March 31, 2010, who were transported by the US Air Force CCATT and had an incidence of hyperthermia. We then divided the cohort into 2 groups, patients transported with an elevation in temperature greater than 100.4°F and patients with no documented elevation in temperature. We used a standardized, secure electronic data collection form to abstract the outcomes. Descriptive data collected included injury type, temperature, use of a mechanical ventilator, cooling treatment modalities, antipyretics, intravenous fluid administration, and use of blood products. We also evaluated the incidence of complications during the transport in patients who had a recorded elevation in temperature greater than 100.4°F. A total of 248 trauma patients met the inclusion criteria, and 101 trauma patients (40%) had fever. The mean age was 28 years, and 98% of patients were men. The mechanism of injury was an explosion in 156 patients (63%), blunt injury in 11 (4%), and penetrating injury in 45 (18%), whereas other trauma-related injuries accounted for 36 patients (15%). Of the patients, 209 (84%) had battle-related injuries and 39 (16%) had non-battle-related injuries. Traumatic brain injury was found in 24 patients (24%) with an incidence of elevated temperature. The mean temperature was 101.6°F (range, 100.5°F-103.9°F). After evaluation of therapies and treatments, 80 trauma patients (51%) were intubated on a mechanical ventilator (P < .001). Of the trauma
Nasa, Prashant; Juneja, Deven; Singh, Omender; Dang, Rohit; Singh, Akhilesh
2012-03-01
The incidence of nosocomial infections caused by extended-spectrum beta-lactamase (ESBL) producing microbes is increasing rapidly in the last few years. However, the clinical significance of infections caused by ESBL-producing bacteria in ICU patients remains unclear. We did a prospective study to look for incidence, risk factors and outcome of these infections in ICU patients. Consecutive isolates of Escherichia coli and Klebsiella pneumoniae in blood cultures were included for the analysis. Patients were divided into two groups based on the production of ESBL. Primary outcome measure was ICU mortality. Logistic regression analysis was done to identify risk factors for ESBL production. Among the 95 isolates tested, 73 (76.8%) produced ESBL. Transfer from other hospitals or wards (OR 3.65; 95% CI: 1.3-10.1 and RR 1.35; 95% CI: 1.05-1.73) and previous history of antibiotics usage (OR 3.54; 95% CI: 1.04-11.97 and RR 1.5; 95% CI: 0.89-2.5) were risk factors for ESBL production. There was no significant difference in ICU mortality (p=0.588), need for organ support between two groups. There is a high incidence of ESBL producing organisms causing blood stream infections in critically ill patients. Transfer from other hospitals and previous antibiotic usage are important risk factors for ESBL production. However ESBL production may not be associated with a poorer outcome if appropriate early antibiotic therapy is instituted. Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Incidence of constipation in an intensive care unit
Guerra, Tatiana Lopes de Souza; Mendonça, Simone Sotero; Guimarães Marshall, Norma
2013-01-01
Objectives To evaluate the incidence of constipation in critical patients on enteral nutrition in a hospital intensive care unit and to correlate this incidence with the variables found for critical patients. Methods The present investigation was a retrospective analytical study conducted in the intensive care unit of Hospital Regional da Asa Norte (DF) via the analysis of medical records of patients admitted during the period from January to December 2011. Data on the incidence of constipation and enteral nutritional support, gastrointestinal changes, stool frequency, ventilatory support, and outcomes were collected and analyzed. Results The initial sample consisted of 127 patients admitted to the unit during the period from January to December 2011. Eighty-four patients were excluded, and the final sample consisted of 43 patients. The incidence of constipation, defined as no bowel movement during the first 4 days of hospitalization, was 72% (n=31). The patients were divided into a control group and a constipated group. The group of constipated patients reached the caloric target, on average, at 6.5 days, and the control group reached the caloric target in 5.6 days (p=0.51). Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization. There was an association between evacuation during hospitalization and a longer duration of hospitalization for a subgroup of patients who did not evacuate during the entire period (p=0.009). Conclusion The incidence of constipation in the unit studied was 72%. Only the absence of evacuation during hospitalization was associated with longer hospital stays. Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization. PMID:23917972
Incidence of constipation in an intensive care unit.
Guerra, Tatiana Lopes de Souza; Mendonça, Simone Sotero; Marshall, Norma Guimarães
2013-01-01
To evaluate the incidence of constipation in critical patients on enteral nutrition in a hospital intensive care unit and to correlate this incidence with the variables found for critical patients. The present investigation was a retrospective analytical study conducted in the intensive care unit of Hospital Regional da Asa Norte (DF) via the analysis of medical records of patients admitted during the period from January to December 2011. Data on the incidence of constipation and enteral nutritional support, gastrointestinal changes, stool frequency, ventilatory support, and outcomes were collected and analyzed. The initial sample consisted of 127 patients admitted to the unit during the period from January to December 2011. Eighty-four patients were excluded, and the final sample consisted of 43 patients. The incidence of constipation, defined as no bowel movement during the first 4 days of hospitalization, was 72% (n=31). The patients were divided into a control group and a constipated group. The group of constipated patients reached the caloric target, on average, at 6.5 days, and the control group reached the caloric target in 5.6 days (p=0.51). Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization. There was an association between evacuation during hospitalization and a longer duration of hospitalization for a subgroup of patients who did not evacuate during the entire period (p=0.009). The incidence of constipation in the unit studied was 72%. Only the absence of evacuation during hospitalization was associated with longer hospital stays. Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization.
Federal Register 2010, 2011, 2012, 2013, 2014
2012-01-13
... Request; Prevalence, Incidence, Epidemiology and Molecular Variants of HIV in Blood Donors in Brazil... Collection: Title: Prevalence, Incidence, Epidemiology and Molecular Variants of HIV in Blood Donors in... behavioral risk behaviors for HIV infection among donors are critical steps to assessing and reducing risk of...
Dimopoulou, Ioanna; Tsagarakis, Stylianos; Theodorakopoulou, Maria; Douka, Evangelia; Zervou, Maria; Kouyialis, Andreas T; Thalassinos, Nikolaos; Roussos, Charis
2004-06-01
To investigate the incidence and type of endocrine abnormalities in critical care patients with traumatic brain injury (TBI) and to examine their relationships to possible predisposing factors. Prospective study. General intensive care unit in a university hospital. Thirty-four TBI patients (27 men, 7 women), having a mean age of 37+/-16 years, were studied after weaning from mechanical ventilation. Baseline endocrine assessment was carried out by measuring cortisol, corticotropin, dehydroepiandrosterone sulfate, free thyroxine, thyrotropin (TSH), testosterone, oestradiol, follicle stimulating hormone (FSH), luteinizing hormone, prolactin, growth hormone and insulin-like growth factor I. Dynamic evaluation was performed by human corticotropin releasing hormone and growth hormone releasing hormone in all patients. Male patients underwent additional investigation with gonadotropin-releasing hormone. Severity of neurological derangement was graded according to Glasgow Coma Scale (GCS), Marshall Computerized Tomographic Classification and intracranial pressure (ICP) levels. Eighteen of the 34 patients (53%) had an abnormal result in at least one hormonal axis tested, with cortisol hyporesponsiveness and gonadal dysfunction being equally common, affecting 24% of patients. Endocrine abnormalities were associated with a higher brain CT-scan classification score ( p=0.02). The GCS on admission correlated positively with baseline FSH (r=0.37, p=0.03), peak FSH (r=0.41, p=0.03), testosterone (r=0.44, p=0.02) and TSH (r=0.39, p=0.03). There were no relations between ICP(max) and any baseline or dynamic hormone measurements. Patients with TBI receiving critical care show changes in their neuroendocrine responses, which depend upon clinical and radiological measures of head injury severity. Most common abnormalities include cortisol hyporesponsiveness and hypogonadism.
NASA Astrophysics Data System (ADS)
Garcia-Adeva, Angel J.; Huber, David L.
2001-07-01
In this work we generalize and subsequently apply the effective-field renormalization-group (EFRG) technique to the problem of ferro- and antiferromagnetically coupled Ising spins with local anisotropy axes in geometrically frustrated geometries (kagomé and pyrochlore lattices). In this framework, we calculate the various ground states of these systems and the corresponding critical points. Excellent agreement is found with exact and Monte Carlo results. The effects of frustration are discussed. As pointed out by other authors, it turns out that the spin-ice model can be exactly mapped to the standard Ising model, but with effective interactions of the opposite sign to those in the original Hamiltonian. Therefore, the ferromagnetic spin ice is frustrated and does not order. Antiferromagnetic spin ice (in both two and three dimensions) is found to undergo a transition to a long-range-ordered state. The thermal and magnetic critical exponents for this transition are calculated. It is found that the thermal exponent is that of the Ising universality class, whereas the magnetic critical exponent is different, as expected from the fact that the Zeeman term has a different symmetry in these systems. In addition, the recently introduced generalized constant coupling method is also applied to the calculation of the critical points and ground-state configurations. Again, a very good agreement is found with exact, Monte Carlo, and renormalization-group calculations for the critical points. Incidentally, we show that the generalized constant coupling approach can be regarded as the lowest-order limit of the EFRG technique, in which correlations outside a frustrated unit are neglected, and scaling is substituted by strict equality of the thermodynamic quantities.
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.
ERIC Educational Resources Information Center
Ellingson, Charlene; Roehrig, Gillian; Bakkum, Kris; Dubinsky, Janet M.
2016-01-01
This article introduces the Critical Response Protocol (CRP), an arts-based technique that engages students in equitable critical discourse and aligns with the "Next Generation Science Standards" vision for providing students opportunities for language learning while advancing science learning (NGSS Lead States 2013). CRP helps teachers…
Forum Guide to Crime, Violence, and Discipline Incident Data. NFES 2011-806
ERIC Educational Resources Information Center
National Forum on Education Statistics, 2011
2011-01-01
This guide is designed for use by school, district, and state staff to improve the effectiveness of efforts to collect and use disciplinary incident data, including reporting accurate and timely incident data to the federal government. It provides recommendations on what types of data to collect, why it is critical to collect such data, and how to…
Connecting Critical Reflection and Group Development in Online Adult Education Classrooms
ERIC Educational Resources Information Center
Glowacki-Dudka, Michelle; Barnett, Nicole
2007-01-01
This qualitative multi-case study explored the space where critical reflection and group development met within the online environment for the adult learner. Using critical reflection with adult learners through their responses to Stephen Brookfield's (1995) Critical Incident Questionnaire (CIQ) in the online environment precipitated instructional…
NASA Astrophysics Data System (ADS)
Fanos, Ali Mutar; Pradhan, Biswajeet
2018-04-01
Rockfall poses risk to people, their properties and to transportation ways in mountainous and hilly regions. This catastrophe shows various characteristics such as vast distribution, sudden occurrence, variable magnitude, strong fatalness and randomicity. Therefore, prediction of rockfall phenomenon both spatially and temporally is a challenging task. Digital Terrain model (DTM) is one of the most significant elements in rockfall source identification and risk assessment. Light detection and ranging (LiDAR) is the most advanced effective technique to derive high-resolution and accurate DTM. This paper presents a critical overview of rockfall phenomenon (definition, triggering factors, motion modes and modeling) and LiDAR technique in terms of data pre-processing, DTM generation and the factors that can be obtained from this technique for rockfall source identification and risk assessment. It also reviews the existing methods that are utilized for the evaluation of the rockfall trajectories and their characteristics (frequency, velocity, bouncing height and kinetic energy), probability, susceptibility, hazard and risk. Detail consideration is given on quantitative methodologies in addition to the qualitative ones. Various methods are demonstrated with respect to their application scales (local and regional). Additionally, attention is given to the latest improvement, particularly including the consideration of the intensity of the phenomena and the magnitude of the events at chosen sites.
Electrospinning as a powerful technique for biomedical applications: a critically selected survey.
Villarreal-Gómez, Luis Jesús; Cornejo-Bravo, José Manuel; Vera-Graziano, Ricardo; Grande, Daniel
2016-01-01
Nowadays, electrospinning has become one of the most versatile, easy, and cost-effective techniques to engineer advanced materials used for many applications, especially in the biomedical and environmental areas. Like the numerous patents around the world, the increasing number of papers witnesses the huge potential of this simple process, and many companies have been emerged during the last years to exploit its innumerable applications. This article presents a critically selected overview of polymers that can be used to produce nanofibers, along with the biomedical applications of the resulting electrospun scaffolds. We have focused on about seven natural and synthetic polymers, but many more can be found in the literature, either as their pristine state or as composites with ceramics, metals, and other polymers. The description of some strategies for nanofiber production, and the characterization used to evaluate their optimization, has been discussed. Finally, several polymers have been recognized as highlights for future work.
Rose, Louise; Adhikari, Neill Kj; Leasa, David; Fergusson, Dean A; McKim, Douglas
2017-01-11
There are various reasons why weaning and extubation failure occur, but ineffective cough and secretion retention can play a significant role. Cough augmentation techniques, such as lung volume recruitment or manually- and mechanically-assisted cough, are used to prevent and manage respiratory complications associated with chronic conditions, particularly neuromuscular disease, and may improve short- and long-term outcomes for people with acute respiratory failure. However, the role of cough augmentation to facilitate extubation and prevent post-extubation respiratory failure is unclear. Our primary objective was to determine extubation success using cough augmentation techniques compared to no cough augmentation for critically-ill adults and children with acute respiratory failure admitted to a high-intensity care setting capable of managing mechanically-ventilated people (such as an intensive care unit, specialized weaning centre, respiratory intermediate care unit, or high-dependency unit).Secondary objectives were to determine the effect of cough augmentation techniques on reintubation, weaning success, mechanical ventilation and weaning duration, length of stay (high-intensity care setting and hospital), pneumonia, tracheostomy placement and tracheostomy decannulation, and mortality (high-intensity care setting, hospital, and after hospital discharge). We evaluated harms associated with use of cough augmentation techniques when applied via an artificial airway (or non-invasive mask once extubated/decannulated), including haemodynamic compromise, arrhythmias, pneumothorax, haemoptysis, and mucus plugging requiring airway change and the type of person (such as those with neuromuscular disorders or weakness and spinal cord injury) for whom these techniques may be efficacious. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2016), MEDLINE (OvidSP) (1946 to April 2016), Embase (OvidSP) (1980 to April 2016), CINAHL (EBSCOhost) (1982
Influence of laser beam incidence angle on laser lap welding quality of galvanized steels
NASA Astrophysics Data System (ADS)
Mei, Lifang; Yan, Dongbing; Chen, Genyu; Wang, Zhenhui; Chen, Shuixuan
2017-11-01
Based on the characteristics of laser welded structural parts of auto bodies, the influence of variation in laser beam incidence angle on the lap welding performance of galvanized auto-body sheets was studied. Lap welding tests were carried out on the galvanized sheets for auto-body application at different laser beam incidence angles by using the optimal welding parameters obtained through orthogonal experiment. The effects of incidence angle variation on seam appearance, cross-sectional shape, joint mechanical properties and microstructure of weldments were analyzed. In addition, the main factors influencing the value of incidence angle were investigated. According to the results, the weld seams had a good appearance as well as a fine, and uniform microstructure when the laser beam incidence angle was smaller than the critical incidence angle, and thus they could withstand great tensile and shear loads. Moreover, all tensile-shear specimens were fractured in the base material zone. When the laser beam incidence angle was larger than the critical incidence angle, defects like shrinkage and collapse tended to emerge, thereby resulting in the deteriorated weldability of specimens. Meanwhile, factors like the type and thickness of sheet, weld width as well as inter-sheet gap all had a certain effect on the value of laser beam incidence angle. When the sheet thickness was small and the weld width was narrow, the laser beam incidence angle could be increased appropriately. At the same time, small changes in the inter-sheet gap could greatly impact the value of incidence angle. When the inter-sheet gap was small, the laser beam incidence angle should not be too large.
Chiang, Yun; Tsai, Cheng-Hong; Kuo, Sung-Hsin; Liu, Chieh-Yu; Yao, Ming; Li, Chi-Cheng; Huang, Shang-Yi; Ko, Bor-Sheng; Lin, Chien-Ting; Hou, Hsin-An; Chou, Wen-Chien; Liu, Jia-Hau; Lin, Chien-Chin; Wu, Shang-Ju; Hsu, Szu-Chun; Chen, Yao-Chang; Lin, Kai-Hsin; Lin, Dong-Tsamn; Chou, Hsien-Tang; Lu, Meng-Yu; Yang, Yung-Li; Chang, Hsiu-Hao; Liu, Ming-Chih; Liao, Xiu-Wen; Wu, Jian-Kuen; Chou, Sheng-Chieh; Cheng, Chieh-Lung; Chen, Chien-Yuan; Tsay, Woei; Tien, Hwei-Fang; Tang, Jih-Luh; Chen, Yu-Hsuan
2016-11-10
Allogeneic hematopoietic stem cell transplantation is a curative-intent treatment for patients with high-risk hematologic diseases. However, interstitial pneumonitis (IP) and other toxicities remain major concerns after total body irradiation (TBI). We have proposed using linear accelerators with rice-bag compensators for intensity modulation (IM-TBI), as an alternative to the traditional cobalt-60 teletherapy with lung-shielding technique (Co-TBI). Patients who received a TBI-based myeloablative conditioning regimen between 1995 and 2014 were recruited consecutively. Before March 2007, TBI was delivered using Co-TBI (n = 181); afterward, TBI was administered using IM-TBI (n = 126). Forty-four patients developed IP; of these cases, 19 were idiopathic. The IP-related mortality rate was 50% in the total IP cohort and 63% in the idiopathic subgroup. The 1-year cumulative incidences of IP and idiopathic IP were 16.5% and 7.4%, respectively; both rates were significantly higher in the Co-TBI group than in the IM-TBI group. Multivariate analysis revealed that Co-TBI was an independent prognostic factor for both total and idiopathic IP. In the acute myeloid leukemia subgroup, patients with different TBI techniques had similar outcomes for both overall and relapse-free survival. In conclusion, IM-TBI is an easy and effective TBI technique that could substantially reduce the complication rate of IP without compromising treatment efficacy.
Amanati, Ali; Karimi, Abdollah; Fahimzad, Alireza; Shamshiri, Ahmad Reza; Fallah, Fatemeh; Mahdavi, Alireza; Talebian, Mahshid
2017-01-01
Background: Among hospital-acquired infections (HAIs) in children, ventilator-associated pneumonia (VAP) is the most common after blood stream infection (BSI). VAP can prolong length of ventilation and hospitalization, increase mortality rate, and directly change a patient’s outcome in Pediatric Intensive Care Units (PICU). Objectives: The research on VAP in children is limited, especially in Iran; therefore, the identification of VAP incidence and mortality rate will be important for both clinical and epidemiological implications. Materials and Methods: Mechanically ventilated pediatric patients were assessed for development of VAP during hospital course on the basis of clinical, laboratory and imaging criteria. We matched VAP group with control group for assessment of VAP related mortality in the critically ill ventilated children. Results: VAP developed in 22.9% of critically ill children undergoing mechanical ventilation. Early VAP and late VAP were found in 19.3% and 8.4% of VAP cases, respectively. Among the known VAP risk factors that were investigated, immunodeficiency was significantly greater in the VAP group (p = 0.014). No significant differences were found between the two groups regarding use of corticosteroids, antibiotics, PH (potential of hydrogen) modifying agents (such as ranitidine or pantoprazole), presence of nasogastric tube and total or partial parenteral nutrition administration. A substantial number of patients in the VAP group had more than four risk factors for development of VAP, compared to those without VAP (p = 0.087). Mortality rate was not statistically different between the VAP and control groups (p = 0.477). Conclusion: VAP is still one of the major causes of mortality in PICUs. It is found that altered immune status is a significant risk factor for acquiring VAP. Also, occurrence of VAP was high in the first week after admission in PICU. PMID:28671616
Sensitivity-Uncertainty Techniques for Nuclear Criticality Safety
DOE Office of Scientific and Technical Information (OSTI.GOV)
Brown, Forrest B.; Rising, Michael Evan; Alwin, Jennifer Louise
2017-08-07
The sensitivity and uncertainty analysis course will introduce students to k eff sensitivity data, cross-section uncertainty data, how k eff sensitivity data and k eff uncertainty data are generated and how they can be used. Discussion will include how sensitivity/uncertainty data can be used to select applicable critical experiments, to quantify a defensible margin to cover validation gaps and weaknesses, and in development of upper subcritical limits.
Diabetes incidence and projections from prevalence surveys in Fiji.
Morrell, Stephen; Lin, Sophia; Tukana, Isimeli; Linhart, Christine; Taylor, Richard; Vatucawaqa, Penina; Magliano, Dianna J; Zimmet, Paul
2016-11-25
Type 2 diabetes mellitus (T2DM) incidence is traditionally derived from cohort studies that are not always feasible, representative, or available. The present study estimates T2DM incidence in Fijian adults from T2DM prevalence estimates assembled from surveys of 25-64 year old adults conducted over 30 years (n = 14,288). T2DM prevalence by five-year age group from five population-based risk factor surveys conducted over 1980-2011 were variously adjusted for urban-rural residency, ethnicity, and sex to previous censuses (1976, 1986, 1996, 2009) to improve representativeness. Prevalence estimates were then used to calculate T2DM incidence based on birth cohorts from the age-period (Lexis) matrix following the Styblo technique, first used to estimate annual risk of tuberculosis infection (incidence) from sequential Mantoux population surveys. Poisson regression of year, age, sex, and ethnicity strata (n = 160) was used to develop projections of T2DM prevalence and incidence to 2020 based on various scenarios of population weight measured by body mass index (BMI) change. T2DM prevalence and annual incidence increased in Fiji over 1980-2011. Prevalence was higher in Indians and men than i-Taukei and women. Incidence was higher in Indians and women. From regression analyses, absolute reductions of 2.6 to 5.1% in T2DM prevalence (13-26% lower), and 0.5-0.9 per 1000 person-years in incidence (8-14% lower), could be expected in 2020 in adults if mean population weight could be reduced by 1-4 kg, compared to the current period trend in weight gain. This is the first application of the Styblo technique to calculate T2DM incidence from population-based prevalence surveys over time. Reductions in population BMI are predicted to reduce T2DM incidence and prevalence in Fiji among adults aged 25-64 years.
NASA Astrophysics Data System (ADS)
Hammerschmidt, Ulf; Hameury, Jacques; Strnad, Radek; Turzó-Andras, Emese; Wu, Jiyu
2015-07-01
This paper presents a critical review of current industrial techniques and instruments to measure the thermal conductivity of thermal insulation materials, especially those insulations that can operate at temperatures above and up to . These materials generally are of a porous nature. The measuring instruments dealt with here are selected based on their maximum working temperature that should be higher than at least . These instruments are special types of the guarded hot-plate apparatus, the guarded heat-flow meter, the transient hot-wire and hot-plane instruments as well as the laser/xenon flash devices. All technical characteristics listed are quoted from the generally accessible information of the relevant manufacturers. The paper includes rankings of the instruments according to their standard retail price, the maximum sample size, and maximum working temperature, as well as the minimum in their measurement range.
ERIC Educational Resources Information Center
Subramaniam, Maithreyi; Hanafi, Jaffri; Putih, Abu Talib
2016-01-01
This study adopted 30 first year graphic design students' artwork, with critical analysis using Feldman's model of art criticism. Data were analyzed quantitatively; descriptive statistical techniques were employed. The scores were viewed in the form of mean score and frequencies to determine students' performances in their critical ability.…
1983-12-01
integration of TAEG findings with contractor findings. Critical incident interview techniques, as used by the contractor, were specifically prohibited in order...than the critical incident interview technique were to be explored for use in the identification of leadership competencies. These competencies and
Multiple incidence angle SIR-B experiment over Argentina
NASA Technical Reports Server (NTRS)
Cimino, Jobea; Casey, Daren; Wall, Stephen; Brandani, Aldo; Domik, Gitta; Leberl, Franz
1986-01-01
The Shuttle Imaging Radar (SIR-B), the second synthetic aperture radar (SAR) to fly aboard a shuttle, was launched on October 5, 1984. One of the primary goals of the SIR-B experiment was to use multiple incidence angle radar images to distinguish different terrain types through the use of their characteristic backscatter curves. This goal was accomplished in several locations including the Chubut Province of southern Argentina. Four descending image acquisitions were collected providing a multiple incidence angle image set. The data were first used to assess stereo-radargrammetric techniques. A digital elevation model was produced using the optimum pair of multiple incidence angle images. This model was then used to determine the local incidence angle of each picture element to generate curves of relative brightness vs. incidence angle. Secondary image products were also generated using the multi-angle data. The results of this work indicate that: (1) various forest species and various structures of a single species may be discriminated using multiple incidence angle radar imagery, and (2) it is essential to consider the variation in backscatter due to a variable incidence angle when analyzing and comparing data collected at varying frequencies and polarizations.
Lai, Alden Yuanhong; Loh, Angela Ping Ping; Mooppil, Nandakumar; Krishnan, Deby Sarojiuy Pala; Griva, Konstadina
2012-01-01
Dialysis can be very stressful with the initial months onto treatment being highly critical in terms of both adaptation and mortality. This qualitative study aimed to explore the lived experiences of incident haemodialysis patients in Singapore. Topics related to the end-stage renal disease diagnosis and haemodialysis treatment were raised with 13 incident haemodialysis patients in the form of semi-structured interviews, and interpretative phenomenological analysis was undertaken as the framework for data analysis. Emotional distress, treatment-related concerns and social support emerged as main issues following a critical review of themes. Our study revealed that incident haemodialysis patients have emotional and informational needs, highlighting the importance of intervention programmes in particular to this patient group to promote better psychosocial adjustment to the disease and its treatment.
DOE Office of Scientific and Technical Information (OSTI.GOV)
Francavilla, T.L.; Gubser, D.U.; Pande, C.S.
1985-03-01
The temperature dependence of V/sub 3/Ga multifilamentary wire produced by the modified jelly roll technique is reported as a function of applied magnetic field in the range 10K - 14K and 0-13T. Parameters which relate J /SUB c/ to H at 4.2K were found to apply at these temperatures and fields. The form of the temperature dependence of the critical current density is compared with theory.
Identifying medication error chains from critical incident reports: a new analytic approach.
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.
Karakitsos, Dimitrios; Labropoulos, Nicolaos; De Groot, Eric; Patrianakos, Alexandros P; Kouraklis, Gregorios; Poularas, John; Samonis, George; Tsoutsos, Dimosthenis A; Konstadoulakis, Manousos M; Karabinis, Andreas
2006-01-01
Introduction Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method. Methods In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index. Results There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001). Conclusion The present data suggest that ultrasound
Connelly, Brian S; Ones, Deniz S; Davies, Stacy E; Birkland, Adib
2014-01-01
Existing taxonomies of Openness's facet structure have produced widely divergent results, and there is limited comprehensive empirical evidence about how Openness-related scales on existing personality inventories align within the 5-factor framework. In Study 1, we used a critical incidents sorting methodology to identify 11 categories of Openness measures; in Study 2, we meta-analyzed the relationships of these categories with global markers of the Big Five traits (utilizing data from 106 samples with a total sample size of N = 35,886). Our results identified 4 true facets of Openness: aestheticism, openness to sensations, nontraditionalism, and introspection. Measures of these facets were unadulterated by variance from other Big Five traits. Many traits frequently conceptualized as facets of Openness (e.g., innovation/creativity, variety-seeking, and tolerance) emerged as trait compounds that, although related to Openness, are also dependent on other Big Five traits. We discuss how Openness should be conceptualized, measured, and studied in light of the empirically based, refined taxonomy emerging from this research.
Healthcare Disparities in Critical Illness
Soto, Graciela J.; Martin, Greg S.; Gong, Michelle Ng
2013-01-01
Objective To summarize the current literature on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness. Data Sources MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest. Study Selection Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities. Data Extraction Study findings are presented according to their association with the incidence, clinical presentation, management, and outcomes in acute critical illness. Data Synthesis This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data is organized along the course of acute critical illness. Conclusions The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research. PMID:24121467
Documentation and tagging of casualties in multiple casualty incidents.
Garner, Alan
2003-01-01
The use of triage tags is widely advocated as a tool to improve the management of multiple casualty incident scenes. However, there are no published reports to suggest that triage tags have improved the management of incidents involving more than 24 persons, and a number of reports have detailed problems associated with triage tag use. Alternative systems of scene management such as geographical triage have been successfully used in very large incidents, and are recommended as an alternative to triage tags. Documentation cards attached to casualties may be of use in situations where casualties will pass through an extended evacuation chain, and clear labels for deceased casualties are of benefit as they discourage repeat assessments. Adoption of an evidence-based approach to multiple casualty incident scene management will require a paradigm shift in the thinking of ambulance services. A broad-based educational approach that encourages critical reappraisal of existing procedures is recommended.
Wavefront Sensing Analysis of Grazing Incidence Optical Systems
NASA Technical Reports Server (NTRS)
Rohrbach, Scott; Saha, Timo
2012-01-01
Wavefront sensing is a process by which optical system errors are deduced from the aberrations in the image of an ideal source. The method has been used successfully in near-normal incidence, but not for grazing incidence systems. This innovation highlights the ability to examine out-of-focus images from grazing incidence telescopes (typically operating in the x-ray wavelengths, but integrated using optical wavelengths) and determine the lower-order deformations. This is important because as a metrology tool, this method would allow the integration of high angular resolution optics without the use of normal incidence interferometry, which requires direct access to the front surface of each mirror. Measuring the surface figure of mirror segments in a highly nested x-ray telescope mirror assembly is difficult due to the tight packing of elements and blockage of all but the innermost elements to normal incidence light. While this can be done on an individual basis in a metrology mount, once the element is installed and permanently bonded into the assembly, it is impossible to verify the figure of each element and ensure that the necessary imaging quality will be maintained. By examining on-axis images of an ideal point source, one can gauge the low-order figure errors of individual elements, even when integrated into an assembly. This technique is known as wavefront sensing (WFS). By shining collimated light down the optical axis of the telescope and looking at out-of-focus images, the blur due to low-order figure errors of individual elements can be seen, and the figure error necessary to produce that blur can be calculated. The method avoids the problem of requiring normal incidence access to the surface of each mirror segment. Mirror figure errors span a wide range of spatial frequencies, from the lowest-order bending to the highest order micro-roughness. While all of these can be measured in normal incidence, only the lowest-order contributors can be determined
NASA Astrophysics Data System (ADS)
Gann, Eliot; Caironi, Mario; Noh, Yong-Young; Kim, Yun-Hi; McNeill, Christopher R.
The depth dependence of crystalline structure within thin films is critical for many technological applications, but has been impossible to measure directly using common techniques. In this work, by monitoring diffraction peak intensity and location and utilizing the highly angle-dependent waveguiding effects of X-rays near grazing incidence we quantitatively measure the thickness, roughness and orientation of stratified crystalline layers within thin films of a high-performance semiconducting polymer. In particular, this diffractive X-ray waveguiding reveals a self-organized 5-nm-thick crystalline surface layer with crystalline orientation orthogonal to the underlying 65-nm-thick layer. While demonstrated for an organic semiconductor film, this approach is applicable to any thin film material system where stratified crystalline structure and orientation can influence important interfacial processes such as charge injection and field-effect transport.
Projecting adverse event incidence rates using empirical Bayes methodology.
Ma, Guoguang Julie; Ganju, Jitendra; Huang, Jing
2016-08-01
Although there is considerable interest in adverse events observed in clinical trials, projecting adverse event incidence rates in an extended period can be of interest when the trial duration is limited compared to clinical practice. A naïve method for making projections might involve modeling the observed rates into the future for each adverse event. However, such an approach overlooks the information that can be borrowed across all the adverse event data. We propose a method that weights each projection using a shrinkage factor; the adverse event-specific shrinkage is a probability, based on empirical Bayes methodology, estimated from all the adverse event data, reflecting evidence in support of the null or non-null hypotheses. Also proposed is a technique to estimate the proportion of true nulls, called the common area under the density curves, which is a critical step in arriving at the shrinkage factor. The performance of the method is evaluated by projecting from interim data and then comparing the projected results with observed results. The method is illustrated on two data sets. © The Author(s) 2013.
Papathanassoglou, Elizabeth D E; Hadjibalassi, Maria; Miltiadous, Panagiota; Lambrinou, Ekaterini; Papastavrou, Evridiki; Paikousis, Lefkios; Kyprianou, Theodoros
2018-05-01
Pain, a persistent problem in critically ill patients, adversely affects outcomes. Despite recommendations, no evidence-based nonpharmacological approaches for pain treatment in critically ill patients have been developed. To investigate the effects of a multimodal integrative intervention on the incidence of pain and on secondary outcomes: intensity of pain, hemodynamic indices (systolic and mean arterial pressure, heart rate), anxiety, fear, relaxation, optimism, and sleep quality. A randomized, controlled, double-blinded repeated-measures trial with predetermined eligibility criteria was conducted. The intervention included relaxation, guided imagery, moderate pressure massage, and listening to music. The primary outcome was incidence of pain (score on Critical Care Pain Observation Tool > 2). Other outcomes included pain ratings, hemodynamic measurements, self-reported psychological outcomes, and quality of sleep. Repeated-measures models with adjustments (baseline levels, confounders) were used. Among the 60 randomized critically ill adults in the sample, the intervention group experienced significant decreases in the incidence ( P = .003) and ratings of pain ( P < .001). Adjusted models revealed a significant trend for lower incidence ( P = .002) and ratings ( P < .001) of pain, systolic arterial pressure ( P < .001), anxiety ( P = .01), and improved quality of sleep ( P = .02). A multimodal integrative intervention may be effective in decreasing pain and improving pain-related outcomes in critically ill patients. © 2018 American Association of Critical-Care Nurses.
An arthroscopic evaluation of the anatomical "critical zone".
Naidoo, N; Lazarus, L; Osman, S A; Satyapal, K S
2017-01-01
The "critical zone", a region of speculated vascularity, is situated approximately 10 mm proximal to the insertion of the supraspinatus tendon. Despite its obvious role as an anatomical landmark demarcator, its patho-anatomic nature has been identified as the source of rotator cuff pathology. Although many studies have attempted to evaluate the vascularity of this region, the architecture regarding the exact length, width and shape of the critical zone, remains unreported. This study aimed to determine the shape and morphometry of the "critical zone" arthroscopically. The sample series, which was comprised of 38 cases (n = 38) specific to pathological types, employed an anatomical investigation of the critical zone during routine real-time arthroscopy. Demographic representation: i) sex: 19 males, 19 females; ii) age range: 18-76 years; iii) race: white (n = 29), Indian (n = 7) and coloured (n = 2). The incidence of shape and the mean lengths and widths of the critical zone were determined in accordance with the relevant demographic factors and patient history. Although the cresenteric shape was predominant, hemispheric and sail-shaped critical zones were also identified. The lengths and widths of the critical zone appeared markedly increased in male individuals. While the increase in age may account for the increased incidence of rotator cuff degeneration due to poor end-vascular supply, the additional factors of height and weight presented as major determinants of the increase in size of the critical zone. In addition, the comparisons of length and width with each other and shape yielded levels of significant difference, therefore indicating a directly proportional relationship between the length and width of the critical zone. This detailed understanding of the critical zone may prove beneficial for the success of post-operative rotator cuff healing.
Anomalous incident-angle and elliptical-polarization rotation of an elastically refracted P-wave
NASA Astrophysics Data System (ADS)
Fa, Lin; Fa, Yuxiao; Zhang, Yandong; Ding, Pengfei; Gong, Jiamin; Li, Guohui; Li, Lijun; Tang, Shaojie; Zhao, Meishan
2015-08-01
We report a newly discovered anomalous incident-angle of an elastically refracted P-wave, arising from a P-wave impinging on an interface between two VTI media with strong anisotropy. This anomalous incident-angle is found to be located in the post-critical incident-angle region corresponding to a refracted P-wave. Invoking Snell’s law for a refracted P-wave provides two distinctive solutions before and after the anomalous incident-angle. For an inhomogeneously refracted and elliptically polarized P-wave at the anomalous incident-angle, its rotational direction experiences an acute variation, from left-hand elliptical to right-hand elliptical polarization. The new findings provide us an enhanced understanding of acoustical-wave scattering and lead potentially to widespread and novel applications.
Zeng, Juan; Wang, Chun-Ting; Zhang, Fu-Shen; Qi, Feng; Wang, Shi-Fu; Ma, Shuang; Wu, Tie-Jun; Tian, Hui; Tian, Zhao-Tao; Zhang, Shu-Liu; Qu, Yan; Liu, Lu-Yi; Li, Yuan-Zhong; Cui, Song; Zhao, He-Ling; Du, Quan-Sheng; Ma, Zhuang; Li, Chun-Hua; Li, Yun; Si, Min; Chu, Yu-Feng; Meng, Mei; Ren, Hong-Sheng; Zhang, Ji-Cheng; Jiang, Jin-Jiao; Ding, Min; Wang, Yu-Ping
2016-06-01
To evaluate the potential preventive effect of probiotics on ventilator-associated pneumonia (VAP). This was an open-label, randomized, controlled multicenter trial involving 235 critically ill adult patients who were expected to receive mechanical ventilation for ≥48 h. The patients were randomized to receive (1) a probiotics capsule containing live Bacillus subtilis and Enterococcus faecalis (Medilac-S) 0.5 g three times daily through a nasogastric feeding tube plus standard preventive strategies or (2) standard preventive strategies alone, for a maximum of 14 days. The development of VAP was evaluated daily, and throat swabs and gastric aspirate were cultured at baseline and once or twice weekly thereafter. The incidence of microbiologically confirmed VAP in the probiotics group was significantly lower than that in the control patients (36.4 vs. 50.4 %, respectively; P = 0.031). The mean time to develop VAP was significantly longer in the probiotics group than in the control group (10.4 vs. 7.5 days, respectively; P = 0.022). The proportion of patients with acquisition of gastric colonization of potentially pathogenic microorganisms (PPMOs) was lower in the probiotics group (24 %) than the control group (44 %) (P = 0.004). However, the proportion of patients with eradication PPMO colonization on both sites of the oropharynx and stomach were not significantly different between the two groups. The administration of probiotics did not result in any improvement in the incidence of clinically suspected VAP, antimicrobial consumption, duration of mechanical ventilation, mortality and length of hospital stay. Therapy with the probiotic bacteria B. Subtilis and E. faecalis are an effective and safe means for preventing VAP and the acquisition of PPMO colonization in the stomach.
DOE Office of Scientific and Technical Information (OSTI.GOV)
Dhawan, Rajnish, E-mail: rajnish@rrcat.gov.in; Rai, Sanjay
2016-05-23
W/Si multilayers four samples have been deposited on silicon substrate using ion beam sputtering system. Thickness of tungsten (W) varies from around 10 Å to 40 Å while the silicon (Si) thickness remains constant at around 30 Å in multilayers [W-Si]{sub x4}. The samples have been characterized by grazing incidence X-ray diffraction (GIXRD) and X-ray reflectivity technique (XRR). GIXRD study shows the crystalline behaviour of W/Si multilayer by varying W thickness and it is found that above 20 Å the W film transform from amorphous to crystalline phase and X-ray reflectivity data shows that the roughnesses of W increases onmore » increasing the W thicknesses in W/Si multilayers.« less
Impaired Job Performance and Critical Incidents: Factors Influencing Supervisory EAP Referrals.
ERIC Educational Resources Information Center
Harley, David A.
Relatively little empirical research has been done on the supervisory referral of employees to employee assistance programs (EAPs). Inclusion of constructive confrontation (supervisory referral) into program standards and its continued promotion as a "central strategy" of program theory and operation calls for critical investigation of…
Human Factors in Financial Trading: An Analysis of Trading Incidents.
Leaver, Meghan; Reader, Tom W
2016-09-01
This study tests the reliability of a system (FINANS) to collect and analyze incident reports in the financial trading domain and is guided by a human factors taxonomy used to describe error in the trading domain. Research indicates the utility of applying human factors theory to understand error in finance, yet empirical research is lacking. We report on the development of the first system for capturing and analyzing human factors-related issues in operational trading incidents. In the first study, 20 incidents are analyzed by an expert user group against a referent standard to establish the reliability of FINANS. In the second study, 750 incidents are analyzed using distribution, mean, pathway, and associative analysis to describe the data. Kappa scores indicate that categories within FINANS can be reliably used to identify and extract data on human factors-related problems underlying trading incidents. Approximately 1% of trades (n = 750) lead to an incident. Slip/lapse (61%), situation awareness (51%), and teamwork (40%) were found to be the most common problems underlying incidents. For the most serious incidents, problems in situation awareness and teamwork were most common. We show that (a) experts in the trading domain can reliably and accurately code human factors in incidents, (b) 1% of trades incur error, and (c) poor teamwork skills and situation awareness underpin the most critical incidents. This research provides data crucial for ameliorating risk within financial trading organizations, with implications for regulation and policy. © 2016, Human Factors and Ergonomics Society.
Scheduling Real-Time Mixed-Criticality Jobs
NASA Astrophysics Data System (ADS)
Baruah, Sanjoy K.; Bonifaci, Vincenzo; D'Angelo, Gianlorenzo; Li, Haohan; Marchetti-Spaccamela, Alberto; Megow, Nicole; Stougie, Leen
Many safety-critical embedded systems are subject to certification requirements; some systems may be required to meet multiple sets of certification requirements, from different certification authorities. Certification requirements in such "mixed-criticality" systems give rise to interesting scheduling problems, that cannot be satisfactorily addressed using techniques from conventional scheduling theory. In this paper, we study a formal model for representing such mixed-criticality workloads. We demonstrate first the intractability of determining whether a system specified in this model can be scheduled to meet all its certification requirements, even for systems subject to two sets of certification requirements. Then we quantify, via the metric of processor speedup factor, the effectiveness of two techniques, reservation-based scheduling and priority-based scheduling, that are widely used in scheduling such mixed-criticality systems, showing that the latter of the two is superior to the former. We also show that the speedup factors are tight for these two techniques.
NASA Astrophysics Data System (ADS)
Koseoglou, P.; Vagena, E.; Stoulos, S.; Manolopoulou, M.
2016-09-01
Neutron spectrum of the sub-critical nuclear assembly-reactor of Aristotle University of Thessaloniki was measured at three radial distances from the reactor core. The neutron activation technique was applied irradiating 15 thick foils - disc of various elements at each position. The data of 38 (n, γ), (n, p) and (n, α) reactions were analyzed for specific activity determination. Discs instead of foils were used due to the relevant low neutron flux, so the gamma self-absorption as well as the neutron self-shielding factors has been calculated using GEANT simulations in order to determine the activity induced. The specific activities calculated for all isotopes studied were the input to the SANDII code, which was built specifically for the neutron spectrum de-convolution when the neutron activation technique is used. For the optimization of the results a technique was applied in order to minimize the influence of the initial-"guessed" spectrum shape SANDII uses. The neutron spectrum estimated presents a peak in the regions of (i) thermal neutrons ranged between 0.001 and 1 eV peaking at neutron energy ∼0.1 eV and (ii) fast neutrons ranged between 0.1 and 20 MeV peaking at neutron energy ∼1.2 MeV. The reduction of thermal neutrons is higher than the fast one as the distance from the reactor core increases since thermal neutrons capture by natural U-fuel has higher cross section than the fast neutrons.
Novak, Avrey; Nyflot, Matthew J; Ermoian, Ralph P; Jordan, Loucille E; Sponseller, Patricia A; Kane, Gabrielle M; Ford, Eric C; Zeng, Jing
2016-05-01
Radiation treatment planning involves a complex workflow that has multiple potential points of vulnerability. This study utilizes an incident reporting system to identify the origination and detection points of near-miss errors, in order to guide their departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or applied a near-miss risk index (NMRI) to gauge severity. From 3/2012 to 3/2014, 1897 incidents were analyzed from a departmental incident learning system. All incidents were prospectively reviewed weekly by a multidisciplinary team and assigned a NMRI score ranging from 0 to 4 reflecting potential harm to the patient (no potential harm to potential critical harm). Incidents were classified by point of incident origination and detection based on a 103-step workflow. The individual steps were divided among nine broad workflow categories (patient assessment, imaging for radiation therapy (RT) planning, treatment planning, pretreatment plan review, treatment delivery, on-treatment quality management, post-treatment completion, equipment/software quality management, and other). The average NMRI scores of incidents originating or detected within each broad workflow area were calculated. Additionally, out of 103 individual process steps, 35 were classified as safety barriers, the process steps whose primary function is to catch errors. The safety barriers which most frequently detected incidents were identified and analyzed. Finally, the distance between event origination and detection was explored by grouping events by the number of broad workflow area events passed through before detection, and average NMRI scores were compared. Near-miss incidents most commonly originated within treatment planning (33%). However, the incidents with the highest average NMRI scores originated during imaging for RT planning (NMRI = 2.0, average NMRI of all events = 1.5), specifically during the documentation of
Incidence of oronasal fistula formation after nasoalveolar molding and primary cleft repair.
Dec, Wojciech; Shetye, Pradip R; Grayson, Barry H; Brecht, Lawrence E; Cutting, Court B; Warren, Stephen M
2013-01-01
The incidence of postoperative complications in cleft care is low. In this 19-year retrospective analysis of cleft lip and palate patients treated with preoperative nasoalveolar molding, we examine the incidence of postoperative oronasal fistulae. The charts of 178 patients who underwent preoperative nasoalveolar molding by the same orthodontist/prosthodontist team and primary cleft lip/palate repair by the same surgeon over a 19-year period were reviewed. Millard, Mohler, Cutting, or Mulliken-type techniques were used for cleft lip repairs. Oxford-, Bardach-, or von Langenbeck-type techniques were used for cleft palate repairs. One nasolabial fistula occurred after primary cleft lip repair (0.56% incidence) and was repaired surgically. Four palatal fistulae (3 at the junction between soft and hard palate and 1 at the right anterior palate near the incisive foramen) occurred, but 3 healed spontaneously. Only 1 palatal fistula (0.71%) required surgical repair. All 5 fistulae occurred within the first 8 years of the study period, with 4 (80%) of 5 occurring within the first 3 years. Although fistula rate may be related to surgeon experience and the evolution of presurgical techniques, nasoalveolar molding in conjunction with nasal floor closure contributes to a low incidence of oronasal fistulae.
Incidence of retear with double-row versus single-row rotator cuff repair.
Shen, Chong; Tang, Zhi-Hong; Hu, Jun-Zu; Zou, Guo-Yao; Xiao, Rong-Chi
2014-11-01
Rotator cuff tears have a high recurrence rate, even after arthroscopic rotator cuff repair. Although some biomechanical evidence suggests the superiority of the double-row vs the single-row technique, clinical findings regarding these methods have been controversial. The purpose of this study was to determine whether the double-row repair method results in a lower incidence of recurrent tearing compared with the single-row method. Electronic databases were systematically searched to identify reports of randomized, controlled trials (RCTs) comparing single-row with double-row rotator cuff repair. The primary outcome assessed was retear of the repaired cuff. Secondary outcome measures were the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Constant shoulder score, and the University of California, Los Angeles (UCLA) score. Heterogeneity between the included studies was assessed. Six studies involving 428 patients were included in the review. Compared with single-row repair, double-row repair demonstrated a lower retear incidence (risk ratio [RR]=1.71 [95% confidence interval (CI), 1.18-2.49]; P=.005; I(2)=0%) and a reduced incidence of partial-thickness retears (RR=2.16 [95% CI, 1.26-3.71]; P=.005; I(2)=26%). Functional ASES, Constant, and UCLA scores showed no difference between single- and double-row cuff repairs. Use of the double-row technique decreased the incidence of retears, especially partial-thickness retears, compared with the single-row technique. The functional outcome was not significantly different between the 2 techniques. To improve the structural outcome of the repaired rotator cuff, surgeons should use the double-row technique. However, further long-term RCTs on this topic are needed. Copyright 2014, SLACK Incorporated.
Britt, H; Miller, G C; Steven, I D; Howarth, G C; Nicholson, P A; Bhasale, A L; Norton, K J
1997-04-01
The prediction and subsequent prevention of errors, which are an integral element of human behaviour, require an understanding of their cause. The incident monitoring technique was developed in the study of aviation errors in the Second World War and has been applied more recently in the field of anaesthetics. This pilot study represents one of the first attempts to apply the incident monitoring technique in the general practice environment. A total of 297 GPs across Australia anonymously reported details of unintended events which harmed or could have harmed the patient. Reports were contemporaneously recorded on prepared forms which allowed a free text description of the incident, and structured responses for contributing and mitigating factors, immediate and long-term out-comes, additional costs etc. The first 500 reports were analysed using both of qualitative and quantitative methods and a brief overview of results is presented. The methodological issues arising in the application of this technique to such a large, widely spread profession, in which episodes of care are not necessarily confined to a single consultation, are discussed. This study demonstrated that the incident monitoring technique can be successfully applied in general practice and that the resulting information can facilitate the identification of common factors contributing to such events and allow the development of preventive interventions.
Solomon Technique Versus Selective Coagulation for Twin-Twin Transfusion Syndrome.
Slaghekke, Femke; Oepkes, Dick
2016-06-01
Monochorionic twin pregnancies can be complicated by twin-to-twin transfusion syndrome (TTTS). The best treatment option for TTTS is fetoscopic laser coagulation of the vascular anastomoses between donor and recipient. After laser therapy, up to 33% residual anastomoses were seen. These residual anastomoses can cause twin anemia polycythemia sequence (TAPS) and recurrent TTTS. In order to reduce the number of residual anastomoses and their complications, a new technique, the Solomon technique, where the whole vascular equator will be coagulated, was introduced. The Solomon technique showed a reduction of recurrent TTS compared to the selective technique. The incidence of recurrent TTTS after the Solomon technique ranged from 0% to 3.9% compared to 5.3-8.5% after the selective technique. The incidence of TAPS after the Solomon technique ranged from 0% to 2.9% compared to 4.2-15.6% after the selective technique. The Solomon technique may improve dual survival rates ranging from 64% to 85% compared to 46-76% for the selective technique. There was no difference reported in procedure-related complications such as intrauterine infection and preterm premature rupture of membranes. The Solomon technique significantly reduced the incidence of TAPS and recurrent TTTS and may improve survival and neonatal outcome, without identifiable adverse outcome or complications; therefore, the Solomon technique is recommended for the treatment of TTTS.
NASA Astrophysics Data System (ADS)
Delvecchio, S.; Bonfiglio, P.; Pompoli, F.
2018-01-01
This paper deals with the state-of-the-art strategies and techniques based on vibro-acoustic signals that can monitor and diagnose malfunctions in Internal Combustion Engines (ICEs) under both test bench and vehicle operating conditions. Over recent years, several authors have summarized what is known in critical reviews mainly focused on reciprocating machines in general or on specific signal processing techniques: no attempts to deal with IC engine condition monitoring have been made. This paper first gives a brief summary of the generation of sound and vibration in ICEs in order to place further discussion on fault vibro-acoustic diagnosis in context. An overview of the monitoring and diagnostic techniques described in literature using both vibration and acoustic signals is also provided. Different faulty conditions are described which affect combustion, mechanics and the aerodynamics of ICEs. The importance of measuring acoustic signals, as opposed to vibration signals, is due since the former seem to be more suitable for implementation on on-board monitoring systems in view of their non-intrusive behaviour, capability in simultaneously capturing signatures from several mechanical components and because of the possibility of detecting faults affecting airborne transmission paths. In view of the recent needs of the industry to (-) optimize component structural durability adopting long-life cycles, (-) verify the engine final status at the end of the assembly line and (-) reduce the maintenance costs monitoring the ICE life during vehicle operations, monitoring and diagnosing system requests are continuously growing up. The present review can be considered a useful guideline for test engineers in understanding which types of fault can be diagnosed by using vibro-acoustic signals in sufficient time in both test bench and operating conditions and which transducer and signal processing technique (of which the essential background theory is here reported) could be
Critical analysis of procurement techniques in construction management sectors
NASA Astrophysics Data System (ADS)
Tiwari, Suman Tiwari Suresh; Chan, Shiau Wei; Faraz Mubarak, Muhammad
2018-04-01
Over the last three decades, numerous procurement techniques have been one of the highlights of the Construction Management (CM) for ventures, administration contracting, venture management as well as design and construct. Due to the development and utilization of those techniques, various researchers have explored the criteria for their choice and their execution in terms of time, cost and quality. Nevertheless, there is a lack of giving an account on the relationship between the procurement techniques and the progressed related issues, for example, supply chain, sustainability, innovation and technology development, lean construction, constructability, value management, Building Information Modelling (BIM) as well as e-procurement. Through chosen papers from the reputable CM-related academic journals, the specified scopes of these issues are methodically assessed with the objective to explore the status and trend in procurement related research. The result of this paper contributes theoretically as well as practically to the researchers and industrialist in order to be aware and appreciate the development of procurement techniques.
DOE Office of Scientific and Technical Information (OSTI.GOV)
Naruka, Preeti, E-mail: preety-naruka@Yyahoo.co.in; Bissa, Shivangi; Nagar, A. K.
In the present paper, we study propagation of a soliton at an interface formed between special type of chalcogenide fibre and gallium in three different phases with the help of equivalent particle theory. Critical angle of incidence and critical power required for transmission and reflection of soliton beam have investigated. Here it is found that if the incident angle of the beam or initial velocity of the equivalent particle is insufficient to overcome the maximum increase in potential energy then the particle (light beam) is reflected by the interface and if this incident angle is greater than a critical anglemore » then light beam will be transmitted by the interface. From an equation these critical angles for α-gallium, one of a metastable phase and liquid gallium are calculated and concluded that at large incident angles, the soliton is transmitted through the boundary, whereas at small incidence angles the soliton get reflected on keeping the power of incident beam constant. These results are explained by phase plane trajectories of the effective potential which are experimentally as well as theoretically proved.« less
A Study Combining Criticism and Qualitative Research Techniques for Appraising Classroom Media.
ERIC Educational Resources Information Center
Swartz, James D.
Qualitative criticism is a method of understanding things, actions, and events within a social framework. It is a method of acquiring knowledge to guide decision making based on local knowledge and a synthesis of principles from criticism and qualitative research. The function of qualitative criticism is centered with Richard Rorty's theoretical…
Cough Augmentation Techniques in the Critically Ill: A Canadian National Survey.
Rose, Louise; Adhikari, Neill K; Poon, Joseph; Leasa, David; McKim, Douglas A
2016-10-01
Critically ill mechanically ventilated patients experience impaired airway clearance due to ineffective cough and impaired secretion mobilization. Cough augmentation techniques, including mechanical insufflation-exsufflation (MI-E), manually assisted cough, and lung volume recruitment, improve cough efficiency. Our objective was to describe use, indications, contraindications, interfaces, settings, complications, and barriers to use across Canada. An e-mail survey was sent to nominated local survey champions in eligible Canadian units (ICUs, weaning centers, and intermediate care units) with 4 telephone/e-mail reminders. The survey response rate was 157 of 238 (66%); 78 of 157 units (50%) used cough augmentation, with 50 (64%) using MI-E, 53 (68%) using manually assisted cough, and 62 (79%) using lung volume recruitment. Secretion clearance was the most common indication (MI-E, 92%; manually assisted cough, 88%; lung volume recruitment, 76%), although the most common units (44%) used it <50% of the time. Use during weaning from invasive (MI-E, 21%; manually assisted cough, 39%; lung volume recruitment, 3%) and noninvasive ventilation (MI-E, 21%; manually assisted cough, 33%; lung volume recruitment, 21%) was infrequent. The most common diagnoses were neuromuscular disease (97%) and spinal cord injury (83%). Pneumothorax was the most frequently identified absolute contraindication for MI-E (93%) and lung volume recruitment (83%); rib fracture was most frequently identified for manually assisted cough (69%). MI-E mean inspiratory pressure was 31 cm H2O, and expiratory pressure was -32 cm H2O. Mucus plugging requiring tracheostomy inner change was the most frequent complication for MI-E (23%), chest pain for manually assisted cough (36%), and hypotension for lung volume recruitment (17%). The most commonly cited barriers were lack of expertise (70%), knowledge (65%), and resources (52%). We found moderate adoption of cough augmentation techniques, particularly for
Cyber Incidents Involving Control Systems
DOE Office of Scientific and Technical Information (OSTI.GOV)
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 Managementmore » 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 information
Abbaskhanian, Ali; Zamanfar, Daniel; Afshar, Parvaneh; Asadpoor, Einollah; Rouhanizadeh, Hamed; Jafarnia, Ali; Shokzadeh, Mohammad
2017-01-01
Background: Classic phenylketonuria (PKU) is a metabolic disorder. The purpose of this study was to assess epidemiological factors of PKU phenotypes in a neonatal screening program for Mazandaran, Iran. Methods: In this descriptive-retrospective study from 2007 to 2015, neonates PKU level was conducted by phenylalanine level based on a biochemical technique by ELISA and then by confirmatory methods high performance liquid chromatography. Results: Of the 407,244 screened newborns (48.7% girls and 51.3% boys), 14 girls and 13 boys were diagnosed definitely from 465 suspicious cases of PKU. The incidence of PKU was 0.66 in 10,000, which was noted in different severity (severe PKU - 1:67,874, mild PKU - 1:45,249, and HPA - 1:33,937). In addition, we did not detect any cases of nonclassic PKU. Conclusions: Although the consanguineous marriage pattern is a major cause of hyperphenylalaninemia (HPA) particularly in Iranian, there was no significant difference between groups in this study. Now, screening should be executed for all of the family that they have the familial history of PKU in Iran. According to varies actual of prevalence and incidence rate of PKU reported a real patient and taking PKU with mild PKU and HPA, it is recommended, the will provide the PKU reports based on the severity of the disease. PMID:29184644
Critical thinking in patient centered care.
Mitchell, Shannon H; Overman, Pamela; Forrest, Jane L
2014-06-01
Health care providers can enhance their critical thinking skills, essential to providing patient centered care, by use of motivational interviewing and evidence-based decision making techniques. The need for critical thinking skills to foster optimal patient centered care is being emphasized in educational curricula for health care professions. The theme of this paper is that evidence-based decision making (EBDM) and motivational interviewing (MI) are tools that when taught in health professions educational programs can aid in the development of critical thinking skills. This paper reviews the MI and EBDM literature for evidence regarding these patient-centered care techniques as they relate to improved oral health outcomes. Comparisons between critical thinking and EBDM skills are presented and the EBDM model and the MI technique are briefly described followed by a discussion of the research to date. The evidence suggests that EBDM and MI are valuable tools; however, further studies are needed regarding the effectiveness of EBDM and MI and the ways that health care providers can best develop critical thinking skills to facilitate improved patient care outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.
ERIC Educational Resources Information Center
Petonito, Gina; Muschert, Glenn W.; Carr, Dawn C.; Kinney, Jennifer M.; Robbins, Emily J.; Brown, J. Scott
2013-01-01
As America ages, greater numbers of older adults will be living with Alzheimer's disease or a related dementia, leading to increased incidence of wandering. Currently there are several initiatives to assist older adults who go missing. We describe and critically examine three prominent and widespread programs: Safe Return, Project Lifesaver, and…
Low pacemaker incidence with continuous-sutured valves: a retrospective analysis.
Niclauss, Lars; Delay, Dominique; Pfister, Raymond; Colombier, Sebastien; Kirsch, Matthias; Prêtre, René
2017-06-01
Background Permanent pacemaker implantation after surgical aortic valve replacement depends on patient selection and risk factors for conduction disorders. We aimed to identify risk criteria and obtain a selected group comparable to patients assigned to transcatheter aortic valve implantation. Methods Isolated sutured aortic valve replacements in 994 patients treated from 2007 to 2015 were reviewed. Demographics, hospital stay, preexisting conduction disorders, surgical technique, and etiology in patients with and without permanent pacemaker implantation were compared. Reported outcomes after transcatheter aortic valve implantation were compared with those of a subgroup including only degenerative valve disease and first redo. Results The incidence of permanent pacemaker implantation was 2.9%. Longer hospital stay ( p = 0.01), preexisting rhythm disorders ( p < 0.001), complex prosthetic endocarditis ( p = 0.01), and complex redo ( p < 0.001) were associated with permanent pacemaker implantation. Although prostheses were sutured with continuous monofilament in the majority of cases (86%), interrupted pledgetted sutures were used more often in the pacemaker group ( p = 0.002). In the subgroup analysis, the incidence of permanent pacemaker implantation was 2%; preexisting rhythm disorders and the suture technique were still major risk factors. Conclusion Permanent pacemaker implantation depends on etiology, preexisting rhythm disorders, and suture technique, and the 2% incidence compares favorably with the reported 5- to 10-fold higher incidence after transcatheter aortic valve implantation. Cost analysis should take this into account. Often dismissed as minor complication, permanent pacemaker implantation increases the risks of endocarditis, impaired myocardial recovery, and higher mortality if associated with prosthesis regurgitation.
Risk of Incident Mental Health Conditions Among Critical Care Air Transport (CCATT) Team Members
2013-06-27
for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 88ABW-2013-2830, cleared 13 June 2013 14. ABSTRACT This study investigated...whether CCATT members were at increased risk for incident post-deployment mental health conditions. A retrospective cohort study of 604 CCATT...13 Study Limitations
Eddy current technique for predicting burst pressure
Petri, Mark C.; Kupperman, David S.; Morman, James A.; Reifman, Jaques; Wei, Thomas Y. C.
2003-01-01
A signal processing technique which correlates eddy current inspection data from a tube having a critical tubing defect with a range of predicted burst pressures for the tube is provided. The method can directly correlate the raw eddy current inspection data representing the critical tubing defect with the range of burst pressures using a regression technique, preferably an artificial neural network. Alternatively, the technique deconvolves the raw eddy current inspection data into a set of undistorted signals, each of which represents a separate defect of the tube. The undistorted defect signal which represents the critical tubing defect is related to a range of burst pressures utilizing a regression technique.
Zhou, Minwen; Wang, Wei; Huang, Wenbin; Zhang, Xiulan
2014-09-06
To evaluate the surgical outcome of Ahmed glaucoma valve (AGV) implantation with a new technique of mitomycin C (MMC) application. This is a retrospective study. All patients with refractory glaucoma underwent FP-7 AGV implantation. Two methods of MMC application were used. In the traditional technique, 6 × 4 mm cotton soaked with MMC (0.25-0.33 mg/ml) was placed in the implantation area for 2-5mins; in the new technique, the valve plate first was encompassed with a thin layer of cotton soaked with MMC, then inserted into the same area. A 200 ml balanced salt solution was applied for irrigation of MMC. The surgical success rate, intraocular pressure (IOP), number of anti-glaucoma medications used, and postoperative complications were analyzed between the groups. The surgical outcomes of two MMC applied techniques were compared. The new technique group had only one case (2.6%) of encapsulated cyst formation out of 38 eyes, while there were eight (19.5%) cases out of 41 eyes the in traditional group. The difference was statistically significant (P = 0.030). According to the definition of success rate, there was 89.5% in the new technique group and 70.7% in the traditional group at the follow-up end point. There was a significant difference between the two groups (P = 0.035). Mean IOP in the new technique group were significantly lower than those of the traditional group at 3 and 6 months (P < 0.05). By using a thin layer of cotton soaked with MMC to encompass the valve plate, the new MMC application technique could greatly decrease the incidence of encapsulated cyst and increase the success rate following AGV implantation.
Critical Thinking: The Importance of Teaching.
ERIC Educational Resources Information Center
Strickland, Glen
Modern society is full of examples of people's inability to employ techniques of critical thinking in everyday situations. Learning to think critically is important because within this complex society, individuals are constantly placed into situations where difficult choices must be made. An ability to analyze critically available alternatives…
Giberti, Claudio; Gallo, Fabrizio; Schenone, Maurizio; Cortese, Pierluigi
2014-06-16
We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to incidental finding of bilateral mesorenal small masses (2.5 cm on the right and 3.5 cm on the left) suspicious for malignancy. We started from the right side with patient in flank position. Port placement: 12-mm periumbilical camera port, two 8-mm robotic ports in wide ''V''configuration, additional 12 mm assistant port on the midline between the umbilicus and symphysis pubis. A right unclamping RAPN with sliding clip renorrhaphy was performed. The trocars were removed and the robot undocked. Without interrupting the anesthesiological procedures, the patient was reported in supine position and, after 180 degrees rotation of the surgical bed, was newly placed in contralateral flank position. Using both the previous periumbilical and midline ports, two other 8-mm robotic trocars were placed. The robot was then redocked and RAPN was also performed on the left side using the same previously reported technique. Results Total time: 285 min. Estimated blood losses: 150 cc. Postoperative period: uneventful. Pathological examination: bilateral renal cell carcinoma, negative surgical margins. Conclusions Our experience was encouraging and confirmed the feasibility and safety of this procedure. The planning of our technique was time and cost effective with cosmetic benefit for the patient. However, we think that an appropriate selection of the patients and a skill in robotic renal surgery are advisable before approaching this type of surgery.
Additive Manufacturing Techniques in Prosthodontics: Where Do We Currently Stand? A Critical Review.
Alharbi, Nawal; Wismeijer, Daniel; Osman, Reham B
The aim of this article was to critically review the current application of additive manufacturing (AM)/3D-printing techniques in prosthodontics and to highlight the influence of various technical factors involved in different AM technologies. A standard approach of searching MEDLINE, EMBASE, and Google Scholar databases was followed. The following search terms were used: (Prosth* OR Restoration) AND (Prototype OR Additive Manufacture* OR Compute* OR 3D-print* OR CAD/CAM) AND (Dentistry OR Dental). Hand searching the reference lists of the included articles and personal connections revealed additional relevant articles. Selection criteria were any article written in English and reporting on the application of AM in prosthodontics from 1990 to February 2016. From a total of 4,290 articles identified, 33 were seen as relevant. Of these, 3 were narrative reviews, 18 were in vitro studies, and 12 were clinical in vivo studies. Different AM technologies are applied in prosthodontics, directly and indirectly for the fabrication of fixed metal copings, metal frameworks for removable partial dentures, and plastic mock-ups and resin patterns for further conventional metal castings. Technical factors involved in different AM techniques influence the overall quality, the mechanical properties of the printed parts, and the total cost and manufacturing time. AM is promising and offers new possibilities in the field of prosthodontics, though its application is still limited. An understanding of these limitations and of developments in material science is crucial prior to considering AM as an acceptable method for the fabrication of dental prostheses.
Using statistical text classification to identify health information technology incidents
Chai, Kevin E K; Anthony, Stephen; Coiera, Enrico; Magrabi, Farah
2013-01-01
Objective To examine the feasibility of using statistical text classification to automatically identify health information technology (HIT) incidents in the USA Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database. Design We used a subset of 570 272 incidents including 1534 HIT incidents reported to MAUDE between 1 January 2008 and 1 July 2010. Text classifiers using regularized logistic regression were evaluated with both ‘balanced’ (50% HIT) and ‘stratified’ (0.297% HIT) datasets for training, validation, and testing. Dataset preparation, feature extraction, feature selection, cross-validation, classification, performance evaluation, and error analysis were performed iteratively to further improve the classifiers. Feature-selection techniques such as removing short words and stop words, stemming, lemmatization, and principal component analysis were examined. Measurements κ statistic, F1 score, precision and recall. Results Classification performance was similar on both the stratified (0.954 F1 score) and balanced (0.995 F1 score) datasets. Stemming was the most effective technique, reducing the feature set size to 79% while maintaining comparable performance. Training with balanced datasets improved recall (0.989) but reduced precision (0.165). Conclusions Statistical text classification appears to be a feasible method for identifying HIT reports within large databases of incidents. Automated identification should enable more HIT problems to be detected, analyzed, and addressed in a timely manner. Semi-supervised learning may be necessary when applying machine learning to big data analysis of patient safety incidents and requires further investigation. PMID:23666777
NASA Astrophysics Data System (ADS)
Westfeld, Patrick; Maas, Hans-Gerd; Bringmann, Oliver; Gröllich, Daniel; Schmauder, Martin
2013-11-01
The paper shows techniques for the determination of structured motion parameters from range camera image sequences. The core contribution of the work presented here is the development of an integrated least squares 3D tracking approach based on amplitude and range image sequences to calculate dense 3D motion vector fields. Geometric primitives of a human body model are fitted to time series of range camera point clouds using these vector fields as additional information. Body poses and motion information for individual body parts are derived from the model fit. On the basis of these pose and motion parameters, critical body postures are detected. The primary aim of the study is to automate ergonomic studies for risk assessments regulated by law, identifying harmful movements and awkward body postures in a workplace.
Norman, Brett C; Jackson, James C; Graves, John A; Girard, Timothy D; Pandharipande, Pratik P; Brummel, Nathan E; Wang, Li; Thompson, Jennifer L; Chandrasekhar, Rameela; Ely, E Wesley
2016-11-01
To characterize survivors' employment status after critical illness and to determine if duration of delirium during hospitalization and residual cognitive function are each independently associated with decreased employment. Prospective cohort investigation with baseline and in-hospital clinical data and follow-up at 3 and 12 months. Medical and surgical ICUs at two tertiary-care hospitals. Previously employed patients from the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors study who survived a critical illness due to respiratory failure or shock were evaluated for global cognition and employment status at 3- and 12-month follow-up. We used multivariable logistic regression to evaluate independent associations between employment at both 3 and 12 months and global cognitive function at the same time point, and delirium during the hospital stay. At 3-month follow-up, 113 of the total survival cohort of 448 (25%) were identified as being employed at study enrollment. Of these, 94 survived to 12-month follow-up. At 3- and 12-month follow-up, 62% and 49% had a decrease in employment, 57% and 49% of whom, respectively, were newly unemployed. After adjustment for physical health status, depressive symptoms, marital status, level of education, and severity of illness, we did not find significant predictors of employment status at 3 months, but better cognition at 12 months was marginally associated with lower odds of employment reduction at 12 months (odds ratio, 0.49; p = 0.07). Reduction in employment after critical illness was present in the majority of our ICU survivors, approximately half of which was new unemployment. Cognitive function at 12 months was a predictor of subsequent employment status. Further research is needed into the potential relationship between the impact of critical illness on cognitive function and employment status.
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
Critical Analysis of Dual-Probe Heat-Pulse Technique Applied to Measuring Thermal Diffusivity
NASA Astrophysics Data System (ADS)
Bovesecchi, G.; Coppa, P.; Corasaniti, S.; Potenza, M.
2018-07-01
The paper presents an analysis of the experimental parameters involved in application of the dual-probe heat pulse technique, followed by a critical review of methods for processing thermal response data (e.g., maximum detection and nonlinear least square regression) and the consequent obtainable uncertainty. Glycerol was selected as testing liquid, and its thermal diffusivity was evaluated over the temperature range from - 20 °C to 60 °C. In addition, Monte Carlo simulation was used to assess the uncertainty propagation for maximum detection. It was concluded that maximum detection approach to process thermal response data gives the closest results to the reference data inasmuch nonlinear regression results are affected by major uncertainties due to partial correlation between the evaluated parameters. Besides, the interpolation of temperature data with a polynomial to find the maximum leads to a systematic difference between measured and reference data, as put into evidence by the Monte Carlo simulations; through its correction, this systematic error can be reduced to a negligible value, about 0.8 %.
NASA Astrophysics Data System (ADS)
Mousam, Aneela; Maggioni, Viviana; Delamater, Paul L.; Quispe, Antonio M.
2017-10-01
Between 2001 and 2010 significant progress was made towards reducing the number of malaria cases in Peru; however, the country saw an increase between 2011 and 2015. This work attempts to uncover the associations among various climatic and environmental variables and the annual malaria parasite incidence in the Peruvian region of Loreto. A Multilevel Mixed-effects Poisson Regression model is employed, focusing on the 2009-2013 period, when trends in malaria incidence shifted from decreasing to increasing. The results indicate that variations in elevation (β = 0.78; 95% confidence interval (CI), 0.75-0.81), soil moisture (β = 0.0021; 95% CI, 0.0019-0.0022), rainfall (β = 0.59; 95% CI, 0.56-0.61), and normalized difference vegetation index (β = 2.13; 95% CI, 1.83-2.43) is associated with higher annual parasite incidence, whereas an increase in temperature (β = -0.0043; 95% CI, - 0.0044- 0.0041) is associated with a lower annual parasite incidence. The results from this study are particularly useful for healthcare workers in Loreto and have the potential of being integrated within malaria elimination plans.
Grazing-incidence coherent x-ray imaging in true reflection geometry
NASA Astrophysics Data System (ADS)
Sun, Tao; Jiang, Zhang; Strzalka, Joseph; Wang, Jin
2012-02-01
The development of the 3^rd and 4^th generation synchrotrons has stimulated extensive research activities in x-ray imaging techniques. Among all, coherent diffractive imaging (CDI) shows great promise, as its resolution is only limited by the wavelength of the source. Most of the CDI work reported thus far used transmission geometry, which however is not suitable for samples on opaque substrates or in which only the surfaces are the regions of interest. Even though two groups have performed CDI experiments (using laser or x-ray) in reflection geometry and succeeded in reconstructing the planar image of the surface, the theoretical underpinnings and analysis approaches of their techniques are essentially identical to transmission CDI. Most importantly, they couldn't obtain the structural information along sample thickness direction. Here, we introduce a reflection CDI technique that works at grazing-incidence geometry. By visualizing Au nanostructures fabricated on Si substrate, we demonstrate that this innovative imaging technique is capable of obtaining both 2D and 3D information of surfaces or buried structures in the samples. In the meanwhile, we will also explain the grazing-incidence-scattering based-algorithm developed for 3D phase retrieval.
NASA Astrophysics Data System (ADS)
Gann, Eliot; Watson, Anne; Tumbleston, John R.; Cochran, Justin; Yan, Hongping; Wang, Cheng; Seok, Jaewook; Chabinyc, Michael; Ade, Harald
2014-12-01
The internal structures of thin films, particularly interfaces between different materials, are critical to system properties and performance across many disciplines, but characterization of buried interface topography is often unfeasible. In this work, we demonstrate that grazing resonant soft x-ray scattering (GRSoXS), a technique measuring diffusely scattered soft x rays from grazing incidence, can reveal the statistical topography of buried thin-film interfaces. By controlling and predicting the x-ray electric field intensity throughout the depth of the film and simultaneously the scattering contrast between materials, we are able to unambiguously identify the microstructure at different interfaces of a model polymer bilayer system. We additionally demonstrate the use of GRSoXS to selectively measure the topography of the surface and buried polymer-polymer interface in an organic thin-film transistor, revealing different microstructure and markedly differing evolution upon annealing. In such systems, where only indirect control of interface topography is possible, accurate measurement of the structure of interfaces for feedback is critically important. While we demonstrate the method here using organic materials, we also show that the technique is readily extendable to any thin-film system with elemental or chemical contrasts exploitable at absorption edges.
Estimating the global incidence of traumatic spinal cord injury.
Fitzharris, M; Cripps, R A; Lee, B B
2014-02-01
Population modelling--forecasting. To estimate the global incidence of traumatic spinal cord injury (TSCI). An initiative of the International Spinal Cord Society (ISCoS) Prevention Committee. Regression techniques were used to derive regional and global estimates of TSCI incidence. Using the findings of 31 published studies, a regression model was fitted using a known number of TSCI cases as the dependent variable and the population at risk as the single independent variable. In the process of deriving TSCI incidence, an alternative TSCI model was specified in an attempt to arrive at an optimal way of estimating the global incidence of TSCI. The global incidence of TSCI was estimated to be 23 cases per 1,000,000 persons in 2007 (179,312 cases per annum). World Health Organization's regional results are provided. Understanding the incidence of TSCI is important for health service planning and for the determination of injury prevention priorities. In the absence of high-quality epidemiological studies of TSCI in each country, the estimation of TSCI obtained through population modelling can be used to overcome known deficits in global spinal cord injury (SCI) data. The incidence of TSCI is context specific, and an alternative regression model demonstrated how TSCI incidence estimates could be improved with additional data. The results highlight the need for data standardisation and comprehensive reporting of national level TSCI data. A step-wise approach from the collation of conventional epidemiological data through to population modelling is suggested.
Embedding learning from adverse incidents: a UK case study.
Eshareturi, Cyril; Serrant, Laura
2017-04-18
Purpose This paper reports on a regionally based UK study uncovering what has worked well in learning from adverse incidents in hospitals. The purpose of this paper is to review the incident investigation methodology used in identifying strengths or weaknesses and explore the use of a database as a tool to embed learning. Design/methodology/approach Documentary examination was conducted of all adverse incidents reported between 1 June 2011 and 30 June 2012 by three UK National Health Service hospitals. One root cause analysis report per adverse incident for each individual hospital was sent to an advisory group for a review. Using terms of reference supplied, the advisory group feedback was analysed using an inductive thematic approach. The emergent themes led to the generation of questions which informed seven in-depth semi-structured interviews. Findings "Time" and "work pressures" were identified as barriers to using adverse incident investigations as tools for quality enhancement. Methodologically, a weakness in approach was that no criteria influenced the techniques which were used in investigating adverse incidents. Regarding the sharing of learning, the use of a database as a tool to embed learning across the region was not supported. Practical implications Softer intelligence from adverse incident investigations could be usefully shared between hospitals through a regional forum. Originality/value The use of a database as a tool to facilitate the sharing of learning from adverse incidents across the health economy is not supported.
Critical Revolutionary Pedagogy Spiced by Pedagogical Love
ERIC Educational Resources Information Center
FitzSimmons, Robert; Uusiautti, Satu
2013-01-01
The latest incidents demonstrating human beings' inhumanity to their fellow human beings have given impetus to dissect the connection between critical revolutionary pedagogy and the idea of pedagogical love. In this essay we attempt to answer the following questions: How do these two pedagogies complement each other? What can they offer for…
McPhail, Mark J W; Parrott, Francesca; Wendon, Julia A; Harrison, David A; Rowan, Kathy A; Bernal, William
2018-05-01
To assess the epidemiology and outcome of patients with cirrhosis following critical care unit admission. Retrospective cohort study. Critical care units in England, Wales, and Northern Ireland participating in the U.K. Intensive Care National Audit and Research Centre Case Mix Programme. Thirty-one thousand three hundred sixty-three patients with cirrhosis identified of 1,168,650 total critical care unit admissions (2.7%) admitted to U.K. critical care units between 1998 and 2012. None. Ten thousand nine hundred thirty-six patients had alcohol-related liver disease (35%). In total, 1.6% of critical care unit admissions in 1998 had cirrhosis rising to 3.1% in 2012. The crude critical care unit mortality of patients with cirrhosis was 41% in 1998 falling to 31% in 2012 (p < 0.001). Crude hospital mortality fell from 58% to 46% over the study period (p < 0.001). Mean(SD) Acute Physiology and Chronic Health Evaluation II score in 1998 was 20.3 (8.5) and 19.5 (7.1) in 2012. Mean Acute Physiology and Chronic Health Evaluation II score for patients with alcohol-related liver disease in 2012 was 20.6 (7.0) and 19.0 (7.2) for non-alcohol-related liver disease (p < 0.001). In adjusted analysis, alcohol-related liver disease was associated with increased risk of death (odds ratio, 1.51 [95% CI, 1.42-1.62; p < 0.001]) with a year-on-year reduction in hospital mortality (adjusted odds ratio, 0.95/yr, [0.94-0.96, p < 0.001]). More patients with cirrhosis are being admitted to critical care units but with increasing survival rates. Patients with alcohol-related liver disease have reduced survival rates partly explained by higher levels of organ failure at admission. Patients with cirrhosis and organ failure warrant a trial of organ support and universal prognostic pessimism is not justified.
Incidence loss for a core turbine rotor blade in a two-dimensional cascade
NASA Technical Reports Server (NTRS)
Stabe, R. G.; Kline, J. F.
1974-01-01
The effect of incidence angle on the aerodynamic performance of an uncooled core turbine rotor blade was investigated experimentally in a two-dimensional cascade. The cascade test covered a range of incidence angles from minus 15 deg to 15 deg in 5-degree increments and a range of pressure ratios corresponding to ideal exit critical velocity ratios of 0.6 to 0.95. The principal measurements were blade-surface static pressures and cross-channel surveys of exit total pressure, static pressure, and flow angle. The results of the investigation include blade-surface velocity distribution and overall performance in terms of weight flow and loss for the range of incidence angles and exit velocity ratios investigated. The measured losses are also compared with two common methods of predicting incidence loss.
NASA Technical Reports Server (NTRS)
Kilaru, Kiranmayee; Ramsey, Brian D.; Gubarev, Mikhail V.
2011-01-01
A coating technique is being developed to correct the surface figure deviations in reflective-grazing-incidence X-ray optics. These optics are typically designed to have precise conic profiles, and any deviation in this profile, as a result of fabrication, results in a degradation of the imaging performance. To correct the mirror profiles, physical vapor deposition has been utilized to selectively deposit a filler material inside the mirror shell. The technique, termed differential deposition, has been implemented as a proof of concept on miniature X-ray optics developed at MSFC for medical-imaging applications. The technique is now being transferred to larger grazing-incidence optics suitable for astronomy and progress to date is reported.
Managing Chronic Conditions in College: Findings from Prompted Health Incidents Diaries
ERIC Educational Resources Information Center
Ravert, Russell D.; Russell, Luke T.; O'Guin, Monica B.
2017-01-01
Objective: This pilot study assessed an electronic health diary method designed to collect data about critical health incidents experienced by college students who have chronic health conditions. Participants: Nine university students with chronic medical conditions were recruited to complete a series of e-mail-based surveys, sent once every…
Racial Justice, Hegemony, and Bias Incidents in U.S. Higher Education
ERIC Educational Resources Information Center
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…
Teachers' Responses to Bullying Incidents: Effects of Teacher Characteristics and Contexts
ERIC Educational Resources Information Center
Yoon, Jina; Sulkowski, Michael L.; Bauman, Sheri A.
2016-01-01
School is a critical context of bullying. This study investigated teacher responses to bullying incidents and the effects of individual and contextual variables on these responses. Participating teachers (N = 236) viewed streaming video vignettes depicting physical, verbal, and relational bullying and reported how they would respond to bullies and…
Systems modeling and simulation applications for critical care medicine
2012-01-01
Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area. PMID:22703718
DOT National Transportation Integrated Search
2016-09-21
The North Carolina Department of Transportation's (NCDOTs) Incident Management Assistance Patrol (IMAP) program provides a critically important service to North Carolinas traveling public. The highly trained and well-equipped IMAP operators pro...
NHD, riverspill, and the development of the incident command tool for drinking water protection.
William B. Samuels; Rakesh Bahadur; Michael C. Monteith; David E. Amstutz; Jonathan M. Pickus; Katherine Parker; Douglas Ryan
2006-01-01
This project involved the development of an information tool that gives Incident Commanders the critical information they need to make informed decisions regarding the consequences of threats to public water supply intakes.
Factors influencing recovery and restoration following a chemical incident.
Peña-Fernández, A; Wyke, S; Brooke, N; Duarte-Davidson, R
2014-11-01
Chemicals are an important part of our society. A wide range of chemicals are discharged into the environment every day from residential, commercial and industrial sources. Many of these discharges do not pose a threat to public health or the environment. However, global events have shown that chemical incidents or accidents can have severe consequences on human health, the environment and society. It is important that appropriate tools and technical guidance are available to ensure that a robust and efficient approach to developing a remediation strategy is adopted. The purpose of remediation is to protect human health from future exposure and to return the affected area back to normal as soon as possible. There are a range of recovery options (techniques or methods for remediation) that are applicable to a broad range of chemicals and incidents. Recovery options should be evaluated according to their appropriateness and efficacy for removing contaminants from the environment; however economic drivers and social and political considerations often influence decision makers on which remedial actions are implemented during the recovery phase of a chemical incident. To date, there is limited information in the literature on remediation strategies and recovery options that have been implemented following a chemical incident, or how successful they have been. Additional factors that can affect the approach taken for recovery are not well assessed or understood by decision makers involved in the remediation and restoration of the environment following a chemical incident. The identification of this gap has led to the development of the UK Recovery Handbook for Chemical Incidents to provide a framework for choosing an effective recovery strategy. A compendium of practical evidence-based recovery options (techniques or methods for remediation) for inhabited areas, food production systems and water environments has also been developed and is included in the chemical
NASA Astrophysics Data System (ADS)
Buerdsell, Sherri Lynn
2009-12-01
As an institution of higher education and as a Hispanic-serving institution, New Mexico State University has a responsibility to its students to provide the skills and experiences necessary for each and every student to become a responsible, reflective citizen, capable of making informed decisions. Postsecondary science has traditionally been taught through lectures. Traditional lecture classes simply do not meet the needs of diverse groups of students in the modern multicultural student body like New Mexico State University's. However, the implementation of nontraditional pedagogy without evaluation of the results is useless as a step to reform; it is necessary to evaluate the results of in situ nontraditional pedagogy to determine its worth. The purpose of this research is to analyze the development and change in students' critical thinking skills, and critical thinking dispositions in single semester in an introductory Environmental Science course. This study utilized a mixed methods approach. The California Critical Thinking Skills Test and the California Critical Thinking Disposition Inventory were administered in the beginning and at the end of the semester. The pretest was used to provide a baseline for each participant against which the posttest score was compared. In addition, student interviews, field notes, and a survey provided qualitative data, which generated themes regarding the development of student critical thinking in this course. The results indicated there were no significant differences in the critical thinking test scores. However, qualitative analysis indicated that students experienced significant changes in critical thinking. Three themes emerged from the qualitative analysis pertaining to the amount of influence on student learning. These themes are active thinking and learning, dialogue, and professor's influence. Due to the conflict between the quantitative and the qualitative results, it is suggested that the critical thinking tests
The Critical Events Interview Manual.
ERIC Educational Resources Information Center
Avery, Donna M.; Taubert, Alexis
This guide for counselors describes the Critical Events Interview (CEI), a new counseling technique designed to be used with women in transition. The concept of critical events and their influence on adult development is described and the history and current status of the CEI are reviewed, along with current results of CEI evaluations and…
UV-Vis reflection spectroscopy under variable angle incidence at the air-liquid interface.
Roldán-Carmona, Cristina; Rubia-Payá, Carlos; Pérez-Morales, Marta; Martín-Romero, María T; Giner-Casares, Juan J; Camacho, Luis
2014-03-07
The UV-Vis reflection spectroscopy (UV-Vis-RS) in situ at the air-liquid interface provides information about tilt and aggregation of chromophores in Langmuir monolayers. This information is particularly important given in most cases the chromophore is located at the polar region of the Langmuir monolayer. This region of the Langmuir monolayers has been hardly accessible by other experimental techniques. In spite of its enormous potential, the application of UV-Vis-RS has been limited mainly to reflection measurements under light normal incidence or at lower incidence angles than the Brewster angle. Remarkably, this technique is quite sensitive to the tilt of the chromophores at values of incidence angles close to or larger than the Brewster angle. Therefore, a novel method to obtain the order parameter of the chromophores at the air-liquid interface by using s- and p-polarized radiation at different incidence angles is proposed. This method allowed for the first time the experimental observation of the two components with different polarization properties of a single UV-Vis band at the air-liquid interface. The method of UV-Vis spectroscopy under variable angle incidence is presented as a new tool for obtaining rich detailed information on Langmuir monolayers.
International Cyber Incident Repository System: Information Sharing on a Global Scale
DOE Office of Scientific and Technical Information (OSTI.GOV)
Joyce, Amanda L.; Evans, PhD, Nathaniel; Tanzman, Edward A.
According to the 2016 Internet Security Threat Report, the largest number of cyber attacks were recorded last year (2015), reaching a total of 430 million incidents throughout the world. As the number of cyber incidents increases, the need for information and intelligence sharing increases, as well. This fairly large increase in cyber incidents is driving the need for an international cyber incident data reporting system. The goal of the cyber incident reporting system is to make available shared and collected information about cyber events among participating international parties. In its 2014 report, Insurance Industry Working Session Readout Report-Insurance for CyberRelatedmore » Critical Infrastructure Loss: Key Issues, on the outcomes of a working session on cyber insurance, the U.S. Department of Homeland Security observed that “many participants cited the need for a secure method through which organizations could pool and share cyber incident information” and noted that one underwriter emphasized the importance of internationally harmonized data taxonomies. This cyber incident data reporting system could benefit all nations that take part in reporting incidents to provide a more common operating picture. In addition, this reporting system could allow for trending and anticipated attacks and could potentially benefit participating members by enabling them to get in front of potential attacks. The purpose of this paper is to identify options for consideration for such a system in fostering cooperative cyber defense.« less
NASA Technical Reports Server (NTRS)
Edwards, David L.; Cooke, William; Scruggs, Rob; Moser, Danielle E.
2008-01-01
The National Aeronautics and Space Administration (NASA) is progressing toward long-term lunar habitation. Critical to the design of a lunar habitat is an understanding of the lunar surface environment; of specific importance is the primary meteoroid and subsequent ejecta environment. The document, NASA SP-8013, was developed for the Apollo program and is the latest definition of the ejecta environment. There is concern that NASA SP-8013 may over-estimate the lunar ejecta environment. NASA's Meteoroid Environment Office (MEO) has initiated several tasks to improve the accuracy of our understanding of the lunar surface ejecta environment. This paper reports the results of experiments on projectile impact into powered pumice and unconsolidated JSC-1A Lunar Mare Regolith stimulant (JSC-1A) targets. The Ames Vertical Gun Range (AVGR) was used to accelerate projectiles to velocities in excess of 5 km/s and impact the targets at normal incidence. The ejected particles were detected by thin aluminum foil targets placed around the impact site and angular distributions were determined for ejecta. Comparison of ejecta angular distribution with previous works will be presented. A simplistic technique to characterize the ejected particles was formulated and improvements to this technique will be discussed for implementation in future tests.
Seo, Jeong-Hwa; Bae, Jun-Yeol; Kim, Hyun Joo; Hong, Deok Man; Jeon, Yunseok; Bahk, Jae-Hyon
2015-10-28
Double-lumen endobronchial tubes (DLTs) are commonly advanced into the mainstem bronchus either blindly or by fiberoptic bronchoscopic guidance. However, blind advancement may result in misplacement of left-sided DLTs into the right bronchus. Therefore, incidence, risk factors, and blind repositioning techniques for right bronchial misplacement of left-sided DLTs were investigated. This was an observational cohort study performed on the data depository consecutively collected from patients who underwent intubation of left-sided DLTs for 2 years. Patients' clinical and anatomical characteristics were analyzed to investigate risk factors for DLT misplacements with logistic regression analysis. Moreover, when DLTs were misplaced into the right bronchus, the bronchial tube was withdrawn into the trachea and blindly readvanced without rotation, or with 90° or 180° counterclockwise rotation while the patient's head was turned right. DLTs were inadvertently advanced into the right bronchus in 48 of 1135 (4.2 %) patients. DLT misplacements occurred more frequently in females, in patients of short stature or with narrow trachea and bronchi, and when small-sized DLTs were used. All of these factors were significantly inter-correlated each other (P < 0.001). In 40 of the 48 (83.3 %) patients, blind repositioning was successful. Smaller left-sided DLTs were more frequently misplaced into the right mainstem bronchus than larger DLTs. Moreover, we were usually able to reposition the misplaced DLTs into the left bronchus by using the blind techniques. ClinicalTrials.gov Identifier: NCT01371773.
Critical Events in the Lives of Interns
Graham, Mark; Schmidt, Hilary; Stern, David T.; Miller, Steven Z.
2008-01-01
BACKGROUND Early residency is a crucial time in the professional development of physicians. As interns assume primary care for their patients, they take on new responsibilities. The events they find memorable during this time could provide us with insight into their developing professional identities. OBJECTIVE To evaluate the most critical events in the lives of interns. PARTICIPANTS Forty-one internal medicine residents at one program participated in a two-day retreat in the fall of their first year. Each resident provided a written description of a recent high point, low point, and patient conflict. MEASUREMENTS We used a variant of grounded theory to analyze these critical incidents and determine the underlying themes of early internship. Independent inter-rater agreement of >90% was achieved for the coding of excerpts. MAIN RESULTS The 123 critical incidents were clustered into 23 categories. The categories were further organized into six themes: confidence, life balance, connections, emotional responses, managing expectations, and facilitating teamwork. High points were primarily in the themes of confidence and connections. Low points were dispersed more generally throughout the conceptual framework. Conflicts with patients were about negotiating the expectations inherent in the physician–patient relationship. CONCLUSION The high points, low points, and conflicts reported by early residents provide us with a glimpse into the lives of interns. The themes we have identified reflect critical challenges interns face the development of their professional identity. Program directors could use this process and conceptual framework to guide the development and promotion of residents’ emerging professional identities. PMID:18972091
[A Method Research on Environmental Damage Assessment of a Truck Rollover Pollution Incident].
Cai, Feng; Zhao, Shi-ho; Chen, Gang-cai; Xian, Si-shu; Yang, Qing-ling; Zhou, Xian-jie; Yu, Hai
2015-05-01
With high occurrence of sudden water pollution incident, China faces an increasingly severe situation of water environment. In order to deter the acts of environmental pollution, ensure the damaged resources of environment can be restored and compensated, it is very critical to quantify the economic losses caused by the sudden water pollution incident. This paper took truck rollover pollution incidents in Chongqing for an example, established a set of evaluation method for quantifying the environmental damage, and then assessed the environmental damage by the method from four aspects, including the property damage, ecological environment and resources damages, the costs of administrative affairs in emergency disposal, and the costs of investigation and evaluation.
NASA Astrophysics Data System (ADS)
Marjanovic, M.; Carton, H. D.; Carbotte, S. M.; Mutter, J. C.; Nedimovic, M. R.; Canales, J.
2012-12-01
Multichannel seismic (MCS) data collected in 2008 along the crest of the East Pacific Rise (EPR) 8°20'-10°10'N offer an excellent opportunity for studying along-axis variations in seismic properties of the mid-crustal magma sill imaged at ˜1.6 km below seafloor and inferring along-axis variations in the physical properties of this melt body. Locally, pre-stack data show a clear decrease in the amplitude of the P-wave reflection off the top of the magma sill as a function of angle of incidence, an observation reminiscent of the amplitude response of some hydrocarbon-saturated reservoirs, which may imply that within these regions the sill contains fully molten material. In oil and gas exploration, a technique known as amplitude variation with angle of incidence (AVA) analysis has been developed to derive reservoir properties from amplitude behavior. One such method, developed recently, uses intercept (derived from near-angle of incidence information, A) vs. slope (derived from mid-angle of incidence information, B) as seismic attributes to infer reservoir properties. Here, for the first time, we apply this approach to the mid-ocean ridge environment to infer variations in melt content of the axial magma sill. Using the presence of a converted P- to S- phase at the AMC as the first-order proxy for melt, we limit the application of AVA analysis to the region between ~9°30' and 10°00'N along the EPR axis. Prior to conducting the AVA analysis properly, data preparation steps are required (Kirchhoff pre-stack time migration, Radon filtering, velocity analysis of the AMC event for its accurate normal move-out correction, conversion of CMP gathers from offset domain to angle of incidence domain, and near and mid angle stacking were carried out here) and an interpretation scheme adequate for the mid-ocean ridge environment is established. The individual regions for conducting the A vs. B AVA analysis were based on previously-defined small-scale segmentation of the axial
NASA Astrophysics Data System (ADS)
Zhan, Honglei; Wang, Jin; Zhao, Kun; Lű, Huibin; Jin, Kuijuan; He, Liping; Yang, Guozhen; Xiao, Lizhi
2016-12-01
Current geological extraction theory and techniques are very limited to adequately characterize the unconventional oil-gas reservoirs because of the considerable complexity of the geological structures. Optical measurement has the advantages of non-interference with the earth magnetic fields, and is often useful in detecting various physical properties. One key parameter that can be detected using optical methods is the dielectric permittivity, which reflects the mineral and organic properties. Here we reported an oblique-incidence reflectivity difference (OIRD) technique that is sensitive to the dielectric and surface properties and can be applied to characterization of reservoir rocks, such as shale and sandstone core samples extracted from subsurface. The layered distribution of the dielectric properties in shales and the uniform distribution in sandstones are clearly identified using the OIRD signals. In shales, the micro-cracks and particle orientation result in directional changes of the dielectric and surface properties, and thus, the isotropy and anisotropy of the rock can be characterized by OIRD. As the dielectric and surface properties are closely related to the hydrocarbon-bearing features in oil-gas reservoirs, we believe that the precise measurement carried with OIRD can help in improving the recovery efficiency in well-drilling process.
"We Won't Get Ahead Speaking like That!" Expressing and Managing Language Criticism in Hawai'i
ERIC Educational Resources Information Center
Marlow, Mikaela L.; Giles, Howard
2010-01-01
Ample research has explored language attitudes and speaker evaluations, yet it has not attended to direct incidences of language criticism. This article presents evidence demonstrating that a majority of those surveyed in Hawai'i have experienced language criticism. Coded data suggest that criticism takes place during employment, educational,…
Drinking water incidents due to chemical contamination in England and Wales, 2006-2008.
Paranthaman, Karthikeyan; Harrison, Henrietta
2010-12-01
Contamination of drinking water by microbiological and chemical agents can lead to adverse health effects. In England and Wales, the Chemicals Hazards and Poisons Division (CHaPD) of the Health Protection Agency provides expert advice on the consequences to public health of chemical contamination incidents affecting drinking water. In this study, we extracted data from the National Database on the type and nature of drinking water contamination events reported to the CHaPD between 2006 and 2008. Eighty-two incidents with confirmed chemical contamination were identified. Among the 70 incidents where data was available, 40% (28/70) of incidents related to contamination of drinking water provided by private suppliers, 31% (22/70) were due to contamination occurring close to the point of consumption (i.e. near consumer) and 29% (20/70) related to incidents where public water supplies were identified as the contaminated source. For the majority of incidents, little or no information was available on the critical exposure variables such as duration of contamination and actual or estimates of the population affected. Reassuringly, the levels of exposure in most incidents were considered unlikely to cause serious immediate or long term ill health effects. Recording of exposure data for reported contamination incidents needs to be improved.
Spatial analysis of leprosy incidence and associated socioeconomic factors.
Cury, Maria Rita de Cassia Oliveira; Paschoal, Vania Del'Arco; Nardi, Susilene Maria Tonelli; Chierotti, Ana Patrícia; Rodrigues Júnior, Antonio Luiz; Chiaravalloti-Neto, Francisco
2012-02-01
To identify clusters of the major occurrences of leprosy and their associated socioeconomic and demographic factors. Cases of leprosy that occurred between 1998 and 2007 in São José do Rio Preto (southeastern Brazil) were geocodified and the incidence rates were calculated by census tract. A socioeconomic classification score was obtained using principal component analysis of socioeconomic variables. Thematic maps to visualize the spatial distribution of the incidence of leprosy with respect to socioeconomic levels and demographic density were constructed using geostatistics. While the incidence rate for the entire city was 10.4 cases per 100,000 inhabitants annually between 1998 and 2007, the incidence rates of individual census tracts were heterogeneous, with values that ranged from 0 to 26.9 cases per 100,000 inhabitants per year. Areas with a high leprosy incidence were associated with lower socioeconomic levels. There were identified clusters of leprosy cases, however there was no association between disease incidence and demographic density. There was a disparity between the places where the majority of ill people lived and the location of healthcare services. The spatial analysis techniques utilized identified the poorer neighborhoods of the city as the areas with the highest risk for the disease. These data show that health departments must prioritize politico-administrative policies to minimize the effects of social inequality and improve the standards of living, hygiene, and education of the population in order to reduce the incidence of leprosy.
Application of the weighted total field-scattering field technique to 3D-PSTD light scattering model
NASA Astrophysics Data System (ADS)
Hu, Shuai; Gao, Taichang; Liu, Lei; Li, Hao; Chen, Ming; Yang, Bo
2018-04-01
PSTD (Pseudo Spectral Time Domain) is an excellent model for the light scattering simulation of nonspherical aerosol particles. However, due to the particularity of its discretization form of the Maxwell's equations, the traditional Total Field/Scattering Field (TF/SF) technique for FDTD (Finite Differential Time Domain) is not applicable to PSTD, and the time-consuming pure scattering field technique is mainly applied to introduce the incident wave. To this end, the weighted TF/SF technique proposed by X. Gao is generalized and applied to the 3D-PSTD scattering model. Using this technique, the incident light can be effectively introduced by modifying the electromagnetic components in an inserted connecting region between the total field and the scattering field region with incident terms, where the incident terms are obtained by weighting the incident field by a window function. To optimally determine the thickness of connection region and the window function type for PSTD calculations, their influence on the modeling accuracy is firstly analyzed. To further verify the effectiveness and advantages of the weighted TF/SF technique, the improved PSTD model is validated against the PSTD model equipped with pure scattering field technique in both calculation accuracy and efficiency. The results show that, the performance of PSTD seems to be not sensitive to variation of window functions. The number of the connection layer required decreases with the increasing of spatial resolution, where for spatial resolution of 24 grids per wavelength, a 6-layer region is thick enough. The scattering phase matrices and integral scattering parameters obtained by the improved PSTD show an excellent consistency with those well-tested models for spherical and nonspherical particles, illustrating that the weighted TF/SF technique can introduce the incident precisely. The weighted TF/SF technique shows higher computational efficiency than pure scattering technique.
Investigation of Critical Heat Flux in Reduced Gravity Using Photomicrographic Techniques
NASA Technical Reports Server (NTRS)
Mudawar, Issam; Zhang, Hui
2003-01-01
Experiments were performed to examine the effects of body force on flow boiling critical heat flux (CHF). FC-72 was boiled along one wall of a transparent rectangular flow channel that permitted photographic study of the vapor-liquid interface just prior to CHF. High-speed video imaging techniques were used to identify dominant CHF mechanisms corresponding to different flow orientations and liquid velocities. Six different CHF regimes were identified: Wavy Vapor Layer, Pool Boiling, Stratification, Vapor Counterflow, Vapor Stagnation, and Separated Concurrent Vapor Flow. CHF showed significant sensitivity to orientation for flow velocities below 0.2 m/s, where extremely low CHF values where measured, especially with downward-facing heated wall and downflow orientations. High flow velocities dampened the effects of orientation considerably. The CHF data were used to assess the suitability of previous CHF models and correlations. It is shown the Interfacial Lift-off Model is very effective at predicting CHF for high velocities at all orientations. The flooding limit, on the other hand, is useful at estimating CHF at low velocities and for downflow orientations. A new method consisting of three dimensionless criteria is developed for determining the minimum flow velocity required to overcome body force effects on near-saturated flow boiling CHF. Vertical upflow boiling experiments were performed in pursuit of identifying the trigger mechanism for subcooled flow boiling CHF. While virtually all prior studies on flow boiling CHF concern the prediction or measurement of conditions that lead to CHF, this study was focused on events that take place during the CHF transient. High-speed video imaging and photomicrographic techniques were used to record the transient behavior of interfacial features from the last steady-state power level before CHF until the moment of power cut-off following CHF. The video records show the development of a wavy vapor layer which propagates
Kinnunen-Luovi, Kaisa; Saarnio, Reetta; Isola, Arja
2014-09-01
To describe the safety incidents involving confused and forgetful older patients in a specialised care setting entered in the HaiPro reporting system. About 10% of patients experience a safety incident during hospitalisation, which causes or could cause them harm. The possibility of a safety incident during hospitalisation increases significantly with age. A mild or moderate memory disorder and acute confusion are often present in the safety incidents originating with an older patient. The design of the study was action research with this study using findings from one of the first-phase studies, which included qualitative and quantitative analysed data. Data were collected from the reporting system for safety incidents (HaiPro) in a university hospital in Finland. There were 672 reported safety incidents from four acute medical wards during the years 2009-2011, which were scrutinised. Seventy-five of them were linked to a confused patient and were analysed. The majority of the safety incidents analysed involved patient-related accidents. In addition to challenging behaviour, contributing factors included ward routines, shortage of nursing staff, environmental factors and staff knowledge and skills. Nurses tried to secure the patient safety in many different ways, but the modes of actions were insufficient. Nursing staff need evidence-based information on how to assess the cognitive status of a confused patient and how to encounter such patients. The number of nursing staff and ward routines should be examined critically and put in proportion to the care intensity demands caused by the patient's confused state. The findings can be used as a starting point in the prevention of safety incidents and in improving the care of older patients. © 2013 John Wiley & Sons Ltd.
A review of rigid body response on sting supported models at high angles of incidence
NASA Astrophysics Data System (ADS)
Mabey, D. G.; Welsh, B. L.; Pyne, C. R.
The new requirement to test wind tunnel models of combat aircraft at high angles of incidence and high kinetic pressures has led to a review of the factors controlling the model stability. The review suggested that dangerous motions might occur (possibly without prior warning) on models at high angles of incidence unless special preventive measures were taken. An internal tuned damper and balance bump stops were recommended to limit the responses. The bump stops would also prevent the moment limits of the strain gauge balance from being exceeded. The effectiveness of both devices was confirmed by tests on a swept wing model which experienced dangerous bending oscillations in a vertical plane at a Mach number of 0.50 in the incidence range from about 27-29° together with dangerous yawing oscillations in a horizontal plane above an incidence of about 35°. Further research is recommended to ensure the safety of other models. For sting supported models in a conventional wind tunnel, it is shown by analysis that the structural damping in the sting bending mode needs to be about 4 to 6% critical damping. In a cryogenic wind tunnel corresponding levels would need to be 7 to 10% critical damping because of the possibility of increased negative aerodynamic damping relative to ambient conditions.
Radović, Jagoš R; Rial, Diego; Lyons, Brett P; Harman, Christopher; Viñas, Lucia; Beiras, Ricardo; Readman, James W; Thomas, Kevin V; Bayona, Josep M
2012-10-30
Oil and chemical spills in the marine environment are an issue of growing concern. Oil exploration and exploitation is moving from the continental shelf to deeper waters, and to northern latitudes where the risk of an oil spill is potentially greater and may affect pristine ecosystems. Moreover, a growing number of chemical products are transported by sea and maritime incidents of hazardous and noxious substances (HNS) are expected to increase. Consequently, it seems timely to review all of the experience gained from past spills to be able to cope with appropriate response and mitigation strategies to combat future incidents. Accordingly, this overview is focused on the dissemination of the most successful approaches to both detect and assess accidental releases using chemical as well as biological approaches for spills of either oil or HNS in the marine environment. Aerial surveillance, sampling techniques for water, suspended particles, sediments and biota are reviewed. Early warning bioassays and biomarkers to assess spills are also presented. Finally, research needs and gaps in knowledge are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.
Symptom-based categorization of in-flight passenger medical incidents.
Mahony, Paul H; Myers, Julia A; Larsen, Peter D; Powell, David M C; Griffiths, Robin F
2011-12-01
The majority of in-flight passenger medical events are managed by cabin crew. Our study aimed to evaluate the reliability of cabin crew reports of in-flight medical events and to develop a symptom-based categorization system. All cabin crew in-flight passenger medical incident reports for an airline over a 9-yr period were examined retrospectively. Validation of incident descriptions were undertaken on a sample of 162 cabin crew reports where medically trained persons' reports were available for comparison using a three Round Delphi technique and testing concordance using Cohen's Kappa. A hierarchical symptom-based categorization system was designed and validated. The rate was 159 incidents per 106 passengers carried, or 70.4/113.3 incidents per 106 revenue passenger kilometres/miles, respectively. Concordance between cabin crew and medical reports was 96%, with a high validity rating (mean 4.6 on a 1-5 scale) and high Cohen's Kappa (0.94). The most common in-flight medical events were transient loss of consciousness (41%), nausea/vomiting/diarrhea (19.5%), and breathing difficulty (16%). Cabin crew records provide reliable data regarding in-flight passenger medical incidents, complementary to diagnosis-based systems, and allow the use of currently underutilized data. The categorization system provides a means for tracking passenger medical incidents internationally and an evidence base for cabin crew first aid training.
Preliminary Evidence Supports Modification of Retraction Technique to Prevent Needlestick Injuries
Fa, Bernadette Alvear; Cuny, Eve
2016-01-01
A modified retraction technique was introduced into the DDS degree preclinical anesthesia course in 2011 with the goal of reducing needlestick exposure incidents. In numerous studies of dental exposures, injuries from dental anesthetic needles account for the highest proportion of all exposures. The purpose of this study was to assess the preliminary impact of a modified retraction technique on the incidence of blood and body fluids (BBF) exposure incidents associated with needles during injection. Data from evaluations of students from 2014 and 2015 were obtained and tracked to determine whether the modified retraction technique was “excellent,” “clinically acceptable,” or “clinically unacceptable.” Data were collected to determine if the patient perceived the modified retraction technique as “comfortable” or “correctable when addressed” to help improve student technique for future injections. Likewise, data from the blood-borne exposure database where all information related to BBF exposures is recorded were reviewed and the information separated by year and class. This study presents preliminary data only and because of the small sample size does not lend itself to validation by statistical analysis. However, the technique effectively removes the operator's hand from the field during injection, reducing the risk of accidental intraoral needlestick to the nondominant hand of the operator. PMID:27973940
Spatial analysis on human brucellosis incidence in mainland China: 2004–2010
Zhang, Junhui; Yin, Fei; Zhang, Tao; Yang, Chao; Zhang, Xingyu; Feng, Zijian; Li, Xiaosong
2014-01-01
Objectives China has experienced a sharply increasing rate of human brucellosis in recent years. Effective spatial monitoring of human brucellosis incidence is very important for successful implementation of control and prevention programmes. The purpose of this paper is to apply exploratory spatial data analysis (ESDA) methods and the empirical Bayes (EB) smoothing technique to monitor county-level incidence rates for human brucellosis in mainland China from 2004 to 2010 by examining spatial patterns. Methods ESDA methods were used to characterise spatial patterns of EB smoothed incidence rates for human brucellosis based on county-level data obtained from the China Information System for Disease Control and Prevention (CISDCP) in mainland China from 2004 to 2010. Results EB smoothed incidence rates for human brucellosis were spatially dependent during 2004–2010. The local Moran test identified significantly high-risk clusters of human brucellosis (all p values <0.01), which persisted during the 7-year study period. High-risk counties were centred in the Inner Mongolia Autonomous Region and other Northern provinces (ie, Hebei, Shanxi, Jilin and Heilongjiang provinces) around the border with the Inner Mongolia Autonomous Region where animal husbandry was highly developed. The number of high-risk counties increased from 25 in 2004 to 54 in 2010. Conclusions ESDA methods and the EB smoothing technique can assist public health officials in identifying high-risk areas. Allocating more resources to high-risk areas is an effective way to reduce human brucellosis incidence. PMID:24713215
DOE Office of Scientific and Technical Information (OSTI.GOV)
Gandini, Roberto; Uccioli, Luigi; Spinelli, Alessio
The purpose of this study was to describe alternative endovascular (EV) techniques and assess their feasibility and efficacy in minimizing failure rates in limb salvage for the treatment of complex below-the knee (BTK) occlusions that could not be crossed with a conventional antegrade access. Between December 2007 and November 2010, 1,035 patients (557 male) underwent EV treatment for critical limb ischemia in our institution. In 124 (12% [83 male], mean age 68.2 {+-} 0.5 years) patients, transfemoral antegrade revascularization attempt failed, and an alternative approach was used. Follow-up was performed at 1 and 6 months. Results were compared with 56more » patients treated between November 2002 and November 2007, in whom conventional technique was unsuccessful and unconventional techniques were not adopted. Technical success was achieved in 119 (96%) patients. The limb-salvage rates were 96.8% and 83% at 1- and 6-month follow-up, respectively. Sixteen (12.9%) and 33 (26.6%) patients underwent reintervention at 1- and 6-month follow-up, respectively. Transcutaneous oxygen tension increased at 1 month (44.7 {+-} 1.1 vs. 15.7 {+-} 0.8 mmHg; p < 0.001) and remained stable at follow-up. Twenty (16.1%) patients required major amputation. Thirteen (10.4%) patients died during follow-up. In our previous experience, percutaneous transluminal angioplasty failure, amputation, and death rates were 10.9, 39.2, and 23.2%, respectively. Alternative techniques allowed a significant decrease of major amputation and death rates (p = 0.0001 and p = 0.02, respectively). The use of alternative techniques seems feasible in case of a failed antegrade BTK revascularization attempt and could minimize failure rates in the treatment of complex occlusions while providing satisfying clinical success rates at 6 months.« less
Role of the dental team in mass fatality incidents.
Fixott, R H; Arendt, D; Chrz, B; Filippi, J; McGivney, J; Warnick, A
2001-04-01
The process of dental identification for a mass fatality incident has unique aspects in comparison with that of a routine dental identification, outside of the obvious increase in the number of victims and responders. The dental team is a small part of a large effort to resolve the incident. Incident command structure applies to the dental team as a unit as well as to the entire organization of the response. Teamwork and planning are essential on all levels. Discussing the casework is limited to the public information officer; only the public information officer is authorized to talk to anyone outside the medical examiner's office. For the team, communication is essential between the team members and between the team and other morgue sections. Daily meetings not only update progress, but also identify and solve problems as they arise. Redundancy and cross-checking occur each step in each section. A core team of trained individuals provides a framework for the use of less experienced members. Use of a dental identification computer program is extremely beneficial, especially as the amount of fragmentation or number of victims increases. Because of the magnitude of the response, the physical and mental stresses require critical incident stress debriefing for all responders, regardless of their experience. The past and future service of the dental profession to the victims of mass fatality incidents and their families is an excellent example of the ideal of service on which the profession is based.
A fluidized bed technique for estimating soil critical shear stress
USDA-ARS?s Scientific Manuscript database
Soil erosion models, depending on how they are formulated, always have erodibilitiy parameters in the erosion equations. For a process-based model like the Water Erosion Prediction Project (WEPP) model, the erodibility parameters include rill and interrill erodibility and critical shear stress. Thes...
Spatial Distribution of Black Bear Incident Reports in Michigan
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
Spatial Distribution of Black Bear Incident Reports in Michigan.
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
Teaching Critical Thinking in Undergraduate Science Courses
NASA Astrophysics Data System (ADS)
Hager, Paul; Sleet, Ray; Logan, Peter; Hooper, Mal
This paper reports on the design and evaluation of a project aimed at fostering the critical thinking abilities and dispositions of first year students at an Australian university. Novel paper and pencil problems were designed to foster the range of critical thinking abilities identified by Ennis (1991). Most of these critical thinking tasks relate to applications of chemistry and physics in everyday life. Some of the tasks were developed from information and/or ideas obtained from critical incident interviews with scientists in private and government organisations. The first year university students were required to attempt the tasks in co-operative groups and to interact in these groups in ways aimed at fostering the dispositions of Ennis' ideal critical thinker (Ennis 1996).The project was evaluated from discussions with groups of students, from comments of tutors who observed the students working in groups and from a questionnaire. Evidence obtained from these data indicated that many students considered their thinking skills were enhanced by their experience of attempting the tasks in small co-operative groups.
Visualizing common operating picture of critical infrastructure
NASA Astrophysics Data System (ADS)
Rummukainen, Lauri; Oksama, Lauri; Timonen, Jussi; Vankka, Jouko
2014-05-01
This paper presents a solution for visualizing the common operating picture (COP) of the critical infrastructure (CI). The purpose is to improve the situational awareness (SA) of the strategic-level actor and the source system operator in order to support decision making. The information is obtained through the Situational Awareness of Critical Infrastructure and Networks (SACIN) framework. The system consists of an agent-based solution for gathering, storing, and analyzing the information, and a user interface (UI) is presented in this paper. The UI consists of multiple views visualizing information from the CI in different ways. Different CI actors are categorized in 11 separate sectors, and events are used to present meaningful incidents. Past and current states, together with geographical distribution and logical dependencies, are presented to the user. The current states are visualized as segmented circles to represent event categories. Geographical distribution of assets is displayed with a well-known map tool. Logical dependencies are presented in a simple directed graph, and users also have a timeline to review past events. The objective of the UI is to provide an easily understandable overview of the CI status. Therefore, testing methods, such as a walkthrough, an informal walkthrough, and the Situation Awareness Global Assessment Technique (SAGAT), were used in the evaluation of the UI. Results showed that users were able to obtain an understanding of the current state of CI, and the usability of the UI was rated as good. In particular, the designated display for the CI overview and the timeline were found to be efficient.
Clinical and critical care concerns in severely ill obese patient
Bajwa, Sukhminder Jit Singh; Sehgal, Vishal; Bajwa, Sukhwinder Kaur
2012-01-01
The incidence of obesity has acquired an epidemic proportion throughout the globe. As a result, increasing number of obese patients is being presented to critical care units for various indications. The attending intensivist has to face numerous challenges during management of such patients. Almost all the organ systems are affected by the impact of obesity either directly or indirectly. The degree of obesity and its prolong duration are the main factors which determine the harmful effect of obesity on human body. The present article reviews few of the important clinical and critical care concerns in critically ill obese patients. PMID:23087857
Yu, Shi Cheng; Hao, Yuan Tao; Zhang, Jing; Xiao, Ge Xin; Liu, Zhuang; Zhu, Qi; Ma, Jia Qi; Wang, Yu
2012-12-01
To identify patterns of hand, foot and mouth disease (HFMD) incidence in China during declining incidence periods of 2008, 2009, and 2010. Reported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System (NDRS) and analyzed. An interrupted time series (ITS) technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years. Over 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level (P<0.0001) when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 (all P<0.005), but not 2009 to 2008. Incremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility. Copyright © 2012 The Editorial Board of Biomedical and Environmental Sciences. Published by Elsevier B.V. All rights reserved.
Incidence of autoantibodies in the infertile population.
Cubillos, J; Lucena, A; Lucena, C; Mendoza, J C; Ruiz, H; Arango, A; Quiroga, G; Ferro, J; Lucena, E
1997-06-01
The purpose of this study was to determine the incidence of autoantibodies in patients with no term pregnancies. Patients selected included 43 with primary infertility and 110 with a history of pregnancy loss. In the first group the incidence of antinuclear antibodies (ANA) and IgG and IgM antiphospholipid antibodies (APL) was 37.2% (p < 0.05) and 53.5% (p < 0.05), respectively. In the group of patients with a history of miscarriage, 31.8% (p < 0.05) were positive for ANA and 38.2% (p < 0.05) for APL. Controls were 35 healthy patients with proven fertility and no history of pregnancy loss or autoimmune disease. In this group the incidence of ANA was 5.7% and 11.4% for APL. The high incidence of autoantibodies found in patients with primary infertility might suggest a direct involvement of these antibodies in reproductive failure and consequently in IVF and assisted fertility procedures. The prevalence of ANA and APL has been extensively described in patients with a history of recurrent pregnancy losses (RPL). In this study we observed antibodies even after the first miscarriage. We therefore conclude that patients with a history of reproductive failure should be immunologically evaluated and treated before undergoing assisted fertilization techniques or before a new pregnancy in those cases of RPL.
Use of an algorithm in choosing abdominoplasty techniques.
Fernandes, Júlio Wilson; Damin, Renata; Holzmann, Marcos Vinícius Nasser; Ribas, Gabriel Gomes DE Oliveira
2018-01-01
to validate an algorithm for the choice of the abdominoplasty surgical technique among the five approaches established in the literature, according to the characteristics of the abdominal wall. we conducted a retrospective study of 245 patients undergoing abdominoplasty, for whom the method of choice of the surgical technique was the proposed algorithm, based on the degree of abdominal flaccidity determined by bimanual maneuver. We studied its applications and conveniences, as well as the complications inherent in each group studied. according to the algorithm used, the most frequently chosen technique was "Technique IV" (transverse dermolipectomy of Pitanguy - or with a Baroudi-Kepke incision), in 25.71% of the cases. "Technique I" (mini abdominoplasty) had the lowest incidence and the lowest rate of complications. On the opposite, "Technique III", dermolipectomy with remaining vertical scarring, presented a higher incidence of complications, requiring extreme caution in its indication, particularly in relation to patients' expectations regarding the resulting scar and its legal aspects. Among all conducts, the most frequent complication was seroma, with a 10.2% occurrence, solved by simple syringe aspiration and use of elastic compression mesh. the proposed algorithm facilitated the choice of abdominoplasty techniques, offering satisfactory results, which are in line with the complication rates published in the world literature.
Hiding Critical Targets in Smart Grid Networks
DOE Office of Scientific and Technical Information (OSTI.GOV)
Bao, Wei; Li, Qinghua
With the integration of advanced communication technologies, the power grid is expected to greatly enhance efficiency and reliability of future power systems. However, since most electrical devices in power grid substations are connected via communication networks, cyber security of these communication networks becomes a critical issue. Real-World incidents such as Stuxnet have shown the feasibility of compromising a device in the power grid network to further launch more sophisticated attacks. To deal with security attacks of this spirit, this paper aims to hide critical targets from compromised internal nodes and hence protect them from further attacks launched by those compromisedmore » nodes. In particular, we consider substation networks and propose to add carefully-controlled dummy traffic to a substation network to make critical target nodes indistinguishable from other nodes in network traffic patterns. This paper describes the design and evaluation of such a scheme. Evaluations show that the scheme can effectively protect critical nodes with acceptable communication cost.« less
2015-06-01
California EMSA, National Incident Management System, NIMS, hospital preparedness program, Nursing Home Incident Command System, NHICS, Hospital...The International Journal of Trauma Nursing published an article in 2007 entitled “Organization of a Hospital-based Victim Decontamination Plan...Journal of Trauma Nursing 5, no. 4 (October– November 2007): 119–123. 32 Ellen Lanser May, “Scarred but Smarter: Lessons Learned from Florida’s 2004
Duty hours and incidents in flight among commercial airline pilots.
O'Hagan, Anna Donnla; Issartel, Johann; Fletcher, Richard; Warrington, Giles
2016-01-01
Working long duty hours has often been associated with increased risk of incidents and accidents in transport industries. Despite this, information regarding the intermediate relationship between duty hours and incident risk is limited. This study aimed to test a work hours/incident model to identify the interplay of factors contributing to incidents within the aviation industry. Nine hundred and fifty-four European-registered commercial airline pilots completed a 30-item survey investigating self-report attitudes and experiences of fatigue. Path analysis was used to test the proposed model. The fit indices indicated this to be a good fit model (χ(2) = 11.066, df = 5, p = 0.05; Comparative Fit Index = 0.991; Normed Fit Index = 0.984; Tucker-Lewis Index = 0.962; Root Mean Square of Approximation = 0.036). Highly significant relationships were identified between duty hours and sleep disturbance (r = 0.18, p < 0.001), sleep disturbance and fatigue in the cockpit (r = 0.40, p < 0.001), and fatigue in the cockpit and microsleeps in the cockpit (r = 0.43, p < 0.001). A critical pathway from duty hours through to self-reported incidents in flight was identified. Further investigation employing both objective and subjective measures of sleep and fatigue is needed.
ERIC Educational Resources Information Center
Chattuchai, Sakkarin; Singseewo, Adisak; Suksringarm, Paitool
2015-01-01
This study aims to investigate the effects of learning environmental education on the knowledge, awareness, global warming decreasing behavior, and critical thinking of eighty grade 11 students from two classes. The Four Noble Truths method with metacognitive techniques and traditional teaching method were used for the investigation. The sample…
Case studies of hydrogen sulphide occupational exposure incidents in the UK.
Jones, Kate
2014-12-15
The UK Health and Safety Executive has investigated several incidents of workplace accidents involving hydrogen sulphide exposure in recent years. Biological monitoring has been used in some incidents to determine the cause of unconsciousness resulting from these incidents and as a supporting evidence in regulatory enforcement. This paper reports on three case incidents and discusses the use of biological monitoring in such cases. Biological monitoring has a role in identifying hydrogen sulphide exposure in incidents, whether these are occupational or in the wider environment. Sample type, time of collection and sample storage are important factors in the applicability of this technique. For non-fatal incidents, multiple urine samples are recommended at two or more time points between the incident and 15 h post-exposure. For routine occupational monitoring, post-shift samples should be adequate. Due to endogenous levels of urinary thiosulphate, it is likely that exposures in excess of 12 ppm for 30 min (or 360 ppm/min equivalent) would be detectable using biological monitoring. This is within the Acute Exposure Guideline Level 2 (the level of the chemical in air at or above which there may be irreversible or other serious long-lasting effects or impaired ability to escape) for hydrogen sulphide. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.
The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection.
Taghavi Zenouz, Ali; Ebrahimi, Hooman; Mahdipour, Masoumeh; Pourshahidi, Sara; Amini, Parisa; Vatankhah, Mahdi
2008-01-01
Dentists administer thousands of local anesthetic injections every day. Injection to a highly vascular area such as pterygomandibular space during an inferior alveolar nerve block has a high risk of intravascular needle entrance. Accidental intravascular injection of local anesthetic agent with vasoconstrictor may result in cardiovascular and central nervous system toxicity, as well as tachycardia and hypertension. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections. Three experienced oral and maxillofacial surgeons performed 359 inferior alveolar nerve block injections using direct or indirect techniques, and reported the results of aspiration. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases. Data were analyzed using t-test. 15.3% of inferior alveolar nerve block injections were aspiration positive. Intravascular needle entrance was seen in 14.2% of cases using direct and 23.3% of cases using indirect block injection techniques. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between direct or indirect block injection techniques (P = 0.127) and between right and left injection sites (P = 0.778). According to our findings, the incidence of intravascular needle entrance during inferior alveolar nerve block injection was relatively high. It seems that technique and maneuver of injection have no considerable effect in incidence of intravascular needle entrance.
Haemodialysis, nutritional disorders and hypoglycaemia in critical care.
Crespo, Jeiel Carlos Lamonica; Gomes, Vanessa Rossato; Barbosa, Ricardo Luís; Padilha, Katia Grillo; Secoli, Silvia Regina
2017-03-09
This study aimed to determine hypoglycemia incidence and associated factors in critically ill patients. It looked at a retrospective cohort with 106 critically ill adult patients with 48 hours of glycaemic control and 72 hours of follow up. The dependent variable, hypoglycaemia (≤70 mg/dl), was assessed with respect to independent variables: age, diet, insulin, catecholamines, haemodialysis, nursing workload and the Simplified Acute Physiology Score. Statistical analysis was performed using Student's t-test, Fisher's exact test and logistic regression at 5% significance level. Incidence of hypoglycaemia was 14.2%. Hypoglycaemia was higher in the group of patients on catecholamines (p=0.040), with higher glycaemic variability (p<0.001) and death in the intensive care unit (p=0.008). Risk factors were identified as absence of oral diet (OR 5.11; 95% CI 1.04-25.10) and haemodialysis (OR 4.28; 95% CI 1.16-15.76). Patients on haemodialysis and with no oral diet should have their glycaemic control intensified in order to prevent and/or manage hypoglycaemic episodes.
Gibbs, N M; Culwick, M; Merry, A F
2017-01-01
webAIRS is a web-based de-identified anaesthesia incident reporting system, which was introduced in Australia and New Zealand in September 2009. By July 2016, 4,000 incident reports had been received. The incidents covered a wide range of patient age (<28 days to >90 years), American Society of Anesthesiologists physical status, and body mass index (<18.5 to >50 kg/m 2 ). They occurred across a wide range of anaesthesia techniques and grade of anaesthesia provider, and over a wide range of anaesthetising locations and times of day. In a high proportion the outcome was not benign; about 26% of incidents were associated with patient harm and a further 4% with death. Incidents appeared to be an ever-present risk in anaesthetic practice, with extrapolated estimates exceeding 200 per week across Australia and New Zealand. Independent of outcomes, many anaesthesia incidents were associated with increased use of health resources. The four most common main categories of incident were Respiratory/Airway, Medication, Cardiovascular, and Medical Device/Equipment. Over 50% of incidents were considered preventable. The narratives accompanying each incident provide a rich source of information, which will be analysed in subsequent reports on particular incident types. The summary data in this initial overview are a sober reminder of the prevalence and unpredictability of anaesthesia incidents, and their potential morbidity and mortality. The data justify current efforts to better prevent and manage anaesthesia incidents in Australia and New Zealand, and identify areas in which increased resources or additional initiatives may be required.
Sample Size Methods for Estimating HIV Incidence from Cross-Sectional Surveys
Brookmeyer, Ron
2015-01-01
Summary Understanding HIV incidence, the rate at which new infections occur in populations, is critical for tracking and surveillance of the epidemic. In this paper we derive methods for determining sample sizes for cross-sectional surveys to estimate incidence with sufficient precision. We further show how to specify sample sizes for two successive cross-sectional surveys to detect changes in incidence with adequate power. In these surveys biomarkers such as CD4 cell count, viral load, and recently developed serological assays are used to determine which individuals are in an early disease stage of infection. The total number of individuals in this stage, divided by the number of people who are uninfected, is used to approximate the incidence rate. Our methods account for uncertainty in the durations of time spent in the biomarker defined early disease stage. We find that failure to account for this uncertainty when designing surveys can lead to imprecise estimates of incidence and underpowered studies. We evaluated our sample size methods in simulations and found that they performed well in a variety of underlying epidemics. Code for implementing our methods in R is available with this paper at the Biometrics website on Wiley Online Library. PMID:26302040
Sample size methods for estimating HIV incidence from cross-sectional surveys.
Konikoff, Jacob; Brookmeyer, Ron
2015-12-01
Understanding HIV incidence, the rate at which new infections occur in populations, is critical for tracking and surveillance of the epidemic. In this article, we derive methods for determining sample sizes for cross-sectional surveys to estimate incidence with sufficient precision. We further show how to specify sample sizes for two successive cross-sectional surveys to detect changes in incidence with adequate power. In these surveys biomarkers such as CD4 cell count, viral load, and recently developed serological assays are used to determine which individuals are in an early disease stage of infection. The total number of individuals in this stage, divided by the number of people who are uninfected, is used to approximate the incidence rate. Our methods account for uncertainty in the durations of time spent in the biomarker defined early disease stage. We find that failure to account for this uncertainty when designing surveys can lead to imprecise estimates of incidence and underpowered studies. We evaluated our sample size methods in simulations and found that they performed well in a variety of underlying epidemics. Code for implementing our methods in R is available with this article at the Biometrics website on Wiley Online Library. © 2015, The International Biometric Society.
Riga, M.; Bibas, A.; Xenellis, J.; Korres, S.
2011-01-01
Background. This study is a review of the incidence, clinical characteristics, and management of secondary BPPV. The different subtypes of secondary BPPV are compared to each other, as well as idiopathic BPPV. Furthermore, the study highlights the coexistence of BPPV with other inner ear pathologies. Methods. A comprehensive search for articles including in the abstract information on incidence, clinical characteristics, and management of secondary BPPV was conducted within the PubMed library. Results. Different referral patterns, different diagnostic criteria used for inner ear diseases, and different patient populations have led to greatly variable incidence results. The differences regarding clinical characteristics and treatment outcomes may support the hypothesis that idiopathic BPPV and the various subtypes of secondary BPPV do not share the exact same pathophysiological mechanisms. Conclusions. Secondary BPPV is often under-diagnosed, because dizziness may be atypical and attributed to the primary inner ear pathology. Reversely, a limited number of BPPV patients may not be subjected to a full examination and characterized as idiopathic, while other inner ear diseases are underdiagnosed. A higher suspicion index for the coexistence of BPPV with other inner ear pathologies, may lead to a more integrated diagnosis and consequently to a more efficient treatment of these patients. PMID:21837242
Warm, D; Edwards, P
2012-01-01
Interest in the field of patient safety incident reporting and analysis with respect to Health Information Technology (HIT) has been growing over recent years as the development, implementation and reliance on HIT systems becomes ever more prevalent. One of the rationales for capturing patient safety incidents is to learn from failures in the delivery of care and must form part of a feedback loop which also includes analysis; investigation and monitoring. With the advent of new technologies and organizational programs of delivery the emphasis is increasingly upon analyzing HIT incidents. This thematic review had two objectives, to test the applicability of a framework specifically designed to categorize HIT incidents and to review the Welsh incidents as communicated via the national incident reporting system in order to understand their implications for healthcare. The incidents were those reported as IT/ telecommunications failure/ overload. Incidents were searched for within a national reporting system using a standardized search strategy for incidents occurring between 1(st) January 2009 and 31(st) May 2011. 149 incident reports were identified and classified. The majority (77%) of which were machine related (technical problems) such as access problems; computer system down/too slow; display issues; and software malfunctions. A further 10% (n = 15) of incidents were down to human-computer interaction issues and 13% (n = 19) incidents, mainly telephone related, could not be classified using the framework being tested. On the basis of this review of incidents, it is recommended that the framework be expanded to include hardware malfunctions and the wrong record retrieved/missing data associated with a machine output error (as opposed to human error). In terms of the implications for clinical practice, the incidents reviewed highlighted critical issues including the access problems particularly relating to the use of mobile technologies.
The effects of solar incidence angle over digital processing of LANDSAT data
NASA Technical Reports Server (NTRS)
Parada, N. D. J. (Principal Investigator); Novo, E. M. L. M.
1983-01-01
A technique to extract the topography modulation component from digital data is described. The enhancement process is based on the fact that the pixel contains two types of information: (1) reflectance variation due to the target; (2) reflectance variation due to the topography. In order to enhance the signal variation due to topography, the technique recommends the extraction from original LANDSAT data of the component resulting from target reflectance. Considering that the role of topographic modulation over the pixel information will vary with solar incidence angle, the results of this technique of digital processing will differ from one season to another, mainly in highly dissected topography. In this context, the effects of solar incidence angle over the topographic modulation technique were evaluated. Two sets of MSS/LANDSAT data, with solar elevation angles varying from 22 to 41 deg were selected to implement the digital processing at the Image-100 System. A secondary watershed (Rio Bocaina) draining into Rio Paraiba do Sul (Sao Paulo State) was selected as a test site. The results showed that the technique used was more appropriate to MSS data acquired under higher Sun elevation angles. Topographic modulation components applied to low Sun elevation angles lessens rather than enhances topography.
Experimental damping-in-pitch of two slender cones at Mach 2 and incidences up to 30 deg
NASA Technical Reports Server (NTRS)
Iyenger, S.
1972-01-01
Oscillatory experiments were performed on two slender cones at Mach 2 and incidences up to 30 deg, using three different experimental arrangements. The damping-in-pitch was found to remain constant at incidences of up to a value approximately corresponding to the cone semi-angle, after which an almost linear increase with incidence was noted. The results obtained with the different techniques were in very good agreement up to an incidence of 15 deg and in some cases up to 25 deg.
Siman-Tov, Maya; Radomislensky, Irina; Knoller, Nachshon; Bahouth, Hany; Kessel, Boris; Klein, Yoram; Michaelson, Moshe; Avraham Rivkind, Bala Miklosh; Shaked, Gad; Simon, Daniel; Soffer, Dror; Stein, Michael; Jeroukhimov, Igor; Peleg, Kobi
2016-01-01
To assess the incidence and injury characteristics of hospitalized trauma patients diagnosed with TBI. A retrospective study of all injured hospitalized patients recorded in the National Trauma Registry at 19 trauma centres in Israel between 2002-2011. Incidence and injury characteristics were examined among children, adults and seniors. The annual incidence rate of hospitalized TBI for the Israeli population in 2011 was 31.8/100,000. Age-specific incidence was highest among seniors with a dramatic decrease in TBI-related mortality rate among them. Adults, in comparison to children and seniors, had higher rates of severe TBI, severe and critical injuries, more admission to the intensive care unit, underwent surgery, were hospitalization for more than 2 weeks and were discharged to rehabilitation. After adjusting for age, gender, ethnicity, mechanism of injury and injury severity score, TBI-related in-hospital mortality was higher among seniors and adults compared to children. Seniors are at high risk for TBI-related in-hospital mortality, although adults had more severe and critical injuries and utilized more hospital resources. However, seniors showed the most significant reduction in mortality rate during the study period. Appropriate intervention programmes should be designed and implemented, targeted to reduce TBI among high risk groups.
Moutzouri, M; Gleeson, N; Billis, E; Tsepis, E; Panoutsopoulou, I; Gliatis, J
2017-11-01
Despite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature. A systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool. Thirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III. Findings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II-III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place.
Zhan, Honglei; Wang, Jin; Zhao, Kun; Lű, Huibin; Jin, Kuijuan; He, Liping; Yang, Guozhen; Xiao, Lizhi
2016-01-01
Current geological extraction theory and techniques are very limited to adequately characterize the unconventional oil-gas reservoirs because of the considerable complexity of the geological structures. Optical measurement has the advantages of non-interference with the earth magnetic fields, and is often useful in detecting various physical properties. One key parameter that can be detected using optical methods is the dielectric permittivity, which reflects the mineral and organic properties. Here we reported an oblique-incidence reflectivity difference (OIRD) technique that is sensitive to the dielectric and surface properties and can be applied to characterization of reservoir rocks, such as shale and sandstone core samples extracted from subsurface. The layered distribution of the dielectric properties in shales and the uniform distribution in sandstones are clearly identified using the OIRD signals. In shales, the micro-cracks and particle orientation result in directional changes of the dielectric and surface properties, and thus, the isotropy and anisotropy of the rock can be characterized by OIRD. As the dielectric and surface properties are closely related to the hydrocarbon-bearing features in oil-gas reservoirs, we believe that the precise measurement carried with OIRD can help in improving the recovery efficiency in well-drilling process. PMID:27976746
Lloyd, Jessica C.; Hornik, Christoph P.; Benjamin, Daniel K.; Clark, Reese H.; Routh, Jonathan C.; Smith, P. Brian
2016-01-01
Breakthrough urinary tract infections (BUTIs) are a source of great morbidity in children on urinary prophylactic antibiotics. The incidence of BUTI in critically ill infants is not known. We investigated the incidence of BUTI in a cohort of infants hospitalized on prophylactic antibiotics in neonatal intensive care units. Predictors of BUTI were evaluated using multivariable Cox regression. Out of 716,787 infants, 631 (0.09%) were prescribed 821 courses of antibiotic prophylaxis. Among this cohort, 60 infants (9.5%) suffered a total of 65 BUTIs. Of all prophylactic antibiotic courses, 65/821 (7.9%) were complicated by BUTI. Klebsiella, Enterobacter, and Escherichia coli species were the most common causes of BUTI. There was no statistically significant difference in BUTI incidence among the four antibiotics assessed (amoxicillin, cephalexin, nitrofurantoin, or trimethoprim-sulfamethoxazole) (p=0.78). PMID:27006413
Cross-cultural perspectives on critical thinking.
Jenkins, Sheryl Daun
2011-05-01
The purpose of this cross-cultural study was to explore critical thinking among nurse scholars in Thailand and the United States. The study used qualitative methodology to examine how nurse scholars describe critical thinking in nursing. Nurse educators in Thailand and the United States were questioned concerning the following aspects of critical thinking: essential components; teaching and evaluation techniques; characteristics of critical thinkers; and the importance of a consensus definition for critical thinking in nursing. Their statements, which revealed both common and specific cultural aspects of critical thinking, were subjected to content analysis. Certain themes emerged that have not been widely discussed in the literature, including the link between staying calm and thinking critically, the assertion that happiness is an essential component of critical thinking, and the participants' nearly unanimous support for coming to a consensus definition of critical thinking for nursing. Copyright 2011, SLACK Incorporated.
Efron, Philip A; Mohr, Alicia M; Bihorac, Azra; Horiguchi, Hiroyuki; Hollen, McKenzie K; Segal, Mark S; Baker, Henry V; Leeuwenburgh, Christiaan; Moldawer, Lyle L; Moore, Frederick A; Brakenridge, Scott C
2018-05-25
As early as the 1990s, chronic critical illness, a distinct syndrome of persistent high-acuity illness requiring management in the ICU, was reported under a variety of descriptive terms including the "neuropathy of critical illness," "myopathy of critical illness," "ICU-acquired weakness," and most recently "post-intensive care unit syndrome." The widespread implementation of targeted shock resuscitation, improved organ support modalities, and evidence-based protocolized ICU care has resulted in significantly decreased in-hospital mortality within surgical ICUs, specifically by reducing early multiple organ failure deaths. However, a new phenotype of multiple organ failure has now emerged with persistent but manageable organ dysfunction, high resource utilization, and discharge to prolonged care facilities. This new multiple organ failure phenotype is now clinically associated with the rapidly increasing incidence of chronic critical illness in critically ill surgery patients. Although the underlying pathophysiology driving chronic critical illness remains incompletely described, the persistent inflammation, immunosuppression, and catabolism syndrome has been proposed as a mechanistic framework in which to explain the increased incidence of chronic critical illness in surgical ICUs. The purpose of this review is to provide a historic perspective of the epidemiologic evolution of multiple organ failure into persistent inflammation, immunosuppression, and catabolism syndrome; describe the mechanism that drives and sustains chronic critical illness, and review the long-term outcomes of surgical patients who develop chronic critical illness. Copyright © 2018 Elsevier Inc. All rights reserved.
NASA Astrophysics Data System (ADS)
Ghigo, Mauro; Proserpio, Laura; Basso, Stefano; Citterio, Oberto; Civitani, Marta M.; Pareschi, Giovanni; Salmaso, Bianca; Sironi, Giorgia; Spiga, Daniele; Tagliaferri, Giampiero; Vecchi, Gabriele; Zambra, Alberto; Parodi, Giancarlo; Martelli, Francesco; Gallieni, Daniele; Tintori, Matteo; Bavdaz, Marcos; Wille, Eric; Ferrario, Ivan; Burwitz, Vadim
2013-09-01
The Astronomical Observatory of Brera (INAF-OAB, Italy), with the financing support of the European Space Agency (ESA), has concluded a study regarding a glass shaping technology for the production of grazing incidence segmented x-ray optics. This technique uses a hot slumping phase, in which pressure is actively applied on thin glass foils being shaped, to form a cylindrical approximation of Wolter I x-ray segments, and a subsequent cold slumping phase, in which the final Wolter I profile is then freeze into the glass segments during their integration in elemental X-ray Optical Units. The final goal of this study was the manufacturing of a prototype containing a number of slumped pair plates (meaning parabola and hyperbola couples) having representative dimensions to be tested both in UV light and in x-rays at the Panter facility (Germany). In this paper, the INAF-OAB slumping technique, comprising a shaping step and an integration step is described, together with the results obtained on the manufactured prototype modules: the first prototype was aimed to test the ad-hoc designed and built semi-automatic Integration MAchine (IMA) and debug its control software. The most complete module comprises 40 slumped segments of Schott D263 glass type of dimension 200 mm x 200 mm and thickness of 0.4 mm, slumped on Zerodur K20 mould and stacked together through glued BK7 glass structural ribs to form the first entire x-ray optical module ever built totally composed by glass. A last prototype was aimed at demonstrate the use of Schott glass AF32 type instead of D263. In particular, a new hot slumping experimental set-up is described whose advantage is to permit a better contact between mould and glass during the shaping process. The integration procedure of the slumped segments into the elemental module is also reviewed.
Gastric exocrine “failure” in critically ill patients: incidence and associated features
Stannard, V A; Hutchinson, A; Morris, D L; Byrne, A
1988-01-01
Following the observation that many critically ill patients cannot maintain their gastric juice pH below 4 without treatment a study was performed to measure the gastric juice pH in such patients and relate it to other clinical data. The case notes of 64 patients who had been admitted to the intensive care unit and taken part in two trials of ranitidine treatment were reviewed. During those trials gastric juice was aspirated hourly and the pH and volume measured. In this study the values recorded during a six hour untreated control phase were used. Data on age, diagnosis, treatment, outcome, episodes of hypoxia, episodes of hypotension, and use of inotropic drugs were also reviewed. Full data were available for 61 patients: 27 had a mean baseline pH of >5 during the control phase and 34 a mean baseline pH of <5. Significantly more of those with a high pH suffered hypotension (21/27 v 13/34) and received inotropic drugs (16/27 v 8/34). These findings suggest that hypotension in critically ill patients adversely affects gastric exocrine function; prophylaxis with drugs that can improve gastric mucosal blood flow may be more effective than with antacids. PMID:3122979
Sexual harassment of critical care nurses: a costly workplace issue.
Kaye, J; Donald, C G; Merker, S
1994-11-01
Sexual harassment in the workplace is a prevalent form of impermissible sex discrimination in employment. The high profile of this issue in the media, together with laws prohibiting sexual harassment, have not prevented this problem for working nurses. To describe and determine the extent of sexual harassment incidents experienced by nurses working in critical care areas, and to determine attitudes about, and presence of policies regarding, sexual harassment in hospitals. For this descriptive study the federal government's definition of sexual harassment and a list of sexually harassing behaviors was mailed with a survey to 188 critical care nurses. Findings indicated that 46% of the respondents had been harassed. Offensive sexual remarks (56%), unwanted physical contact (53%), unwanted nonverbal attention (27%), requests for dates (16%), and sexual propositions (9%) were types of sexual harassment experienced. Sexual assault was experienced by one woman. Harassers were physicians (82%), coworkers (20%), or immediate supervisors (7%). A majority of the incidents (69%) were not reported. Most nurses (80%) had not received training, nor were there policies and procedures to follow in most cases for reporting harassment. These results suggest that many critical care nurses are harassed and that relatively few hospitals have sexual harassment policies known to employees. They also indicate that sexual harassment training, policies, and procedures are needed to provide a safe, healthy work environment for critical care nurses.
Personality and language characteristics in parents from multiple-incidence autism families.
Piven, J; Palmer, P; Landa, R; Santangelo, S; Jacobi, D; Childress, D
1997-07-25
Several studies have suggested that the genetic liability for autism may be expressed in non-autistic relatives of autistic probands, in behavioral characteristics that are milder but qualitatively similar to the defining features of autism. We employ a variety of direct assessment approaches to examine both personality and language in parents ascertained through having two autistic children (multiple-incidence autism parents) and parents of Down syndrome probands. Multiple-incidence autism parents had higher rates of particular personality characteristics (rigidity, aloofness, hypersensitivity to criticism, and anxiousness), speech and pragmatic language deficits, and more limited friendships than parents in the comparison group. The implications of these findings for future genetic studies of autism are discussed.
Two-plasmon decay instability in inhomogeneous plasmas at oblique laser incidence
Wen, H.; Maximov, A. V.; Short, R. W.; ...
2016-09-30
The two-plasmon decay (TPD) and stimulated Raman scattering (SRS) instabilities have been studied in the region near the quarter-critical density in the plasmas of the laser-driven inertial confinement fusion for a wide range of laser angles of incidence. The theoretical analysis of the TPD for oblique laser incidence has been carried out. The theoretical growth rates and thresholds have been compared with the results of the fluid-type simulations, and a good agreement has been found. Here, in the modeling including both TPD and SRS, the spectra of the growing perturbations have multiple peaks, and the maximum growth may be influencedmore » by the interplay between TPD and SRS.« less
Catastrophic Incident Recovery: Long-Term Recovery from an Anthrax Event Symposium
DOE Office of Scientific and Technical Information (OSTI.GOV)
Lesperance, Ann M.
On March 19, 2008, policy makers, emergency managers, and medical and Public Health officials convened in Seattle, Washington, for a workshop on Catastrophic Incident Recovery: Long-Term Recovery from an Anthrax Event. The day-long symposium was aimed at generating a dialogue about restoration and recovery through a discussion of the associated challenges that impact entire communities, including people, infrastructure, and critical systems.
Satellite estimation of incident photosynthetically active radiation using ultraviolet reflectance
NASA Technical Reports Server (NTRS)
Eck, Thomas F.; Dye, Dennis G.
1991-01-01
A new satellite remote sensing method for estimating the amount of photosynthetically active radiation (PAR, 400-700 nm) incident at the earth's surface is described and tested. Potential incident PAR for clear sky conditions is computed from an existing spectral model. A major advantage of the UV approach over existing visible band approaches to estimating insolation is the improved ability to discriminate clouds from high-albedo background surfaces. UV spectral reflectance data from the Total Ozone Mapping Spectrometer (TOMS) were used to test the approach for three climatically distinct, midlatitude locations. Estimates of monthly total incident PAR from the satellite technique differed from values computed from ground-based pyranometer measurements by less than 6 percent. This UV remote sensing method can be applied to estimate PAR insolation over ocean and land surfaces which are free of ice and snow.
Managing chronic conditions in college: Findings from prompted health incidents diaries.
Ravert, Russell D; Russell, Luke T; O'Guin, Monica B
2017-04-01
This pilot study assessed an electronic health diary method designed to collect data about critical health incidents experienced by college students who have chronic health conditions. Nine university students with chronic medical conditions were recruited to complete a series of e-mail-based surveys, sent once every 3 days across the fall 2014 semester. In each survey, participants described a health-related incident that occurred within the past day and cited resources that helped or could have helped in that situation. They completed follow-up interviews and ranked the importance of cited resources. The diary completion rate was 78.3% (141/180). Most frequently affected management areas were activities (61.3%), monitoring (34.9%), and problem-solving (34.3%). Resources considered helpful included situational knowledge, campus health professionals, peer support, and relaxation opportunities. Prompted health incidents diary method achieved a high completion rate and provided data that could be useful for college health researchers and practitioners.
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.
The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection
Taghavi Zenouz, Ali; Ebrahimi, Hooman; Mahdipour, Masoumeh; Pourshahidi, Sara; Amini, Parisa; Vatankhah, Mahdi
2008-01-01
Background and aims Dentists administer thousands of local anesthetic injections every day. Injection to a highly vascular area such as pterygomandibular space during an inferior alveolar nerve block has a high risk of intravascular needle entrance. Accidental intravascular injection of local anesthetic agent with vasoconstrictor may result in cardiovascular and central nervous system toxicity, as well as tachycardia and hypertension. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections. Materials and methods Three experienced oral and maxillofacial surgeons performed 359 inferior alveolar nerve block injections using direct or indirect techniques, and reported the results of aspiration. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases. Data were analyzed using t-test. Results 15.3% of inferior alveolar nerve block injections were aspiration positive. Intravascular needle entrance was seen in 14.2% of cases using direct and 23.3% of cases using indirect block injection techniques. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between direct or indirect block injection techniques (P = 0.127) and between right and left injection sites (P = 0.778). Conclusion According to our findings, the incidence of intravascular needle entrance during inferior alveolar nerve block injection was relatively high. It seems that technique and maneuver of injection have no considerable effect in incidence of intravascular needle entrance. PMID:23285329
"Dealing" with Incidence, Prevalence, and Odds Concepts in Undergraduate Epidemiology
ERIC Educational Resources Information Center
Senchina, David S.; Laurson, Kelly R.
2009-01-01
Concepts and associated statistical formulae of incidence, prevalence, and odds/odds ratios are core knowledge in epidemiology yet can be confusing for students. The purpose of this project was to develop, validate, and share one possible pedagogical technique using playing cards that could be employed to improve undergraduate understanding of…
A CRITICAL ASSESSMENT OF BIODOSIMETRY METHODS FOR LARGE-SCALE INCIDENTS
Swartz, Harold M.; Flood, Ann Barry; Gougelet, Robert M.; Rea, Michael E.; Nicolalde, Roberto J.; Williams, Benjamin B.
2014-01-01
Recognition is growing regarding the possibility that terrorism or large-scale accidents could result in potential radiation exposure of hundreds of thousands of people and that the present guidelines for evaluation after such an event are seriously deficient. Therefore, there is a great and urgent need for after-the-fact biodosimetric methods to estimate radiation dose. To accomplish this goal, the dose estimates must be at the individual level, timely, accurate, and plausibly obtained in large-scale disasters. This paper evaluates current biodosimetry methods, focusing on their strengths and weaknesses in estimating human radiation exposure in large-scale disasters at three stages. First, the authors evaluate biodosimetry’s ability to determine which individuals did not receive a significant exposure so they can be removed from the acute response system. Second, biodosimetry’s capacity to classify those initially assessed as needing further evaluation into treatment-level categories is assessed. Third, we review biodosimetry’s ability to guide treatment, both short- and long-term, is reviewed. The authors compare biodosimetric methods that are based on physical vs. biological parameters and evaluate the features of current dosimeters (capacity, speed and ease of getting information, and accuracy) to determine which are most useful in meeting patients’ needs at each of the different stages. Results indicate that the biodosimetry methods differ in their applicability to the three different stages, and that combining physical and biological techniques may sometimes be most effective. In conclusion, biodosimetry techniques have different properties, and knowledge of their properties for meeting the different needs for different stages will result in their most effective use in a nuclear disaster mass-casualty event. PMID:20065671
Asian International Student Transition to High School in Canada
ERIC Educational Resources Information Center
Popadiuk, Natalee
2010-01-01
There is a paucity of studies conducted with unaccompanied adolescent international students. In this qualitative inquiry, I present a thematic analysis of the critical incidents that Chinese, Japanese, and Korean participants reported as either facilitating or hindering to their transition to Canada. Using the Critical Incident Technique, I…
Martín Delgado, M C; Merino de Cos, P; Sirgo Rodríguez, G; Álvarez Rodríguez, J; Gutiérrez Cía, I; Obón Azuara, B; Alonso Ovies, Á
2015-01-01
To explore contributing factors (CF) associated to related critical patients safety incidents. SYREC study pos hoc analysis. A total of 79 Intensive Care Departments were involved. The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even thought CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
Lin, Zhi-Liang; Yu, Wen-Kui; Shi, Jia-Liang; Chen, Qi-Yi; Tan, Shan-Jun; Li, Ning
2014-05-01
In critically ill patients, gastrointestinal function plays an important role in multiple organ dysfunction syndrome. Patients suffering from acute lower gastrointestinal dysfunction need to be performed a temporary fecal diversion after the failure of conservative treatment. This study aims to determine which type of fecal diversion is associated with better clinical outcomes in critically ill patients. Data of critically ill patients requiring surgical decompression following acute lower gastrointestinal dysfunction between January 2008 and June 2013 were retrospectively analyzed. Comparison was made between ileostomy group and colostomy group regarding the stoma-related complications and the recovery after stoma creation. 63 patients consisted of temporary ileostomy group (n = 35) and temporary colostomy group (n = 28) were included in this study. First bowel movement and length of enteral nutrition intolerance after fecal diversion were both significantly shorter in the ileostomy group than in the colostomy group (1.70 ± 0.95 vs. 3.04 ± 1.40; p < 0.001 and 3.96 ± 2.84 vs. 8.12 ± 7.05; p = 0.009). In comparison of the complication rates, we found a significantly higher incidence of dermatitis (31.43% vs. 7.14%; p = 0.017), hypokalemia (25.71 vs. 3.57; p = 0.017) and hypocalcemia (28.57 vs. 7.14; p = 0.031), and slightly lower incidence of stoma prolapse (0% vs. 10.71%; p = 0.082) in the ileostomy group than in the colostomy group. Both procedures provide an effective defunctioning of the distant gastrointestinal tract with a low complication incidence. We prefer a temporary ileostomy to temporary colostomy for acute lower gastrointestinal dysfunction in critically ill patients.
Shinagawa, Kiyotsugu; Hatta, Taku; Yamamoto, Nobuyuki; Kawakami, Jun; Shiota, Yuki; Mineta, Mitsuyoshi; Itoi, Eiji
2018-05-03
Focus has recently been on the critical shoulder angle (CSA) as a factor related to rotator cuff tear and osteoarthritis (OA) in the European population. However, whether this relationship is observed in the Asian population is unclear. The correlation between the CSAs measured on anteroposterior radiographs and the presence or absence of rotator cuff tears or OA changes was assessed in 295 patients. Rotator cuff tears were diagnosed with magnetic resonance imaging or ultrasonography. OA findings were classified using the Samilson-Prieto classification. The CSAs among the patients with rotator cuff tears, OA changes, and those without pathologies were compared. Multivariable analyses were used to clarify the potential risks for these pathologies. The mean CSA with rotator cuff tear (33.9° ± 4.1°) was significantly greater than that without a rotator cuff tear (32.3° ± 4.5°; P = .002). Multivariable analysis also showed that a greater CSA had a significantly increased risk of rotator cuff tears, with the odds ratio of 1.08 per degree. OA findings showed no significant correlation to the CSAs. Our study demonstrates that the CSA is greater in those with a rotator cuff tear than in those without a tear or OA changes, which may be an independent risk factor for the incidence of rotator cuff tears in the Japanese population. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Incident-response monitoring technologies for aircraft cabin air quality
NASA Astrophysics Data System (ADS)
Magoha, Paul W.
from BAS tests by optical particle counter (OPC) revealed lognormal distributions with the mean (range) of geometric mass mean diameter (GMMD) = 0.41 (0.39, 0.45) microm and geometric standard deviation (GSD), sigma g = 1.92 (1.87, 1.98). FESEM/EDS and NAA techniques found a wide range of elements on filters, and further investigations of used filters are recommended using these techniques. The protocols for air and filter sampling and GC/MS analysis used in this study will increase the options available for detecting jet engine oil on cabin air filters. Such criteria could support policy development for compliance with cabin air quality standards during incidents.
NASA Astrophysics Data System (ADS)
ter Avest, Ina
2017-02-01
To prepare Dutch students in education for critical situations in their professional life as a teacher, part of their training is to ask them to reflect upon their own experiences in their life as a child, a pupil and a student - experiences of crucial moments or with significant others which are still of the utmost importance to them. This article underlines the significance of so-called "experiential learning" in student career counselling. In this context, experiential learning is understood as an extension of in- depth reflection on critical incidents and critical persons in the biography of pre-service teachers. This reflection - customary and effective in Dutch teacher training - is a verbal process. However, this technique does not seem to be adequate for many students from other cultural backgrounds (e.g. second-generation descendants of migrant workers). By consequence, some of these students are not able to take newly offered information on board, but remain imprisoned in their own culture-related narrative, their own ethnic society of mind. Research has shown that for these students, psychodrama techniques, focusing on non-verbal and playful aspects of reflection, seem to be more suitable. The author of this article presents a sample case from a pilot study which used one of the psychodrama techniques called the empty chair. The findings of the pilot study are promising in the sense that experiencing different I- positions does seem to help students from other cultural backgrounds to develop agency in responding to hitherto unfamiliar and confusing situations.
Critical illumination condenser for x-ray lithography
Cohen, S.J.; Seppala, L.G.
1998-04-07
A critical illumination condenser system is disclosed, particularly adapted for use in extreme ultraviolet (EUV) projection lithography based on a ring field imaging system and a laser produced plasma source. The system uses three spherical mirrors and is capable of illuminating the extent of the mask plane by scanning either the primary mirror or the laser plasma source. The angles of radiation incident upon each mirror of the critical illumination condenser vary by less than eight (8) degrees. For example, the imaging system in which the critical illumination condenser is utilized has a 200 {micro}m source and requires a magnification of 26. The three spherical mirror system constitutes a two mirror inverse Cassegrain, or Schwarzschild configuration, with a 25% area obstruction (50% linear obstruction). The third mirror provides the final pupil and image relay. The mirrors include a multilayer reflective coating which is reflective over a narrow bandwidth. 6 figs.
Critical illumination condenser for x-ray lithography
Cohen, Simon J.; Seppala, Lynn G.
1998-01-01
A critical illumination condenser system, particularly adapted for use in extreme ultraviolet (EUV) projection lithography based on a ring field imaging system and a laser produced plasma source. The system uses three spherical mirrors and is capable of illuminating the extent of the mask plane by scanning either the primary mirror or the laser plasma source. The angles of radiation incident upon each mirror of the critical illumination condenser vary by less than eight (8) degrees. For example, the imaging system in which the critical illumination condenser is utilized has a 200 .mu.m source and requires a magnification of 26.times.. The three spherical mirror system constitutes a two mirror inverse Cassegrain, or Schwarzschild configuration, with a 25% area obstruction (50% linear obstruction). The third mirror provides the final pupil and image relay. The mirrors include a multilayer reflective coating which is reflective over a narrow bandwidth.
[Chernobyl nuclear power plant accident and Tokaimura criticality accident].
Takada, Jun
2012-03-01
It is clear from inspection of historical incidents that the scale of disasters in a nuclear power plant accident is quite low level overwhelmingly compared with a nuclear explosion in nuclear war. Two cities of Hiroshima and Nagasaki were destroyed by nuclear blast with about 20 kt TNT equivalent and then approximately 100,000 people have died respectively. On the other hand, the number of acute death is 30 in the Chernobyl nuclear reactor accident. In this chapter, we review health hazards and doses in two historical nuclear incidents of Chernobyl and Tokaimura criticality accident and then understand the feature of the radiation accident in peaceful utilization of nuclear power.
The Citadel, Trying Hard to Shed Old-South Image, Set Back by 'the Incident.'
ERIC Educational Resources Information Center
Hirschorn, Michael W.
1987-01-01
The Citadel, a state institution, has attempted to push for a broad-based education in languages, history, and literature while maintaining its 145-year-old tradition of military discipline and training. An incident with a black cadet has brought on a barrage of public criticism. (MLW)
Carvajal, Thaddeus M; Viacrusis, Katherine M; Hernandez, Lara Fides T; Ho, Howell T; Amalin, Divina M; Watanabe, Kozo
2018-04-17
Several studies have applied ecological factors such as meteorological variables to develop models and accurately predict the temporal pattern of dengue incidence or occurrence. With the vast amount of studies that investigated this premise, the modeling approaches differ from each study and only use a single statistical technique. It raises the question of whether which technique would be robust and reliable. Hence, our study aims to compare the predictive accuracy of the temporal pattern of Dengue incidence in Metropolitan Manila as influenced by meteorological factors from four modeling techniques, (a) General Additive Modeling, (b) Seasonal Autoregressive Integrated Moving Average with exogenous variables (c) Random Forest and (d) Gradient Boosting. Dengue incidence and meteorological data (flood, precipitation, temperature, southern oscillation index, relative humidity, wind speed and direction) of Metropolitan Manila from January 1, 2009 - December 31, 2013 were obtained from respective government agencies. Two types of datasets were used in the analysis; observed meteorological factors (MF) and its corresponding delayed or lagged effect (LG). After which, these datasets were subjected to the four modeling techniques. The predictive accuracy and variable importance of each modeling technique were calculated and evaluated. Among the statistical modeling techniques, Random Forest showed the best predictive accuracy. Moreover, the delayed or lag effects of the meteorological variables was shown to be the best dataset to use for such purpose. Thus, the model of Random Forest with delayed meteorological effects (RF-LG) was deemed the best among all assessed models. Relative humidity was shown to be the top-most important meteorological factor in the best model. The study exhibited that there are indeed different predictive outcomes generated from each statistical modeling technique and it further revealed that the Random forest model with delayed meteorological
Clinical review: Critical illness polyneuropathy and myopathy
Hermans, Greet; De Jonghe, Bernard; Bruyninckx, Frans; Berghe, Greet Van den
2008-01-01
Critical illness polyneuropathy (CIP) and myopathy (CIM) are major complications of severe critical illness and its management. CIP/CIM prolongs weaning from mechanical ventilation and physical rehabilitation since both limb and respiratory muscles can be affected. Among many risk factors implicated, sepsis, systemic inflammatory response syndrome, and multiple organ failure appear to play a crucial role in CIP/CIM. This review focuses on epidemiology, diagnostic challenges, the current understanding of pathophysiology, risk factors, important clinical consequences, and potential interventions to reduce the incidence of CIP/CIM. CIP/CIM is associated with increased hospital and intensive care unit (ICU) stays and increased mortality rates. Recently, it was shown in a single centre that intensive insulin therapy significantly reduced the electrophysiological incidence of CIP/CIM and the need for prolonged mechanical ventilation in patients in a medical or surgical ICU for at least 1 week. The electrophysiological diagnosis was limited by the fact that muscle membrane inexcitability was not detected. These results have yet to be confirmed in a larger patient population. One of the main risks of this therapy is hypoglycemia. Also, conflicting evidence concerning the neuromuscular effects of corticosteroids exists. A systematic review of the available literature on the optimal approach for preventing CIP/CIM seems warranted. PMID:19040777
Roche, Lisa M; Niu, Xiaoling; Pawlish, Karen S; Henry, Kevin A
2011-01-01
The study's purpose was to investigate thyroid cancer incidence time trends, birth cohort effects, and association with socioeconomic status (SES) in New Jersey (NJ), a high incidence state, using NJ State Cancer Registry data. Thyroid cancer incidence rates in each sex, nearly all age groups, two major histologies and all stages significantly increased between 1979 and 2006. For each sex, age-specific incidence rates began greatly increasing in the 1924 birth cohort and, generally, the highest thyroid cancer incidence rate for each five-year age group occurred in the latest birth cohort and diagnosis period. Thyroid cancer incidence rates were significantly higher in NJ Census tracts with higher SES and in counties with a higher percentage of insured residents. These results support further investigation into the relationship between rising thyroid cancer incidence and increasing population exposure to medical (including diagnostic) radiation, as well as widespread use of more sensitive diagnostic techniques.
Martinez-Serra, Jordi; Gutiérrez, Antonio; Marcús, Toni F; Soverini, Simona; Amat, Juan Carlos; Navarro-Palou, María; Ros, Teresa; Bex, Teresa; Ballester, Carmen; Bauça, Josep Miquel; SanFelix, Sara; Novo, Andrés; Vidal, Carmen; Santos, Carmen; Besalduch, Joan
2012-03-01
Within the laboratory protocols, used for the study of BCR-ABL resistance mutations in chronic myeloid leukemia patients treated with Imatinib, direct sequencing remains the reference method. Since the incidence of patients with a mutation-related loss of response is not very high, it is very useful in the routine laboratory to perform a fast pre-screening method. With this in mind, we have designed a new technique, based on a single Real-Time FRET-based PCR, followed by a study of melting peaks. This new tool, developed in a LightCycler 2.0, combines four different fluorescence channels for the simultaneous detection, in a single close tube, of critical mutations within the ABL kinase domain. Assay evaluation performed on 33 samples, previously genotyped by sequentiation, resulted in full concordance of results. This new methodology detects in a few steps the presence of critical mutations associated to Imatinib resistance. Copyright © 2012 Elsevier Inc. All rights reserved.
Constipation in intensive care unit: incidence and risk factors.
Nassar, Antonio Paulo; da Silva, Fernanda Maria Queiroz; de Cleva, Roberto
2009-12-01
Although gastrointestinal motility disorders are common in critically ill patients, constipation and its implications have received very little attention. We aimed to determine the incidence of constipation to find risk factors and its implications in critically ill patients During a 6-month period, we enrolled all patients admitted to an intensive care unit from an universitary hospital who stayed 3 or more days. Patients submitted to bowel surgery were excluded. Constipation occurred in 69.9% of the patients. There was no difference between constipated and not constipated in terms of sex, age, Acute Physiology and Chronic Health Evaluation II, type of admission (surgical, clinical, or trauma), opiate use, antibiotic therapy, and mechanical ventilation. Early (<24 hours) enteral nutrition was associated with less constipation, a finding that persisted at multivariable analysis (P < .01). Constipation was not associated with greater intensive care unit or mortality, length of stay, or days free from mechanical ventilation. Constipation is very common among critically ill patients. Early enteral nutrition is associated with earlier return of bowel function.
Nursing care of children after a traumatic incident.
Mulvihill, Deanna
2007-01-01
The objective of this study was to describe the nursing interventions with children and their parents to reduce the impact of a traumatic incident. A traumatic incident can be a natural disaster, a plane or car accident, or child abuse. The author has conducted an interdisciplinary integrative review of the research literature on the health impact of childhood trauma. This research is summarized and the results are synthesized and presented in a diagram that demonstrates the strong relationships that trauma has to both short and long-term health status. The impact of post-traumatic stress disorder (PTSD) and interventions to reduce its impact are described. Predictability and continuity in nursing care grounded in both routine and personnel are important. Nurses can teach self-soothing techniques and coping skills prior to using exploratory dialogue to assist the child and the parent in reviewing the traumatic incident. Nurses can also act as advocates for unsafe situations and practices, such as corporal punishment. Assessment of children for history of trauma is indicated, especially children who exhibit signs of short-term health effects. Areas for health education and future research are also presented.
Incidence of occult athlete's foot in swimmers.
Attye, A; Auger, P; Joly, J
1990-09-01
Athlete's foot is a dermatophytic infection frequently found in adults. This disease is, in some cases, asymptomatic. In order to evaluate the incidence of subclinical infection, we obtained 300 toe-web samples from the fourth interdigital space of 150 regular swimmers. More over, 66 specimens from the pool area were analysed. The method used was the carpet technique described by Mariat et al. (10). The fungal isolates were identified according to standard methods. A list of epidemiological data was completed for every swimmer. In our results, 22 swimmers had positive cultures (15%), 8 of these cases had no lesions (36%). They included 7 infections with Trichophyton mentagrophytes (87.5%) and one with T. rubrum (12.5%). We observed one case with a dual infection. Only one sample from the inanimate environment was positive. This study showed a significant incidence of occult athlete's foot in swimmers. To control this endemic problem, adequate preventive measures must be taken.
Mass Casualty Chemical Incident Operational Framework, Assessment and Best Practices
DOE Office of Scientific and Technical Information (OSTI.GOV)
Greenwalt, R. J.; Hibbard, W. J.
2016-05-04
Emergency response agencies in most US communities are organized, sized, and equipped to manage those emergencies normally expected. Hospitals in particular do not typically have significant excess capacity to handle massive numbers of casualties, as hospital space is an expensive luxury if not needed. Unfortunately this means that in the event of a mass casualty chemical incident the emergency response system will be overwhelmed. This document provides a self-assessment means for emergency managers to examine their response system and identify shortfalls. It also includes lessons from a detailed analysis of five communities: Baltimore, Boise, Houston, Nassau County, and New Orleans.more » These lessons provide a list of potential critical decisions to allow for pre-planning and a library of best practices that may be helpful in reducing casualties in the event of an incident.« less
Mass Casualty Chemical Incident Operational Framework, Assessment and Best Practices
DOE Office of Scientific and Technical Information (OSTI.GOV)
Greenwalt, R.; Hibbard, W.
2016-08-09
Emergency response agencies in most US communities are organized, sized, and equipped to manage those emergencies normally expected. Hospitals in particular do not typically have significant excess capacity to handle massive numbers of casualties, as hospital space is an expensive luxury if not needed. Unfortunately this means that in the event of a mass casualty chemical incident the emergency response system will be overwhelmed. This document provides a self-assessment means for emergency managers to examine their response system and identify shortfalls. It also includes lessons from a detailed analysis of five communities: Baltimore, Boise, Houston, Nassau County, and New Orleans.more » These lessons provide a list of potential critical decisions to allow for pre-planning and a library of best practices that may be helpful in reducing casualties in the event of an incident.« less
Critical Thinking Concept Reconstructed
ERIC Educational Resources Information Center
Minter, Mary Kennedy
2010-01-01
This paper explores the proposition that teaching of critical thinking (CT) should include: (1) identifying and addressing the many environmental variables acting as barriers to our human thinking, i.e., an open system approach, and (2) utilizing the interrelatedness of the CT building blocks, i.e., creative thinking techniques, levels of…
Critical incident management guidelines
DOT National Transportation Integrated Search
1998-07-01
The public transportation network in the United States includes 508 bus and rail agencies and 15 commuter railroads providing 22 million trips daily, 8 billion trips annually. These agencies employ almost 300,000 people and provide approximately 41 b...
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.
Spanish multicenter study to estimate the incidence of chronic pancreatitis.
Domínguez Muñoz, J Enrique; Lucendo Villarín, Alfredo José; Carballo Álvarez, L Fernando; Tenías, Jose María; Iglesias García, Julio
2016-07-01
To estimate the incidence of chronic pancreatitis in Spain as diagnosed with endoscopic ultrasound (EUS), and to assess the risk factors and complications detected. A descriptive, observational study of chronic pancreatitis cases diagnosed in Spanish health care centers with an EUS unit. A structured questionnaire was used to evaluate the incidence of the disease (cases identified over 18 months: from January 2011 to June 2012), risk factors, EUS criteria, Rosemont classification, and frequency of local complications. Twenty-three centers were selected serving a total reference area of 14,752,704 population. During the study period 1,031 chronic pancreatitis cases were diagnosed, with an incidence of 4.66 cases per 105 inhabitants/year (95% CI: 4.65-4.67). Tobacco and alcohol use appear as risk factors in 63.8% and 66.7% of cases, respectively. Of these, 53.3% met > 5 EUS criteria for chronic pancreatitis, and 69% had findings suggestive of or consistent with chronic pancreatitis according to the Rosemont classification. Most prevalent complications included calcifications (34.7%), pseudocysts (16%), and presence of an inflammatory pancreatic tumor (10.4%). The incidence of chronic pancreatitis in Spain is similar to that of other European countries. Given the widespread use of the technique, EUS units are key in detecting the disease, and their activity and results allow to estimate the incidence of chronic pancreatitis over wide, representative population areas.
Loop, Carole
2013-01-01
Carrying out critical business functions without interruption requires a resilient and robust business continuity framework. By embedding an industry-standard incident management system within its business continuity structure, the Bank of Canada strengthened its response plan by enabling timely response to incidents while maintaining a strong focus on business continuity. A total programme approach, integrating the two disciplines, provided for enhanced recovery capabilities. While the value of an effective and efficient response organisation is clear, as demonstrated by emergency events around the world, incident response structures based on normal operating hierarchy can experience unique challenges. The internationally-recognised Incident Command System (ICS) model addresses these issues and reflects the five primary incident management functions, each contributing to the overall strength and effectiveness of the response organisation. The paper focuses on the Bank of Canada's successful implementation of the ICS model as its incident management and continuity of operations programmes evolved to reflect current best practices.
Plummer, Mark P.; Finnis, Mark E.; Phillips, Liza K.; Kar, Palash; Bihari, Shailesh; Biradar, Vishwanath; Moodie, Stewart; Horowitz, Michael; Shaw, Jonathan E.; Deane, Adam M.
2016-01-01
Objective Stress induced hyperglycemia occurs in critically ill patients who have normal glucose tolerance following resolution of their acute illness. The objective was to evaluate the association between stress induced hyperglycemia and incident diabetes in survivors of critical illness. Design Retrospective cohort study. Setting All adult patients surviving admission to a public hospital intensive care unit (ICU) in South Australia between 2004 and 2011. Patients Stress induced hyperglycemia was defined as a blood glucose ≥ 11.1 mmol/L (200 mg/dL) within 24 hours of ICU admission. Prevalent diabetes was identified through ICD-10 coding or prior registration with the Australian National Diabetes Service Scheme (NDSS). Incident diabetes was identified as NDSS registration beyond 30 days after hospital discharge until July 2015. The predicted risk of developing diabetes was described as sub-hazard ratios using competing risk regression. Survival was assessed using Cox proportional hazards regression. Main Results Stress induced hyperglycemia was identified in 2,883 (17%) of 17,074 patients without diabetes. The incidence of type 2 diabetes following critical illness was 4.8% (821 of 17,074). The risk of diabetes in patients with stress induced hyperglycemia was approximately double that of those without (HR 1.91 (95% CI 1.62, 2.26), p<0.001) and was sustained regardless of age or severity of illness. Conclusions Stress induced hyperglycemia identifies patients at subsequent risk of incident diabetes. PMID:27824898
Boo, Gianluca; Leyk, Stefan; Fabrikant, Sara Irina; Pospischil, Andreas; Graf, Ramona
2017-05-11
Epidemiological research of canine cancers could inform comparative studies of environmental determinants for a number of human cancers. However, such an approach is currently limited because canine cancer data sources are still few in number and often incomplete. Incompleteness is typically due to under-ascertainment of canine cancers. A main reason for this is because dog owners commonly do not seek veterinary care for this diagnosis. Deeper knowledge on under-ascertainment is critical for modelling canine cancer incidence, as an indication of zero incidence might originate from the sole absence of diagnostic examinations within a given sample unit. In the present case study, we investigated effects of such structural zeros on models of canine cancer incidence. In doing so, we contrasted two scenarios for modelling incidence data retrieved from the Swiss Canine Cancer Registry. The first scenario was based on the complete enumeration of incidence data for all Swiss municipal units. The second scenario was based on a filtered sample that systematically discarded structural zeros in those municipal units where no diagnostic examination had been performed. By means of cross-validation, we assessed and contrasted statistical performance and predictive power of the two modelling scenarios. This analytical step allowed us to demonstrate that structural zeros impact on the generalisability of the model of canine cancer incidence, thus challenging future comparative studies of canine and human cancers. The results of this case study show that increased awareness about the effects of structural zeros is critical to epidemiological research.
Simulation verification techniques study
NASA Technical Reports Server (NTRS)
Schoonmaker, P. B.; Wenglinski, T. H.
1975-01-01
Results are summarized of the simulation verification techniques study which consisted of two tasks: to develop techniques for simulator hardware checkout and to develop techniques for simulation performance verification (validation). The hardware verification task involved definition of simulation hardware (hardware units and integrated simulator configurations), survey of current hardware self-test techniques, and definition of hardware and software techniques for checkout of simulator subsystems. The performance verification task included definition of simulation performance parameters (and critical performance parameters), definition of methods for establishing standards of performance (sources of reference data or validation), and definition of methods for validating performance. Both major tasks included definition of verification software and assessment of verification data base impact. An annotated bibliography of all documents generated during this study is provided.
Teaching Critical Thinking in a Library Credit Course.
ERIC Educational Resources Information Center
Poirier, Gayle; Hocker, Susan
1993-01-01
Discussion of critical thinking skills focuses on the academic library's role in teaching critical thinking skills based on experiences with a library resources course at Louisiana State University. Teaching techniques are discussed, sample lessons are described, and evaluation of students' research papers and student retention of skills are…
Kim, Dae Yoon; Park, Jung Cheol; Kim, Jae Kyun; Sung, Yu Sub; Park, Eun Suk; Kwak, Jae Hyuk; Choi, Choong-Gon
2015-01-01
Purpose Diffusion-weighted MR images (DWI) obtained after endovascular treatment of cerebral aneurysms frequently show multiple high-signal intensity (HSI) dots. The purpose of this study was to see whether we could reduce their incidence after embolization of unruptured cerebral aneurysms by modification of our coiling technique, which involves the deliberate aspiration of the microcatheter lumen right after delivery of each detachable coil into the aneurysm sac. Materials and Methods From January 2011 to June 2011, all 71 patients with unruptured cerebral aneurysms were treated using various endovascular methods. During the earlier period, 37 patients were treated using our conventional embolization technique (conventional period). Then 34 patients were treated with a modified coiling technique (modified period). DWI was obtained on the following day. We compared the occurrence of any DWI HSI lesions and the presence of the symptomatic lesions during the two time periods. Results The incidence of the DWI HSI lesions differed significantly at 89.2% (33/37) during the conventional period and 26.5% (9/34) during the modified period (p < 0.0001). The incidence of symptomatic lesions differed between the two periods (29.7% during the conventional period vs. 2.9% during the modified period, p < 0.003). Conclusion Aspiration of the inner content of the microcatheter right after detachable coil delivery was helpful for the reduction of the incidence of microembolisms after endovascular coil embolization for the treatment of unruptured cerebral aneurysms. PMID:26389009
Suddick, Kitty M; De Souza, Lorraine H
2007-12-01
This paper reports the second part of an exploratory study into occupational therapists' and physiotherapists' perceptions and experiences of teamwork in neurological rehabilitation: the factors that were thought to influence effective and ineffective teamwork, and the meaning behind effective and ineffective teamwork in neurological rehabilitation. The study was undertaken through semi-structured interviews of 10 therapists from three different neurological rehabilitation teams based in the United Kingdom, and used the critical incident technique. Through analysis of the data, several main themes emerged regarding the perceived critical happenings in effective and ineffective teamwork. These were: team events and characteristics, team members' characteristics, shared and collaborative working practices, communication, specific organizational structures, environmental, external, and patient and family-related factors. Effective and ineffective team-work was perceived to impact on a number of levels: having implications for the team, the patient, individual team members, and the neurological rehabilitation service. The study supported the perceived value of team work within neurological rehabilitation. It also indicated the extensive and variable factors that may influence the team-working process as well as the complex and diverse nature of the process.
The role of student’s critical asking question in developing student’s critical thinking skills
NASA Astrophysics Data System (ADS)
Santoso, T.; Yuanita, L.; Erman, E.
2018-01-01
Questioning means thinking, and thinking is manifested in the form of questions. Research that studies the relationship between questioning and students’ critical thinking skills is little, if any. The aim of this study is to examine how student’s questions skill correlates to student’s critical thinking skills in learning of chemistry. The research design used was one group pretest-posttest design. The participants involved were 94 students, all of whom attended their last semesters, Chemistry Education of Tadulako University. A pre-test was administered to check participants’ ability to ask critical questions and critical thinking skills in learning chemistry. Then, the students were taught by using questioning technique. After accomplishing the lesson, a post-test was given to evaluate their progress. Obtained data were analyzed by using Pair-Samples T.Test and correlation methods. The result shows that the level of the questions plays an important role in critical thinking skills is the question levels of predictive, analysis, evaluation and inference.
Perfect transmission at oblique incidence by trigonal warping in graphene P-N junctions
NASA Astrophysics Data System (ADS)
Zhang, Shu-Hui; Yang, Wen
2018-01-01
We develop an analytical mode-matching technique for the tight-binding model to describe electron transport across graphene P-N junctions. This method shares the simplicity of the conventional mode-matching technique for the low-energy continuum model and the accuracy of the tight-binding model over a wide range of energies. It further reveals an interesting phenomenon on a sharp P-N junction: the disappearance of the well-known Klein tunneling (i.e., perfect transmission) at normal incidence and the appearance of perfect transmission at oblique incidence due to trigonal warping at energies beyond the linear Dirac regime. We show that this phenomenon arises from the conservation of a generalized pseudospin in the tight-binding model. We expect this effect to be experimentally observable in graphene and other Dirac fermions systems, such as the surface of three-dimensional topological insulators.
An evaluation of the critical care assistant role within an acute NHS Trust Critical Care Unit.
McGloin, Sarah; Knowles, Judie
2005-01-01
This study provides an evaluation of a training programme designed for developing six critical care assistants to work alongside registered nurses to care for patients within the critical care environment. The programme was run as a pilot funded from the Department of Health's 'critical care bid'. At 18 months long, the programme incorporated a foundation programme, and National Vocational Qualification (NVQ) level 3 in care and adapted Operating Department Practitioner (ODP) NVQ units. Six critical care assistants successfully completed the programme; however, they all then left the unit to undertake further study for pre-registration nursing qualifications. Upon evaluation, a number of key issues were identified. Clear definition of the critical care assistants's role is essential as are dedicated practice development staff, who focus purely on developing the critical care assistant role. More importantly, however, with such key changes in the staffing structure within critical care units, appropriate change management techniques should be employed, ensuring that all staff contributing to the training and development are fully involved from the start.
A new suture technique avoids rib fractures and intercostal nerve trauma in thoracotomy.
Huang, Biaotong
2014-12-01
This article describes an alternative suture technique for thoracotomy incisions. A modified mattress suture technique is used to fix the intercostal muscles. The described technique can prevent rib fractures and reduce the incidence of intercostal nerve injury. Also, this technique is easy to perform and is effective. Georg Thieme Verlag KG Stuttgart · New York.
A day in the life of a volunteer incident commander: errors, pressures and mitigating strategies.
Bearman, Christopher; Bremner, Peter A
2013-05-01
To meet an identified gap in the literature this paper investigates the tasks that a volunteer incident commander needs to carry out during an incident, the errors that can be made and the way that errors are managed. In addition, pressure from goal seduction and situation aversion were also examined. Volunteer incident commanders participated in a two-part interview consisting of a critical decision method interview and discussions about a hierarchical task analysis constructed by the authors. A SHERPA analysis was conducted to further identify potential errors. The results identified the key tasks, errors with extreme risk, pressures from strong situations and mitigating strategies for errors and pressures. The errors and pressures provide a basic set of issues that need to be managed by both volunteer incident commanders and fire agencies. The mitigating strategies identified here suggest some ways that this can be done. Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.
Peer coaching as a technique to foster professional development in clinical ambulatory settings.
Sekerka, Leslie E; Chao, Jason
2003-01-01
Few studies have examined how peer coaching is an effective educational and development technique in contexts outside the classroom. This research focused on peer coaching as a platform to study the process of professional development for physicians. The purpose was to identify perceived benefits coaches received from a coaching encounter and how this relates to their own process of professional development. Critical incident interviews with 13 physician coaches were conducted and tape recorded. Themes were identified using a thematic analysis technique. Themes emerged clustering around two distinct benefit orientations. Group 1, reflection and teaching coaches, tended to focus on others and discuss how positively they experienced the encounter. Group 2, personal learning and change coaches, expressed benefits along more personal lines. Peer coaching contributes to physicians' professional development by encouraging reflection time and learning. Peer coaching affords positive impact to those who coach in addition to those who receive the coaching. The two clusters of benefits support the performance, learning, and development theory in that there are multiple modes to describe adult growth and development. Programs of this type should be considered in medical faculty development activities associated with medical education.
Diarrhoea risk factors in enterally tube fed critically ill patients: a retrospective audit.
Jack, Leanne; Coyer, Fiona; Courtney, Mary; Venkatesh, Bala
2010-12-01
Diarrhoea in the enterally tube fed (ETF) intensive care unit (ICU) patient is a multi-factorial problem. Diarrhoeal aetiologies in this patient cohort remain debatable; however, the consequences of diarrhoea have been well established and include electrolyte imbalance, dehydration, bacterial translocation, peri anal wound contamination and sleep deprivation. This study examined the incidence of diarrhoea and explored factors contributing to the development of diarrhoea in the ETF, critically ill, adult patient. After institutional ethical review and approval, a single centre medical chart audit was undertaken to examine the incidence of diarrhoea in ETF, critically ill patients. Retrospective, non-probability sequential sampling was used of all emergency admission adult ICU patients who met the inclusion/exclusion criteria. Fifty patients were audited. Faecal frequency, consistency and quantity were considered important criteria in defining ETF diarrhoea. The incidence of diarrhoea was 78%. Total patient diarrhoea days (r=0.422; p=0.02) and total diarrhoea frequency (r=0.313; p=0.027) increased when the patient was ETF for longer periods of time. Increased severity of illness, peripheral oxygen saturation (Sp02), glucose control, albumin and white cell count were found to be statistically significant factors for the development of diarrhoea. Diarrhoea in ETF critically ill patients is multi-factorial. The early identification of diarrhoea risk factors and the development of a diarrhoea risk management algorithm is recommended. Copyright © 2010. Published by Elsevier Ltd.
Pottage, T; Goode, E; Wyke, S; Bennett, A M
2014-11-01
Since 2000 there have been a number of biological incidents resulting in environmental contamination with Bacillus anthracis, the causative agent of anthrax. These incidents include the US anthrax attacks in 2001, the US and UK drumming incidents in 2006-2008 and more recently, anthrax contamination of heroin in 2009/2010 and 2012/2013. Remediation techniques used to return environments to normal have varied between incidents, with different decontamination technologies being employed. Many factors need to be considered before a remediation strategy or recovery option can be implemented, including; cost, time (length of application), public perception of risk, and sampling strategies (and results) to name a few. These incidents have demonstrated that consolidated guidance for remediating biologically contaminated environments in the aftermath of a biological incident was required. The UK Recovery Handbook for Biological Incidents (UKRHBI) is a project led by Public Health England (PHE), formerly the Health Protection Agency (HPA) to provide guidance and advice on how to remediate the environment following a biological incident or outbreak of infection, and is expected to be published in 2015. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.
Critical Thinking, Parenting, and the Dance of Adolescence.
ERIC Educational Resources Information Center
Sargant, Hope
2002-01-01
A parent of a gifted preteen discusses how parents can promote critical thinking in their gifted adolescents. Parents are urged to focus three levels of cognition where critical thinking is believed to take place: analysis, synthesis, and evaluation. Examples of positive interactions and questioning techniques are provided. (Contains 1 reference.)…
Program Development for Primary School Teachers' Critical Thinking
ERIC Educational Resources Information Center
Boonjeam, Waraporn; Tesaputa, Kowat; Sri-ampai, Anan
2017-01-01
The objectives of this research were: 1) to study the elements and indicators of primary school teachers' critical thinking, 2) to study current situation, desirable situation, development technique, and need for developing the primary school teachers' critical thinking, 3) to develop the program for developing the primary school teachers'…
Concept Mapping for Critical Thinking: Efficacy, Timing, & Type
ERIC Educational Resources Information Center
Harris, Charles M.; Zha, Shenghua
2017-01-01
Many college students are not progressing in the development of their critical thinking skills. Concept mapping is a technique for facilitating validation of one's critical thinking by graphically depicting the structure of complex concepts. Each of our three studies of concept mapping involved approximately 240 students enrolled in four sections…
Fabrication of a grazing incidence telescope by grinding and polishing techniques on aluminum
NASA Technical Reports Server (NTRS)
Gallagher, Dennis; Cash, Webster; Green, James
1991-01-01
The paper describes the fabrication processes, by grinding and polishing, used in making the mirrors for a f/2.8 Wolter type-I grazing incidence telescope at Boulder (Colorado), together with testing procedure used to determine the quality of the images. All grinding and polishing is done on specially designed machine that consists of a horizontal spindle to hold and rotate the mirror and a stroke arm machine to push the various tools back and forth along the mirrors length. The progress is checked by means of the ronchi test during all grinding and polishing stages. Current measurements of the telescope's image quality give a FWHM measurement of 44 arcsec, with the goal set at 5-10 arcsec quality.
Critical thinking: assessing the risks to the future security of supply of critical metals
NASA Astrophysics Data System (ADS)
Gunn, Gus
2015-04-01
supplies of raw materials. These have led to major new programmes of research throughout the minerals value chain, in order to improve the raw materials knowledge base, to develop best practices and promote international collaboration. Although recycling will make an increasingly important contribution to supply, it can never meet the total requirement when demand is increasing. Therefore, new resources of primary materials, identified through geological research, will continue to be required. The availability of regional baseline datasets, comprising geological, geophysical and geochemical data, is fundamental to the identification of exploration targets. However, in order to focus exploration we also require robust mineral deposit models for the critical metals which hitherto these have been largely neglected because of their limited economic importance. For commodities such as the platinum-group metals (PGM), cobalt, niobium, indium, rare earth elements (REE) and cobalt we have some knowledge of the processes controlling their mobilisation and concentration under certain conditions although we have little understanding of the mechanisms of deposit formation elsewhere. We also need effective techniques to explore for these metals. This may involve the development of new geophysical techniques to explore on the sea-floor or beneath thick cover, or new analytical methods for the determination of these elements in exploration samples. Improved metallurgical techniques are also required for effective and energy-efficient recovery of critical metals from ores and concentrates. References European Commission (2010). Critical raw materials for the EU. Report of the Ad-hoc Working Group on Defining Critical Raw Materials. European Commission (2014). Report on Critical raw materials for the EU. Report of the Ad-hoc Working Group on Defining Critical Raw Materials.
Lee, Yong Ho
2014-01-01
Background Infrequent but serious complications of transforaminal epidural steroid injection (TFESI) occur due to inadvertent intravascular injections. A few studies reported that the different needle types can influence on the occurrences of intravascular incidence in TFESI. This study prospectively evaluated whether short-bevel needle can reduce the incidences of intravascular injection of TFESI compared to long-bevel needles. Methods From March 2013 to December 2013, 239 consecutive patients were enrolled and received 249 fluoroscopically guided TFESI using the classic technique. Confirmation of intravascular spread was done initially with real time fluoroscopy and then with digital subtraction angiography method in a same patient. Injection technique for TFESI was the same for both short-bevel and long-bevel needle types. Results The incidences of intravascular injections with the long-bevel and short-bevel needles were 15.0% (21/140) and 9.2% (4/140), respectively. More than half of intravascular injections occurred simultaneously with epidural injections (8.0%, 20/249). There were no statistically significant differences between the long-bevel and the short-bevel needles in the rates of intravascular injections (P = 0.17). Conclusions Short-bevel needles did not demonstrate any benefits in reducing the incidence of intravascular injection. PMID:25302096
International comparisons in critical care: a necessity and challenge.
Wunsch, Hannah; Rowan, Kathryn M; Angus, Derek C
2007-12-01
Understanding variation in critical care resources, and delivery of care between countries will allow for improved disaster planning, evaluation of research findings, and assessment of the utility of critical care itself. This review describes the available data for international comparisons and the many factors that need to be addressed for an appropriate interpretation of results. Recent studies on subgroups of critical care patients include data from many different countries. These new studies provide important information on the overall incidence of these disease states, but most of these international studies do not take into account the critical care resources of the countries being discussed. For an appropriate interpretation of findings the relevant baseline critical care resources, prevalence of diseases, and cultural practices, need to be quantified. The existence of these other factors prevents the use of a severity of illness scoring system alone to account for differences between countries. Many recent critical care studies include data from multiple countries. With continued movement towards international studies, and improvements in data collection systems, comparisons between countries are becoming easier. These findings need to be interpreted in the context of all the relevant country information.
Tremblay, Marlène; Crim, Stacy M; Cole, Dana J; Hoekstra, Robert M; Henao, Olga L; Döpfer, Dörte
2017-10-01
The Foodborne Diseases Active Surveillance Network (FoodNet) is currently using a negative binomial (NB) regression model to estimate temporal changes in the incidence of Campylobacter infection. FoodNet active surveillance in 483 counties collected data on 40,212 Campylobacter cases between years 2004 and 2011. We explored models that disaggregated these data to allow us to account for demographic, geographic, and seasonal factors when examining changes in incidence of Campylobacter infection. We hypothesized that modeling structural zeros and including demographic variables would increase the fit of FoodNet's Campylobacter incidence regression models. Five different models were compared: NB without demographic covariates, NB with demographic covariates, hurdle NB with covariates in the count component only, hurdle NB with covariates in both zero and count components, and zero-inflated NB with covariates in the count component only. Of the models evaluated, the nonzero-augmented NB model with demographic variables provided the best fit. Results suggest that even though zero inflation was not present at this level, individualizing the level of aggregation and using different model structures and predictors per site might be required to correctly distinguish between structural and observational zeros and account for risk factors that vary geographically.
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
Respiratory Acid-Base Disorders in the Critical Care Unit.
Hopper, Kate
2017-03-01
The incidence of respiratory acid-base abnormalities in the critical care unit (CCU) is unknown, although respiratory alkalosis is suspected to be common in this population. Abnormal carbon dioxide tension can have many physiologic effects, and changes in Pco 2 may have a significant impact on outcome. Monitoring Pco 2 in CCU patients is an important aspect of critical patient assessment, and identification of respiratory acid-base abnormalities can be valuable as a diagnostic tool. Treatment of respiratory acid-base disorders is largely focused on resolution of the primary disease, although mechanical ventilation may be indicated in cases with severe respiratory acidosis. Published by Elsevier Inc.
Exploring Gigabyte Datasets in Real Time: Architectures, Interfaces and Time-Critical Design
NASA Technical Reports Server (NTRS)
Bryson, Steve; Gerald-Yamasaki, Michael (Technical Monitor)
1998-01-01
Architectures and Interfaces: The implications of real-time interaction on software architecture design: decoupling of interaction/graphics and computation into asynchronous processes. The performance requirements of graphics and computation for interaction. Time management in such an architecture. Examples of how visualization algorithms must be modified for high performance. Brief survey of interaction techniques and design, including direct manipulation and manipulation via widgets. talk discusses how human factors considerations drove the design and implementation of the virtual wind tunnel. Time-Critical Design: A survey of time-critical techniques for both computation and rendering. Emphasis on the assignment of a time budget to both the overall visualization environment and to each individual visualization technique in the environment. The estimation of the benefit and cost of an individual technique. Examples of the modification of visualization algorithms to allow time-critical control.
Anderson, Janet E; Kodate, Naonori; Walters, Rhiannon; Dodds, Anneliese
2013-04-01
Recent critiques of incident reporting suggest that its role in managing safety has been over emphasized. The objective of this study was to examine the perceived effectiveness of incident reporting in improving safety in mental health and acute hospital settings by asking staff about their perceptions and experiences. Qualitative research design using documentary analysis and semi-structured interviews. Two large teaching hospitals in London; one providing acute and the other mental healthcare. Sixty-two healthcare practitioners with experience of reporting and analysing incidents. Incident reporting was perceived as having a positive effect on safety, not only by leading to changes in care processes but also by changing staff attitudes and knowledge. Staff discussed examples of both instrumental and conceptual uses of the knowledge generated by incident reports. There are difficulties in using incident reports to improve safety in healthcare at all stages of the incident reporting process. Differences in the risks encountered and the organizational systems developed in the two hospitals to review reported incidents could be linked to the differences we found in attitudes to incident reporting between the two hospitals. Incident reporting can be a powerful tool for developing and maintaining an awareness of risks in healthcare practice. Using incident reports to improve care is challenging and the study highlighted the complexities involved and the difficulties faced by staff in learning from incident data.
DOT National Transportation Integrated Search
2017-12-01
In designing an effective traffic management plan for non-recurrent congestion, it is critical for responsible highway agencies to have some vital information, such as estimated incident duration, resulting traffic queues, and the expected delays. Ov...
Mogensen, Kris M; Andrew, Benjamin Y; Corona, Jasmine C; Robinson, Malcolm K
2016-07-01
The Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) recommend that obese, critically ill patients receive 11-14 kcal/kg/d using actual body weight (ABW) or 22-25 kcal/kg/d using ideal body weight (IBW), because feeding these patients 50%-70% maintenance needs while administering high protein may improve outcomes. It is unknown whether these equations achieve this target when validated against indirect calorimetry, perform equally across all degrees of obesity, or compare well with other equations. Measured resting energy expenditure (MREE) was determined in obese (body mass index [BMI] ≥30 kg/m(2)), critically ill patients. Resting energy expenditure was predicted (PREE) using several equations: 12.5 kcal/kg ABW (ASPEN-Actual BW), 23.5 kcal/kg IBW (ASPEN-Ideal BW), Harris-Benedict (adjusted-weight and 1.5 stress-factor), and Ireton-Jones for obesity. Correlation of PREE to 65% MREE, predictive accuracy, precision, bias, and large error incidence were calculated. All equations were significantly correlated with 65% MREE but had poor predictive accuracy, had excessive large error incidence, were imprecise, and were biased in the entire cohort (N = 31). In the obesity cohort (n = 20, BMI 30-50 kg/m(2)), ASPEN-Actual BW had acceptable predictive accuracy and large error incidence, was unbiased, and was nearly precise. In super obesity (n = 11, BMI >50 kg/m(2)), ASPEN-Ideal BW had acceptable predictive accuracy and large error incidence and was precise and unbiased. SCCM/ASPEN-recommended body weight equations are reasonable predictors of 65% MREE depending on the equation and degree of obesity. Assuming that feeding 65% MREE is appropriate, this study suggests that patients with a BMI 30-50 kg/m(2) should receive 11-14 kcal/kg/d using ABW and those with a BMI >50 kg/m(2) should receive 22-25 kcal/kg/d using IBW. © 2015 American Society for Parenteral and Enteral Nutrition.
DOT National Transportation Integrated Search
1976-04-01
The development and testing of incident detection algorithms was based on Los Angeles and Minneapolis freeway surveillance data. Algorithms considered were based on times series and pattern recognition techniques. Attention was given to the effects o...
2018-02-01
the possibility of a correlation between aircraft incidents in the National Transportation Safety Board database and meteorological conditions. If a...strong correlation could be found, it could be used to derive a model to predict aircraft incidents and become part of a decision support tool for...techniques, primarily the random forest algorithm, were used to explore the possibility of a correlation between aircraft incidents in the National
Prediction of high incidence of dengue in the Philippines.
Buczak, Anna L; Baugher, Benjamin; Babin, Steven M; Ramac-Thomas, Liane C; Guven, Erhan; Elbert, Yevgeniy; Koshute, Phillip T; Velasco, John Mark S; Roque, Vito G; Tayag, Enrique A; Yoon, In-Kyu; Lewis, Sheri H
2014-04-01
Accurate prediction of dengue incidence levels weeks in advance of an outbreak may reduce the morbidity and mortality associated with this neglected disease. Therefore, models were developed to predict high and low dengue incidence in order to provide timely forewarnings in the Philippines. Model inputs were chosen based on studies indicating variables that may impact dengue incidence. The method first uses Fuzzy Association Rule Mining techniques to extract association rules from these historical epidemiological, environmental, and socio-economic data, as well as climate data indicating future weather patterns. Selection criteria were used to choose a subset of these rules for a classifier, thereby generating a Prediction Model. The models predicted high or low incidence of dengue in a Philippines province four weeks in advance. The threshold between high and low was determined relative to historical incidence data. Model accuracy is described by Positive Predictive Value (PPV), Negative Predictive Value (NPV), Sensitivity, and Specificity computed on test data not previously used to develop the model. Selecting a model using the F0.5 measure, which gives PPV more importance than Sensitivity, gave these results: PPV = 0.780, NPV = 0.938, Sensitivity = 0.547, Specificity = 0.978. Using the F3 measure, which gives Sensitivity more importance than PPV, the selected model had PPV = 0.778, NPV = 0.948, Sensitivity = 0.627, Specificity = 0.974. The decision as to which model has greater utility depends on how the predictions will be used in a particular situation. This method builds prediction models for future dengue incidence in the Philippines and is capable of being modified for use in different situations; for diseases other than dengue; and for regions beyond the Philippines. The Philippines dengue prediction models predicted high or low incidence of dengue four weeks in advance of an outbreak with high accuracy, as measured by PPV
Prediction of High Incidence of Dengue in the Philippines
Buczak, Anna L.; Baugher, Benjamin; Babin, Steven M.; Ramac-Thomas, Liane C.; Guven, Erhan; Elbert, Yevgeniy; Koshute, Phillip T.; Velasco, John Mark S.; Roque, Vito G.; Tayag, Enrique A.; Yoon, In-Kyu; Lewis, Sheri H.
2014-01-01
Background Accurate prediction of dengue incidence levels weeks in advance of an outbreak may reduce the morbidity and mortality associated with this neglected disease. Therefore, models were developed to predict high and low dengue incidence in order to provide timely forewarnings in the Philippines. Methods Model inputs were chosen based on studies indicating variables that may impact dengue incidence. The method first uses Fuzzy Association Rule Mining techniques to extract association rules from these historical epidemiological, environmental, and socio-economic data, as well as climate data indicating future weather patterns. Selection criteria were used to choose a subset of these rules for a classifier, thereby generating a Prediction Model. The models predicted high or low incidence of dengue in a Philippines province four weeks in advance. The threshold between high and low was determined relative to historical incidence data. Principal Findings Model accuracy is described by Positive Predictive Value (PPV), Negative Predictive Value (NPV), Sensitivity, and Specificity computed on test data not previously used to develop the model. Selecting a model using the F0.5 measure, which gives PPV more importance than Sensitivity, gave these results: PPV = 0.780, NPV = 0.938, Sensitivity = 0.547, Specificity = 0.978. Using the F3 measure, which gives Sensitivity more importance than PPV, the selected model had PPV = 0.778, NPV = 0.948, Sensitivity = 0.627, Specificity = 0.974. The decision as to which model has greater utility depends on how the predictions will be used in a particular situation. Conclusions This method builds prediction models for future dengue incidence in the Philippines and is capable of being modified for use in different situations; for diseases other than dengue; and for regions beyond the Philippines. The Philippines dengue prediction models predicted high or low incidence of dengue four weeks in advance of
Improved ultrasonic TV images achieved by use of Lamb-wave orientation technique
NASA Technical Reports Server (NTRS)
Berger, H.
1967-01-01
Lamb-wave sample orientation technique minimizes the interference from standing waves in continuous wave ultrasonic television imaging techniques used with thin metallic samples. The sample under investigation is oriented such that the wave incident upon it is not normal, but slightly angled.
Ottomeyer, Christina; Taylor, Benjamin C; Isaacson, Mark; Martinez, Lara; Ebaugh, Pierce; French, Bruce G
2017-02-01
Simultaneous ipsilateral clavicle and acromioclavicular (AC) joint injury have been infrequently reported in the literature at this time. The purpose of this study was to assess incidence as well as assess risk factors for this dual injury pattern. We performed a retrospective review of a prospectively collected database (Level III evidence), evaluating 383 adult patients without previous shoulder girdle injury or trauma with a minimum 1-year follow-up who sustained a displaced diaphyseal clavicle fracture. All patients in the study underwent either nonoperative management or surgical reduction and stabilization of a diaphyseal clavicle fracture with a plate and screw construct. Study subjects were followed with serial radiographs. Clavicle and shoulder radiographs, as well as chest radiographs and contralateral films in questionable cases, were used to assess for acromioclavicular joint injury in both operative and nonoperative groups. Additional data was collected on concurrent injuries, patient demographics, fracture characteristics, fixation techniques, surgical/post-operative data, and operative or nonoperative treatment. We found that 13/183 (7.1%) of patients undergoing fixation of a diaphyseal clavicle fracture had an ipsilateral AC joint injury, while 13/200 (6.5%) of patients undergoing conservative management had an ipsilateral AC joint injury. Critical analysis of the data revealed that presence of ipsilateral scapular body fractures, and a likely incidental association with superior plating fixation, were associated with an increased rate of this injury pattern. Ipsilateral clavicle fracture and AC joint injury is much more common than traditionally believed, with an incidence of 6.8% overall. It is unknown how the presence of an associated AC injury influences outcome, as AC injury was not universally symptomatic. Copyright © 2016 Elsevier Ltd. All rights reserved.
Introduction to Pesticide Incidents
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 explain and facilitate such incident reporting.
Ding, Shifang; Kilickaya, Oguz; Senkal, Serkan; Gajic, Ognjen; Hubmayr, Rolf D.
2013-01-01
Background: Recent changes in critical care delivery, including the widespread implementation of health-care bundles, were aimed at reducing complications of critical illness, in particular ventilator-associated pneumonia (VAP), but no population-based study evaluated its effectiveness. Methods: Using a previously validated electronic medical record database, we identified adult (≥ 18 years old) critically ill patients from Olmsted County, Minnesota, requiring mechanical ventilation for ≥ 48 h from January 2003 to December 2009. Trained intensivists identified cases of VAP according to different established clinical definitions. The incidence and outcome of VAP was compared before and after implementation of the so-called “VAP bundle.” Results: The median age, severity of illness, proportion of surgical patients, and patients with neurologic disease increased over time (P < .05 for trend in all). Regardless of the definition used, the VAP rate remained similar throughout the study period and did not change with the introduction of the VAP bundle. According to previous Centers for Disease Control and Prevention criteria, the yearly estimates of the VAP incidence ranged between 7.1 and 10.4 cases per 1,000 ventilator-days, with an age-adjusted incidence of 3.1 vs 5.6 per 100,000 population (P = .54 for trends). Standardized hospital mortality ratio of patients at high risk to develop VAP significantly decreased from 1.7 (95% CI, 0.8-3.0) to 0.7 (95% CI, 0.3-1.4; P = .0003 for trend). Conclusions: The incidence of VAP was unaffected by the implementation of the VAP bundle. Secular changes in hospital mortality are unlikely to be attributed to the VAP bundle per se. PMID:23907411
Beam profile measurement on HITU transducers using a thermal intensity sensor technique
NASA Astrophysics Data System (ADS)
Wilkens, V.; Sonntag, S.; Jenderka, K.-V.
2011-02-01
Thermal intensity sensors based on the transformation of the incident ultrasonic energy into heat inside a small cylindrical absorber have been developed at PTB in the past, in particular to determine the acoustic output of medical diagnostic ultrasound equipment. Currently, this sensor technique is being expanded to match the measurement challenges of high intensity therapeutic ultrasound (HITU) fields. At the high acoustic power levels as utilized in the clinical application of HITU transducers, beam characterization using hydrophones is critical due to the possible damage of the sensitive and expensive measurement devices. Therefore, the low-cost and robust thermal sensors developed offer a promising alternative for the determination of high intensity output beam profiles. A sensor prototype with a spatial resolution of 0.5 mm was applied to the beam characterization of an HITU transducer operated at several driving amplitude levels. Axial beam plots and lateral profiles at focus were acquired. The absolute continuous wave output power was, in addition, determined using a radiation force balance.
Traffic incident management in hazardous materials spills in incident clearance.
DOT National Transportation Integrated Search
2009-01-01
Hazardous materials spills provide unique challenges to traffic incident clearance. When hazardous materials are present, not only do response personnel have to deal with typical traffic incident issues, they also must deal with potential chemical ha...
Understanding and Reducing Disability in Older Adults Following Critical Illness
Brummel, N.E.; Balas, M.C.; Morandi, A.; Ferrante, L.E.; Gill, T.M.; Ely, E.W.
2015-01-01
Objective To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness. Data Sources Review of the literature describing post-critical illness disability in older adults and expert opinion. Results We identified 19 studies evaluating disability outcomes in critically ill patients age 65 years and older. Newly acquired disability in activities of daily living, instrumental activities of daily living and mobility activities was commonplace among older adults who survived a critical illness. Incident dementia and less-severe cognitive impairment was also highly prevalent. Factors related to the acute critical illness, intensive care unit practices such as heavy sedation, physical restraints and immobility as well as aging physiology and coexisting geriatric conditions can combine to result in these poor outcomes. Conclusion Older adults who survive critical illness suffer physical and cognitive declines resulting in disability at greater rates than hospitalized, non-critically ill and community dwelling older adults. Interventions derived from widely available geriatric care models in use outside of the ICU, which address modifiable risk factors including immobility and delirium, are associated with improved functional and cognitive outcomes and can be used to complement ICU-focused models such as the ABCDEs. PMID:25756418
Manzanares, W; Langlois, P L
2016-01-01
Third-generation lipid emulsions (LE) are soybean oil sparing strategies with immunomodulatory and antiinflammatory effects. Current evidence supporting the use of intravenous (i.v) fish oil (FO) LE in critically ill patients requiring parenteral nutrition or receiving enteral nutrition (pharmaconutrient strategy) mainly derives from small phase ii clinical trials in heterogenous intensive care unit patient's population. Over the last three years, there have been published different systematic reviews and meta-analyses evaluating the effects of FO containing LE in the critically ill. Recently, it has been demonstrated that i.v FO based LE may be able to significantly reduce the incidence of infections as well as mechanical ventilation days and hospital length of stay. Nonetheless, more robust evidence is required before giving a definitive recommendation. Finally, we strongly believe that a dosing study is required before new phase iii clinical trials comparing i.v FO containing emulsions versus other soybean oil strategies can be conducted. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
NASA Astrophysics Data System (ADS)
Sanchez, A. R.; Laguna, A.; Reimann, T.; Giráldez, J. V.; Peña, A.; Wallinga, J.; Vanwalleghem, T.
2017-12-01
Different geomorphological processes such as bioturbation and erosion-deposition intervene in soil formation and landscape evolution. The latter processes produce the alteration and degradation of the materials that compose the rocks. The degree to which the bedrock is weathered is estimated through the fraction of the bedrock which is mixing in the soil either vertically or laterally. This study presents an analytical solution for the diffusion-advection equation to quantify bioturbation and erosion-depositions rates in profiles along a catena. The model is calibrated with age-depth data obtained from profiles using the luminescence dating based on single grain Infrared Stimulated Luminescence (IRSL). Luminescence techniques contribute to a direct measurement of the bioturbation and erosion-deposition processes. Single-grain IRSL techniques is applied to feldspar minerals of fifteen samples which were collected from four soil profiles at different depths along a catena in Santa Clotilde Critical Zone Observatory, Cordoba province, SE Spain. A sensitivity analysis is studied to know the importance of the parameters in the analytical model. An uncertainty analysis is carried out to stablish the better fit of the parameters to the measured age-depth data. The results indicate a diffusion constant at 20 cm in depth of 47 (mm2/year) in the hill-base profile and 4.8 (mm2/year) in the hilltop profile. The model has high uncertainty in the estimation of erosion and deposition rates. This study reveals the potential of luminescence single-grain techniques to quantify pedoturbation processes.
HEKATE-A novel grazing incidence neutron scattering concept for the European Spallation Source.
Glavic, Artur; Stahn, Jochen
2018-03-01
Structure and magnetism at surfaces and buried interfaces on the nanoscale can only be accessed by few techniques, one of which is grazing incidence neutron scattering. While the technique has its strongest limitation in a low signal and large background, due to the low scattering probability and need for high resolution, it can be expected that the high intensity of the European Spallation Source in Lund, Sweden, will make many more such studies possible, warranting a dedicated beamline for this technique. We present an instrument concept, Highly Extended K range And Tunable Experiment (HEKATE), for surface scattering that combines the advantages of two Selene neutron guides with unique capabilities of spatially separated distinct wavelength frames. With this combination, it is not only possible to measure large specular reflectometry ranges, even on free liquid surfaces, but also to use two independent incident beams with tunable sizes and resolutions that can be optimized for the specifics of the investigated samples. Further the instrument guide geometry is tuned for reduction of high energy particle background and only uses low to moderate supermirror coatings for high reliability and affordable cost.
HEKATE—A novel grazing incidence neutron scattering concept for the European Spallation Source
NASA Astrophysics Data System (ADS)
Glavic, Artur; Stahn, Jochen
2018-03-01
Structure and magnetism at surfaces and buried interfaces on the nanoscale can only be accessed by few techniques, one of which is grazing incidence neutron scattering. While the technique has its strongest limitation in a low signal and large background, due to the low scattering probability and need for high resolution, it can be expected that the high intensity of the European Spallation Source in Lund, Sweden, will make many more such studies possible, warranting a dedicated beamline for this technique. We present an instrument concept, Highly Extended K range And Tunable Experiment (HEKATE), for surface scattering that combines the advantages of two Selene neutron guides with unique capabilities of spatially separated distinct wavelength frames. With this combination, it is not only possible to measure large specular reflectometry ranges, even on free liquid surfaces, but also to use two independent incident beams with tunable sizes and resolutions that can be optimized for the specifics of the investigated samples. Further the instrument guide geometry is tuned for reduction of high energy particle background and only uses low to moderate supermirror coatings for high reliability and affordable cost.
Monitoring of pipeline ruptures by means of a Robust Satellite Technique (RST)
NASA Astrophysics Data System (ADS)
Filizzola, C.; Baldassarre, G.; Corrado, R.; Mazzeo, G.; Marchese, F.; Paciello, R.; Pergola, N.; Tramutoli, V.
2009-04-01
Pipeline ruptures have deep economic and ecologic consequences so that pipeline networks represent critical infrastructures to be carefully monitored particularly in areas which are frequently affected by natural disasters like earthquakes, hurricanes, landslide, etc. In order to minimize damages, the detection of harmful events along pipelines should be as rapid as possible and, at the same time, what is detected should be an actual incident and not a false alarm. In this work, a Robust Satellite Technique (RST), already applied to the prevision and NRT (Near Real Time) monitoring of major natural and environmental hazards (such as seismically active areas, volcanic activity, hydrological risk, forest fires and oil spills) has been employed to automatically identify, from satellite, anomalous Thermal Infrared (TIR) transients related to explosions of oil/gas pipelines. In this context, the combination of the RST approach with high temporal resolution, offered by geostationary satellites, seems to assure both a reliable and timely detection of such events. The potentials of the technique (applied to MSG-SEVIRI data) were tested over Iraq, a region which is sadly known for the numerous (mainly manmade) accidents to pipelines, in order to have a simulation of the effects (such as fires or explosions near or directly involving a pipeline facility) due to natural disasters.
Rowe, Meredeth A; Greenblum, Catherine A; DʼAoust, Rita F
2012-12-01
At every stage of dementia, people with the condition are at risk for both missing incidents, in which they are unattended and unable to navigate a safe return to their caregiver, and "wandering," a term often used to describe repetitive locomotion with patterns such as lapping or pacing. By understanding the differences between these two phenomena, nurses can teach caregivers how to anticipate and prevent missing incidents, which are not necessarily related to wandering. The authors differentiate missing incidents from wandering, describe personal characteristics that may influence the outcomes in missing incidents, and suggest strategies for preventing and responding to missing incidents.
Reid, Malcolm J; Langford, Katherine H; Grung, Merete; Gjerde, Hallvard; Amundsen, Ellen J; Morland, Jorg; Thomas, Kevin V
2012-01-01
Objectives A range of approaches are now available to estimate the level of drug use in the community so it is desirable to critically compare results from the differing techniques. This paper presents a comparison of the results from three methods for estimating the level of cocaine use in the general population. Design The comparison applies to; a set of regional-scale sample survey questionnaires, a representative sample survey on drug use among drivers and an analysis of the quantity of cocaine-related metabolites in sewage. Setting 14 438 participants provided data for the set of regional-scale sample survey questionnaires; 2341 drivers provided oral-fluid samples and untreated sewage from 570 000 people was analysed for biomarkers of cocaine use. All data were collected in Oslo, Norway. Results 0.70 (0.36–1.03) % of drivers tested positive for cocaine use which suggest a prevalence that is higher than the 0.22 (0.13–0.30) % (per day) figure derived from regional-scale survey questionnaires, but the degree to which cocaine consumption in the driver population follows the general population is an unanswered question. Despite the comparatively low-prevalence figure the survey questionnaires did provide estimates of the volume of consumption that are comparable with the amount of cocaine-related metabolites in sewage. Per-user consumption estimates are however highlighted as a significant source of uncertainty as little or no data on the quantities consumed by individuals are available, and much of the existing data are contradictory. Conclusions The comparison carried out in the present study can provide an excellent means of checking the quality and accuracy of the three measurement techniques because they each approach the problem from a different viewpoint. Together the three complimentary techniques provide a well-balanced assessment of the drug-use situation in a given community and identify areas where more research is needed. PMID:23144259
Jack, Leanne; Coyer, Fiona; Courtney, Mary; Venkatesh, Bala
2010-12-01
The aim of this literature review is to identify the role of probiotics in the management of enteral tube feeding (ETF) diarrhoea in critically ill patients. Diarrhoea is a common gastrointestinal problem seen in ETF patients. The incidence of diarrhoea in tube fed patients varies from 2% to 68% across all patients. Despite extensive investigation, the pathogenesis surrounding ETF diarrhoea remains unclear. Evidence to support probiotics to manage ETF diarrhoea in critically ill patients remains sparse. Literature on ETF diarrhoea and probiotics in critically ill, adult patients was reviewed from 1980 to 2010. The Cochrane Library, Pubmed, Science Direct, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic databases were searched using specific inclusion/exclusion criteria. Key search terms used were: enteral nutrition, diarrhoea, critical illness, probiotics, probiotic species and randomised clinical control trial (RCT). Four RCT papers were identified with two reporting full studies, one reporting a pilot RCT and one conference abstract reporting an RCT pilot study. A trend towards a reduction in diarrhoea incidence was observed in the probiotic groups. However, mortality associated with probiotic use in some severely and critically ill patients must caution the clinician against its use. Evidence to support probiotic use in the management of ETF diarrhoea in critically ill patients remains unclear. This paper argues that probiotics should not be administered to critically ill patients until further research has been conducted to examine the causal relationship between probiotics and mortality, irrespective of the patient's disease state or projected prophylactic benefit of probiotic administration. Copyright © 2010 Elsevier Ltd. All rights reserved.
Spatial Estimation of Populations at Risk from Radiological Dispersion Device Terrorism Incidents
DOE Office of Scientific and Technical Information (OSTI.GOV)
Regens, J.L.; Gunter, J.T.
2008-07-01
Delineation of the location and size of the population potentially at risk of exposure to ionizing radiation is one of the key analytical challenges in estimating accurately the severity of the potential health effects associated with a radiological terrorism incident. Regardless of spatial scale, the geographical units for which population data commonly are collected rarely coincide with the geographical scale necessary for effective incident management and medical response. This paper identifies major government and commercial open sources of U.S. population data and presents a GIS-based approach for allocating publicly available population data, including age distributions, to geographical units appropriate formore » planning and implementing incident management and medical response strategies. In summary: The gravity model offers a straight-forward, empirical tool for estimating population flows, especially when geographical areas are relatively well-defined in terms of accessibility and spatial separation. This is particularly important for several reasons. First, the spatial scale for the area impacted by a RDD terrorism event is unlikely to match fully the spatial scale of available population data. That is, the plume spread typically will not uniformly overlay the impacted area. Second, the number of people within the impacted area varies as a function whether an attack occurs during the day or night. For example, the population of a central business district or industrial area typically is larger during the day while predominately residential areas have larger night time populations. As a result, interpolation techniques that link population data to geographical units and allocate those data based on time-frame at a spatial scale that is relevant to enhancing preparedness and response. The gravity model's main advantage is that it efficiently allocates readily available, open source population data to geographical units appropriate for planning and
Phipps, Denham L; Tam, W Vanessa; Ashcroft, Darren M
2017-03-01
To explore the combined use of a critical incident database and work domain analysis to understand patient safety issues in a health-care setting. A retrospective review was conducted of incidents reported to the UK National Reporting and Learning System (NRLS) that involved community pharmacy between April 2005 and August 2010. A work domain analysis of community pharmacy was constructed using observational data from 5 community pharmacies, technical documentation, and a focus group with 6 pharmacists. Reports from the NRLS were mapped onto the model generated by the work domain analysis. Approximately 14,709 incident reports meeting the selection criteria were retrieved from the NRLS. Descriptive statistical analysis of these reports found that almost all of the incidents involved medication and that the most frequently occurring error types were dose/strength errors, incorrect medication, and incorrect formulation. The work domain analysis identified 4 overall purposes for community pharmacy: business viability, health promotion and clinical services, provision of medication, and use of medication. These purposes were served by lower-order characteristics of the work system (such as the functions, processes and objects). The tasks most frequently implicated in the incident reports were those involving medication storage, assembly, or patient medication records. Combining the insights from different analytical methods improves understanding of patient safety problems. Incident reporting data can be used to identify general patterns, whereas the work domain analysis can generate information about the contextual factors that surround a critical task.
Age- and Sex-Specific Social Contact Patterns and Incidence of Mycobacterium tuberculosis Infection.
Dodd, Peter J; Looker, Clare; Plumb, Ian D; Bond, Virginia; Schaap, Ab; Shanaube, Kwame; Muyoyeta, Monde; Vynnycky, Emilia; Godfrey-Faussett, Peter; Corbett, Elizabeth L; Beyers, Nulda; Ayles, Helen; White, Richard G
2016-01-15
We aimed to model the incidence of infection with Mycobacterium tuberculosis among adults using data on infection incidence in children, disease prevalence in adults, and social contact patterns. We conducted a cross-sectional face-to-face survey of adults in 2011, enumerating "close" (shared conversation) and "casual" (shared indoor space) social contacts in 16 Zambian communities and 8 South African communities. We modeled the incidence of M. tuberculosis infection in all age groups using these contact patterns, as well as the observed incidence of M. tuberculosis infection in children and the prevalence of tuberculosis disease in adults. A total of 3,528 adults participated in the study. The reported rates of close and casual contact were 4.9 per adult per day (95% confidence interval: 4.6, 5.2) and 10.4 per adult per day (95% confidence interval: 9.3, 11.6), respectively. Rates of close contact were higher for adults in larger households and rural areas. There was preferential mixing of close contacts within age groups and within sexes. The estimated incidence of M. tuberculosis infection in adults was 1.5-6 times higher (2.5%-10% per year) than that in children. More than 50% of infections in men, women, and children were estimated to be due to contact with adult men. We conclude that estimates of infection incidence based on surveys in children might underestimate incidence in adults. Most infections may be due to contact with adult men. Treatment and control of tuberculosis in men is critical to protecting men, women, and children from tuberculosis. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.
Injuries in students of three different dance techniques.
Echegoyen, Soledad; Acuña, Eugenia; Rodríguez, Cristina
2010-06-01
As with any athlete, the dancer has a high risk for injury. Most studies carried out relate to classical and modern dance; however, there is a lack of reports on injuries involving other dance techniques. This study is an attempt to determine the differences in the incidence, the exposure-related rates, and the kind of injuries in three different dance techniques. A prospective study about dance injuries was carried out between 2004 and 2007 on students of modern, Mexican folkloric, and Spanish dance at the Escuela Nacional de Danza. A total of 1,168 injuries were registered in 444 students; the injury rate was 4 injuries/student for modern dance and 2 injuries/student for Mexican folkloric and Spanish dance. The rate per training hours was 4 for modern, 1.8 for Mexican folkloric, and 1.5 injuries/1,000 hr of training for Spanish dance. The lower extremity is the most frequent structure injured (70.47%), and overuse injuries comprised 29% of the total. The most frequent injuries were strain, sprain, back pain, and patellofemoral pain. This study has a consistent medical diagnosis of the injuries and is the first attempt in Mexico to compare the incidence of injuries in different dance techniques. To decrease the frequency of student injury, it is important to incorporate prevention programs into dance program curricula. More studies are necessary to define causes and mechanisms of injury, as well as an analysis of training methodology, to decrease the incidence of the muscle imbalances resulting in injury.
Boyum, James H; Atwell, Thomas D; Wall, Darci J; Mansfield, Aaron S; Kerr, Sarah E; Gunderson, Tina M; Rumilla, Kandelaria M; Weisbrod, Adam J; Kurup, A Nicholas
2018-05-17
To analyze a large volume of image-guided liver mass biopsies to assess for an increased incidence of major hemorrhage after aggressive liver mass sampling, and to determine if coaxial technique reduces major hemorrhage rate. Patients who underwent image-guided liver mass biopsy over a 15-year period (December 7, 2001-September 22, 2016) were retrospectively identified. An aggressive biopsy was defined as a biopsy event in which ≥ 4 core needle passes were performed. Association of major hemorrhage after aggressive liver mass biopsy and other potential risk factors of interest were assessed using logistic regression analysis. For the subset of aggressive biopsies, Fisher's exact test was used to compare the incidence of major hemorrhage using coaxial versus noncoaxial techniques. Aggressive biopsies constituted 11.6% of biopsy events (N =579/5011). The incidence of major hemorrhage with <4 passes was 0.4% (N =18/4432) and with ≥4 passes 1.2% (N =6/579). In univariable models, aggressive biopsy was significantly associated with major hemorrhage (OR 3.0, 95% CI 1.16-6.92, p =0.025). After adjusting for gender and platelet count, the association was not significant at the p =0.05 level (OR 2.58, 95% CI 0.927-6.24, p =0.067). The rate of major hemorrhage in the coaxial biopsy technique group was 1.4% (N =3/209) compared to 1.1% (N =4/370) in the noncoaxial biopsy technique group, which was not a significant difference (p =0.707). Although aggressive image-guided liver mass biopsies had an increased incidence of major hemorrhage, the overall risk of bleeding remained low. The benefit of such biopsies will almost certainly outweigh the risk in most patients.
Tuberculosis in migrants in low-incidence countries: epidemiology and intervention entry points.
Lönnroth, K; Mor, Z; Erkens, C; Bruchfeld, J; Nathavitharana, R R; van der Werf, M J; Lange, C
2017-06-01
As tuberculosis (TB) rates continue to decline in native populations in most low TB incidence countries, the proportion of TB patients born outside their country of residence ('foreign-born') increases. Some low-incidence countries have experienced a substantial increase in TB rates related to recent increases in the number of asylum seekers and other migrants from TB-endemic countries. However, average TB rates among the foreign-born in low-incidence countries declined moderately in 2009-2015. TB in foreign-born individuals is commonly the result of reactivation of latent infection with Mycobacterium tuberculosis acquired outside the host country. Transmission is generally low in low-incidence countries, and transmission from migrants to the native population is often modest. Variations in levels and trends in TB notifications among the foreign-born are likely explained by differences and fluctuations in the number and profile of migrants, as well as by variations in TB control, health and social policies in the host countries. To optimise TB care and prevention in migrants from endemic to low-incidence countries, we propose a framework for identifying possible TB care and prevention interventions before, during and after migration. Universal access to high-quality care along the entire migration pathway is critical. Screening for active TB and latent tuberculous infection should be tailored to the TB epidemiology, adapted to the needs of specific migrant groups and linked to treatment. Ultimately, the long-term TB elimination goal can be reached only if global health and socio-economic inequalities are dramatically reduced. Low-incidence countries, most of which are among the wealthiest nations, need to contribute through international assistance.
Jokela, Jorma; Rådestad, Monica; Gryth, Dan; Nilsson, Helené; Rüter, Anders; Svensson, Leif; Harkke, Ville; Luoto, Markku; Castrén, Maaret
2012-02-01
In mass-casualty situations, communications and information management to improve situational awareness is a major challenge for responders. In this study, the feasibility of a prototype system that utilizes commercially available, low-cost components, including Radio Frequency Identification (RFID) and mobile phone technology, was tested in two simulated mass-casualty incidents. The feasibility and the direct benefits of the system were evaluated in two simulated mass-casualty situations: one in Finland involving a passenger ship accident resulting in multiple drowning/hypothermia patients, and another at a major airport in Sweden using an aircraft crash scenario. Both simulations involved multiple agencies and functioned as test settings for comparing the disaster management's situational awareness with and without using the RFID-based system. Triage documentation was done using both an RFID-based system, which automatically sent the data to the Medical Command, and a traditional method using paper triage tags. The situational awareness was measured by comparing the availability of up-to date information at different points in the care chain using both systems. Information regarding the numbers and status or triage classification of the casualties was available approximately one hour earlier using the RFID system compared to the data obtained using the traditional method. The tested prototype system was quick, stable, and easy to use, and proved to work seamlessly even in harsh field conditions. It surpassed the paper-based system in all respects except simplicity of use. It also improved the general view of the mass-casualty situations, and enhanced medical emergency readiness in a multi-organizational medical setting. The tested technology is feasible in a mass-casualty incident; further development and testing should take place.
NASA Astrophysics Data System (ADS)
Bontempi, E.; Colombi, P.; Depero, L. E.; Cartechini, L.; Presciutti, F.; Brunetti, B. G.; Sgamellotti, A.
2006-06-01
Lustre is known as one of the most significant decorative techniques of Medieval and Renaissance pottery in the Mediterranean basin, characterized by brilliant gold and red metallic reflections and iridescence effects. Previous studies by various techniques (SEM-EDS and TEM, UV-VIS, XRF, RBS and EXAFS) demonstrated that lustre consists of a heterogeneous metal-glass composite film, formed by Cu and Ag nanoparticles dispersed within the outer layer of a tin-opacified lead glaze. In the present work the investigation of an original gold lustre sample from Deruta has been carried out by means of glancing-incidence X-ray diffraction techniques (GIXRD). The study was aimed at providing information on structure and depth distribution of Ag nanoparticles. Exploiting the capability of controlling X-ray penetration in the glaze by changing the incidence angle, we used GIXRD measurements to estimate non-destructively thickness and depth of silver particles present in the first layers of the glaze.
Collaborative Learning in the Dance Technique Class
ERIC Educational Resources Information Center
Raman, Tanja
2009-01-01
This research was designed to enhance dance technique learning by promoting critical thinking amongst students studying on a degree programme at the University of Wales Institute, Cardiff. Students were taught Cunningham-based dance technique using pair work together with the traditional demonstration/copying method. To evaluate the study,…
Medication Incidents Involving Antiepileptic Drugs in Canadian Hospitals: A Multi-Incident Analysis.
Cheng, Roger; Yang, Yu Daisy; Chan, Matthew; Patel, Tejal
2017-01-01
Medication errors involving antiepileptic drugs (AEDs) are not well studied but have the potential to cause significant harm. We investigated the occurrence of medication incidents in Canadian hospitals that involve AEDs, their severity and contributing factors by analyzing data from two national databases. Our multi-incident analysis revealed that while medication errors were rarely fatal, errors do occur of which some are serious. Medication incidents were most commonly caused by dose omissions, the dose or its frequency being incorrect and the wrong AED being given. Our analysis could augment quality-improvement initiatives by medication safety administrators to reduce AED medication incidents in hospitals.
Cocron, Peter; Bachl, Veronika; Früh, Laura; Koch, Iris; Krems, Josef F
2014-12-01
The low noise emission of battery electric vehicles (BEVs) has led to discussions about how to address potential safety issues for other road users. Legislative actions have already been undertaken to implement artificial sounds. In previous research, BEV drivers reported that due to low noise emission they paid particular attention to pedestrians and bicyclists. For the current research, we developed a hazard detection task to test whether drivers with BEV experience respond faster to incidents, which arise due to the low noise emission, than inexperienced drivers. The first study (N=65) revealed that BEV experience only played a minor role in drivers' response to hazards resulting from low BEV noise. The tendency to respond, reaction times and hazard evaluations were similar among experienced and inexperienced BEV drivers; only small trends in the assumed direction were observed. Still, both groups clearly differentiated between critical and non-critical scenarios and responded accordingly. In the second study (N=58), we investigated additionally if sensitization to low noise emission of BEVs had an effect on hazard perception in incidents where the noise difference is crucial. Again, participants in all groups differentiated between critical and non-critical scenarios. Even though trends in response rates and latencies occurred, experience and sensitization to low noise seemed to only play a minor role in detecting hazards due to low BEV noise. An additional global evaluation of BEV noise further suggests that even after a short test drive, the lack of noise is perceived more as a comfort feature than a safety threat. Copyright © 2014 Elsevier Ltd. All rights reserved.