Skill Transfer and Virtual Training for IND Response Decision-Making: Project Summary and Next Steps

DTIC Science & Technology

2016-01-01

to be very productive partners—independent video - game developers and academic game degree programs—are not familiar with working with government...experimental validation. • Independent Video - Game Developers. Small companies and individuals that pursue video - game design and development can be inexpensive...Emergency Management Agency (FEMA) that examines alternative mechanisms for training and evaluation of emergency managers (EMs) to augment and

Users' guides to the medical literature: how to use an article about mortality in a humanitarian emergency

PubMed Central

Mills, Edward J; Checchi, Francesco; Orbinski, James J; Schull, Michael J; Burkle, Frederick M; Beyrer, Chris; Cooper, Curtis; Hardy, Colleen; Singh, Sonal; Garfield, Richard; Woodruff, Bradley A; Guyatt, Gordon H

2008-01-01

The accurate interpretation of mortality surveys in humanitarian crises is useful for both public health responses and security responses. Recent examples suggest that few medical personnel and researchers can accurately interpret the validity of a mortality survey in these settings. Using an example of a mortality survey from the Democratic Republic of Congo (DRC), we demonstrate important methodological considerations that readers should keep in mind when reading a mortality survey to determine the validity of the study and the applicability of the findings to their settings. PMID:18826636

Operation Windshield and the simplification of emergency management.

PubMed

Andrews, Michael

2016-01-01

Large, complex, multi-stakeholder exercises are the culmination of years of gradual progression through a comprehensive training and exercise programme. Exercises intended to validate training, refine procedures and test processes initially tested in isolation are combined to ensure seamless response and coordination during actual crises. The challenges of integrating timely and accurate situational awareness from an array of sources, including response agencies, municipal departments, partner agencies and the public, on an ever-growing range of media platforms, increase information management complexity in emergencies. Considering that many municipal emergency operations centre roles are filled by staff whose day jobs have little to do with crisis management, there is a need to simplify emergency management and make it more intuitive. North Shore Emergency Management has accepted the challenge of making emergency management less onerous to occasional practitioners through a series of initiatives aimed to build competence and confidence by making processes easier to use as well as by introducing technical tools that can simplify processes and enhance efficiencies. These efforts culminated in the full-scale earthquake exercise, Operation Windshield, which preceded the 2015 Emergency Preparedness and Business Continuity Conference in Vancouver, British Columbia.

Developing a database for pedestrians' earthquake emergency evacuation in indoor scenarios.

PubMed

Zhou, Junxue; Li, Sha; Nie, Gaozhong; Fan, Xiwei; Tan, Jinxian; Li, Huayue; Pang, Xiaoke

2018-01-01

With the booming development of evacuation simulation software, developing an extensive database in indoor scenarios for evacuation models is imperative. In this paper, we conduct a qualitative and quantitative analysis of the collected videotapes and aim to provide a complete and unitary database of pedestrians' earthquake emergency response behaviors in indoor scenarios, including human-environment interactions. Using the qualitative analysis method, we extract keyword groups and keywords that code the response modes of pedestrians and construct a general decision flowchart using chronological organization. Using the quantitative analysis method, we analyze data on the delay time, evacuation speed, evacuation route and emergency exit choices. Furthermore, we study the effect of classroom layout on emergency evacuation. The database for indoor scenarios provides reliable input parameters and allows the construction of real and effective constraints for use in software and mathematical models. The database can also be used to validate the accuracy of evacuation models.

Web 2.0 and internet social networking: a new tool for disaster management?--lessons from Taiwan.

PubMed

Huang, Cheng-Min; Chan, Edward; Hyder, Adnan A

2010-10-06

Internet social networking tools and the emerging web 2.0 technologies are providing a new way for web users and health workers in information sharing and knowledge dissemination. Based on the characters of immediate, two-way and large scale of impact, the internet social networking tools have been utilized as a solution in emergency response during disasters. This paper highlights the use of internet social networking in disaster emergency response and public health management of disasters by focusing on a case study of the typhoon Morakot disaster in Taiwan. In the case of typhoon disaster in Taiwan, internet social networking and mobile technology were found to be helpful for community residents, professional emergency rescuers, and government agencies in gathering and disseminating real-time information, regarding volunteer recruitment and relief supplies allocation. We noted that if internet tools are to be integrated in the development of emergency response system, the accessibility, accuracy, validity, feasibility, privacy and the scalability of itself should be carefully considered especially in the effort of applying it in resource poor settings. This paper seeks to promote an internet-based emergency response system by integrating internet social networking and information communication technology into central government disaster management system. Web-based networking provides two-way communication which establishes a reliable and accessible tunnel for proximal and distal users in disaster preparedness and management.

Development and Validation of a Bilingual Stroke Preparedness Assessment Instrument

PubMed Central

Skolarus, Lesli E.; Mazor, Kathleen M.; Sánchez, Brisa N.; Dome, Mackenzie; Biller, José; Morgenstern, Lewis B.

2017-01-01

Background and Purpose Stroke preparedness interventions are limited by the lack of psychometrically sound intermediate endpoints. We sought to develop and assess the reliability and validity of the video-Stroke Action Test, video-STAT, an English and Spanish video-based test to assess people’s ability to recognize and react to stroke signs. Methods Video-STAT development and testing was divided into four phases: 1) video development and community-generated response options; 2) pilot testing in community health centers; 3) administration in a national sample, bilingual sample and neurologist sample; and 4) administration before and after a stroke preparedness intervention. Results The final version of the video-STAT included 8 videos: 4 acute stroke/emergency, 2 prior stroke/non-emergency, 1 non-stroke/emergency, 1 non-stroke/non-emergency. Acute stroke recognition and action response were queried after each vignette. Video-STAT scoring was based on the acute stroke vignettes only (score range 0–12 best). The national sample consisted of 598 participants, 438 who took the video-STAT in English and 160 who took the video-STAT in Spanish. There was adequate internal consistency (Cronbach’s alpha=0.72). The average video-STAT score was 5.6 (sd=3.6) while the average neurologist score was 11.4 (sd=1.3). There was no difference in video-STAT scores between the 116 bilingual video-STAT participants who took the video-STAT in English or Spanish. Compared to baseline scores, the video-STAT scores increased following a stroke preparedness intervention (6.2 vs. 8.9, p<0.01) among a sample of 101 African American adults and youth. Conclusion The video-STAT yields reliable scores that appear to be valid measures of stroke preparedness. PMID:28250199

Quantitative assessment of anthrax vaccine immunogenicity using the dried blood spot matrix.

PubMed

Schiffer, Jarad M; Maniatis, Panagiotis; Garza, Ilana; Steward-Clark, Evelene; Korman, Lawrence T; Pittman, Phillip R; Mei, Joanne V; Quinn, Conrad P

2013-03-01

The collection, processing and transportation to a testing laboratory of large numbers of clinical samples during an emergency response situation present significant cost and logistical issues. Blood and serum are common clinical samples for diagnosis of disease. Serum preparation requires significant on-site equipment and facilities for immediate processing and cold storage, and significant costs for cold-chain transport to testing facilities. The dried blood spot (DBS) matrix offers an alternative to serum for rapid and efficient sample collection with fewer on-site equipment requirements and considerably lower storage and transport costs. We have developed and validated assay methods for using DBS in the quantitative anti-protective antigen IgG enzyme-linked immunosorbent assay (ELISA), one of the primary assays for assessing immunogenicity of anthrax vaccine and for confirmatory diagnosis of Bacillus anthracis infection in humans. We have also developed and validated high-throughput data analysis software to facilitate data handling for large clinical trials and emergency response. Published by Elsevier Ltd.

Uniting statistical and individual-based approaches for animal movement modelling.

PubMed

Latombe, Guillaume; Parrott, Lael; Basille, Mathieu; Fortin, Daniel

2014-01-01

The dynamic nature of their internal states and the environment directly shape animals' spatial behaviours and give rise to emergent properties at broader scales in natural systems. However, integrating these dynamic features into habitat selection studies remains challenging, due to practically impossible field work to access internal states and the inability of current statistical models to produce dynamic outputs. To address these issues, we developed a robust method, which combines statistical and individual-based modelling. Using a statistical technique for forward modelling of the IBM has the advantage of being faster for parameterization than a pure inverse modelling technique and allows for robust selection of parameters. Using GPS locations from caribou monitored in Québec, caribou movements were modelled based on generative mechanisms accounting for dynamic variables at a low level of emergence. These variables were accessed by replicating real individuals' movements in parallel sub-models, and movement parameters were then empirically parameterized using Step Selection Functions. The final IBM model was validated using both k-fold cross-validation and emergent patterns validation and was tested for two different scenarios, with varying hardwood encroachment. Our results highlighted a functional response in habitat selection, which suggests that our method was able to capture the complexity of the natural system, and adequately provided projections on future possible states of the system in response to different management plans. This is especially relevant for testing the long-term impact of scenarios corresponding to environmental configurations that have yet to be observed in real systems.

Uniting Statistical and Individual-Based Approaches for Animal Movement Modelling

PubMed Central

Latombe, Guillaume; Parrott, Lael; Basille, Mathieu; Fortin, Daniel

2014-01-01

The dynamic nature of their internal states and the environment directly shape animals' spatial behaviours and give rise to emergent properties at broader scales in natural systems. However, integrating these dynamic features into habitat selection studies remains challenging, due to practically impossible field work to access internal states and the inability of current statistical models to produce dynamic outputs. To address these issues, we developed a robust method, which combines statistical and individual-based modelling. Using a statistical technique for forward modelling of the IBM has the advantage of being faster for parameterization than a pure inverse modelling technique and allows for robust selection of parameters. Using GPS locations from caribou monitored in Québec, caribou movements were modelled based on generative mechanisms accounting for dynamic variables at a low level of emergence. These variables were accessed by replicating real individuals' movements in parallel sub-models, and movement parameters were then empirically parameterized using Step Selection Functions. The final IBM model was validated using both k-fold cross-validation and emergent patterns validation and was tested for two different scenarios, with varying hardwood encroachment. Our results highlighted a functional response in habitat selection, which suggests that our method was able to capture the complexity of the natural system, and adequately provided projections on future possible states of the system in response to different management plans. This is especially relevant for testing the long-term impact of scenarios corresponding to environmental configurations that have yet to be observed in real systems. PMID:24979047

Request for Information Response for the Flight Validation of Adaptive Control to Prevent Loss-of-Control Events. Overview of RFI Responses

NASA Technical Reports Server (NTRS)

Bosworth, John T.

2009-01-01

Adaptive control should be integrated with a baseline controller and only used when necessary (5 responses). Implementation as an emergency system. Immediately re-stabilize and return to controlled flight. Forced perturbation (excitation) for fine-tuning system a) Check margins; b) Develop requirements for amplitude of excitation. Adaptive system can improve performance by eating into margin constraints imposed on the non-adaptive system. Nonlinear effects due to multi-string voting.

Design, Construction and Validation of a Nose-only Inhalation Exposure System to Study Infectivity of Filtered Bioaerosols in Mice

DTIC Science & Technology

2011-12-01

important natural transmis- sion mechanism for influenza is actively debated ( Tellier 2006, 2007a,b; Brankston et al. 2007; Gardam and Lemieux 2007; Lee...Microbiol 20, 720–722. Tellier , R. (2006) Review of aerosol transmission of influenza a virus. Emerg Infect Dis 12, 1657–1662. Tellier , R. (2007a...Questioning aerosol transmission of influenza: in response. Emerg Infect Dis 13, 174–175. Tellier , R. (2007b) Reflection and reaction—transmission of

77 FR 13257 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-06

... Service Title: Emergency Management Response System (EMRS). OMB Control Number: 0579-0071. Summary of... Regulatory Affairs, Office of Management and Budget (OMB), [email protected] or fax (202) 395-5806... displays a currently valid OMB control number and the agency informs potential persons who are to respond...

Invalid before impaired: an emerging paradox of embedded validity indicators.

PubMed

Erdodi, Laszlo A; Lichtenstein, Jonathan D

Embedded validity indicators (EVIs) are cost-effective psychometric tools to identify non-credible response sets during neuropsychological testing. As research on EVIs expands, assessors are faced with an emerging contradiction: the range of credible impairment disappears between the 'normal' and 'invalid' range of performance. We labeled this phenomenon as the invalid-before-impaired paradox. This study was designed to explore the origin of this psychometric anomaly, subject it to empirical investigation, and generate potential solutions. Archival data were analyzed from a mixed clinical sample of 312 (M Age  = 45.2; M Education  = 13.6) patients medically referred for neuropsychological assessment. The distribution of scores on eight subtests of the third and fourth editions of Wechsler Adult Intelligence Scale (WAIS) were examined in relation to the standard normal curve and two performance validity tests (PVTs). Although WAIS subtests varied in their sensitivity to non-credible responding, they were all significant predictors of performance validity. While subtests previously identified as EVIs (Digit Span, Coding, and Symbol Search) were comparably effective at differentiating credible and non-credible response sets, their classification accuracy was driven by their base rate of low scores, requiring different cutoffs to achieve comparable specificity. Invalid performance had a global effect on WAIS scores. Genuine impairment and non-credible performance can co-exist, are often intertwined, and may be psychometrically indistinguishable. A compromise between the alpha and beta bias on PVTs based on a balanced, objective evaluation of the evidence that requires concessions from both sides is needed to maintain/restore the credibility of performance validity assessment.

Predicting clinical response to anticancer drugs using an ex vivo platform that captures tumour heterogeneity.

PubMed

Majumder, Biswanath; Baraneedharan, Ulaganathan; Thiyagarajan, Saravanan; Radhakrishnan, Padhma; Narasimhan, Harikrishna; Dhandapani, Muthu; Brijwani, Nilesh; Pinto, Dency D; Prasath, Arun; Shanthappa, Basavaraja U; Thayakumar, Allen; Surendran, Rajagopalan; Babu, Govind K; Shenoy, Ashok M; Kuriakose, Moni A; Bergthold, Guillaume; Horowitz, Peleg; Loda, Massimo; Beroukhim, Rameen; Agarwal, Shivani; Sengupta, Shiladitya; Sundaram, Mallikarjun; Majumder, Pradip K

2015-02-27

Predicting clinical response to anticancer drugs remains a major challenge in cancer treatment. Emerging reports indicate that the tumour microenvironment and heterogeneity can limit the predictive power of current biomarker-guided strategies for chemotherapy. Here we report the engineering of personalized tumour ecosystems that contextually conserve the tumour heterogeneity, and phenocopy the tumour microenvironment using tumour explants maintained in defined tumour grade-matched matrix support and autologous patient serum. The functional response of tumour ecosystems, engineered from 109 patients, to anticancer drugs, together with the corresponding clinical outcomes, is used to train a machine learning algorithm; the learned model is then applied to predict the clinical response in an independent validation group of 55 patients, where we achieve 100% sensitivity in predictions while keeping specificity in a desired high range. The tumour ecosystem and algorithm, together termed the CANScript technology, can emerge as a powerful platform for enabling personalized medicine.

Technical Analysis of Teacher Responses to the Self-Evaluation Scale-Teacher (SES-T) Version

ERIC Educational Resources Information Center

Erford, Bradley T.; Lowe, Samantha; Chang, Catherine Y.

2011-01-01

The Self-Evaluation Scale--Teacher version, used to assess teacher perceived self-esteem of students, was analyzed. A unidimensional model emerged from exploratory factor analysis, with cautious acceptance of data fit. Reliability and external aspects of validity were supported by the Self-Evaluation Scale--Teacher data.

A prospective cohort study to refine and validate the Panic Screening Score for identifying panic attacks associated with unexplained chest pain in the emergency department

PubMed Central

Foldes-Busque, Guillaume; Denis, Isabelle; Poitras, Julien; Fleet, Richard P; Archambault, Patrick; Dionne, Clermont E

2013-01-01

Introduction Panic-like anxiety (panic attacks with or without panic disorder), a highly treatable condition, is the most prevalent condition associated with unexplained chest pain in the emergency department. Panic-like anxiety may be responsible for a significant portion of the negative consequences of unexplained chest pain, such as functional limitations and chronicity. However, more than 92% of panic-like anxiety cases remain undiagnosed at the time of discharge from the emergency department. The 4-item Panic Screening Score (PSS) questionnaire was derived in order to increase the identification of panic-like anxiety in emergency department patients with unexplained chest pain. Methods and analysis The goals of this prospective cohort study were to (1) refine the PSS; (2) validate the revised version of the PSS; (3) measure the reliability of the revised version of the PSS and (4) assess the acceptability of the instrument among emergency physicians. Eligible and consenting patients will be administered the PSS in a large emergency department. Patients will be contacted by phone for administration of the criterion standard for panic attacks as well as by a standardised interview to collect information for other predictors of panic attacks. Multivariate analysis will be used to refine the PSS. The new version will be prospectively validated in an independent sample and inter-rater agreement will be assessed in 10% of cases. The screening instrument acceptability will be assessed with the Ottawa Acceptability of Decision Rules Instrument. Ethics and dissemination This study protocol has been reviewed and approved by the Alphonse-Desjardins research ethics committee. The results of the study will be presented in scientific conferences and published in peer-reviewed scientific journals. Further dissemination via workshops and a dedicated website is planned. PMID:24163208

Using a discrete-event simulation to balance ambulance availability and demand in static deployment systems.

PubMed

Wu, Ching-Han; Hwang, Kevin P

2009-12-01

To improve ambulance response time, matching ambulance availability with the emergency demand is crucial. To maintain the standard of 90% of response times within 9 minutes, the authors introduce a discrete-event simulation method to estimate the threshold for expanding the ambulance fleet when demand increases and to find the optimal dispatching strategies when provisional events create temporary decreases in ambulance availability. The simulation model was developed with information from the literature. Although the development was theoretical, the model was validated on the emergency medical services (EMS) system of Tainan City. The data are divided: one part is for model development, and the other for validation. For increasing demand, the effect was modeled on response time when call arrival rates increased. For temporary availability decreases, the authors simulated all possible alternatives of ambulance deployment in accordance with the number of out-of-routine-duty ambulances and the durations of three types of mass gatherings: marathon races (06:00-10:00 hr), rock concerts (18:00-22:00 hr), and New Year's Eve parties (20:00-01:00 hr). Statistical analysis confirmed that the model reasonably represented the actual Tainan EMS system. The response-time standard could not be reached when the incremental ratio of call arrivals exceeded 56%, which is the threshold for the Tainan EMS system to expand its ambulance fleet. When provisional events created temporary availability decreases, the Tainan EMS system could spare at most two ambulances from the standard configuration, except between 20:00 and 01:00, when it could spare three. The model also demonstrated that the current Tainan EMS has two excess ambulances that could be dropped. The authors suggest dispatching strategies to minimize the response times in routine daily emergencies. Strategies of capacity management based on this model improved response times. The more ambulances that are out of routine duty, the better the performance of the optimal strategies that are based on this model.

Full-Scale Crash Tests and Analyses of Three High-Wing Single

NASA Technical Reports Server (NTRS)

Annett, Martin S.; Littell, Justin D.; Stimson, Chad M.; Jackson, Karen E.; Mason, Brian H.

2015-01-01

The NASA Emergency Locator Transmitter Survivability and Reliability (ELTSAR) project was initiated in 2014 to assess the crash performance standards for the next generation of ELT systems. Three Cessna 172 aircraft have been acquired to conduct crash testing at NASA Langley Research Center's Landing and Impact Research Facility. Testing is scheduled for the summer of 2015 and will simulate three crash conditions; a flare to stall while emergency landing, and two controlled flight into terrain scenarios. Instrumentation and video coverage, both onboard and external, will also provide valuable data of airframe response. Full-scale finite element analyses will be performed using two separate commercial explicit solvers. Calibration and validation of the models will be based on the airframe response under these varying crash conditions.

Data for Preparedness Metrics: Legal, Economic, and Operational

PubMed Central

Potter, Margaret A.; Houck, Olivia C.; Miner, Kathleen; Shoaf, Kimberley

2013-01-01

Tracking progress toward the goal of preparedness for public health emergencies requires a foundation in evidence derived both from scientific inquiry and from preparedness officials and professionals. Proposed in this article is a conceptual model for this task from the perspective of the Centers for Disease Control and Prevention–funded Preparedness and Emergency Response Research Centers. The necessary data capture the areas of responsibility of not only preparedness professionals but also legislative and executive branch officials. It meets the criteria of geographic specificity, availability in standardized and reliable measures, parameterization as quantitative values or qualitative distinction, and content validity. The technical challenges inherent in preparedness tracking are best resolved through consultation with the jurisdictions and communities whose preparedness is at issue. PMID:23903389

Health risk behaviors in adolescents and emerging adults with congenital heart disease: psychometric properties of the Health Behavior Scale-Congenital Heart Disease.

PubMed

Goossens, Eva; Luyckx, Koen; Mommen, Nele; Gewillig, Marc; Budts, Werner; Zupancic, Nele; Moons, Philip

2013-12-01

To optimize long-term outcomes, patients with congenital heart disease (CHD) should adopt health-promoting behaviors. Studies on health behavior in afflicted patients are scarce and comparability of study results is limited. To enlarge the body of evidence, we have developed the Health Behavior Scale-Congenital Heart Disease (HBS-CHD). We examined the psychometric properties of the HBS-CHD by providing evidence for (a) the content validity; (b) validity based on the relationships with other variables; (c) reliability in terms of stability; and (d) responsiveness. Ten experts rated the relevance of the HBS-CHD items. The item content validity index (I-CVI) and the averaged scale content validity index (S-CVI/Ave); the modified multi-rater Kappa and proportion of missing values for each question were calculated. Relationships with other variables were evaluated using six hypotheses that were tested in 429 adolescents with CHD. Stability of the instrument was assessed using Heise's method; and responsiveness was tested by calculating the Guyatt's Responsiveness Index (GRI). Overall, 86.3% of the items had a good to excellent content validity; the S-CVI/Ave (0.81) and multi-rater Kappa (0.78) were adequate. The average proportion of missing values was low (1.2%). Because five out of six hypotheses were confirmed, evidence for the validity of the HBS-CHD based on relationships with other variables was provided. The stability of the instrument could not be confirmed based on our data. The GRI showed good to excellent capacity of the HBS-CHD to detect clinical changes in the health behavior over time. We found that the HBS-CHD is a valid and responsive questionnaire to assess health behaviors in patients with CHD.

The impact of underreporting and overreporting on the validity of the Personality Inventory for DSM-5 (PID-5): A simulation analog design investigation.

PubMed

Dhillon, Sonya; Bagby, R Michael; Kushner, Shauna C; Burchett, Danielle

2017-04-01

The Personality Inventory for DSM-5 (PID-5) is a 220-item self-report instrument that assesses the alternative model of personality psychopathology in Section III (Emerging Measures and Models) of DSM-5 . Despite its relatively recent introduction, the PID-5 has generated an impressive accumulation of studies examining its psychometric properties, and the instrument is also already widely and frequently used in research studies. Although the PID-5 is psychometrically sound overall, reviews of this instrument express concern that this scale does not possess validity scales to detect invalidating levels of response bias, such as underreporting and overreporting. McGee Ng et al. (2016), using a "known-groups" (partial) criterion design, demonstrated that both underreporting and overreporting grossly affect mean scores on PID-5 scales. In the current investigation, we replicate these findings using an analog simulation design. An important extension to this replication study was the finding that the construct validity of the PID-5 was also significantly compromised by response bias, with statistically significant attenuation noted in validity coefficients of the PID-5 domain scales with scales from other instruments measuring congruent constructs. This attenuation was found for underreporting and overreporting bias. We believe there is a need to develop validity scales to screen for data-distorting response bias in research contexts and in clinical assessments where response bias is likely or otherwise suspected. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A comparison of global rating scale and checklist scores in the validation of an evaluation tool to assess performance in the resuscitation of critically ill patients during simulated emergencies (abbreviated as "CRM simulator study IB").

PubMed

Kim, John; Neilipovitz, David; Cardinal, Pierre; Chiu, Michelle

2009-01-01

Crisis resource management (CRM) skills are a set of nonmedical skills required to manage medical emergencies. There is currently no gold standard for evaluation of CRM performance. A prior study examined the use of a global rating scale (GRS) to evaluate CRM performance. This current study compared the use of a GRS and a checklist as formal rating instruments to evaluate CRM performance during simulated emergencies. First-year and third-year residents participated in two simulator scenarios each. Three raters then evaluated resident performance in CRM using edited video recordings using both a GRS and a checklist. The Ottawa GRS provides a seven-point anchored ordinal scale for performance in five categories of CRM, and an overall performance score. The Ottawa CRM checklist provides 12 items in the five categories of CRM, with a maximum cumulative score of 30 points. Construct validity was measured on the basis of content validity, response process, internal structure, and response to other variables. T-test analysis of Ottawa GRS scores was conducted to examine response to the variable of level of training. Intraclass correlation coefficient (ICC) scores were used to measure inter-rater reliability for both scenarios. Thirty-two first-year and 28 third-year residents participated in the study. Third-year residents produced higher mean scores for overall CRM performance than first-year residents (P < 0.05), and in all individual categories within the Ottawa GRS (P < 0.05) and the Ottawa CRM checklist (P < 0.05). This difference was noted for both scenarios and for each individual rater (P < 0.05). No statistically significant difference in resident scores was observed between scenarios for both instruments. ICC scores of 0.59 and 0.61 were obtained for Scenarios 1 and 2 with the Ottawa GRS, whereas ICC scores of 0.63 and 0.55 were obtained with the Ottawa CRM checklist. Users indicated a strong preference for the Ottawa GRS given ease of scoring, presence of an overall score, and the potential for formative evaluation. Construct validity seems to be present when using both the Ottawa GRS and CRM checklist to evaluate CRM performance during simulated emergencies. Data also indicate the presence of moderate inter-rater reliability when using both the Ottawa GRS and CRM checklist.

Health-related quality of life for pediatric emergency department febrile illnesses: an evaluation of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales.

PubMed

Mistry, Rakesh D; Stevens, Molly W; Gorelick, Marc H

2009-01-29

We sought to assess the validity and short-term responsiveness of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) for febrile illnesses evaluated in the pediatric emergency department (ED). Prospective cohort study of children 2-18 years discharged after ED evaluation for fever (>or= 38 degrees C). Self-administered, parent-report of health-related quality of life (HRQOL) was assessed using the PedsQL Acute Version, a validated HRQOL instrument. HRQOL was measured on ED presentation and at 7-10 day follow-up. At follow-up, duration of fever, child functional impairment, missed daycare/school, and disrupted family unit functioning, were assessed. Of 160 subjects enrolled, 97 (61%) completed the study; mean follow-up was 8.7 days. Mean total HRQOL score on ED presentation was 76.4; mean follow-up score was 86.3. Compared to subjects that returned to baseline, statistically significant differences in HRQOL were noted for those with prolonged fever, child functional impairment, and relapse. Significant correlation was observed between HRQOL at follow-up and days of daycare/school missed (r = -0.35, p = .003) and days of family disruption (r = -0.43, p < .001). Mean change in HRQOL within subjects, from ED visit to follow-up, was +9.8 (95% CI: 5.6-14.6). Effect size was 0.53, indicating moderate responsiveness. The PedsQL appears to be a valid and responsive indicator of HRQOL for short-term febrile illnesses evaluated in the ED.

Field validation of Burned Area Reflectance Classification (BARC) products for post fire assessment

Treesearch

Andrew T. Hudak; Peter R. Robichaud; Jeffery B. Evans; Jess Clark; Keith Lannom; Penelope Morgan; Carter Stone

2004-01-01

The USFS Remote Sensing Applications Center (RSAC) and the USGS EROS Data Center (EDC) produce Burned Area Reflectance Classification (BARC) maps for use by Burned Area Emergency Rehabilitation (BAER) teams in rapid response to wildfires. BAER teams desire maps indicative of soil burn severity, but photosynthetic and nonphotosynthetic vegetation also influences the...

The development of the PARENTS: a tool for parents to assess residents' non-technical skills in pediatric emergency departments.

PubMed

Moreau, Katherine A; Eady, Kaylee; Tang, Kenneth; Jabbour, Mona; Frank, Jason R; Campbell, Meaghan; Hamstra, Stanley J

2017-11-14

Parents can assess residents' non-technical skills (NTS) in pediatric emergency departments (EDs). There are no assessment tools, with validity evidence, for parental use in pediatric EDs. The purpose of this study was to develop the Parents' Assessment of Residents Enacting Non-Technical Skills (PARENTS) educational assessment tool and collect three sources of validity evidence (i.e., content, response process, internal structure) for it. We established content evidence for the PARENTS through interviews with physician-educators and residents, focus groups with parents, a literature review, and a modified nominal group technique with experts. We collected response process evidence through cognitive interviews with parents. To examine the internal structure evidence, we administered the PARENTS and performed exploratory factor analysis. Initially, a 20-item PARENTS was developed. Cognitive interviews led to the removal of one closed-ended item, the addition of resident photographs, and wording/formatting changes. Thirty-seven residents and 434 parents participated in the administration of the resulting 19-item PARENTS. Following factor analysis, a one-factor model prevailed. The study presents initial validity evidence for the PARENTS. It also highlights strategies for potentially: (a) involving parents in the assessment of residents, (b) improving the assessment of NTS in pediatric EDs, and (c) capturing parents' perspectives to improve the preparation of future physicians.

Development of a Core Clinical Dataset to Characterize Serious Illness, Injuries, and Resource Requirements for Acute Medical Responses to Public Health Emergencies.

PubMed

Murphy, David J; Rubinson, Lewis; Blum, James; Isakov, Alexander; Bhagwanjee, Statish; Cairns, Charles B; Cobb, J Perren; Sevransky, Jonathan E

2015-11-01

In developed countries, public health systems have become adept at rapidly identifying the etiology and impact of public health emergencies. However, within the time course of clinical responses, shortfalls in readily analyzable patient-level data limit capabilities to understand clinical course, predict outcomes, ensure resource availability, and evaluate the effectiveness of diagnostic and therapeutic strategies for seriously ill and injured patients. To be useful in the timeline of a public health emergency, multi-institutional clinical investigation systems must be in place to rapidly collect, analyze, and disseminate detailed clinical information regarding patients across prehospital, emergency department, and acute care hospital settings, including ICUs. As an initial step to near real-time clinical learning during public health emergencies, we sought to develop an "all-hazards" core dataset to characterize serious illness and injuries and the resource requirements for acute medical response across the care continuum. A multidisciplinary panel of clinicians, public health professionals, and researchers with expertise in public health emergencies. Group consensus process. The consensus process included regularly scheduled conference calls, electronic communications, and an in-person meeting to generate candidate variables. Candidate variables were then reviewed by the group to meet the competing criteria of utility and feasibility resulting in the core dataset. The 40-member panel generated 215 candidate variables for potential dataset inclusion. The final dataset includes 140 patient-level variables in the domains of demographics and anthropometrics (7), prehospital (11), emergency department (13), diagnosis (8), severity of illness (54), medications and interventions (38), and outcomes (9). The resulting all-hazard core dataset for seriously ill and injured persons provides a foundation to facilitate rapid collection, analyses, and dissemination of information necessary for clinicians, public health officials, and policymakers to optimize public health emergency response. Further work is needed to validate the effectiveness of the dataset in a variety of emergency settings.

A cross-sectional questionnaire study of the rules governing pupils' carriage of inhalers for asthma treatment in secondary schools in North East England.

PubMed

Funston, Wendy; Howard, Simon J

2016-01-01

Objectives. The primary objective of this study was to assess the rules governing secondary school pupils' carriage of inhalers for emergency treatment of asthma in the North East of England. Design. This study was based upon a postal questionnaire survey. Setting. The setting for this study was mainstream free-to-attend secondary schools which admit 16 year old pupils within the 12 Local Authority areas which make up the North East of England. Participants. All 153 schools meeting the inclusion criteria were invited to participate in the study, of which 106 (69%) took part. Main Outcome Measures. Our three main outcome measures were: whether pupils are permitted to carry inhalers on their person while at school; whether advance permission is required for pupils to carry inhalers, and from whom; and whether the school has an emergency 'standby' salbutamol inhaler for use in asthma emergencies, as permitted since October 2014 under recent amendments to The Human Medicines Regulations 2012. Results. Of 98 schools submitting valid responses to the question, 99% (n = 97) permitted pupils to carry inhalers on their person while at school; the remaining school stored pupils' inhalers in a central location within the school. A total of 22% of included schools (n = 22) required parental permission before pupils were permitted to carry inhalers. Of 102 schools submitting valid responses to the question, 44% (n = 45) had purchased a 'standby' salbutamol inhaler for use in asthma emergencies. Conclusions. Most secondary schools in North East England permit pupils to carry inhalers on their person. The requirement in a minority of schools for parental permission to be given possibly contravenes the standard ethical practices in clinical medicine for children of this age. Only a minority of schools hold a 'standby' salbutamol inhaler for use in asthma emergencies. Wider availability may improve outcomes for asthma emergencies occurring in schools.

Measuring Coverage in MNCH: Validating Women’s Self-Report of Emergency Cesarean Sections in Ghana and the Dominican Republic

PubMed Central

Tunçalp, Özge; Stanton, Cynthia; Castro, Arachu; Adanu, Richard; Heymann, Marilyn; Adu-Bonsaffoh, Kwame; Lattof, Samantha R.; Blanc, Ann; Langer, Ana

2013-01-01

Background Cesarean section is the only surgery for which we have nearly global population-based data. However, few surveys provide additional data related to cesarean sections. Given weaknesses in many health information systems, health planners in developing countries will likely rely on nationally representative surveys for the foreseeable future. The objective is to validate self-reported data on the emergency status of cesarean sections among women delivering in teaching hospitals in the capitals of two contrasting countries: Accra, Ghana and Santo Domingo, Dominican Republic (DR). Methods and Findings This study compares hospital-based data, considered the reference standard, against women’s self-report for two definitions of emergency cesarean section based on the timing of the decision to operate and the timing of the cesarean section relative to onset of labor. Hospital data were abstracted from individual medical records, and hospital discharge interviews were conducted with women who had undergone cesarean section in two hospitals. The study assessed sensitivity, specificity, and positive predictive value of responses to questions regarding emergency versus non-emergency cesarean section and estimated the percent of emergency cesarean sections that would be obtained from a survey, given the observed prevalence, sensitivity, and specificity from this study. Hospital data were matched with exit interviews for 659 women delivered via cesarean section for Ghana and 1,531 for the Dominican Republic. In Ghana and the Dominican Republic, sensitivity and specificity for emergency cesarean section defined by decision time were 79% and 82%, and 50% and 80%, respectively. The validity of emergency cesarean defined by operation time showed less favorable results than decision time in Ghana and slightly more favorable results in the Dominican Republic. Conclusions Questions used in this study to identify emergency cesarean section are promising but insufficient to promote for inclusion in international survey questionnaires. Additional studies which confirm the accuracy of key facility-based indicators in advance of data collection and which use a longer recall period are warranted. PMID:23667428

Evaluation of the DAVROS (Development And Validation of Risk-adjusted Outcomes for Systems of emergency care) risk-adjustment model as a quality indicator for healthcare

PubMed Central

Wilson, Richard; Goodacre, Steve W; Klingbajl, Marcin; Kelly, Anne-Maree; Rainer, Tim; Coats, Tim; Holloway, Vikki; Townend, Will; Crane, Steve

2014-01-01

Background and objective Risk-adjusted mortality rates can be used as a quality indicator if it is assumed that the discrepancy between predicted and actual mortality can be attributed to the quality of healthcare (ie, the model has attributional validity). The Development And Validation of Risk-adjusted Outcomes for Systems of emergency care (DAVROS) model predicts 7-day mortality in emergency medical admissions. We aimed to test this assumption by evaluating the attributional validity of the DAVROS risk-adjustment model. Methods We selected cases that had the greatest discrepancy between observed mortality and predicted probability of mortality from seven hospitals involved in validation of the DAVROS risk-adjustment model. Reviewers at each hospital assessed hospital records to determine whether the discrepancy between predicted and actual mortality could be explained by the healthcare provided. Results We received 232/280 (83%) completed review forms relating to 179 unexpected deaths and 53 unexpected survivors. The healthcare system was judged to have potentially contributed to 10/179 (8%) of the unexpected deaths and 26/53 (49%) of the unexpected survivors. Failure of the model to appropriately predict risk was judged to be responsible for 135/179 (75%) of the unexpected deaths and 2/53 (4%) of the unexpected survivors. Some 10/53 (19%) of the unexpected survivors died within a few months of the 7-day period of model prediction. Conclusions We found little evidence that deaths occurring in patients with a low predicted mortality from risk-adjustment could be attributed to the quality of healthcare provided. PMID:23605036

Development of the Parent Responses to School Functioning Questionnaire.

PubMed

Barber Garcia, Brittany N; Gray, Laura S; Simons, Laura E; Logan, Deirdre E

2017-10-01

Parents play an important role in supporting school functioning in youth with chronic pain, but no validated tools exists to assess parental responses to child and adolescent pain behaviors in the school context. Such a tool would be useful in identifying targets of change to reduce pain-related school impairment. The goal of this study was to develop and preliminarily validate the Parent Responses to School Functioning Questionnaire (PRSF), a parent self-report measure of this construct. After initial expert review and pilot testing, the measure was administered to 418 parents of children (ages 6-17 years) seen for initial multidisciplinary chronic pain clinic evaluation. The final 16-item PRSF showed evidence of good internal consistency (α = .82) and 2-week test-retest reliability (intraclass correlation coefficient = .87). Criterion validity was demonstrated by significant correlations with school absence rates and overall school functioning, and construct validity was demonstrated by correlations with general parental responses to pain. Three subscales emerged capturing parents' personal distress, parents' level of distrust of the school, and parents' expectations and behaviors related to their child's management of challenging school situations. These results provide preliminary support for the PRSF as a psychometrically sound tool to assess parents' responses to child pain in the school setting. The 16-item PRSF measures parental responses to their child's chronic pain in the school context. The clinically useful measure can inform interventions aimed reducing functional disability in children with chronic pain by enhancing parents' ability to respond adaptively to child pain behaviors. Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights reserved.

Nurse Practitioners’ Experience With Herbal Therapy

DTIC Science & Technology

2000-05-01

supplements has also grown. Patient use, benefits, and potential adverse effects of herbal therapy have been well documented in the literature, but...established and a core variable emerged. Results identified nine theme categories related to knowledge, safety, validity and effectiveness , responsibility...decade. Advertisement and access to these supplements has also grown. Patient use, benefits, and potential adverse effects of herbal therapy have been

Comparing Human and Automated Essay Scoring for Prospective Graduate Students with Learning Disabilities and/or ADHD

ERIC Educational Resources Information Center

Buzick, Heather; Oliveri, Maria Elena; Attali, Yigal; Flor, Michael

2016-01-01

Automated essay scoring is a developing technology that can provide efficient scoring of large numbers of written responses. Its use in higher education admissions testing provides an opportunity to collect validity and fairness evidence to support current uses and inform its emergence in other areas such as K-12 large-scale assessment. In this…

The needs of families accompanying injured patients into the emergency department in a tertiary hospital in Gauteng.

PubMed

Botes, Meghan L; Langley, Gayle

2016-06-24

Families are not prepared for traumatic injuries of loved ones. Emergency nurses have the important role of caring for patients and families in this time of crisis. Family needs in the critical care setting have been explored using the Critical Care Family Needs Inventory (CCFNI), however little is known about family needs in the emergency department. This study sought to determine the needs of family members accompanying injured patients into the emergency department, and if these needs were met. A quantitative, descriptive, study was conducted in a level 1 trauma facility in Johannesburg, South Africa. The population included families of patients admitted to the emergency department, sampling 100 participants. The instrument, based on the CCFNI, was validated in a pilot study in Melbourne, Australia and re-evaluated using the Cronbach Alpha validity test to ensure internal consistency.Five themes were explored: 'meaning', 'proximity', 'communication', 'comfort' and 'support' and data were analysed using descriptive statistics. Responses to open-ended questions were analysed using content analysis. Permission from the Human Research Ethics Committee was granted and participants were ensured confidentiality and the option for counselling if required. Themes ranked highly important were 'meaning' and 'communication'. Satisfaction was highest for 'meaning'. Low satisfaction levels for 'communication' were found. Issues regarding prolonged time spent in the emergency department and discrimination were raised. These findings have a negative impact on the family's satisfaction with care and it is recommended that the nurse's role in family care be further explored and emphasised.

Validation of biomarkers of food intake-critical assessment of candidate biomarkers.

PubMed

Dragsted, L O; Gao, Q; Scalbert, A; Vergères, G; Kolehmainen, M; Manach, C; Brennan, L; Afman, L A; Wishart, D S; Andres Lacueva, C; Garcia-Aloy, M; Verhagen, H; Feskens, E J M; Praticò, G

2018-01-01

Biomarkers of food intake (BFIs) are a promising tool for limiting misclassification in nutrition research where more subjective dietary assessment instruments are used. They may also be used to assess compliance to dietary guidelines or to a dietary intervention. Biomarkers therefore hold promise for direct and objective measurement of food intake. However, the number of comprehensively validated biomarkers of food intake is limited to just a few. Many new candidate biomarkers emerge from metabolic profiling studies and from advances in food chemistry. Furthermore, candidate food intake biomarkers may also be identified based on extensive literature reviews such as described in the guidelines for Biomarker of Food Intake Reviews (BFIRev). To systematically and critically assess the validity of candidate biomarkers of food intake, it is necessary to outline and streamline an optimal and reproducible validation process. A consensus-based procedure was used to provide and evaluate a set of the most important criteria for systematic validation of BFIs. As a result, a validation procedure was developed including eight criteria, plausibility, dose-response, time-response, robustness, reliability, stability, analytical performance, and inter-laboratory reproducibility. The validation has a dual purpose: (1) to estimate the current level of validation of candidate biomarkers of food intake based on an objective and systematic approach and (2) to pinpoint which additional studies are needed to provide full validation of each candidate biomarker of food intake. This position paper on biomarker of food intake validation outlines the second step of the BFIRev procedure but may also be used as such for validation of new candidate biomarkers identified, e.g., in food metabolomic studies.

Reflexive Orienting in Response to Short- and Long-Duration Gaze Cues in Young, Young-Old, and Old-Old Adults

PubMed Central

Gayzur, Nora D.; Langley, Linda K.; Kelland, Chris; Wyman, Sara V.; Saville, Alyson L.; Ciernia, Annie T.; Padmanabhan, Ganesh

2013-01-01

Shifting visual focus based on the perceived gaze direction of another person is one form of joint attention. The present study investigated if this socially-relevant form of orienting is reflexive and whether it is influenced by age. Green and Woldorff (2012) argued that rapid cueing effects (faster responses to validly-cued targets than to invalidly-cued targets) were limited to conditions in which a cue overlapped in time with a target. They attributed slower responses following invalid cues to the time needed to resolve incongruent spatial information provided by the concurrently-presented cue and target. The present study examined orienting responses of young (18-31 years), young-old (60-74 years), and old-old adults (75-91 years) following uninformative central gaze cues that overlapped in time with the target (Experiment 1) or that were removed prior to target presentation (Experiment 2). When the cue and target overlapped, all three groups localized validly-cued targets faster than invalidly-cued targets, and validity effects emerged earlier for the two younger groups (at 100 ms post cue onset) than for the old-old group (at 300 ms post cue onset). With a short duration cue (Experiment 2), validity effects developed rapidly (by 100 ms) for all three groups, suggesting that validity effects resulted from reflexive orienting based on gaze cue information rather than from cue-target conflict. Thus, although old-old adults may be slow to disengage from persistent gaze cues, attention continues to be reflexively guided by gaze cues late in life. PMID:24170377

Emergency medicine leadership in industry-sponsored clinical trials.

PubMed

Newgard, Craig D; Kim, Sunghye; Camargo, Carlos A

2003-02-01

To identify and characterize emergency medicine (EM) researchers who, since 1990, have served on a steering committee (SC) or as overall principal investigator (PI) of an industry-sponsored, multicenter clinical trial involving a pharmaceutical or device. North American EM research directors (RDs) and other prominent EM investigators (for those hospitals without a RD) were identified from eight sources, including the Society for Academic Emergency Medicine RD Interest Group and the Multicenter Airway Research Collaboration (MARC) database. The identified investigators were sent a screening survey requesting information regarding industry-sponsored clinical research at their site. The individual EM investigators identified by this screening survey were then interviewed by telephone (validation survey) to further explore their leadership experience in industry-sponsored clinical trials. Of 153 identified RDs and prominent EM researchers, 138 responded to the screening survey (90% response rate). Eighty-five EM investigators reportedly had served on a SC or as overall PI for an industry-sponsored clinical trial. Of these 85 North American EM investigators, 77 were available for a structured telephone interview (91% response rate). Although 41 (53%) of the investigators confirmed their leadership role, 36 (47%) had not served in either role. Among the 41 confirmed investigators, 19 (25%) had served as a SC member, 10 (13%) had served as overall PI, and 12 (16%) had experience in both roles. Individual responses provided suggestions for pursuing such leadership positions. These data suggest the opportunity to expand EM leadership in industry-sponsored clinical trials and demonstrate the need for validation of reports obtained by a departmental research contact. The suggestions from EM researchers who have attained these leadership roles may provide strategies for investigators interested in pursuing these positions.

Operational guidance for radiation emergency response organisations in Europe for using biodosimetric tools developed in EU MULTIBIODOSE project.

PubMed

Jaworska, Alicja; Ainsbury, Elizabeth A; Fattibene, Paola; Lindholm, Carita; Oestreicher, Ursula; Rothkamm, Kai; Romm, Horst; Thierens, Hubert; Trompier, Francois; Voisin, Philippe; Vral, Anne; Woda, Clemens; Wojcik, Andrzej

2015-04-01

In the event of a large-scale radiological emergency, the triage of individuals according to their degree of exposure forms an important initial step of the accident management. Although clinical signs and symptoms of a serious exposure may be used for radiological triage, they are not necessarily radiation specific and can lead to a false diagnosis. Biodosimetry is a method based on the analysis of radiation-induced changes in cells of the human body or in portable electronic devices and enables the unequivocal identification of exposed people who should receive medical treatment. The MULTIBIODOSE (MBD) consortium developed and validated several biodosimetric assays and adapted and tested them as tools for biological dose assessment in a mass-casualty event. Different biodosimetric assays were validated against the 'gold standard' of biological dosimetry-the dicentric assay. The assays were harmonised in such a way that, in an emergency situation, they can be run in parallel in a network of European laboratories. The aim of this guidance is to give a concise overview of the developed biodosimetric tools as well as how and when they can be used in an emergency situation. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Workload differences across command levels and emergency response organizations during a major joint training exercise.

PubMed

Prytz, Erik G; Rybing, Jonas; Jonson, Carl-Oscar

2016-01-01

This study reports on an initial test using a validated workload measurement method, the NASA Task Load Index (TLX), as an indicator of joint emergency exercise effectiveness. Prior research on emergency exercises indicates that exercises must be challenging, ie, result in high workload, to be effective. However, this is often problematic with some participants being underloaded and some overloaded. The NASA TLX was used to test for differences in workload between commanders and subordinates and among three different emergency response organizations during a joint emergency exercise. Questionnaire-based evaluation with professional emergency responders. The study was performed in conjunction with a large-scale interorganizational joint emergency exercise in Sweden. A total of 20 participants from the rescue services, 12 from the emergency medical services, and 12 from the police participated in the study (N=44). Ten participants had a command-level role during the exercise and the remaining 34 were subordinates. The main outcome measures were the workload subscales of the NASA TLX: mental demands, physical demands, temporal demands, performance, effort, and frustration. The results showed that the organizations experienced different levels of workload, that the commanders experienced a higher workload than the subordinates, and that two out of three organizations fell below the twenty-fifth percentile of average workload scores compiled from 237 prior studies. The results support the notion that the NASA TLX could be a useful complementary tool to evaluate exercise designs and outcomes. This should be further explored and verified in additional studies.

Evaluation of community-acquired sepsis by PIRO system in the emergency department.

PubMed

Chen, Yun-Xia; Li, Chun-Sheng

2013-09-01

The predisposition, infection/insult, response, and organ dysfunction (PIRO) staging system for septic patients allows grouping of heterogeneous patients into homogeneous subgroups. The purposes of this single-center, prospective, observational cohort study were to create a PIRO system for patients with community-acquired sepsis (CAS) presenting to the emergency department (ED) and assess its prognostic and stratification capabilities. Septic patients were enrolled and allocated to derivation (n = 831) or validation (n = 860) cohorts according to their enrollment dates. The derivation cohort was used to identify independent predictors of mortality and create a PIRO system by binary logistic regression analysis, and the prognostic performance of PIRO was investigated in the validation cohort by receiver operator characteristic (ROC) curve. Ten independent predictors of 28-day mortality were identified. The PIRO system combined the components of predisposition (age, chronic obstructive pulmonary disease, hypoalbuminemia), infection (central nervous system infection), response (temperature, procalcitonin), and organ dysfunction (brain natriuretic peptide, troponin I, mean arterial pressure, Glasgow coma scale score). The area under the ROC of PIRO was 0.833 for the derivation cohort and 0.813 for the validation cohort. There was a stepwise increase in 28-day mortality with increasing PIRO score and the differences between the low- (PIRO 0-10), intermediate- (11-20), and high- (>20) risk groups were very significant in both cohorts (p < 0.01). The present study demonstrates that this PIRO system is valuable for prognosis and risk stratification in patients with CAS in the ED.

A new scale for disaster nursing core competencies: Development and psychometric testing.

PubMed

Al Thobaity, Abdulellah; Williams, Brett; Plummer, Virginia

2016-02-01

All nurses must have core competencies in preparing for, responding to and recovering from a disaster. In the Kingdom of Saudi Arabia (KSA), as in many other countries, disaster nursing core competencies are not fully understood and lack reliable, validated tools. Thus, it is imperative to develop a scale for exploring disaster nursing core competencies, roles and barriers in the KSA. This study's objective is to develop a valid, reliable scale that identifies and explores core competencies of disaster nursing, nurses' roles in disaster management and barriers to developing disaster nursing in the KSA. This study developed a new scale testing its validity and reliability. A principal component analysis (PCA) was used to develop and test psychometric properties of the new scale. The PCA used a purposive sample of nurses from emergency departments in two hospitals in the KSA. Participants rated 93 paper-based, self-report questionnaire items from 1 to 10 on a Likert scale. PCA using Varimax rotation was conducted to explore factors emerging from responses. The study's participants were 132 nurses (66% response rate). PCA of the 93 questionnaire items revealed 49 redundant items (which were deleted) and 3 factors with eigenvalues of >1. The remaining 44 items accounted for 77.3% of the total variance. The overall Cronbach's alpha was 0.96 for all factors: 0.98 for Factor 1, 0.92 for Factor 2 and 0.86 for Factor 3. This study provided a validated, reliable scale for exploring nurses' core competencies, nurses' roles and barriers to developing disaster nursing in the KSA. The new scale has many implications, such as for improving education, planning and curricula. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Complex PTSD as Proposed for ICD-11: Validation of a New Disorder in Children and Adolescents and Their Response to Trauma-Focused Cognitive Behavioral Therapy

ERIC Educational Resources Information Center

Sachser, Cedric; Keller, Ferdinand; Goldbeck, Lutz

2017-01-01

Background: To evaluate whether the symptoms of children and adolescents with clinically significant posttraumatic stress symptoms (PTSS) form classes consistent with the diagnostic criteria of complex PTSD (CPTSD) as proposed for the ICD-11, and to relate the emerging classes with treatment outcome of Trauma-Focused Cognitive Behavioral Therapy…

Emergency department surge capacity: recommendations of the Australasian Surge Strategy Working Group.

PubMed

Bradt, David A; Aitken, Peter; FitzGerald, Gerry; Swift, Roger; O'Reilly, Gerard; Bartley, Bruce

2009-12-01

For more than a decade, emergency medicine (EM) organizations have produced guidelines, training, and leadership for disaster management. However, to date there have been limited guidelines for emergency physicians (EPs) needing to provide a rapid response to a surge in demand. The aim of this project was to identify strategies that may guide surge management in the emergency department (ED). A working group of individuals experienced in disaster medicine from the Australasian College for Emergency Medicine Disaster Medicine Subcommittee (the Australasian Surge Strategy Working Group) was established to undertake this work. The Working Group used a modified Delphi technique to examine response actions in surge situations and identified underlying assumptions from disaster epidemiology and clinical practice. The group then characterized surge strategies from their corpus of experience; examined them through available relevant published literature; and collated these within domains of space, staff, supplies, and system operations. These recommendations detail 22 potential actions available to an EP working in the context of surge, along with detailed guidance on surge recognition, triage, patient flow through the ED, and clinical goals and practices. The article also identifies areas that merit future research, including the measurement of surge capacity, constraints to strategy implementation, validation of surge strategies, and measurement of strategy impacts on throughput, cost, and quality of care.

Chemical decontamination technical resources at Los Alamos National Laboratory (2008)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moore, Murray E

This document supplies information resources for a person seeking to create planning or pre-planning documents for chemical decontamination operations. A building decontamination plan can be separated into four different sections: Pre-planning, Characterization, Decontamination (Initial response and also complete cleanup), and Clearance. Of the identified Los Alamos resources, they can be matched with these four sections: Pre-planning -- Dave Seidel, EO-EPP, Emergency Planning and Preparedness; David DeCroix and Bruce Letellier, D-3, Computational fluids modeling of structures; Murray E. Moore, RP-2, Aerosol sampling and ventilation engineering. Characterization (this can include development projects) -- Beth Perry, IAT-3, Nuclear Counterterrorism Response (SNIPER database); Fernandomore » Garzon, MPA-11, Sensors and Electrochemical Devices (development); George Havrilla, C-CDE, Chemical Diagnostics and Engineering; Kristen McCabe, B-7, Biosecurity and Public Health. Decontamination -- Adam Stively, EO-ER, Emergency Response; Dina Matz, IHS-IP, Industrial hygiene; Don Hickmott, EES-6, Chemical cleanup. Clearance (validation) -- Larry Ticknor, CCS-6, Statistical Sciences.« less

Evaluating instruments for quality: testing convergent validity of the consumer emergency care satisfaction scale.

PubMed

Davis, Barbara A; Kiesel, Cynthia K; McFarland, Julie; Collard, Adressa; Coston, Kyle; Keeton, Ada

2005-01-01

Having reliable and valid instruments is a necessity for nurses and others measuring concepts such as patient satisfaction. The purpose of this article is to describe the use of convergence to test the construct validity of the Davis Consumer Emergency Care Satisfaction Scale (CECSS). Results indicate convergence of the CECSS with the Risser Patient Satisfaction Scale and 2 single-item visual analogue scales, therefore supporting construct validity. Persons measuring patient satisfaction with nurse behaviors in the emergency department can confidently use the CECSS.

An Extended Validity Argument for Assessing Feedback Culture.

PubMed

Rougas, Steven; Clyne, Brian; Cianciolo, Anna T; Chan, Teresa M; Sherbino, Jonathan; Yarris, Lalena M

2015-01-01

NEGEA 2015 CONFERENCE ABSTRACT (EDITED): Measuring an Organization's Culture of Feedback: Can It Be Done? Steven Rougas and Brian Clyne. CONSTRUCT: This study sought to develop a construct for measuring formative feedback culture in an academic emergency medicine department. Four archetypes (Market, Adhocracy, Clan, Hierarchy) reflecting an organization's values with respect to focus (internal vs. external) and process (flexibility vs. stability and control) were used to characterize one department's receptiveness to formative feedback. The prevalence of residents' identification with certain archetypes served as an indicator of the department's organizational feedback culture. New regulations have forced academic institutions to implement wide-ranging changes to accommodate competency-based milestones and their assessment. These changes challenge residencies that use formative feedback from faculty as a major source of data for determining training advancement. Though various approaches have been taken to improve formative feedback to residents, there currently exists no tool to objectively measure the organizational culture that surrounds this process. Assessing organizational culture, commonly used in the business sector to represent organizational health, may help residency directors gauge their program's success in fostering formative feedback. The Organizational Culture Assessment Instrument (OCAI) is widely used, extensively validated, applicable to survey research, and theoretically based and may be modifiable to assess formative feedback culture in the emergency department. Using a modified Delphi technique and several iterations of focus groups amongst educators at one institution, four of the original six OCAI domains (which each contain 4 possible responses) were modified to create a 16-item Formative Feedback Culture Tool (FFCT) that was administered to 26 residents (response rate = 55%) at a single academic emergency medicine department. The mean score of each item on the FFCT (range = 0-100) was analyzed. Convergent and divergent properties of the four archetypes were assessed using a multitrait-multimethod matrix of Pearson's coefficients. Expecting that items in one archetype would diverge from the others, whereas items within an archetype should have strong convergent properties, convergent validity was assessed by comparing items across domains that all related to the same archetype. Similarly, divergent validity was assessed by comparing the correlation of items within an archetype to the correlations of those items within a hetero-domain block (i.e., to other items within the same domain). Three of the four domains of the FFCT (Overall Departmental Characteristics 35.4 ± 15.4, Departmental Foundation of Feedback 46.1 ± 16.7, and Departmental Emphasis of Feedback 30.3 ± 17.7) had the highest mean in the Market archetype (results/achievement oriented), whereas the final domain (Departmental Definition of Successful Feedback 34.8 ± 22.1) had the highest mean in the Clan archetype (personal growth/team achievement). Item responses in the Clan and Hierarchy archetypes had the strongest convergent and divergent validity, respectively. Item responses in the Adhocracy archetype had the weakest convergent and divergent validity. Although the sample size was small, this initial study demonstrates that a modified organizational culture assessment tool can feasibly be utilized to identify the primary formative feedback archetype of a cohort of residents. This may have future implications for measuring changes in culture after the implementation of strategic programs to address formative feedback. Future studies should examine the generalizability of the FFCT to other institutions, as well as address the weak validity evidence of the Adhocracy archetype in the FFCT.

Translating research into licensed vaccines and validated and licensed diagnostic tests.

PubMed

Hill, R E; Foley, P L; Clough, N E; Ludemann, L R; Murtle, D C

2013-01-01

The USDA Center for Veterinary Biologics (CVB) has the regulatory authority to issue licenses and permits that allow the marketing of pure, safe, potent, and effective veterinary biological products. Under the standard licensing or permitting process, a manufacturer develops, characterizes, and evaluates a product prior to licensure. The CVB evaluates the submitted information, inspects the manufacturing facilities and methods of production and testing, and confirms key product test results through independent testing. This complete and comprehensive evaluation may not be possible during the emergence of a new animal disease or in response to an introduction of a significant transboundary animal disease agent. Processes are in place in the US that allow for more rapid availability of veterinary products in an emerging or emergency animal health situation. But, it can be advantageous to attain preapproval of products prior to their anticipated need. In this article, issues associated with obtaining approval for use of a biological product under emerging or emergency conditions are discussed.

Development of geriatric competencies for emergency medicine residents using an expert consensus process.

PubMed

Hogan, Teresita M; Losman, Eve D; Carpenter, Christopher R; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M

2010-03-01

The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. In Phase I, participants (n=363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n=24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. Copyright (c) 2010 by the Society for Academic Emergency Medicine.

A comparison of four embedded validity indices for the RBANS in a memory disorders clinic.

PubMed

Paulson, Daniel; Horner, Michael David; Bachman, David

2015-05-01

This examination of four embedded validity indices for the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) explores the potential utility of integrating cognitive and self-reported depressive measures. Examined indices include the proposed RBANS Performance Validity Index (RBANS PVI) and the Charleston Revised Index of Effort for the RBANS (CRIER). The CRIER represented the novel integration of cognitive test performance and depression self-report information. The sample included 234 patients without dementia who could be identified as having demonstrated either valid or invalid responding, based on standardized criteria. Sensitivity and specificity for invalid responding varied widely, with the CRIER emerging as the best all-around index (sensitivity = 0.84, specificity = 0.90, AUC = 0.94). Findings support the use of embedded response validity indices, and suggest that the integration of cognitive and self-report depression data may optimize detection of invalid responding among older Veterans. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Validation of biomarkers to predict response to immunotherapy in cancer: Volume I - pre-analytical and analytical validation.

PubMed

Masucci, Giuseppe V; Cesano, Alessandra; Hawtin, Rachael; Janetzki, Sylvia; Zhang, Jenny; Kirsch, Ilan; Dobbin, Kevin K; Alvarez, John; Robbins, Paul B; Selvan, Senthamil R; Streicher, Howard Z; Butterfield, Lisa H; Thurin, Magdalena

2016-01-01

Immunotherapies have emerged as one of the most promising approaches to treat patients with cancer. Recently, there have been many clinical successes using checkpoint receptor blockade, including T cell inhibitory receptors such as cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death-1 (PD-1). Despite demonstrated successes in a variety of malignancies, responses only typically occur in a minority of patients in any given histology. Additionally, treatment is associated with inflammatory toxicity and high cost. Therefore, determining which patients would derive clinical benefit from immunotherapy is a compelling clinical question. Although numerous candidate biomarkers have been described, there are currently three FDA-approved assays based on PD-1 ligand expression (PD-L1) that have been clinically validated to identify patients who are more likely to benefit from a single-agent anti-PD-1/PD-L1 therapy. Because of the complexity of the immune response and tumor biology, it is unlikely that a single biomarker will be sufficient to predict clinical outcomes in response to immune-targeted therapy. Rather, the integration of multiple tumor and immune response parameters, such as protein expression, genomics, and transcriptomics, may be necessary for accurate prediction of clinical benefit. Before a candidate biomarker and/or new technology can be used in a clinical setting, several steps are necessary to demonstrate its clinical validity. Although regulatory guidelines provide general roadmaps for the validation process, their applicability to biomarkers in the cancer immunotherapy field is somewhat limited. Thus, Working Group 1 (WG1) of the Society for Immunotherapy of Cancer (SITC) Immune Biomarkers Task Force convened to address this need. In this two volume series, we discuss pre-analytical and analytical (Volume I) as well as clinical and regulatory (Volume II) aspects of the validation process as applied to predictive biomarkers for cancer immunotherapy. To illustrate the requirements for validation, we discuss examples of biomarker assays that have shown preliminary evidence of an association with clinical benefit from immunotherapeutic interventions. The scope includes only those assays and technologies that have established a certain level of validation for clinical use (fit-for-purpose). Recommendations to meet challenges and strategies to guide the choice of analytical and clinical validation design for specific assays are also provided.

Material characterization and modeling with shear ography

NASA Technical Reports Server (NTRS)

Workman, Gary L.; Callahan, Virginia

1993-01-01

Shearography has emerged as a useful technique for nondestructible evaluation and materials characterization of aerospace materials. A suitable candidate for the technique is to determine the response of debonds on foam-metal interfaces such as the TPS system on the External Tank. The main thrust is to develop a model which allows valid interpretation of shearographic information on TPS type systems. Confirmation of the model with shearographic data will be performed.

IMPRESS: medical location-aware decision making during emergencies

NASA Astrophysics Data System (ADS)

Gkotsis, I.; Eftychidis, G.; Leventakis, G.; Mountzouris, M.; Diagourtas, D.; Kostaridis, A.; Hedel, R.; Olunczek, A.; Hahmann, S.

2017-09-01

Emergency situations and mass casualties involve several agencies and public authorities, which need to gather data from the incident scene and exchange geo-referenced information to provide fast and accurate first aid to the people in need. Tracking patients on their way to the hospitals can prove critical in taking lifesaving decisions. Increased and continuous flow of information combined by vital signs and geographic location of emergency victims can greatly reduce the response time of the medical emergency chain and improve the efficiency of disaster medicine activity. Recent advances in mobile positioning systems and telecommunications are providing the technology needed for the development of location-aware medical applications. IMPRESS is an advanced ICT platform based on adequate technologies for developing location-aware medical response during emergencies. The system incorporates mobile and fixed components that collect field data from diverse sources, support medical location and situation-based services and share information on the patient's transport from the field to the hospitals. In IMPRESS platform tracking of victims, ambulances and emergency services vehicles is integrated with medical, traffic and crisis management information into a common operational picture. The Incident Management component of the system manages operational resources together with patient tracking data that contain vital sign values and patient's status evolution. Thus, it can prioritize emergency transport decisions, based on medical and location-aware information. The solution combines positioning and information gathered and owned by various public services involved in MCIs or large-scale disasters. IMPRESS solution, were validated in field and table top exercises in cooperation with emergency services and hospitals.

Hesitant Fuzzy Thermodynamic Method for Emergency Decision Making Based on Prospect Theory.

PubMed

Ren, Peijia; Xu, Zeshui; Hao, Zhinan

2017-09-01

Due to the timeliness of emergency response and much unknown information in emergency situations, this paper proposes a method to deal with the emergency decision making, which can comprehensively reflect the emergency decision making process. By utilizing the hesitant fuzzy elements to represent the fuzziness of the objects and the hesitant thought of the experts, this paper introduces the negative exponential function into the prospect theory so as to portray the psychological behaviors of the experts, which transforms the hesitant fuzzy decision matrix into the hesitant fuzzy prospect decision matrix (HFPDM) according to the expectation-levels. Then, this paper applies the energy and the entropy in thermodynamics to take the quantity and the quality of the decision values into account, and defines the thermodynamic decision making parameters based on the HFPDM. Accordingly, a whole procedure for emergency decision making is conducted. What is more, some experiments are designed to demonstrate and improve the validation of the emergency decision making procedure. Last but not the least, this paper makes a case study about the emergency decision making in the firing and exploding at Port Group in Tianjin Binhai New Area, which manifests the effectiveness and practicability of the proposed method.

Curriculum evaluation and revision in a nascent field: the utility of the retrospective pretest--posttest model in a homeland security program of study.

PubMed

Pelfrey, William V; Pelfrey, William V

2009-02-01

Although most academic disciplines evolve at a measured pace, the emerging field of homeland security must, for reasons of safety and security, evolve rapidly. The Department of Homeland Security sponsored the establishment of a graduate educational program for key officials holding homeland security roles. Because homeland security is a nascent field, the establishment of a program curriculum was forced to draw from a variety of disciplines. Curriculum evaluation was complicated by the rapid changes occurring in the emerging discipline, producing response shift bias, and interfering with the pre-post assessments. To compensate for the validity threat associated with response shift bias, a retrospective pretest-posttest evaluative methodology was used. Data indicate the program has evolved in a significant and orderly fashion and these data support the use of this innovative evaluation approach in the development of any discipline.

Beyond policy networks: policy framing and the politics of expertise in the 2001 Foot and Mouth Disease crisis.

PubMed

Wilkinson, Katy; Lowe, Philip; Donaldson, Andrew

2010-01-01

For the past decade, the policy community/issue network typology of pressure group interaction has been used to explain policy outcomes and the policy-making process. To re-examine the validity of this typology, the paper focuses on the UK government's response to the 2001 Foot and Mouth Disease (FMD) crisis, and in particular the decision to pursue contiguous culling rather than vaccination to overcome the epidemic. Rather than illustrating the emergence of an issue network in agricultural policy, the decision-making process of the FMD outbreak demonstrates continuity with prior crises. In addition, the politicization of scientific expertise is identified as an emerging trend in crisis management. Policy framing is used to explain the impetus behind the contiguous cull decision, concluding that the legacy of previous policy choices conditioned the crisis response to a far greater degree than contemporaneous pressure group action.

Development and validation of phytotoxicity tests with emergent and submerged aquatic plants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hughes, J.S.; Powell, R.L.; Nelson, M.K.

1995-12-31

Toxicity testing procedures have recently been developed for assessment of contaminant effects on emergent and submerged aquatic macrophytes commonly found in freshwater wetlands. These tests have potential application in risk assessments for contaminated wetlands as well as for new chemical substances. The objective of this study was to evaluate and modify, if necessary, these methods and to validate them, using two benchmark chemicals, in a contract laboratory setting. Oryza sativa (domestic rice) was used as a surrogate emergent vascular plant, while Ceratophylium demersum (coontail) and Myriophyllum heterophyllum (variable-leaf milfoil) were the representative submerged vascular plants. Subsequent to evaluating culturing techniquesmore » and testing conditions, toxicity tests were conducted using boron and metribuzin. The test procedure for the emergent plants involves a two-week pro-exposure period followed by a two-week aqueous exposure. Five types of sediment, including both natural and artificial sediments, were evaluated for use with rice. Fresh weight and chlorophyll a content were the selected test endpoints. The submerged plants were exposed for two weeks, and the response variables evaluated included length, weight (fresh and dry), and root number. The sensitivity of these tests were comparable to the results obtained for the same two chemicals using the green alga, Selenastrum capricornutum, and the duckweed, Lemna gibba, with the exception that rice was less sensitive to metribuzin than the other species.« less

Evaluation of Serologic and Antigenic Relationships Between Middle Eastern Respiratory Syndrome Coronavirus and Other Coronaviruses to Develop Vaccine Platforms for the Rapid Response to Emerging Coronaviruses

PubMed Central

Agnihothram, Sudhakar; Gopal, Robin; Yount, Boyd L.; Donaldson, Eric F.; Menachery, Vineet D.; Graham, Rachel L.; Scobey, Trevor D.; Gralinski, Lisa E.; Denison, Mark R.; Zambon, Maria; Baric, Ralph S.

2014-01-01

Background. Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012, causing severe acute respiratory disease and pneumonia, with 44% mortality among 136 cases to date. Design of vaccines to limit the virus spread or diagnostic tests to track newly emerging strains requires knowledge of antigenic and serologic relationships between MERS-CoV and other CoVs. Methods. Using synthetic genomics and Venezuelan equine encephalitis virus replicons (VRPs) expressing spike and nucleocapsid proteins from MERS-CoV and other human and bat CoVs, we characterize the antigenic responses (using Western blot and enzyme-linked immunosorbent assay) and serologic responses (using neutralization assays) against 2 MERS-CoV isolates in comparison with those of other human and bat CoVs. Results. Serologic and neutralization responses against the spike glycoprotein were primarily strain specific, with a very low level of cross-reactivity within or across subgroups. CoV N proteins within but not across subgroups share cross-reactive epitopes with MERS-CoV isolates. Our findings were validated using a convalescent-phase serum specimen from a patient infected with MERS-CoV (NA 01) and human antiserum against SARS-CoV, human CoV NL63, and human CoV OC43. Conclusions. Vaccine design for emerging CoVs should involve chimeric spike protein containing neutralizing epitopes from multiple virus strains across subgroups to reduce immune pathology, and a diagnostic platform should include a panel of nucleocapsid and spike proteins from phylogenetically distinct CoVs. PMID:24253287

Heparin-Binding Protein Measurement Improves the Prediction of Severe Infection With Organ Dysfunction in the Emergency Department

PubMed Central

Arnold, Ryan; Boyd, John H.; Zindovic, Marko; Zindovic, Igor; Lange, Anna; Paulsson, Magnus; Nyberg, Patrik; Russell, James A.; Pritchard, David; Christensson, Bertil; Åkesson, Per

2015-01-01

Objectives: Early identification of patients with infection and at risk of developing severe disease with organ dysfunction remains a difficult challenge. We aimed to evaluate and validate the heparin-binding protein, a neutrophil-derived mediator of vascular leakage, as a prognostic biomarker for risk of progression to severe sepsis with circulatory failure in a multicenter setting. Design: A prospective international multicenter cohort study. Setting: Seven different emergency departments in Sweden, Canada, and the United States. Patients: Adult patients with a suspected infection and at least one of three clinical systemic inflammatory response syndrome criteria (excluding leukocyte count). Intervention: None. Measurements and Main Results: Plasma levels of heparin-binding protein, procalcitonin, C-reactive protein, lactate, and leukocyte count were determined at admission and 12–24 hours after admission in 759 emergency department patients with suspected infection. Patients were defined depending on the presence of infection and organ dysfunction. Plasma samples from 104 emergency department patients with suspected sepsis collected at an independent center were used to validate the results. Of the 674 patients diagnosed with an infection, 487 did not have organ dysfunction at enrollment. Of these 487 patients, 141 (29%) developed organ dysfunction within the 72-hour study period; 78.0% of the latter patients had an elevated plasma heparin-binding protein level (> 30 ng/mL) prior to development of organ dysfunction (median, 10.5 hr). Compared with other biomarkers, heparin-binding protein was the best predictor of progression to organ dysfunction (area under the receiver operating characteristic curve = 0.80). The performance of heparin-binding protein was confirmed in the validation cohort. Conclusion: In patients presenting at the emergency department, heparin-binding protein is an early indicator of infection-related organ dysfunction and a strong predictor of disease progression to severe sepsis within 72 hours. PMID:26468696

Memory T cell responses targeting the SARS coronavirus persist up to 11 years post-infection.

PubMed

Ng, Oi-Wing; Chia, Adeline; Tan, Anthony T; Jadi, Ramesh S; Leong, Hoe Nam; Bertoletti, Antonio; Tan, Yee-Joo

2016-04-12

Severe acute respiratory syndrome (SARS) is a highly contagious infectious disease which first emerged in late 2002, caused by a then novel human coronavirus, SARS coronavirus (SARS-CoV). The virus is believed to have originated from bats and transmitted to human through intermediate animals such as civet cats. The re-emergence of SARS-CoV remains a valid concern due to the continual persistence of zoonotic SARS-CoVs and SARS-like CoVs (SL-CoVs) in bat reservoirs. In this study, the screening for the presence of SARS-specific T cells in a cohort of three SARS-recovered individuals at 9 and 11 years post-infection was carried out, and all memory T cell responses detected target the SARS-CoV structural proteins. Two CD8(+) T cell responses targeting the SARS-CoV membrane (M) and nucleocapsid (N) proteins were characterized by determining their HLA restriction and minimal T cell epitope regions. Furthermore, these responses were found to persist up to 11 years post-infection. An absence of cross-reactivity of these CD8(+) T cell responses against the newly-emerged Middle East respiratory syndrome coronavirus (MERS-CoV) was also demonstrated. The knowledge of the persistence of SARS-specific celullar immunity targeting the viral structural proteins in SARS-recovered individuals is important in the design and development of SARS vaccines, which are currently unavailable. Copyright © 2016 Elsevier Ltd. All rights reserved.

WMD first response: requirements, emerging technologies, and policy implications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vergino, E S; Hoehn, W E

2000-06-19

In the US today, efforts are underway to defend against the possible terrorist use of weapons of mass destruction (WMD) against US cities. These efforts include the development and adaptation of technologies to support prevention and detection, to defend against a possible attack, and, if these fail, to provide both mitigation responses and attribution for a WMD incident. Technologies under development span a range of systems, from early detection and identification of an agent or explosive, to diagnostic and systems analysis tools; and to forensic analysis for law enforcement. Also, many techniques and tools that have been developed for othermore » applications are being examined to determine whether, with some modification, they could be of use by the emergency preparedness, public health, and law enforcement communities. However, anecdotal evidence suggests the existence of a serious disconnect between the technology development communities and these user communities. This disconnect arises because funding for technology development is derived primarily from sources (principally federal agencies) distant from the emergency response communities, which are predominantly state, county, or local entities. Moreover, the first responders with whom we have worked candidly admit that their jurisdictions have been given, or have purchased for them, a variety of technological devices, typically without consulting the emergency responders about their utility. In private discussions, emergency responders derisively refer to these as a closet full of useless toys. Technology developers have many new and relevant technologies currently in the development pipeline, but most have not been adequately vetted against the field needs or validated for field use. The Center for Global Security Research at the Lawrence Livermore National Laboratory and the Sam Nunn School of International Affairs at the Georgia Institute of Technology recently sponsored a two-day workshop to bring together some 50 representatives of the emergency response, technology development, and policy communities. Participating in this workshop were first responders (representing law enforcement, public health, and emergency response personnel from Los Angeles County, Salt Lake City, Atlanta, and London, England), technology developers from US government laboratories and universities, and policymakers from both the executive and legislative branches of the federal government. The workshop had several objectives. First, we wanted the emergency responders to define the utility of various technologies and tools currently available for first response to a WMD event. Second, we expected the workshop to provide input to the technologists directly from the field users, regarding their special requirements for, and constraints on the use of, new emergency response technologies. Third, we planned to expose the first responders to the types of new technologies under development and allow them the opportunity to ask questions and voice their needs. Finally, we planned to provide recommendations to policymakers for new directions for development and investment of technology.« less

An analysis of hospital preparedness capacity for public health emergency in four regions of China: Beijing, Shandong, Guangxi, and Hainan.

PubMed

Li, Xingming; Huang, Jianshi; Zhang, Hui

2008-09-20

Hospital preparedness is critical for the early detection and management of public health emergency (PHE). Understanding the current status of PHE preparedness is the first step in planning to enhance hospitals' capacities for emergency response. The objective of this study is to understand the current status of hospital PHE preparedness in China. Four hundred hospitals in four city and provinces of China were surveyed using a standardized questionnaire. Data related to hospital demographic data; PHE preparation; response to PHE in community; stockpiles of drugs and materials; detection and identification of PHE; procedures for medical treatment; laboratory diagnosis and management; staff training; and risk communication were collected and analyzed. Valid responses were received from 318 (79.5%) of the 400 hospitals surveyed. Of the valid responses, 264 (85.2%) hospitals had emergency plans; 93.3% had command centres and personnel for PHE; 22.9% included community organisations during the training for PHE; 97.4% could transport needed medical staff to a PHE; 53.1% had evaluated stockpiles of drugs; 61.5% had evaluated their supply systems; 55.5% had developed surveillance systems; and 74.6% could monitor the abnormity(See in appendix). Physicians in 80.2% of the analyzed hospitals reported up-to-date knowledge of their institution's PHE protocol. Of the 318 respondents, 97.4% followed strict laboratory regulations, however, only about 33.5% had protocols for suspected samples. Furthermore, only 59.0% could isolate and identify salmonella and staphylococcus and less than 5% could isolate and identify human H5N1 avian flu and SARS. Staff training or drill programs were reported in 94.5% of the institutions; 50.3% periodically assessed the efficacy of staff training; 45% had experts to provide psychological counselling; 12.1% had provided training for their medical staff to assess PHE-related stress. All of the above capacities related to the demographic characteristics of hospitals and will be discussed in-depth in this paper. Our survey suggested that, at the time of the survey, hospital preparedness for PHE in China was at an early stage of development. Comprehensive measures should be taken to enhance hospital capacity in the prevention and management of PHE.

DOE Partnerships with States, Tribes and Other Federal Programs Help Responders Prepare for Challenges Involving Transport of Radioactive Materials

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marsha Keister

2001-02-01

DOE Partnerships with States, Tribes and Other Federal Programs Help Responders Prepare for Challenges Involving Transport of Radioactive Materials Implementing adequate institutional programs and validating preparedness for emergency response to radiological transportation incidents along or near U.S. Department of Energy (DOE) shipping corridors poses unique challenges to transportation operations management. Delayed or insufficient attention to State and Tribal preparedness needs may significantly impact the transportation operations schedule and budget. The DOE Transportation Emergency Preparedness Program (TEPP) has successfully used a cooperative planning process to develop strong partnerships with States, Tribes, Federal agencies and other national programs to support responder preparednessmore » across the United States. DOE TEPP has found that building solid partnerships with key emergency response agencies ensures responders have access to the planning, training, technical expertise and assistance necessary to safely, efficiently and effectively respond to a radiological transportation accident. Through the efforts of TEPP over the past fifteen years, partnerships have resulted in States and Tribal Nations either using significant portions of the TEPP planning resources in their programs and/or adopting the Modular Emergency Response Radiological Transportation Training (MERRTT) program into their hazardous material training curriculums to prepare their fire departments, law enforcement, hazardous materials response teams, emergency management officials, public information officers and emergency medical technicians for responding to transportation incidents involving radioactive materials. In addition, through strong partnerships with Federal Agencies and other national programs TEPP provided technical expertise to support a variety of radiological response initiatives and assisted several programs with integration of the nationally recognized MERRTT program into other training venues, thus ensuring consistency of radiological response curriculums delivered to responders. This presentation will provide an overview of the steps to achieve coordination, to avoid redundancy, and to highlight several of the successful partnerships TEPP has formed with States, Tribes, Federal agencies and other national programs. Events, accident scenarios, and training where TEPP was proven to be integral in building the radiological response capabilities for first responders to actual radiological incidents are also highlighted. Participants will gain an appreciation for the collaborative efforts States and Tribes are engaging in with the DOE to ensure that responders all along the DOE transportation corridors are adequately prepared to respond to shipments of radioactive materials through their communities.« less

Development of Geriatric Competencies for Emergency Medicine Residents Using an Expert Consensus Process

PubMed Central

Hogan, Teresita M.; Losman, Eve D.; Carpenter, Christopher R.; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M.

2011-01-01

Background The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. Objectives The objective was to develop a consensus document, “Geriatric Competencies for Emergency Medicine Residents,” by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. Methods This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. Results In Phase I, participants (n = 363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n = 24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. Conclusions The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. PMID:20370765

Image and Imaging an Emergency Department: Expense and Benefit of Different Quality Assessment Methods

PubMed Central

Pfortmueller, Carmen Andrea; Keller, Michael; Mueller, Urs; Zimmermann, Heinz; Exadaktylos, Aristomenis Konstantinos

2013-01-01

Introduction. In this era of high-tech medicine, it is becoming increasingly important to assess patient satisfaction. There are several methods to do so, but these differ greatly in terms of cost, time, and labour and external validity. The aim of this study is to describe and compare the structure and implementation of different methods to assess the satisfaction of patients in an emergency department. Methods. The structure and implementation of the different methods to assess patient satisfaction were evaluated on the basis of a 90-minute standardised interview. Results. We identified a total of six different methods in six different hospitals. The average number of patients assessed was 5012, with a range from 230 (M5) to 20 000 patients (M2). In four methods (M1, M3, M5, and M6), the questionnaire was composed by a specialised external institute. In two methods, the questionnaire was created by the hospital itself (M2, M4).The median response rate was 58.4% (range 9–97.8%). With a reminder, the response rate increased by 60% (M3). Conclusion. The ideal method to assess patient satisfaction in the emergency department setting is to use a patient-based, in-emergency department-based assessment of patient satisfaction, planned and guided by expert personnel. PMID:23984073

Enhancing Cytogenetic Biological Dosimetry Capabilities of the Philippines for Nuclear Incident Preparedness.

PubMed

Asaad, Celia O; Caraos, Gloriamaris L; Robles, Gerardo Jose M; Asa, Anie Day D C; Cobar, Maria Lucia C; Asaad, Al-Ahmadgaid

2016-01-01

The utility of a biological dosimeter based on the analysis of dicentrics is invaluable in the event of a radiological emergency wherein the estimated absorbed dose of an exposed individual is crucial in the proper medical management of patients. The technique is also used for routine monitoring of occupationally exposed workers to determine radiation exposure. An in vitro irradiation study of human peripheral blood lymphocytes was conducted to establish a dose-response curve for radiation-induced dicentric aberrations. Blood samples were collected from volunteer donors and together with optically stimulated luminescence (OSL) dosimeters and were irradiated at 0, 0.1, 0.25, 0.5, 0.75, 1, 2, 4, and 6 Gy using a cobalt-60 radiotherapy unit. Blood samples were cultured for 48 h, and the metaphase chromosomes were prepared following the procedure of the International Atomic Energy Agency's Emergency Preparedness and Response - Biodosimetry 2011 manual. At least 100 metaphases were scored for dicentric aberrations at each dose point. The data were analyzed using R language program. The results indicated that the distribution of dicentric cells followed a Poisson distribution and the dose-response curve was established using the estimated model, Y dic = 0.0003 (±0.0003) +0.0336 (±0.0115) × D + 0.0236 (±0.0054) × D 2 . In this study, the reliability of the dose-response curve in estimating the absorbed dose was also validated for 2 and 4 Gy using OSL dosimeters. The data were fitted into the constructed curve. The result of the validation study showed that the obtained estimate for the absorbed exposure doses was close to the true exposure doses.

The Drug Abuse Screening Test preserves its excellent psychometric properties in psychiatric patients evaluated in an emergency setting.

PubMed

Giguère, Charles-Édouard; Potvin, Stéphane

2017-01-01

Substance use disorders (SUDs) are significant risk factors for psychiatric relapses and hospitalizations in psychiatric populations. Unfortunately, no instrument has been validated for the screening of SUDs in psychiatric emergency settings. The Drug Abuse Screening Test (DAST) is widely used in the addiction field, but is has not been validated in that particular context. The objective of the current study is to examine the psychometric properties of the DAST administered to psychiatric populations evaluated in an emergency setting. The DAST was administered to 912 psychiatric patients in an emergency setting, of which 119 had a SUD (excluding those misusing alcohol only). The internal consistency, the construct validity, the test-retest reliability and the predictive validity (using SUD diagnoses) of the DAST were examined. The convergent validity was also examined, using a validated impulsivity scale. Regarding the internal consistency of the DAST, the Cronbach's alpha was 0.88. The confirmatory factor analysis showed that the DAST has one underlying factor. The test-retest reliability analysis produced a correlation coefficient of 0.86. ROC curve analyses produced an area under the curve of 0.799. Interestingly, a sex effect was observed. Finally, the convergent validity analysis showed that the DAST total score is specifically correlated with the sensation seeking dimension of impulsivity. The results of this validation study shows that the DAST preserves its excellent psychometric properties in psychiatric populations evaluated in an emergency setting. These results should encourage the use of the DAST in this unstable clinical situation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Analytical method for the evaluation of the outdoor air contamination by emerging pollutants using tree leaves as bioindicators.

PubMed

Barroso, Pedro José; Martín, Julia; Santos, Juan Luis; Aparicio, Irene; Alonso, Esteban

2018-01-01

In this work, an analytical method, based on sonication-assisted extraction, clean-up by dispersive solid-phase extraction and determination by liquid chromatography-tandem mass spectrometry, has been developed and validated for the simultaneous determination of 15 emerging pollutants in leaves from four ornamental tree species. Target compounds include perfluorinated organic compounds, plasticizers, surfactants, brominated flame retardant, and preservatives. The method was optimized using Box-Behnken statistical experimental design with response surface methodology and validated in terms of recovery, accuracy, precision, and method detection and quantification limits. Quantification of target compounds was carried out using matrix-matched calibration curves. The highest recoveries were achieved for the perfluorinated organic compounds (mean values up to 87%) and preservatives (up to 88%). The lowest recoveries were achieved for plasticizers (51%) and brominated flame retardant (63%). Method detection and quantification limits were in the ranges 0.01-0.09 ng/g dry matter (dm) and 0.02-0.30 ng/g dm, respectively, for most of the target compounds. The method was successfully applied to the determination of the target compounds on leaves from four tree species used as urban ornamental trees (Citrus aurantium, Celtis australis, Platanus hispanica, and Jacaranda mimosifolia). Graphical abstract Analytical method for the biomonitorization of emerging pollutants in outdoor air.

Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale.

PubMed

Le May, Sylvie; Ballard, Ariane; Khadra, Christelle; Gouin, Serge; Plint, Amy C; Villeneuve, Edith; Mâsse, Benoit; Tsze, Daniel S; Neto, Gina; Drendel, Amy L; Auclair, Marie-Christine; McGrath, Patrick J; Ali, Samina

2018-03-30

Appropriate pain measurement relies on the use of valid, reliable tools. The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED). The inclusion criteria were children aged 6 to 17 years presenting to the ED with a musculoskeletal injury and self-reported pain scores ≥30 mm on the mechanical Visual Analogue Scale (VAS). Self-reported pain intensity was assessed using the mechanical VAS, Faces Pain Scale-Revised (FPS-R), and Colour Analogue Scale (CAS). Convergent validity was assessed by Pearson correlations and the Bland-Altman method; responsiveness to change was assessed using paired sample t tests and standardized mean responses; and reliability was estimated using relative and absolute indices. A total of 456 participants were included, with a mean age of 11.9 years ± 2.7 and a majority were boys (252/456, 55.3%). Correlations between each pair of scales were 0.78 (VAS/FPS-R), 0.92 (VAS/CAS), and 0.79 (CAS/FPS-R). Limits of agreement (95% confidence interval) were -3.77 to 2.33 (VAS/FPS-R), -1.74 to 1.75 (VAS/CAS), and -2.21 to 3.62 (CAS/FPS-R). Responsiveness to change was demonstrated by significant differences in mean pain scores among the scales (P < 0.0001). Intraclass correlation coefficient and coefficient of repeatability estimates suggested acceptable reliability for the 3 scales at, respectively, 0.79 and ±2.29 (VAS), 0.82 and ±2.07 (CAS), and 0.76 and ±2.82 (FPS-R). The scales demonstrated good psychometric properties for children with acute pain in the ED. The VAS and CAS showed a strong convergent validity, whereas FPS-R was not in agreement with the other scales.

[General organizational issues in disaster health response].

PubMed

Pacifici, L E; Riccardo, F; De Rosa, A G; Pacini, A; Nardi, L; Russo, G; Scaroni, E

2007-01-01

Recent studies show how in the 2004-2005 period there has been an increase in natural disasters of 18% worldwide. According to a renowned author planning for disaster response is as valid as the starting hypothesis. The study of an inductive mental process in disaster response planning is the key to avoiding the invention and re-invention of the wheel for each emergency. Research in this field however is hampered by different factors one of which is data collection that during disaster response requires specific training. Standardization of data collection models with limitation of the number of variables is required as is taking into account problems related to people migration and subsequent sampling problems and retrospective analysis. Moreover poor attention to the training of the volunteers employed on the field is an issue to be considered.

Emerging biomarkers for cancer immunotherapy in melanoma.

PubMed

Axelrod, Margaret L; Johnson, Douglas B; Balko, Justin M

2017-09-14

The treatment and prognosis of metastatic melanoma has changed substantially since the advent of novel immune checkpoint inhibitors (ICI), agents that enhance the anti-tumor immune response. Despite the success of these agents, clinically actionable biomarkers to aid patient and regimen selection are lacking. Herein, we summarize and review the evidence for candidate biomarkers of response to ICIs in melanoma. Many of these candidates can be examined as parts of a known molecular pathway of immune response, while others are clinical in nature. Due to the ability of ICIs to illicit dramatic and durable responses, well-validated biomarkers that can be effectively implemented in the clinic will require strong negative predictive values that do not limit patients with who may benefit from ICI therapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Computerized Hammer Sounding Interpretation for Concrete Assessment with Online Machine Learning.

PubMed

Ye, Jiaxing; Kobayashi, Takumi; Iwata, Masaya; Tsuda, Hiroshi; Murakawa, Masahiro

2018-03-09

Developing efficient Artificial Intelligence (AI)-enabled systems to substitute the human role in non-destructive testing is an emerging topic of considerable interest. In this study, we propose a novel hammering response analysis system using online machine learning, which aims at achieving near-human performance in assessment of concrete structures. Current computerized hammer sounding systems commonly employ lab-scale data to validate the models. In practice, however, the response signal patterns can be far more complicated due to varying geometric shapes and materials of structures. To deal with a large variety of unseen data, we propose a sequential treatment for response characterization. More specifically, the proposed system can adaptively update itself to approach human performance in hammering sounding data interpretation. To this end, a two-stage framework has been introduced, including feature extraction and the model updating scheme. Various state-of-the-art online learning algorithms have been reviewed and evaluated for the task. To conduct experimental validation, we collected 10,940 response instances from multiple inspection sites; each sample was annotated by human experts with healthy/defective condition labels. The results demonstrated that the proposed scheme achieved favorable assessment accuracy with high efficiency and low computation load.

Validation of electronic medical record-based phenotyping algorithms: results and lessons learned from the eMERGE network.

PubMed

Newton, Katherine M; Peissig, Peggy L; Kho, Abel Ngo; Bielinski, Suzette J; Berg, Richard L; Choudhary, Vidhu; Basford, Melissa; Chute, Christopher G; Kullo, Iftikhar J; Li, Rongling; Pacheco, Jennifer A; Rasmussen, Luke V; Spangler, Leslie; Denny, Joshua C

2013-06-01

Genetic studies require precise phenotype definitions, but electronic medical record (EMR) phenotype data are recorded inconsistently and in a variety of formats. To present lessons learned about validation of EMR-based phenotypes from the Electronic Medical Records and Genomics (eMERGE) studies. The eMERGE network created and validated 13 EMR-derived phenotype algorithms. Network sites are Group Health, Marshfield Clinic, Mayo Clinic, Northwestern University, and Vanderbilt University. By validating EMR-derived phenotypes we learned that: (1) multisite validation improves phenotype algorithm accuracy; (2) targets for validation should be carefully considered and defined; (3) specifying time frames for review of variables eases validation time and improves accuracy; (4) using repeated measures requires defining the relevant time period and specifying the most meaningful value to be studied; (5) patient movement in and out of the health plan (transience) can result in incomplete or fragmented data; (6) the review scope should be defined carefully; (7) particular care is required in combining EMR and research data; (8) medication data can be assessed using claims, medications dispensed, or medications prescribed; (9) algorithm development and validation work best as an iterative process; and (10) validation by content experts or structured chart review can provide accurate results. Despite the diverse structure of the five EMRs of the eMERGE sites, we developed, validated, and successfully deployed 13 electronic phenotype algorithms. Validation is a worthwhile process that not only measures phenotype performance but also strengthens phenotype algorithm definitions and enhances their inter-institutional sharing.

The Imperial Paediatric Emergency Training Toolkit (IPETT) for use in paediatric emergency training: development and evaluation of feasibility and validity.

PubMed

Lambden, Simon; DeMunter, Claudine; Dowson, Anne; Cooper, Mehrengise; Gautama, Sanjay; Sevdalis, Nick

2013-06-01

To develop and test the feasibility, reliability, and validity of a practical toolkit for the assessment and feedback of skills required to manage paediatric emergencies in critical care settings. The Imperial Paediatric Emergency Training Toolkit (IPETT) was developed based on current evidence-base and expert input. IPETT assesses both technical and non-technical skills. The technical component covers skills in the areas of clinical assessment, airway and breathing, cardiovascular, and drugs. The non-technical component is based on the validated NOTECHS tool and covers communication and interaction, cooperation and team skills, leadership and managerial skills, and decision-making. The reliability (internal consistency), content validity (inter-correlations between different skills) and concurrent validity (correlations between global technical and non-technical scores) of IPETT were prospectively evaluated in 45 simulated paediatric crises carried out in a PICU with anaesthetic and paediatric trainees (N=52). Non-parametric analyses were carried out. Significance was set at P<0.05. Cronbach alpha reliability coefficients were overall acceptable for the technical (alpha range=0.638-0.810) and good for the non-technical (alpha range=0.701-0.899) component of IPETT. The median inter-skill correlation was rho=0.564 and rho=0.549 for the technical and non-technical components, respectively. These indicate good content validity, as the skills were inter-related but not redundant. We also demonstrate a correlation between the global technical and non-technical scores (rho=0.471) - all Ps<0.05 during the assessments. IPETT offers a psychometrically viable and feasible to use tool in the context of paediatric emergencies training. This study shows that assessment of technical and non-technical skills in combination may offer a more clinically relevant model for training in paediatric emergencies. Further validation should aim to demonstrate skill retention over time and skill transfer from simulation-based training to real emergencies. Copyright © 2013. Published by Elsevier Ireland Ltd.

Developing an analytical tool for evaluating EMS system design changes and their impact on cardiac arrest outcomes: combining geographic information systems with register data on survival rates

PubMed Central

2013-01-01

Background Out-of-hospital cardiac arrest (OHCA) is a frequent and acute medical condition that requires immediate care. We estimate survival rates from OHCA in the area of Stockholm, through developing an analytical tool for evaluating Emergency Medical Services (EMS) system design changes. The study also is an attempt to validate the proposed model used to generate the outcome measures for the study. Methods and results This was done by combining a geographic information systems (GIS) simulation of driving times with register data on survival rates. The emergency resources comprised ambulance alone and ambulance plus fire services. The simulation model predicted a baseline survival rate of 3.9 per cent, and reducing the ambulance response time by one minute increased survival to 4.6 per cent. Adding the fire services as first responders (dual dispatch) increased survival to 6.2 per cent from the baseline level. The model predictions were validated using empirical data. Conclusion We have presented an analytical tool that easily can be generalized to other regions or countries. The model can be used to predict outcomes of cardiac arrest prior to investment in EMS design changes that affect the alarm process, e.g. (1) static changes such as trimming the emergency call handling time or (2) dynamic changes such as location of emergency resources or which resources should carry a defibrillator. PMID:23415045

Design, Monitoring, and Validation of a High Performance Sustainable Building

DTIC Science & Technology

2013-08-01

normalized by building average population and square footage. Longstreet had a larger number of emergency calls than CESS, but the ESTCP team did not have...system was measured sUSEPArately from the domestic water use. The rainwater was used to displace potable water for toilet flushing and vehicle washing...ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for

All-Hazard Consequence Management Planning for the Water Sector: Preparedness, Emergency Response, and Recovery CIPAC Workshop

DTIC Science & Technology

2009-11-01

subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE...of Health Mark Miller Centers for Disease Control and Prevention National Center for Environmental Health Debbie Newberry, co-chair US EPA...Utilities Linda Eichmiller Association of State and Interstate Water Pollution Control Administrators Jeff Fencil US EPA Office of Ground Water and

Handheld Multi-Gas Meters Assessment Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williams, Gustavious; Wald-Hopkins, Mark David; Obrey, Stephen J.

2016-06-27

Handheld multi-gas meters (MGMs) are equipped with sensors to monitor oxygen (O2) levels and additional sensors to detect the presence of combustible or toxic gases in the environment. This report is limited to operational response-type MGMs that include at least four different sensors. These sensors can vary by type and by the monitored chemical. In real time, the sensors report the concentration of monitored gases in the atmosphere near the MGM. In April 2016 the System Assessment and Validation for Emergency Responders (SAVER) Program conducted an operationally-oriented assessment of MGMs. Five MGMs were assessed by emergency responders. The criteria andmore » scenarios used in this assessment were derived from the results of a focus group of emergency responders with experience in using MGMs. The assessment addressed 16 evaluation criteria in four SAVER categories: Usability, Capability, Maintainability, and Deployability.« less

Handheld Multi-Gas Meters Market Survey Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williams, Gustavious; Wald-Hopkins, Mark David; Obrey, Stephen J.

2016-06-23

Handheld multi-gas meters (MGMs) are equipped with sensors to monitor oxygen (O2) levels and additional sensors to detect the presence of combustible or toxic gases in the environment. This report is limited to operational response-type MGMs that include at least four different sensors. These sensors can vary by type and by the chemical monitored. In real time, the sensors report the concentration of monitored gases in the atmosphere near the MGM. To provide emergency responders with information on handheld multi-gas meters, the System Assessment and Validation for Emergency Responders (SAVER) Program conducted a market survey. This market survey report ismore » based on information gathered between November 2015 and February 2016 from vendors, Internet research, industry publications, an emergency responder focus group, and a government issued Request for Information (RFI) that was posted on the Federal Business Opportunities website.« less

Development and Validation of a Bilingual Stroke Preparedness Assessment Instrument.

PubMed

Skolarus, Lesli E; Mazor, Kathleen M; Sánchez, Brisa N; Dome, Mackenzie; Biller, José; Morgenstern, Lewis B

2017-04-01

Stroke preparedness interventions are limited by the lack of psychometrically sound intermediate end points. We sought to develop and assess the reliability and validity of the video-Stroke Action Test (video-STAT) an English and a Spanish video-based test to assess people's ability to recognize and react to stroke signs. Video-STAT development and testing was divided into 4 phases: (1) video development and community-generated response options, (2) pilot testing in community health centers, (3) administration in a national sample, bilingual sample, and neurologist sample, and (4) administration before and after a stroke preparedness intervention. The final version of the video-STAT included 8 videos: 4 acute stroke/emergency, 2 prior stroke/nonemergency, 1 nonstroke/emergency, and 1 nonstroke/nonemergency. Acute stroke recognition and action response were queried after each vignette. Video-STAT scoring was based on the acute stroke vignettes only (score range 0-12 best). The national sample consisted of 598 participants, 438 who took the video-STAT in English and 160 who took the video-STAT in Spanish. There was adequate internal consistency (Cronbach α=0.72). The average video-STAT score was 5.6 (SD=3.6), whereas the average neurologist score was 11.4 (SD=1.3). There was no difference in video-STAT scores between the 116 bilingual video-STAT participants who took the video-STAT in English or Spanish. Compared with baseline scores, the video-STAT scores increased after a stroke preparedness intervention (6.2 versus 8.9, P <0.01) among a sample of 101 black adults and youth. The video-STAT yields reliable scores that seem to be valid measures of stroke preparedness. © 2017 American Heart Association, Inc.

Clinical applications of the functional connectome

PubMed Central

Castellanos, F. Xavier; Di Martino, Adriana; Craddock, R. Cameron; Mehta, Ashesh D.; Milham, Michael P.

2013-01-01

Central to the development of clinical applications of functional connectomics for neurology and psychiatry is the discovery and validation of biomarkers. Resting state fMRI (R-fMRI) is emerging as a mainstream approach for imaging-based biomarker identification, detecting variations in the functional connectome that can be attributed to clinical variables (e.g., diagnostic status). Despite growing enthusiasm, many challenges remain. Here, we assess evidence of the readiness of R-fMRI based functional connectomics to lead to clinically meaningful biomarker identification through the lens of the criteria used to evaluate clinical tests (i.e., validity, reliability, sensitivity, specificity, and applicability). We focus on current R-fMRI-based prediction efforts, and survey R-fMRI used for neurosurgical planning. We identify gaps and needs for R-fMRI-based biomarker identification, highlighting the potential of emerging conceptual, analytical and cultural innovations (e.g., the Research Domain Criteria Project (RDoC), open science initiatives, and Big Data) to address them. Additionally, we note the need to expand future efforts beyond identification of biomarkers for disease status alone to include clinical variables related to risk, expected treatment response and prognosis. PMID:23631991

Reimagining psychoses: an agnostic approach to diagnosis.

PubMed

Keshavan, Matcheri S; Clementz, Brett A; Pearlson, Godfrey D; Sweeney, John A; Tamminga, Carol A

2013-05-01

Current approaches to defining and classifying psychotic disorders are compromised by substantive heterogeneity within, blurred boundaries between, as well as overlaps across the various disorders in outcome, treatment response, emerging evidence regarding pathophysiology and presumed etiology. We herein review the evolution, current status and the constraints posed by classic symptom-based diagnostic approaches. We compare the continuing constructs that underlie the current classification of psychoses, and contrast those to evolving new thinking in other areas of medicine. An important limitation in current psychiatric nosology may stem from the fact that symptom-based diagnoses do not "carve nature at its joints"; while symptom-based classifications have improved our reliability, they may lack validity. Next steps in developing a more valid scientific nosology for psychoses include a) agnostic deconstruction of disease dimensions, identifying disease markers and endophenotypes; b) mapping such markers across translational domains from behaviors to molecules, c) reclustering cross-cutting bio-behavioral data using modern phenotypic and biometric approaches, and finally d) validating such entities using etio-pathology, outcome and treatment-response measures. The proposed steps of deconstruction and "bottom-up" disease definition, as elsewhere in medicine, may well provide a better foundation for developing a nosology for psychotic disorders that may have better utility in predicting outcome, treatment response and etiology, and identifying novel treatment approaches. Copyright © 2013 Elsevier B.V. All rights reserved.

Validity and responsiveness of the pediatric quality of life inventory (PedsQL) 4.0 generic core scales in the pediatric inpatient setting.

PubMed

Desai, Arti D; Zhou, Chuan; Stanford, Susan; Haaland, Wren; Varni, James W; Mangione-Smith, Rita M

2014-12-01

Validated patient-reported outcomes responsive to clinical change are needed to evaluate the effectiveness of quality improvement interventions. To evaluate responsiveness, construct validity, and predictive validity of the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales in the pediatric inpatient setting. Prospective, cohort study of parents and caregivers of patients 1 month to 18 years old (n = 4637) and patients 13 to 18 years old (n = 359) admitted to Seattle Children's Hospital between October 1, 2011, and December 31, 2013. Of 7184 eligible participants invited to complete the survey, 4637 (64.5%) completed the PedsQL on admission, and of these 2694 (58.1%) completed the follow-up survey 2 to 8 weeks after discharge. Responsiveness was assessed by calculating improvement scores (difference between follow-up and admission scores). Construct validity was examined by comparing the mean improvement scores for known groups differing by medical complexity. Predictive validity was assessed using Poisson regression to examine associations among admission scores, prolonged length of stay (≥3 days), and 30-day readmissions or emergency department (ED) return visits. Similar models examined the association between improvement scores and risk for 30-day readmissions or ED return visits. The mean (SD) PedsQL improvement scores (scale, 0-100) were 22.1 (22.7) for total, 29.4 (32.4) for physical, and 17.1 (21.0) for psychosocial. The mean PedsQL total improvement scores were lower for patients with medically complex conditions compared with patients without chronic conditions (13.7 [95% CI, 11.6-15.8] vs. 24.1 [95% CI, 22.4-25.7], P < .001). A 10-point decrement in the PedsQL total admission score below the established community-based mean was associated with an increase in risk for prolonged length of stay (15% [95% CI, 13%-17%]), 30-day readmissions (8% [95% CI, 3%-14%]), and ED return visits (13% [95% CI, 6%-20%]). A 5-point decrement in the PedsQL total improvement score below the study sample mean improvement score was associated with an increase in risk for 30-day readmissions or ED return visits (9% [95% CI, -1% to 19%]). The PedsQL demonstrated responsiveness, construct validity, and predictive validity in hospitalized pediatric patients. The PedsQL may be a useful patient-reported outcome for hospital-based clinical effectiveness research.

How linear response shaped models of neural circuits and the quest for alternatives.

PubMed

Herfurth, Tim; Tchumatchenko, Tatjana

2017-10-01

In the past decades, many mathematical approaches to solve complex nonlinear systems in physics have been successfully applied to neuroscience. One of these tools is the concept of linear response functions. However, phenomena observed in the brain emerge from fundamentally nonlinear interactions and feedback loops rather than from a composition of linear filters. Here, we review the successes achieved by applying the linear response formalism to topics, such as rhythm generation and synchrony and by incorporating it into models that combine linear and nonlinear transformations. We also discuss the challenges encountered in the linear response applications and argue that new theoretical concepts are needed to tackle feedback loops and non-equilibrium dynamics which are experimentally observed in neural networks but are outside of the validity regime of the linear response formalism. Copyright © 2017 Elsevier Ltd. All rights reserved.

Emergency Physician Utilization of Alcohol/Substance Screening, Brief Advice and Discharge: A 10-Year Comparison.

PubMed

Broderick, Kerryann B; Kaplan, Bonnie; Martini, Dyllon; Caruso, Emily

2015-10-01

In 2007, of the 130 million emergency department (ED) visits, ∼ 38 million were due to injury, and of those, 1.9 million involved alcohol. The emergency department is a pivotal place to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) due to the high number of patients presenting with alcohol/substance abuse risk factors or related injuries. This study compares two surveys, approximately 11 years apart, of emergency physicians nationwide which assesses the use of validated screening tools, the availability of community resources for alcohol/substance abuse treatment, and the prevailing attitudes of emergency physicians regarding Screening and Brief Intervention for alcohol/substance abuse. We performed cross-sectional anonymous surveys of 1500 emergency physicians drawn from American College of Emergency Physicians members. The survey results were compared for time interval change. The two surveys had comparable response rates. The median percentage of patients screened for alcohol/substance abuse in 1999 was 15%, vs. 20% in 2010. In 2010, 26% of emergency physicians had a formal screening tool, and the majority used Cut-down, Annoyed, Guilty, Eye-opener (85%). In 2010, a statistically significant increase in the number of emergency physicians said they would "always" or "almost always" use discharge instructions that were specific for alcohol/substance abuse, if available, vs. 1999. Few emergency physicians screen for alcohol/substance abuse despite evidence that screening and brief intervention is effective. Emergency physicians are receptive to the use of discharge material. Copyright © 2015 Elsevier Inc. All rights reserved.

Content Validity of the Hypogonadism Impact of Symptoms Questionnaire (HIS-Q): A Patient-Reported Outcome Measure to Evaluate Symptoms of Hypogonadism.

PubMed

Gelhorn, Heather L; Vernon, Margaret K; Stewart, Katie D; Miller, Michael G; Brod, Meryl; Althof, Stanley E; DeRogatis, Leonard R; Dobs, Adrian; Seftel, Allen D; Revicki, Dennis A

2016-04-01

Hypogonadism, or low testosterone, is a common disorder. There are currently no patient-reported outcome (PRO) instruments designed to comprehensively evaluate the symptoms of hypogonadism and to detect changes in these symptoms in response to treatment. The purpose of this study was to develop a PRO instrument, the Hypogonadism Impact of Symptoms Questionnaire (HIS-Q) and to assess its content validity. A literature review, expert clinician input, and qualitative concept elicitation with 39 male hypogonadism patients (four focus groups: n = 25; individual interviews: n = 14; mean age 52.3 ± 14.3 years) from the USA were used to develop the draft HIS-Q. Subsequent cognitive interviews (n = 29; mean age 51.5 ± 15.4 years) were used to evaluate content validity. Emergent discussion with participants yielded symptoms within the sexual, physical, energy, sleep, cognition, and mood domains. Low libido and tiredness were most commonly reported. The initial version of the HIS-Q includes 53 items that were consistently understood by the participants, who found the instrument to be relevant to their experiences with hypogonadism and comprehensive in the content coverage of symptoms. The HIS-Q is a comprehensive PRO measure of hypogonadism symptom severity in males. Its design elements, including the response options and recall period, were suitable, and content validity was confirmed.

Construct Validity: Advances in Theory and Methodology

PubMed Central

Strauss, Milton E.; Smith, Gregory T.

2008-01-01

Measures of psychological constructs are validated by testing whether they relate to measures of other constructs as specified by theory. Each test of relations between measures reflects on the validity of both the measures and the theory driving the test. Construct validation concerns the simultaneous process of measure and theory validation. In this chapter, we review the recent history of validation efforts in clinical psychological science that has led to this perspective, and we review five recent advances in validation theory and methodology of importance for clinical researchers. These are: the emergence of nonjustificationist philosophy of science; an increasing appreciation for theory and the need for informative tests of construct validity; valid construct representation in experimental psychopathology; the need to avoid representing multidimensional constructs with a single score; and the emergence of effective new statistical tools for the evaluation of convergent and discriminant validity. PMID:19086835

Screening emergency department patients for opioid drug use: A qualitative systematic review.

PubMed

Sahota, Preet Kaur; Shastry, Siri; Mukamel, Dana B; Murphy, Linda; Yang, Narisu; Lotfipour, Shahram; Chakravarthy, Bharath

2018-05-24

The opioid drug epidemic is a major public health concern and an economic burden in the United States. The purpose of this systematic review is to assess the reliability and validity of screening instruments used in emergency medicine settings to detect opioid use in patients and to assess psychometric data for each screening instrument. PubMed/MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for articles published up to May 2018. The extracted articles were independently screened for eligibility by two reviewers. We extracted 1555 articles for initial screening and 95 articles were assessed for full-text eligibility. Six articles were extracted from the full-text assessment. Six instruments were identified from the final article list: Screener and Opioid Assessment for Patients with Pain - Revised; Drug Abuse Screening Test; Opioid Risk Tool; Current Opioid Misuse Measure; an Emergency Medicine Providers Clinician Assessment Questionnaire; and an Emergency Provider Impression Data Collection Form. Screening instrument characteristics, and reliability and validity data were extracted from the six studies. A meta-analysis was not conducted due to heterogeneity between the studies. There is a lack of validity and reliability evidence in all six articles; and sensitivity, specificity and predictive values varied between the different instruments. These instruments cannot be validated for use in emergency medicine settings. There is no clear evidence to state which screening instruments are appropriate for use in detecting opioid use disorders in emergency medicine patients. There is a need for brief, reliable, valid and feasible opioid use screening instruments in the emergency medicine setting. Copyright © 2018 Elsevier Ltd. All rights reserved.

Reliability and Validity of Survey Instruments to Measure Work-Related Fatigue in the Emergency Medical Services Setting: A Systematic Review

DOT National Transportation Integrated Search

2018-01-11

Background: This study sought to systematically search the literature to identify reliable and valid survey instruments for fatigue measurement in the Emergency Medical Services (EMS) occupational setting. Methods: A systematic review study design wa...

Emergency Physician Attitudes, Preferences, and Risk Tolerance for Stroke as a Potential Cause of Dizziness Symptoms.

PubMed

Kene, Mamata V; Ballard, Dustin W; Vinson, David R; Rauchwerger, Adina S; Iskin, Hilary R; Kim, Anthony S

2015-09-01

We evaluated emergency physicians' (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients. We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness. We calculated descriptive statistics and post-test probabilities for such a clinical prediction rule. The response rate was 68% (366/535). Respondents' median practice tenure was eight years (37% female, 92% emergency medicine board certified). Symptom quality and typical vascular risk factors increased suspicion for stroke as a cause of dizziness. Most respondents reported obtaining head computed tomography (CT) (74%). Nearly all respondents used and felt confident using cranial nerve and limb strength testing. A substantial minority of EPs used the Epley maneuver (49%) and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation) testing (30%); however, few EPs reported confidence in these tests' bedside application (35% and 16%, respectively). Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful. EPs report relying on symptom quality, vascular risk factors, simple physical exam elements, and head CT to diagnose stroke as the cause of dizziness, but would find a validated clinical prediction rule for dizziness helpful. A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.

T cell Bim levels reflect responses to anti–PD-1 cancer therapy

PubMed Central

Dronca, Roxana S.; Liu, Xin; Harrington, Susan M.; Chen, Lingling; Cao, Siyu; Kottschade, Lisa A.; McWilliams, Robert R.; Block, Matthew S.; Nevala, Wendy K.; Thompson, Michael A.; Mansfield, Aaron S.; Park, Sean S.; Markovic, Svetomir N.

2016-01-01

Immune checkpoint therapy with PD-1 blockade has emerged as an effective therapy for many advanced cancers; however, only a small fraction of patients achieve durable responses. To date, there is no validated blood-based means of predicting the response to PD-1 blockade. We report that Bim is a downstream signaling molecule of the PD-1 pathway, and its detection in T cells is significantly associated with expression of PD-1 and effector T cell markers. High levels of Bim in circulating tumor-reactive (PD-1+CD11ahiCD8+) T cells were prognostic of poor survival in patients with metastatic melanoma who did not receive anti–PD-1 therapy and were also predictive of clinical benefit in patients with metastatic melanoma who were treated with anti–PD-1 therapy. Moreover, this circulating tumor-reactive T cell population significantly decreased after successful anti–PD-1 therapy. Our study supports a crucial role of Bim in both T cell activation and apoptosis as regulated by PD-1 and PD-L1 interactions in effector CD8+ T cells. Measurement of Bim levels in circulating T cells of patients with cancer may provide a less invasive strategy to predict and monitor responses to anti–PD-1 therapy, although future prospective analyses are needed to validate its utility. PMID:27182556

Modeling Framework and Validation of a Smart Grid and Demand Response System for Wind Power Integration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Broeer, Torsten; Fuller, Jason C.; Tuffner, Francis K.

2014-01-31

Electricity generation from wind power and other renewable energy sources is increasing, and their variability introduces new challenges to the power system. The emergence of smart grid technologies in recent years has seen a paradigm shift in redefining the electrical system of the future, in which controlled response of the demand side is used to balance fluctuations and intermittencies from the generation side. This paper presents a modeling framework for an integrated electricity system where loads become an additional resource. The agent-based model represents a smart grid power system integrating generators, transmission, distribution, loads and market. The model incorporates generatormore » and load controllers, allowing suppliers and demanders to bid into a Real-Time Pricing (RTP) electricity market. The modeling framework is applied to represent a physical demonstration project conducted on the Olympic Peninsula, Washington, USA, and validation simulations are performed using actual dynamic data. Wind power is then introduced into the power generation mix illustrating the potential of demand response to mitigate the impact of wind power variability, primarily through thermostatically controlled loads. The results also indicate that effective implementation of Demand Response (DR) to assist integration of variable renewable energy resources requires a diversity of loads to ensure functionality of the overall system.« less

Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre.

PubMed

Buckland, Aaron J; Bressan, Silvia; Jowett, Helen; Johnson, Michael B; Teague, Warwick J

2016-10-01

Evidence-based decision-making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric-specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children. A cross-sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken. Participation was voluntary and responses de-idenitified. The survey comprised 20 questions regarding initial assessment, imaging, immobilisation and perioperative management. Physicians' responses were compared with available current evidence. Sixty-seven physicians (28% registrars, 17% fellows and 55.2% consultants) participated. Physicians rated altered mental state, intoxication and distracting injury as the most important contraindications to cervical spine clearance in children. Fifty-four per cent considered adequate plain imaging to be 3-view cervical spine radiographs (anterior-posterior, lateral and odontoid), whereas 30% considered CT the most sensitive modality for detecting unstable cervical spine injuries. Physicians' responses reflected marked heterogeneity regarding semi-rigid cervical collars and what constitutes cervical spine 'clearance'. Greater consensus existed for perioperative precautions in this setting. Physicians actively engaged in paediatric trauma care demonstrate marked heterogeneity in their knowledge and application of cervical spine assessment. This is compounded by a lack of paediatric-specific evidence and definitions, involvement of multiple specialties and staff turnover within busy departments. A validated decision-making tool for cervical spine assessment will represent an important advance in paediatric trauma. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Determinants of Paramedic Response Readiness for CBRNE Threats

PubMed Central

Jones, Alison; Smith, George; Nelson, Jenny; Agho, Kingsley; Taylor, Melanie; Raphael, Beverley

2010-01-01

Paramedics play a pivotal role in the response to major emergencies. Recent evidence indicates that their confidence and willingness to respond to chemical, biological, radiological, nuclear, and explosives-related (CBRNE) incidents differs from that relating to their “routine” emergency work. To further investigate the factors underpinning their readiness to respond to CBRNE incidents, paramedics in New South Wales (NSW), Australia, were asked to complete a validated online survey instrument. Univariate and multivariate analyses were performed to examine associated factors determining readiness. The sample of 663 respondents was weighted to reflect the NSW paramedic population as a whole. The univariate analysis indicated that gender, length of service, deployment concern, perceived personal resilience, CBRNE training, and incident experience were significantly associated with perceived CBRNE response readiness. In the initial multivariate analysis, significantly higher response readiness was associated with male gender, university education, and greater length of service (10-15 years). In the final multivariate model, the combined effect of training/incident experience negated the significant effects observed in the initial model and, importantly, showed that those with recent training reported higher readiness, irrespective of incident experience. Those with lower concern regarding CBRNE deployment and those with higher personal resilience were significantly more likely to report higher readiness (Adjusted Relative Risk [ARR] = 0.91, 95% CI: 0.84-0.99; ARR = 1.40, 95% CI: 1.11-1.72, respectively). These findings will assist emergency medical planners in recognizing occupational and dispositional factors associated with enhanced CBRNE readiness and highlight the important role of training in redressing potential readiness differences associated with these factors. PMID:20569060

Fall classification by machine learning using mobile phones.

PubMed

Albert, Mark V; Kording, Konrad; Herrmann, Megan; Jayaraman, Arun

2012-01-01

Fall prevention is a critical component of health care; falls are a common source of injury in the elderly and are associated with significant levels of mortality and morbidity. Automatically detecting falls can allow rapid response to potential emergencies; in addition, knowing the cause or manner of a fall can be beneficial for prevention studies or a more tailored emergency response. The purpose of this study is to demonstrate techniques to not only reliably detect a fall but also to automatically classify the type. We asked 15 subjects to simulate four different types of falls-left and right lateral, forward trips, and backward slips-while wearing mobile phones and previously validated, dedicated accelerometers. Nine subjects also wore the devices for ten days, to provide data for comparison with the simulated falls. We applied five machine learning classifiers to a large time-series feature set to detect falls. Support vector machines and regularized logistic regression were able to identify a fall with 98% accuracy and classify the type of fall with 99% accuracy. This work demonstrates how current machine learning approaches can simplify data collection for prevention in fall-related research as well as improve rapid response to potential injuries due to falls.

Robust linear parameter-varying control of blood pressure using vasoactive drugs

NASA Astrophysics Data System (ADS)

Luspay, Tamas; Grigoriadis, Karolos

2015-10-01

Resuscitation of emergency care patients requires fast restoration of blood pressure to a target value to achieve hemodynamic stability and vital organ perfusion. A robust control design methodology is presented in this paper for regulating the blood pressure of hypotensive patients by means of the closed-loop administration of vasoactive drugs. To this end, a dynamic first-order delay model is utilised to describe the vasoactive drug response with varying parameters that represent intra-patient and inter-patient variability. The proposed framework consists of two components: first, an online model parameter estimation is carried out using a multiple-model extended Kalman-filter. Second, the estimated model parameters are used for continuously scheduling a robust linear parameter-varying (LPV) controller. The closed-loop behaviour is characterised by parameter-varying dynamic weights designed to regulate the mean arterial pressure to a target value. Experimental data of blood pressure response of anesthetised pigs to phenylephrine injection are used for validating the LPV blood pressure models. Simulation studies are provided to validate the online model estimation and the LPV blood pressure control using phenylephrine drug injection models representing patients showing sensitive, nominal and insensitive response to the drug.

Organizational culture during the accident response process

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shurberg, D.A.; Haber, S.B.

1992-01-01

The ability of an organization to effectively move from an anticipatory to an ad hoc strategy may well depend on the organization having the ability to balance these two apparently dichotomous cultural styles. The organization which is most capable of making the necessary transition in an optimal manner may well exhibit some aspects of both cultural styles during normal operations. Data collected at one NPP does exhibit this pattern of results, with the organization exhibiting a clear hierarchical chain of command and perceived conventional behavioral expectations as well as exhibiting a more decentralized and collegial approach to decisionmaking, a teammore » work orientation, and informal communications. Thus, it is expected that this organization possesses the capabilities to make a successful transition from an anticipatory to an ad hoc strategy. Data collected at a second NPP more strongly exhibits the traditional style suggested as being important during the anticipatory strategy, with more formal communications and bureaucratically controlled decision-making. This organization may experience difficulty if faced with the need to make a transition from an anticipatory to an ad hoc strategy. These conclusions are further validated based on observation of Emergency Preparedness Exercise Inspections, which suggest that the more anticipatory types of behaviors actually inhibit successful performance during an ad hoc response. The final validation of these hypotheses needs to be demonstrated with cultural data collected during emergency simulations. The mechanism to obtain such data during these types of situations is an area for future research.« less

Organizational culture during the accident response process

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shurberg, D.A.; Haber, S.B.

1992-08-01

The ability of an organization to effectively move from an anticipatory to an ad hoc strategy may well depend on the organization having the ability to balance these two apparently dichotomous cultural styles. The organization which is most capable of making the necessary transition in an optimal manner may well exhibit some aspects of both cultural styles during normal operations. Data collected at one NPP does exhibit this pattern of results, with the organization exhibiting a clear hierarchical chain of command and perceived conventional behavioral expectations as well as exhibiting a more decentralized and collegial approach to decisionmaking, a teammore » work orientation, and informal communications. Thus, it is expected that this organization possesses the capabilities to make a successful transition from an anticipatory to an ad hoc strategy. Data collected at a second NPP more strongly exhibits the traditional style suggested as being important during the anticipatory strategy, with more formal communications and bureaucratically controlled decision-making. This organization may experience difficulty if faced with the need to make a transition from an anticipatory to an ad hoc strategy. These conclusions are further validated based on observation of Emergency Preparedness Exercise Inspections, which suggest that the more anticipatory types of behaviors actually inhibit successful performance during an ad hoc response. The final validation of these hypotheses needs to be demonstrated with cultural data collected during emergency simulations. The mechanism to obtain such data during these types of situations is an area for future research.« less

Explicating Experience: Development of a Valid Scale of Past Hazard Experience for Tornadoes.

PubMed

Demuth, Julie L

2018-03-23

People's past experiences with a hazard theoretically influence how they approach future risks. Yet, past hazard experience has been conceptualized and measured in wide-ranging, often simplistic, ways, resulting in mixed findings about its relationship with risk perception. This study develops a scale of past hazard experiences, in the context of tornadoes, that is content and construct valid. A conceptual definition was developed, a set of items were created to measure one's most memorable and multiple tornado experiences, and the measures were evaluated through two surveys of the public who reside in tornado-prone areas. Four dimensions emerged of people's most memorable experience, reflecting their awareness of the tornado risk that day, their personalization of the risk, the intrusive impacts on them personally, and impacts experienced vicariously through others. Two dimensions emerged of people's multiple experiences, reflecting common types of communication received and negative emotional responses. These six dimensions are novel in that they capture people's experience across the timeline of a hazard as well as intangible experiences that are both direct and indirect. The six tornado experience dimensions were correlated with tornado risk perceptions measured as cognitive-affective and as perceived probability of consequences. The varied experience-risk perception results suggest that it is important to understand the nuances of these concepts and their relationships. This study provides a foundation for future work to continue explicating past hazard experience, across different risk contexts, and for understanding its effect on risk assessment and responses. © 2018 Society for Risk Analysis.

Fun and games in reviewing neonatal emergency care.

PubMed

Gordon, D W; Brown, H N

1995-04-01

To develop a game-based review instrument for use by newborn caregivers in preparing for emergency situations. One hundred and one test questions covering pathophysiology, resuscitation, and medications were developed. The questions then underwent expert and peer review, psychometric testing for content validity and test-retest reliability, and a game trial. The needs of adult learners are different from those of other learners. The gaming format uses knowledge gained through experience and provides an avenue for validating knowledge and sharing experiences. This format has been found effective for review and reinforcement of facts. Twelve nurses participated in a trial game and completed a written evaluation using a Likert scale. The Neonatal Emergency Trivia Game is an effective tool for reviewing material related to neonatal emergency care decisions. Additional testing with a larger group would strengthen validity and reliability data.

Validation of the new diagnosis grouping system for pediatric emergency department visits using the International Classification of Diseases, 10th Revision.

PubMed

Lee, Jin Hee; Hong, Ki Jeong; Kim, Do Kyun; Kwak, Young Ho; Jang, Hye Young; Kim, Hahn Bom; Noh, Hyun; Park, Jungho; Song, Bongkyu; Jung, Jae Yun

2013-12-01

A clinically sensible diagnosis grouping system (DGS) is needed for describing pediatric emergency diagnoses for research, medical resource preparedness, and making national policy for pediatric emergency medical care. The Pediatric Emergency Care Applied Research Network (PECARN) developed the DGS successfully. We developed the modified PECARN DGS based on the different pediatric population of South Korea and validated the system to obtain the accurate and comparable epidemiologic data of pediatric emergent conditions of the selected population. The data source used to develop and validate the modified PECARN DGS was the National Emergency Department Information System of South Korea, which was coded by the International Classification of Diseases, 10th Revision (ICD-10) code system. To develop the modified DGS based on ICD-10 code, we matched the selected ICD-10 codes with those of the PECARN DGS by the General Equivalence Mappings (GEMs). After converting ICD-10 codes to ICD-9 codes by GEMs, we matched ICD-9 codes into PECARN DGS categories using the matrix developed by PECARN group. Lastly, we conducted the expert panel survey using Delphi method for the remaining diagnosis codes that were not matched. A total of 1879 ICD-10 codes were used in development of the modified DGS. After 1078 (57.4%) of 1879 ICD-10 codes were assigned to the modified DGS by GEM and PECARN conversion tools, investigators assigned each of the remaining 801 codes (42.6%) to DGS subgroups by 2 rounds of electronic Delphi surveys. And we assigned the remaining 29 codes (4%) into the modified DGS at the second expert consensus meeting. The modified DGS accounts for 98.7% and 95.2% of diagnoses of the 2008 and 2009 National Emergency Department Information System data set. This modified DGS also exhibited strong construct validity using the concepts of age, sex, site of care, and seasons. This also reflected the 2009 outbreak of H1N1 influenza in Korea. We developed and validated clinically feasible and sensible DGS system for describing pediatric emergent conditions in Korea. The modified PECARN DGS showed good comprehensiveness and demonstrated reliable construct validity. This modified DGS based on PECARN DGS framework may be effectively implemented for research, reporting, and resource planning in pediatric emergency system of South Korea.

NASA Countermeasures Evaluation and Validation Project

NASA Technical Reports Server (NTRS)

Lundquist, Charlie M.; Paloski, William H. (Technical Monitor)

2000-01-01

To support its ISS and exploration class mission objectives, NASA has developed a Countermeasure Evaluation and Validation Project (CEVP). The goal of this project is to evaluate and validate the optimal complement of countermeasures required to maintain astronaut health, safety, and functional ability during and after short- and long-duration space flight missions. The CEVP is the final element of the process in which ideas and concepts emerging from basic research evolve into operational countermeasures. The CEVP is accomplishing these objectives by conducting operational/clinical research to evaluate and validate countermeasures to mitigate these maladaptive responses. Evaluation is accomplished by testing in space flight analog facilities, and validation is accomplished by space flight testing. Both will utilize a standardized complement of integrated physiological and psychological tests, termed the Integrated Testing Regimen (ITR) to examine candidate countermeasure efficacy and intersystem effects. The CEVP emphasis is currently placed on validating the initial complement of ISS countermeasures targeting bone, muscle, and aerobic fitness; followed by countermeasures for neurological, psychological, immunological, nutrition and metabolism, and radiation risks associated with space flight. This presentation will review the processes, plans, and procedures that will enable CEVP to play a vital role in transitioning promising research results into operational countermeasures necessary to maintain crew health and performance during long duration space flight.

Assessing quality of maternity care in Hungary: expert validation and testing of the mother-centered prenatal care (MCPC) survey instrument.

PubMed

Rubashkin, Nicholas; Szebik, Imre; Baji, Petra; Szántó, Zsuzsa; Susánszky, Éva; Vedam, Saraswathi

2017-11-16

Instruments to assess quality of maternity care in Central and Eastern European (CEE) region are scarce, despite reports of poor doctor-patient communication, non-evidence-based care, and informal cash payments. We validated and tested an online questionnaire to study maternity care experiences among Hungarian women. Following literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context. An expert panel assessed items for clarity and relevance on a 4-point ordinal scale. We calculated item-level Content Validation Index (CVI) scores. We designed 9 new items concerning informal cash payments, as well as 7 new "model of care" categories based on mode of payment. The final questionnaire (N = 111 items) was tested in two samples of Hungarian women, representative (N = 600) and convenience (N = 657). We conducted bivariate analysis and thematic analysis of open-ended responses. Experts rated pre-existing English-language items as clear and relevant to Hungarian women's maternity care experiences with an average CVI for included questions of 0.97. Significant differences emerged across the model of care categories in terms of informal payments, informed consent practices, and women's perceptions of autonomy. Thematic analysis (N = 1015) of women's responses identified 13 priority areas of the maternity care experience, 9 of which were addressed by the questionnaire. We developed and validated a comprehensive questionnaire that can be used to evaluate respectful maternity care, evidence-based practice, and informal cash payments in CEE region and beyond.

The 6 "ws" of rapid response systems: best practices for improving development, implementation, and evaluation.

PubMed

Lazzara, Elizabeth H; Benishek, Lauren E; Sonesh, Shirley C; Patzer, Brady; Robinson, Patricia; Wallace, Ruth; Salas, Eduardo

2014-01-01

Delays in care have been cited as one of the primary contributors of preventable mortality; thus, quality patient safety is often contingent upon the delivery of timely clinical care. Rapid response systems (RRSs) have been touted as one mechanism to improve the ability of suitable staff to respond to deteriorating patients quickly and appropriately. Rapid response systems are defined as highly skilled individual(s) who mobilize quickly to provide medical care in response to clinical deterioration. While there is mounting evidence that RRSs are a valid strategy for managing obstetric emergencies, reducing adverse events, and improving patient safety, there remains limited insight into the practices underlying the development and execution of these systems. Therefore, the purpose of this article was to synthesize the literature and answer the primary questions necessary for successfully developing, implementing, and evaluating RRSs within inpatient settings-the Who, What, When, Where, Why, and How of RRSs.

Determinants Of Oral corticosteroid Responsiveness in Wheezing Asthmatic Youth (DOORWAY): protocol for a prospective multicentre cohort study of children with acute moderate-to-severe asthma exacerbations

PubMed Central

Ducharme, F M; Zemek, R; Gravel, J; Chalut, D; Poonai, N; Laberge, S; Quach, C; Krajinovic, M; Guimont, C; Lemière, C; Guertin, M C

2014-01-01

Introduction Oral corticosteroids are the cornerstone of acute asthma management in the emergency department. Recent evidence has raised doubts about the efficacy of this treatment in preschool-aged children with viral-induced wheezing and in smoking adults. The aims of the study were to: (1) document the magnitude of response to oral corticosteroids in children presenting to the emergency department with moderate or severe asthma; (2) quantify potential determinants of response to corticosteroids and (3) explore the role of gene polymorphisms associated with the responsiveness to corticosteroids. Methods and analysis The design is a prospective cohort study of 1008 children aged 1–17 years meeting a strict definition of asthma and presenting with a clinical score of ≥4 on the validated Pediatric Respiratory Assessment Measure. All children will receive standardised severity-specific treatment with prednisone/prednisolone and cointerventions (salbutamol with/without ipratropium bromide). Determinants, namely viral aetiology, environmental tobacco smoke and single nucleotide polymorphism, will be objectively documented. The primary efficacy endpoint is the failure of emergency department (ED) management within 72 h of the ED visit. Secondary endpoints include other measures of asthma severity and time to recovery within 7 days of the index visit. The study has 80% power for detecting a risk difference of 7.5% associated with each determinant from a baseline risk of 21%, at an α of 0.05. Ethics and dissemination Ethical approval has been obtained from all participating institutions. An impaired response to systemic steroids in certain subgroups will challenge the current standard of practice and call for the immediate search for better approaches. A potential host–environment interaction will broaden our understanding of corticosteroid responsiveness in children. Documentation of similar effectiveness of corticosteroids across determinants will provide the needed reassurance regarding current treatment recommendations. Results Results will be disseminated at international conferences and manuscripts targeted at emergency physicians, paediatricians, geneticists and respirologists. Trial registration number This study is registered at Clinicaltrials.gov (NCT02013076). PMID:24710133

Effective Disengagement: Insecure People Are More Likely to Disengage From an Ongoing Task and Take Effective Action When Facing Danger.

PubMed

Ein-Dor, Tsachi; Perry-Paldi, Adi; Merrin, Jenna; Efrati, Yaniv; Hirschberger, Gilad

2018-04-01

People believe that they can respond effectively to threats, but actually they experience difficulties in disengaging from ongoing tasks and shifting their attention to life-threatening events. We contend that this tendency is especially true for secure people with respect to their worldview and perception of others and not for insecure individuals. In Study 1 (N = 290), we examined individuals' reactions to various threat scenarios. In Study 2 (N = 65), we examined these reactions using a behavioral design high in ecological validity. In Study 3 (N = 78), we examined group-level benefits for the actions of insecure individuals by manipulating asocial behavior in response to an emergency. Study 1 indicated that anxiously attached individuals stayed away from threats and sought help; avoidant people tended to take action by either assessing the risk of the event and/or enacting an asocial action such as fight or flight. Study 2 added ecological validity to these findings, and Study 3 showed that priming asocial behavior responses promoted actions that increased group members' chances of survival. Results validate the central tenets of social defense theory and indicate that actions that are deemed asocial may paradoxically promote the survival of individuals and groups. © 2017 Wiley Periodicals, Inc.

Advancing Partnerships Towards an Integrated Approach to Oil Spill Response

NASA Astrophysics Data System (ADS)

Green, D. S.; Stough, T.; Gallegos, S. C.; Leifer, I.; Murray, J. J.; Streett, D.

2015-12-01

Oil spills can cause enormous ecological and economic devastation, necessitating application of the best science and technology available, and remote sensing is playing a growing critical role in the detection and monitoring of oil spills, as well as facilitating validation of remote sensing oil spill products. The FOSTERRS (Federal Oil Science Team for Emergency Response Remote Sensing) interagency working group seeks to ensure that during an oil spill, remote sensing assets (satellite/aircraft/instruments) and analysis techniques are quickly, effectively, appropriately, and seamlessly available to oil spills responders. Yet significant challenges remain for addressing oils spanning a vast range of chemical properties that may be spilled from the Tropics to the Arctic, with algorithms and scientific understanding needing advances to keep up with technology. Thus, FOSTERRS promotes enabling scientific discovery to ensure robust utilization of available technology as well as identifying technologies moving up the TRL (Technology Readiness Level). A recent FOSTERRS facilitated support activity involved deployment of the AVIRIS NG (Airborne Visual Infrared Imaging Spectrometer- Next Generation) during the Santa Barbara Oil Spill to validate the potential of airborne hyperspectral imaging to real-time map beach tar coverage including surface validation data. Many developing airborne technologies have potential to transition to space-based platforms providing global readiness.

The predictive validity of naturally acquired delayed-type hypersensitivity to leishmanin in resistance to Leishmania major-associated cutaneous leishmaniasis.

PubMed

Ben Salah, Afif; Louzir, Hechmi; Chlif, Sadok; Mokni, Mourad; Zaatour, Amor; Raouene, Mohamed; Ismail, Riadh Ben; Dellagi, Koussay

2005-12-01

To accurately quantify the different outcomes of Leishmania major infection and to evaluate the fraction of zoonotic cutaneous leishmaniasis (ZCL) cases prevented by naturally acquired leishmanin skin test (LST) reactivity, a cohort of 470 children was followed up in 2 endemic foci, Remada and Dhiba, in southern Tunisia. During May 1997, before the ZCL emergence season, LST was performed, and results were reassessed 12 months later. Active case detection during the ZCL emergence season showed a high incidence of ZCL: 57.0% in Remada and 13.7% in Dhiba. The preventive fraction of ZCL conferred by LST reactivity increased proportionally with the reaction size before the emergence season, revealing a dose-response effect of approximately 70%. In addition, asymptomatic L. major infection appeared to be a significant form of natural immunization, particularly in the context of relatively low transmission. These findings may help in the design and evaluation of vaccines.

Emergency physician evaluation of PA and NP practice patterns.

PubMed

Phillips, Andrew W; Klauer, Kevin M; Kessler, Chad S

2018-05-01

The unprecedented surge in physician assistants (PAs) and NPs in the ED developed quickly in recent years, but scope of practice and practice patterns are not well described. We conducted two cross-sectional electronic surveys of the American College of Emergency Physicians' council. Survey construction was informed by interviews and evaluated with validity and reliability studies. Univariate analyses to establish associations also were performed. Most councilors' departments employ PAs and NPs (72.4% of 163 responses). Supervisory requirements varied greatly among respondents for the same emergency severity index (ESI) level. Regardless of experience level, NPs were reported to use significantly more resources than PAs; chi-square(4) = 105.292, P < .001 for less-experienced PAs or NPs; chi-square(4) = 120.415, P < .001 for more experienced PAs or NPs. Councilors reported great variation in PA and NP scope of practice. The results also suggest that new graduate PAs may be more clinically prepared to practice in the ED than new graduate NPs.

Examination of the Triarchic Assessment Procedure for Inconsistent Responding in six non-English language samples.

PubMed

Kelley, Shannon E; van Dongen, Josanne D M; Donnellan, M Brent; Edens, John F; Eisenbarth, Hedwig; Fossati, Andrea; Howner, Katarina; Somma, Antonella; Sörman, Karolina

2018-05-01

The Triarchic Assessment Procedure for Inconsistent Responding (TAPIR; Mowle et al., 2016) was recently developed to identify inattentiveness or comprehension difficulties that may compromise the validity of responses on the Triarchic Psychopathy Measure (TriPM; Patrick, 2010). The TAPIR initially was constructed and cross-validated using exclusively English-speaking participants from the United States; however, research using the TriPM has been increasingly conducted internationally, with numerous foreign language translations of the measure emerging. The present study examined the cross-language utility of the TAPIR in German, Dutch, Swedish, and Italian translations of the TriPM using 6 archival samples of community members, university students, forensic psychiatric inpatients, forensic detainees, and adolescents residing outside the United States (combined N = 5,404). Findings suggest that the TAPIR effectively detects careless responding across these 4 translated versions of the TriPM without the need for language-specific modifications. The TAPIR total score meaningfully discriminated genuine participant responses from both fully and partially randomly generated data in every sample, and demonstrated further utility in detecting fixed "all true" or "all false" response patterns. In addition, TAPIR scores were reliably associated with inconsistent responding scores from another psychopathy inventory. Specificity for a range of tentative cut scores for assessing profile validity was modestly reduced among our samples relative to rates previously obtained with the English version of the TriPM; however, overall the TAPIR appears to demonstrate satisfactory cross-language generalizability. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Analytical Validation of a Portable Mass Spectrometer Featuring Interchangeable, Ambient Ionization Sources for High Throughput Forensic Evidence Screening

NASA Astrophysics Data System (ADS)

Lawton, Zachary E.; Traub, Angelica; Fatigante, William L.; Mancias, Jose; O'Leary, Adam E.; Hall, Seth E.; Wieland, Jamie R.; Oberacher, Herbert; Gizzi, Michael C.; Mulligan, Christopher C.

2017-06-01

Forensic evidentiary backlogs are indicative of the growing need for cost-effective, high-throughput instrumental methods. One such emerging technology that shows high promise in meeting this demand while also allowing on-site forensic investigation is portable mass spectrometric (MS) instrumentation, particularly that which enables the coupling to ambient ionization techniques. While the benefits of rapid, on-site screening of contraband can be anticipated, the inherent legal implications of field-collected data necessitates that the analytical performance of technology employed be commensurate with accepted techniques. To this end, comprehensive analytical validation studies are required before broad incorporation by forensic practitioners can be considered, and are the focus of this work. Pertinent performance characteristics such as throughput, selectivity, accuracy/precision, method robustness, and ruggedness have been investigated. Reliability in the form of false positive/negative response rates is also assessed, examining the effect of variables such as user training and experience level. To provide flexibility toward broad chemical evidence analysis, a suite of rapidly-interchangeable ion sources has been developed and characterized through the analysis of common illicit chemicals and emerging threats like substituted phenethylamines. [Figure not available: see fulltext.

44 CFR 352.26 - Arrangements for Federal response in the licensee offsite emergency response plan.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Federal response in the licensee offsite emergency response plan. Federal agencies may be called upon to assist the licensee in developing a licensee offsite emergency response plan in areas such as: (a... response in the licensee offsite emergency response plan. 352.26 Section 352.26 Emergency Management and...

44 CFR 352.26 - Arrangements for Federal response in the licensee offsite emergency response plan.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Federal response in the licensee offsite emergency response plan. Federal agencies may be called upon to assist the licensee in developing a licensee offsite emergency response plan in areas such as: (a... response in the licensee offsite emergency response plan. 352.26 Section 352.26 Emergency Management and...

44 CFR 352.26 - Arrangements for Federal response in the licensee offsite emergency response plan.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Federal response in the licensee offsite emergency response plan. Federal agencies may be called upon to assist the licensee in developing a licensee offsite emergency response plan in areas such as: (a... response in the licensee offsite emergency response plan. 352.26 Section 352.26 Emergency Management and...

44 CFR 352.26 - Arrangements for Federal response in the licensee offsite emergency response plan.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Federal response in the licensee offsite emergency response plan. Federal agencies may be called upon to assist the licensee in developing a licensee offsite emergency response plan in areas such as: (a... response in the licensee offsite emergency response plan. 352.26 Section 352.26 Emergency Management and...

Telephone CPR Instructions in Emergency Dispatch Systems: Qualitative Survey of 911 Call Centers.

PubMed

Sutter, John; Panczyk, Micah; Spaite, Daniel W; Ferrer, Jose Maria E; Roosa, Jason; Dameff, Christian; Langlais, Blake; Murphy, Ryan A; Bobrow, Bentley J

2015-09-01

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. The 2010 American Heart Association Emergency Cardiovascular Care (ECC) Guidelines recognize emergency dispatch as an integral component of emergency medical service response to OHCA and call for all dispatchers to be trained to provide telephone cardiopulmonary resuscitation (T-CPR) pre-arrival instructions. To begin to measure and improve this critical intervention, this study describes a nationwide survey of public safety answering points (PSAPs) focusing on the current practices and resources available to provide T-CPR to callers with the overall goal of improving survival from OHCA. We conducted this survey in 2010, identifying 5,686 PSAPs; 3,555 had valid e-mail addresses and were contacted. Each received a preliminary e-mail announcing the survey, an e-mail with a link to the survey, and up to three follow-up e-mails for non-responders. The survey contained 23 primary questions with sub-questions depending on the response selected. Of the 5,686 identified PSAPs in the United States, 3,555 (63%) received the survey, with 1,924/3,555 (54%) responding. Nearly all were public agencies (n=1,888, 98%). Eight hundred seventy-eight (46%) responding agencies reported that they provide no instructions for medical emergencies, and 273 (14%) reported that they are unable to transfer callers to another facility to provide T-CPR. Of the 1,924 respondents, 975 (51%) reported that they provide pre-arrival instructions for OHCA: 67 (3%) provide compression-only CPR instructions, 699 (36%) reported traditional CPR instructions (chest compressions with rescue breathing), 166 (9%) reported some other instructions incorporating ventilations and compressions, and 92 (5%) did not specify the type of instructions provided. A validation follow up showed no substantial difference in the provision of instructions for OHCA by non-responders to the survey. This is the first large-scale, nationwide assessment of the practices of PSAPs in the United States regarding T-CPR for OHCA. These data showing that nearly half of the nation's PSAPs do not provide T-CPR for OHCA, and very few PSAPs provide compression-only instructions, suggest that there is significant potential to improve the implementation of this critical link in the chain of survival for OHCA.

Geographic Discordance Between Patient Residence and Incident Location in Emergency Medical Services Responses.

PubMed

Hsia, Renee Y; Dai, Mengtao; Wei, Ran; Sabbagh, Sarah; Mann, N Clay

2017-01-01

The location of a patient's residence is often used for emergency medical services (EMS) system planning. Our objective is to evaluate the association between patient residence and emergency incident zip codes for 911 calls. We used data from the 2013 National Emergency Medical Services Information System (NEMSIS) Public-Release Research Dataset. We studied all 911 calls with a valid complaint by dispatch, identifying zip codes for both the residence and incident locations (n=12,376,784). The primary outcomes were geographic and distance discordances between patient residence and incident zip codes. We used a multivariate logistic regression model to determine geographic discordance between residence and incident zip codes by dispatch complaint, age, and sex. We also measured distances between locations with geospatial processing. The overall proportion of geographic discordance for all 911 calls was 27.7% (95% confidence interval [CI] 27.7% to 27.8%) and the median distance discordance was 11.5 miles (95% CI 11.5 to 11.5 miles). Lower geographic discordance rates were found among patients aged 65 to 79 years (20.2%; 95% CI 20.1% to 20.2%) and 80 years and older (14.5%; 95% CI 14.5% to 14.6%). Motor vehicle crashes (63.5%; 95% CI 63.5% to 63.6%), industrial accidents (59.3%; 95% CI 58.0% to 60.6%), and mass casualty incidents (50.6%; 95% CI 49.6% to 51.5%) were more likely to occur outside a patient's residence zip code. Median network distance between home and incident zip centroid codes ranged from 8.6 to 23.5 miles. In NEMSIS, there was geographic discordance between patient residence zip code and call location zip code in slightly more than one quarter of EMS responses records. The geographic discordance rates between residence and incident zip codes were associated with dispatch complaints and age. Although a patient's residence might be a valid proxy for incident location for elderly patients, this relationship holds less true for other age groups and among different complaints. Our findings have important implications for EMS system planning, resource allocation, and injury surveillance. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Mindfulness: A systematic review of instruments to measure an emergent patientreported outcome (PRO)

PubMed Central

Park, Taehwan; Reilly-Spong, Maryanne

2013-01-01

Purpose Mindfulness has emerged as an important health concept based on evidence that mindfulness interventions reduce symptoms and improve health-related quality of life. The objectives of this study were to systematically assess and compare the properties of instruments to measure self-reported mindfulness. Methods Ovid Medline®, CINAHL®, and PsycINFO® were searched through May 2012, and articles were selected if their primary purpose was development or evaluation of the measurement properties (validity, reliability, responsiveness) of a self-report mindfulness scale. Two reviewers independently evaluated the methodological quality of the selected studies using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. Discrepancies were discussed with a third reviewer, and scored by consensus. Finally, a level of evidence approach was used to synthesize results and study quality. Results Our search strategy identified a total of 2,588 articles. Forty-six articles, reporting 79 unique studies, met inclusion criteria. Ten instruments quantifying mindfulness as a unidimensional scale (n=5) or as a set of 2 to 5 subscales (n=5) were reviewed. The Mindful Attention Awareness Scale (MAAS) was evaluated by the most studies (n=27), and had positive overall quality ratings for most of the psychometric properties reviewed. The Five Facet Mindfulness Questionnaire (FFMQ) received the highest possible rating (“consistent findings in multiple studies of good methodological quality”) for two properties, internal consistency and construct validation by hypothesis testing. However, none of the instruments had sufficient evidence of content validity. Comprehensiveness of construct coverage had not been assessed; qualitative methods to confirm understanding and relevance were absent. In addition, estimates of test-retest reliability, responsiveness, or measurement error to guide users in protocol development or interpretation of scores were lacking. Conclusions Current mindfulness scales have important conceptual differences, and none can be strongly recommended based solely on superior psychometric properties. Important limitations in the field are the absence of qualitative evaluations and accepted external referents to support construct validity. Investigators need to proceed cautiously before optimizing any mindfulness intervention based on the existing scales. PMID:23539467

National survey of emergency physicians for transient ischemic attack (TIA) risk stratification consensus and appropriate treatment for a given level of risk.

PubMed

Perry, Jeffrey J; Losier, Justin H; Stiell, Ian G; Sharma, Mukul; Abdulaziz, Kasim

2016-01-01

Five percent of transient ischemic attack (TIA) patients have a subsequent stroke within 7 days. The Canadian TIA Score uses clinical findings to calculate the subsequent stroke risk within 7 days. Our objectives were to assess 1) anticipated use; 2) component face validity; 3) risk strata for stroke within 7 days; and 4) actions required, for a given risk for subsequent stroke. After a rigorous development process, a survey questionnaire was administered to a random sample of 300 emergency physicians selected from those registered in a national medical directory. The surveys were distributed using a modified Dillman technique. From a total of 271 eligible surveys, we received 131 (48.3%) completed surveys; 96.2% of emergency physicians would use a validated Canadian TIA Score; 8 of 13 components comprising the Canadian TIA Score were rated as Very Important or Important by survey respondents. Risk categories for subsequent stroke were defined as minimal-risk: 10% risk of subsequent stroke within 7 days. A validated Canadian TIA Score will likely be used by emergency physicians. Most components of the TIA Score have high face validity. Risk strata are definable, which may allow physicians to determine immediate actions, based on subsequent stroke risk, in the emergency department.

Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study

PubMed Central

Émond, Marcel; Guimont, Chantal; Chauny, Jean-Marc; Daoust, Raoul; Bergeron, Éric; Vanier, Laurent; Moore, Lynne; Plourde, Miville; Kuimi, Batomen; Boucher, Valérie; Allain-Boulé, Nadine; Le Sage, Natalie

2017-01-01

Background: About 75% of patients with minor thoracic injury are discharged after an emergency department visit. However, complications such as delayed hemothorax can occur. We sought to derive and validate a clinical decision rule to predict hemothorax in patients discharged from the emergency department. Methods: We conducted a 6-year prospective cohort study in 4 university-affiliated emergency departments. Patients aged 16 years or older presenting with a minor thoracic injury were assessed at 5 time points (initial visit and 7, 14, 30 and 90 d after the injury). Radiologists' reports were reviewed for the presence of hemothorax. We used log-binomial regression models to identify predictors of hemothorax. Results: A total of 1382 patients were included: 830 in the derivation phase and 552 in the validation phase. Of these, 151 (10.9%) had hemothorax at the 14-day follow-up. Patients 65 years of age or older represented 25.3% (210/830) and 23.7% (131/552) of the derivation and validation cohorts, respectively. The final clinical decision rule included a combination of age (> 70 yr, 2 points; 45-70 yr, 1 point), fracture of any high to mid thorax rib (ribs 3-9, 2 points) and presence of 3 or more rib fractures (1 point). Twenty (30.8%) of the 65 high-risk patients (score ≥ 4) experienced hemothorax during the follow-up period. The clinical decision rule had a high specificity (90.7%, 95% confidence interval 87.7%-93.1%) in this high-risk group, thus guiding appropriate post-emergency care. Interpretation: One patient out of every 10 presented with delayed hemothorax after discharge from the emergency department. Implementation of this validated clinical decision rule for minor thoracic injury could guide emergency discharge plans. PMID:28611156

Absolute number of new lesions on 18F-FDG PET/CT is more predictive of clinical response than SUV changes in metastatic melanoma patients receiving ipilimumab.

PubMed

Anwar, Hoda; Sachpekidis, Christos; Winkler, Julia; Kopp-Schneider, Annette; Haberkorn, Uwe; Hassel, Jessica C; Dimitrakopoulou-Strauss, Antonia

2018-03-01

Evaluation of response to immunotherapy is a matter of debate. The aim of the present study was to evaluate the response of metastatic melanoma to treatment with ipilimumab by means of 18 F-FDG PET/CT, using the patients' clinical response as reference. The final cohort included in the analyses consisted of 41 patients with metastatic melanoma who underwent 18 F-FDG PET/CT before and after administration of ipilimumab. After determination of the best clinical response, the PET/CT scans were reviewed and a separate independent analysis was performed, based on the number and functional size of newly emerged 18 F-FDG-avid lesions, as well as on the SUV changes after therapy. The median observation time of the patients after therapy was 21.4 months (range 6.3-41.9 months). Based on their clinical response, patients were dichotomized into those with clinical benefit (CB) and those without CB (No-CB). The CB group (31 patients) included those with stable disease, partial remission and complete remission, and the No-CB group (10 patients) included those with progressive disease. The application of a threshold of four newly emerged 18 F-FDG-avid lesions on the posttherapy PET/CT scan led to a sensitivity (correctly predicting CB) of 84% and a specificity (correctly predicting No-CB) of 100%. This cut-off was lower for lesions with larger functional diameters (three new lesions larger than 1.0 cm and two new lesions larger than 1.5 cm). SUV changes after therapy did not correlate with clinical response. Based on these findings, we developed criteria for predicting clinical response to immunotherapy by means of 18 F-FDG PET/CT (PET Response Evaluation Criteria for Immunotherapy, PERCIMT). Our results show that a cut-off of four newly emerged 18 F-FDG-avid lesions on posttherapy PET/CT gives a reliable indication of treatment failure in patients under ipilimumab treatment. Moreover, the functional size of the new lesions plays an important role in predicting the clinical response. Validation of these results in larger cohorts of patients is warranted.

The attitudes and awareness of emergency department (ED) physicians towards the management of common dentofacial emergencies.

PubMed

Trivedy, Chetan; Kodate, Naonori; Ross, Alastair; Al-Rawi, Harrith; Jaiganesh, Thiagarajan; Harris, Tim; Anderson, Janet E

2012-04-01

Dentofacial emergencies are a common presentation to the emergency department (ED) but there is little recent data on physicians' knowledge, confidence and attitudes in handling these cases. A questionnaire was administered to 103 ED physicians. The sample was primarily drawn from London hospitals as well a smaller contribution from around the UK and included physicians with a range of experience and at different grades. The majority of the 102 participants (76.5%) did not receive any formal training in managing dentofacial emergencies. The percentage of participants who were happy to manage common dentofacial emergencies is as follows: dental trauma (20.4%); major facial trauma (39.8%); interpreting facial X-rays (68.0%); and facial suturing (85.4%). When questioned 12.1% of the participants felt that ED physicians should be responsible for managing dental emergencies compared to 22.4% who felt that ED physicians should manage maxillofacial emergencies. Only 3.9% of the participants would opt to be treated by an ED doctor in the event of them presenting to the ED with a dental injury. The remaining 72.5% would prefer to be seen by a maxillofacial surgeon, 23.5% by a dentist and none of the participants opted to be seen by the emergency nurse practitioner. ED physicians do not feel confident in managing some dentofacial emergencies. This may be attributed to a lack of training in this area as well as exposure to these types of emergencies. There is a need for greater awareness, validated guidelines and training resources for ED physicians to treat dentofacial emergencies as well more research in this field of emergency medicine. © 2011 John Wiley & Sons A/S.

Human pathogenic bacteria, fungi, and viruses in Drosophila

PubMed Central

Panayidou, Stavria; Ioannidou, Eleni; Apidianakis, Yiorgos

2014-01-01

Drosophila has been the invertebrate model organism of choice for the study of innate immune responses during the past few decades. Many Drosophila–microbe interaction studies have helped to define innate immunity pathways, and significant effort has been made lately to decipher mechanisms of microbial pathogenesis. Here we catalog 68 bacterial, fungal, and viral species studied in flies, 43 of which are relevant to human health. We discuss studies of human pathogens in flies revealing not only the elicitation and avoidance of immune response but also mechanisms of tolerance, host tissue homeostasis, regeneration, and predisposition to cancer. Prominent among those is the emerging pattern of intestinal regeneration as a defense response induced by pathogenic and innocuous bacteria. Immunopathology mechanisms and many microbial virulence factors have been elucidated, but their relevance to human health conventionally necessitates validation in mammalian models of infection. PMID:24398387

Logistics modelling: improving resource management and public information strategies in Florida.

PubMed

Walsh, Daniel M; Van Groningen, Chuck; Craig, Brian

2011-10-01

One of the most time-sensitive and logistically-challenging emergency response operations today is to provide mass prophylaxis to every man, woman and child in a community within 48 hours of a bioterrorism attack. To meet this challenge, federal, state and local public health departments in the USA have joined forces to develop, test and execute large-scale bioterrorism response plans. This preparedness and response effort is funded through the US Centers for Disease Control and Prevention's Cities Readiness Initiative, a programme dedicated to providing oral antibiotics to an entire population within 48 hours of a weaponised inhalation anthrax attack. This paper will demonstrate how the State of Florida used a logistics modelling tool to improve its CRI mass prophylaxis plans. Special focus will be on how logistics modelling strengthened Florida's resource management policies and validated its public information strategies.

Cross-informant and cross-national equivalence using item-response theory (IRT) linking: A case study using the behavioral assessment for children of African heritage in the United States and Jamaica.

PubMed

Lambert, Michael Canute; Ferguson, Gail M; Rowan, George T

2016-03-01

Cross-national study of adolescents' psychological adjustment requires measures that permit reliable and valid assessment across informants and nations, but such measures are virtually nonexistent. Item-response-theory-based linking is a promising yet underutilized methodological procedure that permits more accurate assessment across informants and nations. To demonstrate this procedure, the Resilience Scale of the Behavioral Assessment for Children of African Heritage (Lambert et al., 2005) was administered to 250 African American and 294 Jamaican nonreferred adolescents and their caregivers. Multiple items without significant differential item functioning emerged, allowing scale linking across informants and nations. Calibrating item parameters via item response theory linking can permit cross-informant cross-national assessment of youth. (c) 2016 APA, all rights reserved).

Predictors of In-Hospital Mortality After Rapid Response Team Calls in a 274 Hospital Nationwide Sample.

PubMed

Shappell, Claire; Snyder, Ashley; Edelson, Dana P; Churpek, Matthew M

2018-07-01

Despite wide adoption of rapid response teams across the United States, predictors of in-hospital mortality for patients receiving rapid response team calls are poorly characterized. Identification of patients at high risk of death during hospitalization could improve triage to intensive care units and prompt timely reevaluations of goals of care. We sought to identify predictors of in-hospital mortality in patients who are subjects of rapid response team calls and to develop and validate a predictive model for death after rapid response team call. Analysis of data from the national Get with the Guidelines-Medical Emergency Team event registry. Two-hundred seventy four hospitals participating in Get with the Guidelines-Medical Emergency Team from June 2005 to February 2015. 282,710 hospitalized adults on surgical or medical wards who were subjects of a rapid response team call. None. The primary outcome was death during hospitalization; candidate predictors included patient demographic- and event-level characteristics. Patients who died after rapid response team were older (median age 72 vs 66 yr), were more likely to be admitted for noncardiac medical illness (70% vs 58%), and had greater median length of stay prior to rapid response team (81 vs 47 hr) (p < 0.001 for all comparisons). The prediction model had an area under the receiver operating characteristic curve of 0.78 (95% CI, 0.78-0.79), with systolic blood pressure, time since admission, and respiratory rate being the most important variables. Patients who die following rapid response team calls differ significantly from surviving peers. Recognition of these factors could improve postrapid response team triage decisions and prompt timely goals of care discussions.

Development, validation and testing of a nursing home to emergency room transfer checklist.

PubMed

Tsai, Hsiu-Hsin; Tsai, Yun-Fang

2018-01-01

To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults between facilities such as nursing homes and hospitals. © 2017 John Wiley & Sons Ltd.

Zero-Fidelity Simulation: Engaging Team Coordination without Physical, Functional, or Psychological Re-Creation

NASA Technical Reports Server (NTRS)

Toups, Zachary O.; Hamilton, William A.; Kerne, Andruid

2012-01-01

Team coordination is essential across domains, enabling efficiency and safety. As technology improves, our temptation is to simulate with ever-higher fidelity, by making simulators re-create reality through their physical interfaces, functionality, and by making participants believe they are undertaking the simulated task. However, high-fidelity simulations often miss salient human-human work practices. We introduce the concept of zero-fidelity simulation (ZFS), a move away from literal high-fidelity mimesis of the concrete environment. ZFS alternatively models cooperation and communication as the basis of simulation. The ZFS Team Coordination Game (TeC) is developed from observation of fire emergency response work practice. We identify ways in which team members are mutually dependent on one another for information, and use these as the basis for the ZFS game design. The design creates a need for cooperation by restricting individual activity and requiring communication. The present research analyzes the design of interdependence in the validated ZFS TeC game. We successfully simulate interdependence between roles in emergency response without simulating the concrete environment.

Validation of Measures of Cyberbullying Perpetration and Victimization in Emerging Adulthood

ERIC Educational Resources Information Center

Lee, Jungup; Abell, Neil; Holmes, Jennifer L.

2017-01-01

Objective: Cyber bullying represents a new and alarming form of bullying that potentially leads to serious and long-lasting consequences for young people; yet, there is a dearth of research on the assessment of cyberbullying behaviors among emerging adults. Thus, this study aims to close this gap by assessing the development and validation of the…

All Source Solution Decision Support Products Created for Stennis Space Center in Response to Hurricane Katrina

NASA Technical Reports Server (NTRS)

Ross, Kenton W.; Graham, William D.

2007-01-01

In the aftermath of Hurricane Katrina and in response to the needs of SSC (Stennis Space Center), NASA required the generation of decision support products with a broad range of geospatial inputs. Applying a systems engineering approach, the NASA ARTPO (Applied Research and Technology Project Office) at SSC evaluated the Center's requirements and source data quality. ARTPO identified data and information products that had the potential to meet decision-making requirements; included were remotely sensed data ranging from high-spatial-resolution aerial images through high-temporal-resolution MODIS (Moderate Resolution Imaging Spectroradiometer) products. Geospatial products, such as FEMA's (Federal Emergency Management Agency's) Advisory Base Flood Elevations, were also relevant. Where possible, ARTPO applied SSC calibration/validation expertise to both clarify the quality of various data source options and to validate that the inputs that were finally chosen met SSC requirements. ARTPO integrated various information sources into multiple decision support products, including two maps: Hurricane Katrina Inundation Effects at Stennis Space Center (highlighting surge risk posture) and Vegetation Change In and Around Stennis Space Center: Katrina and Beyond (highlighting fire risk posture).

Measuring adverse events in helicopter emergency medical services: establishing content validity.

PubMed

Patterson, P Daniel; Lave, Judith R; Martin-Gill, Christian; Weaver, Matthew D; Wadas, Richard J; Arnold, Robert M; Roth, Ronald N; Mosesso, Vincent N; Guyette, Francis X; Rittenberger, Jon C; Yealy, Donald M

2014-01-01

We sought to create a valid framework for detecting adverse events (AEs) in the high-risk setting of helicopter emergency medical services (HEMS). We assembled a panel of 10 expert clinicians (n = 6 emergency medicine physicians and n = 4 prehospital nurses and flight paramedics) affiliated with a large multistate HEMS organization in the Northeast US. We used a modified Delphi technique to develop a framework for detecting AEs associated with the treatment of critically ill or injured patients. We used a widely applied measure, the content validity index (CVI), to quantify the validity of the framework's content. The expert panel of 10 clinicians reached consensus on a common AE definition and four-step protocol/process for AE detection in HEMS. The consensus-based framework is composed of three main components: (1) a trigger tool, (2) a method for rating proximal cause, and (3) a method for rating AE severity. The CVI findings isolate components of the framework considered content valid. We demonstrate a standardized process for the development of a content-valid framework for AE detection. The framework is a model for the development of a method for AE identification in other settings, including ground-based EMS.

Emergency Physician Attitudes, Preferences, and Risk Tolerance for Stroke as a Potential Cause of Dizziness Symptoms

PubMed Central

Kene, Mamata V.; Ballard, Dustin W.; Vinson, David R.; Rauchwerger, Adina S.; Iskin, Hilary R.; Kim, Anthony S.

2015-01-01

Introduction We evaluated emergency physicians’ (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients. Methods We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness. We calculated descriptive statistics and post-test probabilities for such a clinical prediction rule. Results The response rate was 68% (366/535). Respondents’ median practice tenure was eight years (37% female, 92% emergency medicine board certified). Symptom quality and typical vascular risk factors increased suspicion for stroke as a cause of dizziness. Most respondents reported obtaining head computed tomography (CT) (74%). Nearly all respondents used and felt confident using cranial nerve and limb strength testing. A substantial minority of EPs used the Epley maneuver (49%) and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation) testing (30%); however, few EPs reported confidence in these tests’ bedside application (35% and 16%, respectively). Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful. Conclusion EPs report relying on symptom quality, vascular risk factors, simple physical exam elements, and head CT to diagnose stroke as the cause of dizziness, but would find a validated clinical prediction rule for dizziness helpful. A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability. PMID:26587108

Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation-Enhanced Interprofessional Curriculum

PubMed Central

Wong, Ambrose H.; Wing, Lisa; Weiss, Brenda; Gang, Maureen

2015-01-01

Introduction While treating potentially violent patients in the emergency department (ED), both patients and staff may be subject to unintentional injury. Emergency healthcare providers are at the greatest risk of experiencing physical and verbal assault from patients. Preliminary studies have shown that a team-based approach with targeted staff training has significant positive outcomes in mitigating violence in healthcare settings. Staff attitudes toward patient aggression have also been linked to workplace safety, but current literature suggests that providers experience fear and anxiety while caring for potentially violent patients. The objectives of the study were (1) to develop an interprofessional curriculum focusing on improving teamwork and staff attitudes toward patient violence using simulation-enhanced education for ED staff, and (2) to assess attitudes towards patient aggression both at pre- and post-curriculum implementation stages using a survey-based study design. Methods Formal roles and responsibilities for each member of the care team, including positioning during restraint placement, were predefined in conjunction with ED leadership. Emergency medicine residents, nurses and hospital police officers were assigned to interprofessional teams. The curriculum started with an introductory lecture discussing de-escalation techniques and restraint placement as well as core tenets of interprofessional collaboration. Next, we conducted two simulation scenarios using standardized participants (SPs) and structured debriefing. The study consisted of a survey-based design comparing pre- and post-intervention responses via a paired Student t-test to assess changes in staff attitudes. We used the validated Management of Aggression and Violence Attitude Scale (MAVAS) consisting of 30 Likert-scale questions grouped into four themed constructs. Results One hundred sixty-two ED staff members completed the course with >95% staff participation, generating a total of 106 paired surveys. Constructs for internal/biomedical factors, external/staff factors and situational/interactional perspectives on patient aggression significantly improved (p<0.0001, p<0.002, p<0.0001 respectively). Staff attitudes toward management of patient aggression did not significantly change (p=0.542). Multiple quality improvement initiatives were successfully implemented, including the creation of an interprofessional crisis management alert and response protocol. Staff members described appreciation for our simulation-based curriculum and welcomed the interaction with SPs during their training. Conclusion A structured simulation-enhanced interprofessional intervention was successful in improving multiple facets of ED staff attitudes toward behavioral emergency care. PMID:26594279

Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation-Enhanced Interprofessional Curriculum.

PubMed

Wong, Ambrose H; Wing, Lisa; Weiss, Brenda; Gang, Maureen

2015-11-01

While treating potentially violent patients in the emergency department (ED), both patients and staff may be subject to unintentional injury. Emergency healthcare providers are at the greatest risk of experiencing physical and verbal assault from patients. Preliminary studies have shown that a team-based approach with targeted staff training has significant positive outcomes in mitigating violence in healthcare settings. Staff attitudes toward patient aggression have also been linked to workplace safety, but current literature suggests that providers experience fear and anxiety while caring for potentially violent patients. The objectives of the study were (1) to develop an interprofessional curriculum focusing on improving teamwork and staff attitudes toward patient violence using simulation-enhanced education for ED staff, and (2) to assess attitudes towards patient aggression both at pre- and post-curriculum implementation stages using a survey-based study design. Formal roles and responsibilities for each member of the care team, including positioning during restraint placement, were predefined in conjunction with ED leadership. Emergency medicine residents, nurses and hospital police officers were assigned to interprofessional teams. The curriculum started with an introductory lecture discussing de-escalation techniques and restraint placement as well as core tenets of interprofessional collaboration. Next, we conducted two simulation scenarios using standardized participants (SPs) and structured debriefing. The study consisted of a survey-based design comparing pre- and post-intervention responses via a paired Student t-test to assess changes in staff attitudes. We used the validated Management of Aggression and Violence Attitude Scale (MAVAS) consisting of 30 Likert-scale questions grouped into four themed constructs. One hundred sixty-two ED staff members completed the course with >95% staff participation, generating a total of 106 paired surveys. Constructs for internal/biomedical factors, external/staff factors and situational/interactional perspectives on patient aggression significantly improved (p<0.0001, p<0.002, p<0.0001 respectively). Staff attitudes toward management of patient aggression did not significantly change (p=0.542). Multiple quality improvement initiatives were successfully implemented, including the creation of an interprofessional crisis management alert and response protocol. Staff members described appreciation for our simulation-based curriculum and welcomed the interaction with SPs during their training. A structured simulation-enhanced interprofessional intervention was successful in improving multiple facets of ED staff attitudes toward behavioral emergency care.

The crisis in United States hospital emergency services.

PubMed

Harrison, Jeffrey P; Ferguson, Emily D

2011-01-01

Emergency services are critical for high-quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (U.S.) acute care hospital staffs ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers. Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities. U.S. acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, U.S. emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staffs ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state-of-the-art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement. This research uses the AHA annual surveys,which represent self-reported data by individual hospital staff. However, the AHA expendssignificant resources to validate reported information and the annual survey data are widely used for hospital research. The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure. This article has important information on US emergency service availability in the hospital industry.

Developing a 'personalome' for precision medicine: emerging methods that compute interpretable effect sizes from single-subject transcriptomes.

PubMed

Vitali, Francesca; Li, Qike; Schissler, A Grant; Berghout, Joanne; Kenost, Colleen; Lussier, Yves A

2017-12-18

The development of computational methods capable of analyzing -omics data at the individual level is critical for the success of precision medicine. Although unprecedented opportunities now exist to gather data on an individual's -omics profile ('personalome'), interpreting and extracting meaningful information from single-subject -omics remain underdeveloped, particularly for quantitative non-sequence measurements, including complete transcriptome or proteome expression and metabolite abundance. Conventional bioinformatics approaches have largely been designed for making population-level inferences about 'average' disease processes; thus, they may not adequately capture and describe individual variability. Novel approaches intended to exploit a variety of -omics data are required for identifying individualized signals for meaningful interpretation. In this review-intended for biomedical researchers, computational biologists and bioinformaticians-we survey emerging computational and translational informatics methods capable of constructing a single subject's 'personalome' for predicting clinical outcomes or therapeutic responses, with an emphasis on methods that provide interpretable readouts. (i) the single-subject analytics of the transcriptome shows the greatest development to date and, (ii) the methods were all validated in simulations, cross-validations or independent retrospective data sets. This survey uncovers a growing field that offers numerous opportunities for the development of novel validation methods and opens the door for future studies focusing on the interpretation of comprehensive 'personalomes' through the integration of multiple -omics, providing valuable insights into individual patient outcomes and treatments. © The Author 2017. Published by Oxford University Press.

A poverty-related quality of life questionnaire can help to detect health inequalities in emergency departments.

PubMed

Boyer, Laurent; Baumstarck, Karine; Iordanova, Teodora; Fernandez, Jessica; Jean, Philippe; Auquier, Pascal

2014-03-01

This study aimed to develop a self-administered, multidimensional, poverty-related quality of life (PQoL) questionnaire for individuals seeking care in emergency departments (EDs): the PQoL-17. The development of the PQoL was undertaken in three steps: item generation, item reduction, and validation. The content of the PQoL was derived from 80 interviews with patients seeking care in EDs. Using item response and classical test theories, item reduction was performed in 3 EDs on 300 patients and validation was completed in 10 EDs on 619 patients. The PQoL contains 17 items describing seven dimensions (self-esteem/vitality, psychological well-being, relationships with family, relationships with friends, autonomy, physical well-being/access to care, and future perception). The seven-factor structure accounted for 75.1% of the total variance. This model showed a good fit (indices from the LISREL model: root mean square error of approximation, 0.055; comparative fit index, 0.97; general fit index, 0.96; standardized root mean square residual, 0.058). Each item achieved the 0.40 standard for item internal consistency, and Cronbach α coefficients were >0.70. Significant associations with socioeconomic and clinical indicators showed good discriminant and external validity. Infit statistics ranged from 0.82 to 1.16. The PQoL-17 presents satisfactory psychometric properties and can be completed quickly, thereby fulfilling the goal of brevity sought in EDs. Copyright © 2014 Elsevier Inc. All rights reserved.

A quick earthquake disaster loss assessment method supported by dasymetric data for emergency response in China

NASA Astrophysics Data System (ADS)

Xu, Jinghai; An, Jiwen; Nie, Gaozong

2016-04-01

Improving earthquake disaster loss estimation speed and accuracy is one of the key factors in effective earthquake response and rescue. The presentation of exposure data by applying a dasymetric map approach has good potential for addressing this issue. With the support of 30'' × 30'' areal exposure data (population and building data in China), this paper presents a new earthquake disaster loss estimation method for emergency response situations. This method has two phases: a pre-earthquake phase and a co-earthquake phase. In the pre-earthquake phase, we pre-calculate the earthquake loss related to different seismic intensities and store them in a 30'' × 30'' grid format, which has several stages: determining the earthquake loss calculation factor, gridding damage probability matrices, calculating building damage and calculating human losses. Then, in the co-earthquake phase, there are two stages of estimating loss: generating a theoretical isoseismal map to depict the spatial distribution of the seismic intensity field; then, using the seismic intensity field to extract statistics of losses from the pre-calculated estimation data. Thus, the final loss estimation results are obtained. The method is validated by four actual earthquakes that occurred in China. The method not only significantly improves the speed and accuracy of loss estimation but also provides the spatial distribution of the losses, which will be effective in aiding earthquake emergency response and rescue. Additionally, related pre-calculated earthquake loss estimation data in China could serve to provide disaster risk analysis before earthquakes occur. Currently, the pre-calculated loss estimation data and the two-phase estimation method are used by the China Earthquake Administration.

Measuring the Cognitions, Emotions, and Motivation Associated With Avoidance Behaviors in the Context of Pain: Preliminary Development of the Negative Responsivity to Pain Scales.

PubMed

Jensen, Mark P; Ward, L Charles; Thorn, Beverly E; Ehde, Dawn M; Day, Melissa A

2017-04-01

We recently proposed a Behavioral Inhibition System-Behavioral Activation System (BIS-BAS) model to help explain the effects of pain treatments. In this model, treatments are hypothesized to operate primarily through their effects on the domains within 2 distinct neurophysiological systems that underlie approach (BAS) and avoidance (BIS) behaviors. Measures of the model's domains are needed to evaluate and modify the model. An item pool of negative responses to pain (NRP; hypothesized to be BIS related) and positive responses (PR; hypothesized to be BAS related) were administered to 395 undergraduates, 325 of whom endorsed recurrent pain. The items were administered to 176 of these individuals again 1 week later. Analyses were conducted to develop and validate scales assessing NRP and PR domains. Three NRP scales (Despondent Response to Pain, Fear of Pain, and Avoidant Response to Pain) and 2 PR scales (Happy/Hopeful Responses and Approach Response) emerged. Consistent with the model, the scales formed 2 relatively independent overarching domains. The scales also demonstrated excellent internal consistency, and associations with criterion variables supported their validity. However, whereas the NRP scales evidenced adequate test-retest stability, the 2 PR scales were not adequately stable. The study yielded 3 brief scales assessing NRP, which may be used to further evaluate the BIS-BAS model and to advance research elucidating the mechanisms of psychosocial pain treatments. The findings also provide general support for the BIS-BAS model, while also suggesting that some minor modifications in the model are warranted.

Validating Signs and Symptoms From An Actual Mass Casualty Incident to Characterize An Irritant Gas Syndrome Agent (IGSA) Exposure: A First Step in The Development of a Novel IGSA Triage Algorithm.

PubMed

Culley, Joan M; Richter, Jane; Donevant, Sara; Tavakoli, Abbas; Craig, Jean; DiNardi, Salvatore

2017-07-01

• Chemical exposures daily pose a significant threat to life. Rapid assessment by first responders/emergency nurses is required to reduce death and disability. Currently, no informatics tools for Irritant Gas Syndrome Agents (IGSA) exposures exist to process victims efficiently, continuously monitor for latent signs/symptoms, or make triage recommendations. • This study uses actual patient data from a chemical incident to characterize and validate signs/symptoms of an IGSA Syndrome. Validating signs/symptoms is the first step in developing new emergency department informatics tools with the potential to revolutionize the process by which emergency nurses manage triage victims of chemical incidents. Chemical exposures can pose a significant threat to life. Rapid assessment by first responders/emergency nurses is required to reduce death and disability. Currently, no informatics tools for irritant gas syndrome agents (IGSA) exposures exist to process victims efficiently, continuously monitor for latent signs/symptoms, or make triage recommendations. This study describes the first step in developing ED informatics tools for chemical incidents: validation of signs/symptoms that characterize an IGSA syndrome. Data abstracted from 146 patients treated for chlorine exposure in one emergency department during a 2005 train derailment and 152 patients not exposed to chlorine (a comparison group) were mapped to 93 possible signs/symptoms within 2 tools (WISER and CHEMM-IST) designed to assist emergency responders/emergency nurses with managing hazardous material exposures. Inferential statistics (χ 2 /Fisher's exact test) and diagnostics tests were used to examine mapped signs/symptoms of persons who were and were not exposed to chlorine. Three clusters of signs/symptoms are statistically associated with an IGSA syndrome (P < .01): respiratory (shortness of breath, wheezing, coughing, and choking); chest discomfort (tightness, pain, and burning), and eye, nose and/or throat (pain, irritation, and burning). The syndrome requires the presence of signs/symptoms from at least 2 of these clusters. The latency period must also be considered for exposed/potentially exposed persons. This study uses actual patient data from a chemical incident to characterize and validate signs/symptoms of an IGSA syndrome. Validating signs/symptoms is the first step in developing new ED informatics tools with the potential to revolutionize the process by which emergency nurses manage triage victims of chemical incidents. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Adolescent Suicide Risk Screening: The Effect of Communication about Type of Follow-Up on Adolescents’ Screening Responses

PubMed Central

King, Cheryl A.; Hill, Ryan M.; Wynne, Henry A.; Cunningham, Rebecca M.

2013-01-01

Objective This experimental study examined the effect of communication about type of screening follow-up (in-person follow-up versus no in-person follow-up) on adolescents’ responses to a self-report suicide risk screen. Method Participants were 245 adolescents (131 girls, 114 boys; ages 13 to 17; 80% White, 21.6% Black; 9.8% American Indian; 2.9% Asian), seeking medical emergency services. They were randomized to a screening follow-up condition. Screening measures assessed primary risk factors for suicidal behavior, including suicidal thoughts, depressive symptoms, alcohol use, and aggressive/delinquent behavior. Results There was no main effect of follow-up condition on adolescents’ screening scores; however, significant interactions between follow-up condition and public assistance status were evident. Adolescents whose families received public assistance were less likely to report aggressive-delinquent behavior if assigned to In-Person Follow-Up. Adolescents whose families did not receive public assistance reported significantly higher levels of suicidal ideation if assigned to In-Person Follow-Up. Conclusions Findings suggest that response biases impact some adolescents’ responses to suicide risk screenings. Because national policy strongly recommends suicide risk screening in emergency settings, and because screening scores are used to make critical decisions regarding risk management and treatment recommendations, findings indicate the importance of improving the reliability and validity of suicide risk screening for adolescents. PMID:22540534

Adolescent suicide risk screening: the effect of communication about type of follow-up on adolescents' screening responses.

PubMed

King, Cheryl A; Hill, Ryan M; Wynne, Henry A; Cunningham, Rebecca M

2012-01-01

This experimental study examined the effect of communication about type of screening follow-up (in-person follow-up vs. no in-person follow-up) on adolescents' responses to a self-report suicide risk screen. Participants were 245 adolescents (131 girls, 114 boys; ages 13-17; 80% White, 21.6% Black, 9.8% American Indian, 2.9% Asian) seeking medical emergency services. They were randomized to a screening follow-up condition. Screening measures assessed primary risk factors for suicidal behavior, including suicidal thoughts, depressive symptoms, alcohol use, and aggressive/delinquent behavior. There was no main effect of follow-up condition on adolescents' screening scores; however, significant interactions between follow-up condition and public assistance status were evident. Adolescents whose families received public assistance were less likely to report aggressive-delinquent behavior if assigned to in-person follow-up. Adolescents whose families did not receive public assistance reported significantly higher levels of suicidal ideation if assigned to in-person follow-up. Findings suggest that response biases impact some adolescents' responses to suicide risk screenings. Because national policy strongly recommends suicide risk screening in emergency settings, and because screening scores are used to make critical decisions regarding risk management and treatment recommendations, findings indicate the importance of improving the reliability and validity of suicide risk screening for adolescents.

Using standard clinical assessments for home care to identify vulnerable populations before, during, and after disasters.

PubMed

van Solm, Alexandra I T; Hirdes, John P; Eckel, Leslie A; Heckman, George A; Bigelow, Philip L

Several studies have shown the increased vulnerability of and disproportionate mortality rate among frail community-dwelling older adults as a result of emergencies and disasters. This article will discuss the applicability of the Vulnerable Persons at Risk (VPR) and VPR Plus decision support algorithms designed based on the Resident Assessment Instrument-Home Care (RAI-HC) to identify the most vulnerable community-dwelling (older) adults. A sample was taken from the Ontario RAI-HC database by selecting unique home care clients with assessments closest to December 31, 2014 (N = 275,797). Statistical methods used include cross tabulation, bivariate logistic regression as well as Kaplan-Meier survival plotting and Cox proportional hazards ratios calculations. The VPR and VPR Plus algorithms, were highly predictive of mortality, long-term care admission and hospitalization in ordinary circumstances. This provides a good indication of the strength of the algorithms in identifying vulnerable persons at times of emergencies. Access to real-time person-level information of persons with functional care needs is a vital enabler for emergency responders in prioritizing and allocating resources during a disaster, and has great utility for emergency planning and recovery efforts. The development of valid and reliable algorithms supports the rapid identification and response to vulnerable community-dwelling persons for all phases of emergency management.

Recommendations from the Society for Academic Emergency Medicine (SAEM) Taskforce on women in academic emergency medicine.

PubMed

Kuhn, Gloria J; Abbuhl, Stephanie B; Clem, Kathleen J

2008-08-01

The Society for Academic Emergency Medicine (SAEM) convened a taskforce to study issues pertaining to women in academic emergency medicine (EM). The charge to the Taskforce was to "Create a document for the SAEM Board of Directors that defines and describes the unique recruitment, retention, and advancement needs for women in academic emergency medicine." To this end, the Taskforce and authors reviewed the literature to highlight key data points in understanding this issue and made recommendations for individuals at four levels of leadership and accountability: leadership of national EM organizations, medical school deans, department chairs, and individual women faculty members. The broad range of individuals targeted for recommendations reflects the interdependent and shared responsibility required to address changes in the culture of academic EM. The following method was used to determine the recommendations: 1) Taskforce members discussed career barriers and potential solutions that could improve the recruitment, retention, and advancement of women in academic EM; 2) the authors reviewed recommendations in the literature by national consensus groups and experts in the field to validate the recommendations of Taskforce members and the authors; and 3) final recommendations were sent to all Taskforce members to obtain and incorporate additional comments and ensure a consensus. This article contains those recommendations and cites the relevant literature addressing this topic.

Rating teams' non-technical skills in the emergency department: A qualitative study of nurses' experience.

PubMed

Porter, Joanne E; Cant, Robyn P; Cooper, Simon J

2018-05-01

Non-technical skills (NTS) teamwork training can enhance clinicians' understanding of roles and improve communication. We evaluated a quality improvement project rating teams' NTS performance to determine the value of formal rating and debriefing processes. In two Australian emergency departments the NTS of resuscitation teams were rated by senior nurses and medical staff. Key measures were leadership, teamwork, and task management using a valid instrument: Team Emergency Assessment Measure (TEAM™). Emergency nurses were asked to attend a focus group from which key themes around the quality improvement process were identified. Main themes were: 'Team composition' (allocation of resuscitation team roles), 'Resuscitation leadership' (including both nursing and medical leadership roles) and 'TEAM™ ratings promote reflective practice' (providing staff a platform to discuss team effectiveness). Objective ratings were seen as enabling staff to provide feedback to other team members. Reflection on practice and debriefing were thought to improve communication, help define roles and responsibilities, and clarify leadership roles. Use of a non-technical skills rating scheme such as TEAM™ after team-based clinical resuscitation events was seen by emergency department nurses as feasible and a useful process for examining and improving multi-disciplinary practice, while improving team performance. Copyright © 2018 Elsevier Ltd. All rights reserved.

Design and development of a mobile system for supporting emergency triage.

PubMed

Michalowski, W; Slowinski, R; Wilk, S; Farion, K J; Pike, J; Rubin, S

2005-01-01

Our objective was to design and develop a mobile clinical decision support system for emergency triage of different acute pain presentations. The system should interact with existing hospital information systems, run on mobile computing devices (handheld computers) and be suitable for operation in weak-connectivity conditions (with unstable connections between mobile clients and a server). The MET (Mobile Emergency Triage) system was designed following an extended client-server architecture. The client component, responsible for triage decision support, is built as a knowledge-based system, with domain ontology separated from generic problem solving methods and used for the automatic creation of a user interface. The MET system is well suited for operation in the Emergency Department of a hospital. The system's external interactions are managed by the server, while the MET clients, running on handheld computers are used by clinicians for collecting clinical data and supporting triage at the bedside. The functionality of the MET client is distributed into specialized modules, responsible for triaging specific types of acute pain presentations. The modules are stored on the server, and on request they can be transferred and executed on the mobile clients. The modular design provides for easy extension of the system's functionality. A clinical trial of the MET system validated the appropriateness of the system's design, and proved the usefulness and acceptance of the system in clinical practice. The MET system captures the necessary hospital data, allows for entry of patient information, and provides triage support. By operating on handheld computers, it fits into the regular emergency department workflow without introducing any hindrances or disruptions. It supports triage anytime and anywhere, directly at the point of care, and also can be used as an electronic patient chart, facilitating structured data collection.

Educational Milestone Development in the First 7 Specialties to Enter the Next Accreditation System

PubMed Central

Swing, Susan R.; Beeson, Michael S.; Carraccio, Carol; Coburn, Michael; Iobst, William; Selden, Nathan R.; Stern, Peter J.; Vydareny, Kay

2013-01-01

Background The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project introduced 6 general competencies relevant to medical practice but fell short of its goal to create a robust assessment system that would allow program accreditation based on outcomes. In response, the ACGME, the specialty boards, and other stakeholders collaborated to develop educational milestones, observable steps in residents' professional development that describe progress from entry to graduation and beyond. Objectives We summarize the development of the milestones, focusing on 7 specialties, moving to the next accreditation system in July 2013, and offer evidence of their validity. Methods Specialty workgroups with broad representation used a 5-level developmental framework and incorporated information from literature reviews, specialty curricula, dialogue with constituents, and pilot testing. Results The workgroups produced richly diverse sets of milestones that reflect the community's consideration of attributes of competence relevant to practice in the given specialty. Both their development process and the milestones themselves establish a validity argument, when contemporary views of validity for complex performance assessment are used. Conclusions Initial evidence for validity emerges from the development processes and the resulting milestones. Further advancing a validity argument will require research on the use of milestone data in resident assessment and program accreditation. PMID:24404235

An Environmental Scan of Academic Emergency Medicine at the 17 Canadian Medical Schools: Why Does this Matter to Emergency Physicians?

PubMed

Stiell, Ian G; Artz, Jennifer D; Lang, Eddy S; Sherbino, Jonathan; Morrison, Laurie J; Christenson, James; Perry, Jeffrey J; Topping, Claude; Woods, Robert; Green, Robert S; Lim, Rodrick; Magee, Kirk; Foote, John; Meckler, Garth; Mensour, Mark; Field, Simon; Chung, Brian; Kuuskne, Martin; Ducharme, James; Klein, Vera; McEwen, Jill

2017-01-01

We sought to conduct a major objective of the CAEP Academic Section, an environmental scan of the academic emergency medicine programs across the 17 Canadian medical schools. We developed an 84-question questionnaire, which was distributed to academic heads. The responses were validated by phone by the lead author to ensure that the questions were answered completely and consistently. Details of pediatric emergency medicine units were excluded from the scan. At eight of 17 universities, emergency medicine has full departmental status and at two it has no official academic status. Canadian academic emergency medicine is practiced at 46 major teaching hospitals and 13 specialized pediatric hospitals. Another 69 Canadian hospital EDs regularly take clinical clerks and emergency medicine residents. There are 31 full professors of emergency medicine in Canada. Teaching programs are strong with clerkships offered at 16/17 universities, CCFP(EM) programs at 17/17, and RCPSC residency programs at 14/17. Fourteen sites have at least one physician with a Master's degree in education. There are 55 clinical researchers with salary support at 13 universities. Sixteen sites have published peer-reviewed papers in the past five years, ranging from four to 235 per site. Annual budgets range from $200,000 to $5,900,000. This comprehensive review of academic activities in emergency medicine across Canada identifies areas of strengths as well as opportunities for improvement. CAEP and the Academic Section hope we can ultimately improve ED patient care by sharing best academic practices and becoming better teachers, educators, and researchers.

Where is the evidence for emergency planning: a scoping review.

PubMed

Challen, Kirsty; Lee, Andrew C K; Booth, Andrew; Gardois, Paolo; Woods, Helen Buckley; Goodacre, Steve W

2012-07-23

Recent terrorist attacks and natural disasters have led to an increased awareness of the importance of emergency planning. However, the extent to which emergency planners can access or use evidence remains unclear. The aim of this study was to identify, analyse and assess the location, source and quality of emergency planning publications in the academic and UK grey literature. We conducted a scoping review, using as data sources for academic literature Embase, Medline, Medline in Process, Psychinfo, Biosis, Science Citation Index, Cinahl, Cochrane library and Clinicaltrials.gov. For grey literature identification we used databases at the Health Protection Agency, NHS Evidence, British Association of Immediate Care Schemes, Emergency Planning College and the Health and Safety Executive, and the websites of UK Department of Health Emergency Planning Division and UK Resilience.Aggregative synthesis was used to analyse papers and documents against a framework based on a modified FEMA Emergency Planning cycle. Of 2736 titles identified from the academic literature, 1603 were relevant. 45% were from North America, 27% were commentaries or editorials and 22% were event reports.Of 192 documents from the grey literature, 97 were relevant. 76% of these were event reports.The majority of documents addressed emergency planning and response. Very few documents related to hazard analysis, mitigation or capability assessment. Although a large body of literature exists, its validity and generalisability is unclear There is little evidence that this potential evidence base has been exploited through synthesis to inform policy and practice. The type and structure of evidence that would be of most value of emergency planners and policymakers has yet to be identified.

Improving the governance of patient safety in emergency care: a systematic review of interventions

PubMed Central

Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

2016-01-01

Objectives To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. Design A systematic review of the literature. Methods PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base. PMID:26826151

Teaching wilderness first aid in a remote First Nations community: the story of the Sachigo Lake Wilderness Emergency Response Education Initiative.

PubMed

Born, Karen; Orkin, Aaron; VanderBurgh, David; Beardy, Jackson

2012-01-01

To understand how community members of a remote First Nations community respond to an emergency first aid education programme. A qualitative study involving focus groups and participant observation as part of a community-based participatory research project, which involved the development and implementation of a wilderness first aid course in collaboration with the community. Twenty community members participated in the course and agreed to be part of the research focus groups. Three community research partners validated and reviewed the data collected from this process. These data were coded and analysed using open coding. Community members responded to the course in ways related to their past experiences with injury and first aid, both as individuals and as members of the community. Feelings of confidence and self-efficacy related access to care and treatment of injury surfaced during the course. Findings also highlighted how the context of the remote First Nations community influenced the delivery and development of course materials. Developing and delivering a first aid course in a remote community requires sensitivity towards the response of participants to the course, as well as the context in which it is being delivered. Employing collaborative approaches to teaching first aid can aim to address these unique needs. Though delivery of a first response training programme in a small remote community will probably not impact the morbidity and mortality associated with injury, it has the potential to impact community self-efficacy and confidence when responding to an emergency situation.

Report on the emergency response to the event on May 14, 1997, at the plutonuim reclamation facility, Hanford Site, Richland,Washington

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shoop, D.S.

1997-08-20

On the evening of May 14,1997, a chemical explosion Occurred at the Plutonium Reclamation Facility (PRF) in the 200 West Area(200-W) of the Hanford Site. The event warranted the declaration of an Alert emergency, activation of the Hanford Emergency Response Organization (BRO), and notification of offsite agencies. As a result of the emergency declaration, a subsequent evaluation was conducted to assess: 9 the performance of the emergency response organization o the occupational health response related to emergency activities o event notifications to offsite and environmental agencies. Additionally, the evaluation was designed to: 9 document the chronology of emergency and occupationalmore » health responses and environmental notifications connected with the explosion at the facility 0 assess the adequacy of the Hanford Site emergency preparedness activities; response readiness; and emergency management actions, occupational health, and environmental actions 0 provide an analysis of the causes of the deficiencies and weaknesses in the preparedness and response system that have been identified in the evaluation of the response a assign organizational responsibility to correct deficiencies and weaknesses a improve future performance 0 adjust elements of emergency implementing procedures and emergency preparedness activities.« less

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

PubMed

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

2012-12-01

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

Acceptability and Reliability of a Novel Palliative Care Screening Tool Among Emergency Department Providers.

PubMed

Bowman, Jason; George, Naomi; Barrett, Nina; Anderson, Kelsey; Dove-Maguire, Kalie; Baird, Janette

2016-06-01

The Palliative Care and Rapid Emergency Screening (P-CaRES) Project is an initiative intended to improve access to palliative care (PC) among emergency department (ED) patients with life-limiting illness by facilitating early referral for inpatient PC consultations. In the previous two phases of this project, we derived and validated a novel PC screening tool. This paper reports on the third and final preimplementation phase. Examine the acceptability of the P-CaRES tool among PC and ED providers as well as test its reliability on case vignettes. Compare variations in reliability and acceptability of the tool based on ED providers' roles (attendings, residents, and nurses) and lengths of experience. A two-part electronic survey was distributed to ED providers at multiple sites across the United States. We tested the reliability of the tool in the first part of the survey, through a series of case vignettes. A criterion standard of correct responses was first defined by consensus input from expert PC physicians' interpretations of the vignettes. The experts' input was validated using the Gwet's AC1 coefficient for inter-rater reliability. ED providers were then presented with the case vignettes and asked to use the P-CaRES tool to correctly identify which patients had unmet PC needs. ED provider responses were compared both against the criterion standard and against different subsets of respondents (divided both by role and by level of experience). The second part of the survey assessed acceptability of the P-CaRES tool among ED providers using responses to questions from a modified Ottawa Acceptability of Decision Rules Instrument, based on a 1-5 Likert rating scale. Descriptive statistics were used to report all outcomes. In total, 213 ED providers employed in three different regions across the country responded to the survey (39.4%) and 185 (86.9%) of those completed it. The majority of providers felt that the tool would be useful in their practice (80.5%), agreed that the tool was clear and unambiguous (87.1%), thought that use of the tool would likely benefit patients (87.5%), and thought that it would result in improved use of resources to help severely ill patients (83.6%). Over three-quarters of ED providers (78.5%) also self-reported that they refer patients with unmet PC needs less than 10% of the time, and only 10.8% of respondents believed that they are already utilizing an effective strategy to screen or refer patients to PC. Applying our P-CaRES tool to case vignettes, ED providers generated PC referrals in concordance with PC experts over 88.7% of the time (95% confidence interval = 86.4% to 90.6%), with an overall sensitivity of more than 90%. These results varied minimally regardless of the respondent's role in the ED or their level of experience. Screening by emergency medicine providers for unmet PC needs using a brief, novel, content-validated screening tool is acceptable and is also reliable when applied to case vignettes-regardless of provider role or experience. Clinical trial and further study are warranted and are currently under way. © 2016 by the Society for Academic Emergency Medicine.

44 CFR 352.27 - Federal role in the emergency response.

Code of Federal Regulations, 2014 CFR

2014-10-01

... response. 352.27 Section 352.27 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Federal Participation § 352.27 Federal role in the emergency response. In addition to the Federal component of the licensee offsite emergency response plan described in subpart B (§ 352.26), and after...

44 CFR 352.27 - Federal role in the emergency response.

Code of Federal Regulations, 2011 CFR

2011-10-01

... response. 352.27 Section 352.27 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Federal Participation § 352.27 Federal role in the emergency response. In addition to the Federal component of the licensee offsite emergency response plan described in subpart B (§ 352.26), and after...

44 CFR 352.27 - Federal role in the emergency response.

Code of Federal Regulations, 2013 CFR

2013-10-01

... response. 352.27 Section 352.27 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Federal Participation § 352.27 Federal role in the emergency response. In addition to the Federal component of the licensee offsite emergency response plan described in subpart B (§ 352.26), and after...

44 CFR 352.27 - Federal role in the emergency response.

Code of Federal Regulations, 2012 CFR

2012-10-01

... response. 352.27 Section 352.27 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Federal Participation § 352.27 Federal role in the emergency response. In addition to the Federal component of the licensee offsite emergency response plan described in subpart B (§ 352.26), and after...

Validity for What? The Peril of Overclarifying

ERIC Educational Resources Information Center

Murphy, Kevin R.

2012-01-01

As Paul Newton so ably demonstrates, the concept of validity is both important and problematic. Over the last several decades, a consensus definition of validity has emerged; the current edition of "Standards for Educational and Psychological Testing" notes, "Validity refers to the degree to which evidence and theory support the interpretations of…

Measuring Adverse Events in Helicopter Emergency Medical Services: Establishing Content Validity

PubMed Central

Patterson, P. Daniel; Lave, Judith R.; Martin-Gill, Christian; Weaver, Matthew D.; Wadas, Richard J.; Arnold, Robert M.; Roth, Ronald N.; Mosesso, Vincent N.; Guyette, Francis X.; Rittenberger, Jon C.; Yealy, Donald M.

2015-01-01

Introduction We sought to create a valid framework for detecting Adverse Events (AEs) in the high-risk setting of Helicopter Emergency Medical Services (HEMS). Methods We assembled a panel of 10 expert clinicians (n=6 emergency medicine physicians and n=4 prehospital nurses and flight paramedics) affiliated with a large multi-state HEMS organization in the Northeast U.S. We used a modified Delphi technique to develop a framework for detecting AEs associated with the treatment of critically ill or injured patients. We used a widely applied measure, the Content Validity Index (CVI), to quantify the validity of the framework’s content. Results The expert panel of 10 clinicians reached consensus on a common AE definition and four-step protocol/process for AE detection in HEMS. The consensus-based framework is composed of three main components: 1) a trigger tool, 2) a method for rating proximal cause, and 3) a method for rating AE severity. The CVI findings isolate components of the framework considered content valid. Conclusions We demonstrate a standardized process for the development of a content valid framework for AE detection. The framework is a model for the development of a method for AE identification in other settings, including ground-based EMS. PMID:24003951

40 CFR 1.47 - Office of Solid Waste and Emergency Response.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the Agency's solid and hazardous wastes and emergency response programs. This Office has primary..., under the supervision of a Director, is responsible for the emergency and remedial response functions of...) Providing direction, guidance, and support to the Agency's non-enforcement emergency and remedial response...

An environmental scan of academic pediatric emergency medicine at Canadian medical schools: Identifying variability across Canada.

PubMed

Artz, Jennifer D; Meckler, Garth; Argintaru, Niran; Lim, Roderick; Stiell, Ian G

2018-01-28

To complement our environmental scan of academic emergency medicine departments, we conducted a similar environmental scan of the academic pediatric emergency medicine programs offered by the Canadian medical schools. We developed an 88-question form, which was distributed to pediatric academic leaders at each medical school. The responses were validated via email to ensure that the questions were answered completely and consistently. Fourteen of the 17 Canadian medical schools have some type of pediatric emergency medicine academic program. None of the pediatric emergency medicine units have full departmental status, while nine are divisions, two are sections, and three have no status. Canadian academic pediatric emergency medicine is practised at 13 major teaching hospitals and one specialized pediatric emergency department. There are 394 pediatric emergency medicine faculty members, including 13 full professors and 64 associate professors. Eight sites regularly take pediatric undergraduate clinical clerks, and all 14 provide resident education. Fellowship training is offered at 10 sites, with five offering advanced pediatric emergency medicine fellowship training. Half of the sites have at least one physician with a Master's degree in education, totalling 18 faculty members across Canada. There are 31 clinical researchers with salary support at nine universities. Eleven sites have published peer-reviewed papers (n=423) in the past five years, ranging from two to 102 per site. Annual academic budgets range from $10,000 to $2,607,515. This comprehensive review of academic activities in pediatric emergency medicine across Canada identifies the variability across the country, including the recognition of sites above and below the national average, which may prompt change at individual sites. Sharing these academic practices may inspire sites to provide more support to teachers, educators, and researchers.

Validation of different pediatric triage systems in the emergency department

PubMed Central

Aeimchanbanjong, Kanokwan; Pandee, Uthen

2017-01-01

BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage system in the pediatric emergency department. METHODS: This was a prospective observational study. This study was divided into two phases. The first phase determined the inter-rater reliability of five triage systems: Manchester Triage System (MTS), Emergency Severity Index (ESI) version 4, Pediatric Canadian Triage and Acuity Scale (CTAS), Australasian Triage Scale (ATS), and Ramathibodi Triage System (RTS) by triage nurses and pediatric residents. In the second phase, to analyze the validity of each triage system, patients were categorized as two groups, i.e., high acuity patients (triage level 1, 2) and low acuity patients (triage level 3, 4, and 5). Then we compared the triage acuity with actual admission. RESULTS: In phase I, RTS illustrated almost perfect inter-rater reliability with kappa of 1.0 (P<0.01). ESI and CTAS illustrated good inter-rater reliability with kappa of 0.8–0.9 (P<0.01). Meanwhile, ATS and MTS illustrated moderate to good inter-rater reliability with kappa of 0.5–0.7 (P<0.01). In phase II, we included 1 041 participants with average age of 4.7±4.2 years, of which 55% were male and 45% were female. In addition 32% of the participants had underlying diseases, and 123 (11.8%) patients were admitted. We found that ESI illustrated the most appropriate predicting ability for admission with sensitivity of 52%, specificity of 81%, and AUC 0.78 (95%CI 0.74–0.81). CONCLUSION: RTS illustrated almost perfect inter-rater reliability. Meanwhile, ESI and CTAS illustrated good inter-rater reliability. Finally, ESI illustrated the appropriate validity for triage system. PMID:28680520

40 CFR 68.180 - Emergency response program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... activities and the emergency response plan is coordinated. (c) The owner or operator shall list other Federal... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.180 Emergency response program... written emergency response plan? (2) Does the plan include specific actions to be taken in response to an...

40 CFR 68.180 - Emergency response program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... activities and the emergency response plan is coordinated. (c) The owner or operator shall list other Federal... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.180 Emergency response program... written emergency response plan? (2) Does the plan include specific actions to be taken in response to an...

40 CFR 68.180 - Emergency response program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... activities and the emergency response plan is coordinated. (c) The owner or operator shall list other Federal... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.180 Emergency response program... written emergency response plan? (2) Does the plan include specific actions to be taken in response to an...

40 CFR 68.180 - Emergency response program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... activities and the emergency response plan is coordinated. (c) The owner or operator shall list other Federal... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.180 Emergency response program... written emergency response plan? (2) Does the plan include specific actions to be taken in response to an...

RMP Guidance for Chemical Distributors - Chapter 8: Emergency Response Program

EPA Pesticide Factsheets

Depending on the level of processes at your facility, part 68 may require an emergency response program: an emergency response plan, emergency response equipment procedures, employee training, and procedures to ensure the program is up-to-date.

Le Bon Samaritain: A Community-Based Care Model Supported by Technology.

PubMed

Gay, Valerie; Leijdekkers, Peter; Gill, Asif; Felix Navarro, Karla

2015-01-01

The effective care and well-being of a community is a challenging task especially in an emergency situation. Traditional technology-based silos between health and emergency services are challenged by the changing needs of the community that could benefit from integrated health and safety services. Low-cost smart-home automation solutions, wearable devices and Cloud technology make it feasible for communities to interact with each other, and with health and emergency services in a timely manner. This paper proposes a new community-based care model, supported by technology, that aims at reducing healthcare and emergency services costs while allowing community to become resilient in response to health and emergency situations. We looked at models of care in different industries and identified the type of technology that can support the suggested new model of care. Two prototypes were developed to validate the adequacy of the technology. The result is a new community-based model of care called 'Le Bon Samaritain'. It relies on a network of people called 'Bons Samaritains' willing to help and deal with the basic care and safety aspects of their community. Their role is to make sure that people in their community receive and understand the messages from emergency and health services. The new care model is integrated with existing emergency warning, community and health services. Le Bon Samaritain model is scalable, community-based and can help people feel safer, less isolated and more integrated in their community. It could be the key to reduce healthcare cost, increase resilience and drive the change for a more integrated emergency and care system.

Validation of an auditory sensory reinforcement paradigm: Campbell's monkeys (Cercopithecus campbelli) do not prefer consonant over dissonant sounds.

PubMed

Koda, Hiroki; Basile, Muriel; Olivier, Marion; Remeuf, Kevin; Nagumo, Sumiharu; Blois-Heulin, Catherine; Lemasson, Alban

2013-08-01

The central position and universality of music in human societies raises the question of its phylogenetic origin. One of the most important properties of music involves harmonic musical intervals, in response to which humans show a spontaneous preference for consonant over dissonant sounds starting from early human infancy. Comparative studies conducted with organisms at different levels of the primate lineage are needed to understand the evolutionary scenario under which this phenomenon emerged. Although previous research found no preference for consonance in a New World monkey species, the question remained opened for Old World monkeys. We used an experimental paradigm based on a sensory reinforcement procedure to test auditory preferences for consonant sounds in Campbell's monkeys (Cercopithecus campbelli campbelli), an Old World monkey species. Although a systematic preference for soft (70 dB) over loud (90 dB) control white noise was found, Campbell's monkeys showed no preference for either consonant or dissonant sounds. The preference for soft white noise validates our noninvasive experimental paradigm, which can be easily reused in any captive facility to test for auditory preferences. This would suggest that human preference for consonant sounds is not systematically shared with New and Old World monkeys. The sensitivity for harmonic musical intervals emerged probably very late in the primate lineage.

Measurement tools and outcome measures used in transitional patient safety; a systematic review.

PubMed

van Melle, Marije A; van Stel, Henk F; Poldervaart, Judith M; de Wit, Niek J; Zwart, Dorien L M

2018-01-01

Patients are at risk for harm when treated simultaneously by healthcare providers from different healthcare organisations. To assess current practice and improvements of transitional patient safety, valid measurement tools are needed. To identify and appraise all measurement tools and outcomes that measure aspects of transitional patient safety, PubMed, Cinahl, Embase and Psychinfo were systematically searched. Two researchers performed the title and abstract and full-text selection. First, publications about validation of measurement tools were appraised for quality following COSMIN criteria. Second, we inventoried all measurement tools and outcome measures found in our search that assessed current transitional patient safety or the effect of interventions targeting transitional patient safety. The initial search yielded 8288 studies, of which 18 assessed validity of measurement tools of different aspects of transitional safety, and 191 assessed current transitional patient safety or effect of interventions. In the validated measurement tools, the overall quality of content and structural validity was acceptable; other COSMIN criteria, such as reliability, measurement error and responsiveness, were mostly poor or not reported. In our outcome inventory, the most frequently used validated outcome measure was the Care Transition Measure (n = 9). The most frequently used non-validated outcome measures were: medication discrepancies (n = 98), hospital readmissions (n = 55), adverse events (n = 34), emergency department visits (n = 33), (mental or physical) health status (n = 28), quality and timeliness of discharge summary, and patient satisfaction (n = 23). Although no validated measures exist that assess all aspects of transitional patient safety, we found validated measurement tools on specific aspects. Reporting of validity of transitional measurement tools was incomplete. Numerous outcome measures with unknown measurement properties are used in current studies on safety of care transitions, which makes interpretation or comparison of their results uncertain.

Thermoelastic Formulation of Stiffened, Unsymmetric Composite Panels for Finite Element Analysis of High Speed Aircraft

NASA Technical Reports Server (NTRS)

Collier, Craig S.

2004-01-01

An emerging technology need for capturing 3-D panel thermoelastic response with 2-D planar finite element models (FEMs) is aided with an equivalent plate stiffness and thermal coefficient formulation. The formulation is general and applies to all panel concepts. Included with the formulation is the ability to provide membrane-bending coupling of unsymmetric sections and calculation of all thermal expansion and bending responses from in-plane and through-the-thickness temperature gradients. Thermal residual strains for both the laminates and plies are included. The general formulation is defined and then applied to a hat-shaped, corrugated stiffened panel. Additional formulations are presented where required to include all of the hat's unique characteristics. Each formulation is validated independently with 3-D FEA.

Fostering Student Introspection through Guided Reflection Forms

NASA Astrophysics Data System (ADS)

Wood, Laura; Matheson, Amanda; Franklin, Scott

2017-01-01

Student self-reflection is an important metacognitive skill to developing expert-like habits of mind. This study focuses on student responses to Guided Reflection Forms (GRFs) and individualized instructor feedback to the submissions. Student and instructor entries were hand-coded by an emergent rubric and, separately, analyzed with LIWC (Linguistic Inquiry and Word Count), a computerized text analysis program that extracts affective sentiment. Sentiment analysis supports the development of a stable basis set (rubric) to describe responses that is robust across both introductory and advanced classes. The analysis also reveals the instructor's use of the ``praise sandwich,'' instinctively embedding critiques and suggestions between specific and general encouragements. The study demonstrates the utility of validated, automated, sentiment analysis as a method by which to analyze large corpuses of written text.

Using principles from emergency management to improve emergency response plans for research animals.

PubMed

Vogelweid, Catherine M

2013-10-01

Animal research regulatory agencies have issued updated requirements for emergency response planning by regulated research institutions. A thorough emergency response plan is an essential component of an institution's animal care and use program, but developing an effective plan can be a daunting task. The author provides basic information drawn from the field of emergency management about best practices for developing emergency response plans. Planners should use the basic principles of emergency management to develop a common-sense approach to managing emergencies in their facilities.

MRM for the verification of cancer biomarker proteins: recent applications to human plasma and serum.

PubMed

Chambers, Andrew G; Percy, Andrew J; Simon, Romain; Borchers, Christoph H

2014-04-01

Accurate cancer biomarkers are needed for early detection, disease classification, prediction of therapeutic response and monitoring treatment. While there appears to be no shortage of candidate biomarker proteins, a major bottleneck in the biomarker pipeline continues to be their verification by enzyme linked immunosorbent assays. Multiple reaction monitoring (MRM), also known as selected reaction monitoring, is a targeted mass spectrometry approach to protein quantitation and is emerging to bridge the gap between biomarker discovery and clinical validation. Highly multiplexed MRM assays are readily configured and enable simultaneous verification of large numbers of candidates facilitating the development of biomarker panels which can increase specificity. This review focuses on recent applications of MRM to the analysis of plasma and serum from cancer patients for biomarker verification. The current status of this approach is discussed along with future directions for targeted mass spectrometry in clinical biomarker validation.

Southern states radiological emergency response laws and regulations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1989-07-01

The purpose of this report is to provide a summary of the emergency response laws and regulations in place in the various states within the southern region for use by legislators, emergency response planners, the general public and all persons concerned about the existing legal framework for emergency response. SSEB expects to periodically update the report as necessary. Radiation protection regulations without emergency response provisions are not included in the summary.

Validity of the MMPI-2-RF (restructured form) L-r and K-r scales in detecting underreporting in clinical and nonclinical samples.

PubMed

Sellbom, Martin; Bagby, R Michael

2008-12-01

In the current investigation, the authors examined the validity of the L-r and K-r scales on the recently developed Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Y. S. Ben-Porath & A. Tellegen, in press) in measuring underreported response bias. Three archival samples previously collected for examining MMPI-2 validity scales were reanalyzed in 2 studies. In Study 1 L-r and K-r significantly differentiated 2 groups of participants (patients with schizophrenia and university students) who had been instructed to underreport on the MMPI-2 from participants who took the test under standard instructions. L-r and K-r also added incremental predictive variance to one another in differentiating these groups. In Study 2 a similar set of outcomes emerged through the use of a differential prevalence design in which L-r and K-r significantly differentiated a group of child custody litigants who were administered the MMPI-2 from university students taking the test under standard instructions. (c) 2008 APA, all rights reserved.

Biomarkers of response and resistance to antiangiogenic therapy

PubMed Central

Jain, Rakesh K.; Duda, Dan G.; Willett, Christopher G.; Sahani, Dushyant V.; Zhu, Andrew X.; Loeffler, Jay S.; Batchelor, Tracy T.; Sorensen, A. Gregory

2011-01-01

No validated biological markers (or biomarkers) currently exist for appropriately selecting patients with cancer for antiangiogenic therapy. Nor are there biomarkers identifying escape pathways that should be targeted after tumors develop resistance to a given antiangiogenic agent. A number of potential systemic, circulating, tissue and imaging biomarkers have emerged from recently completed phase I–III studies. Some of these are measured at baseline (for example VEGF polymorphisms), others are measured during treatment (such as hypertension, MRI-measured Ktrans, circulating angiogenic molecules or collagen IV), and all are mechanistically based. Some of these biomarkers might be pharmacodynamic (for example, increase in circulating VEGF, placental growth factor) while others have potential for predicting clinical benefit or identifying the escape pathways (for example, stromal-cell-derived factor 1α, interleukin-6). Most biomarkers are disease and/or agent specific and all of them need to be validated prospectively. We discuss the current challenges in establishing biomarkers of antiangiogenic therapy, define systemic, circulating, tissue and imaging biomarkers and their advantages and disadvantages, and comment on the future opportunities for validating biomarkers of antiangiogenic therapy. PMID:19483739

How Developments in Psychology and Technology Challenge Validity Argumentation

ERIC Educational Resources Information Center

Mislevy, Robert J.

2016-01-01

Validity is the sine qua non of properties of educational assessment. While a theory of validity and a practical framework for validation has emerged over the past decades, most of the discussion has addressed familiar forms of assessment and psychological framings. Advances in digital technologies and in cognitive and social psychology have…

Liberia national disaster preparedness coordination exercise: Implementing lessons learned from the West African disaster preparedness initiative.

PubMed

Hamer, Melinda J Morton; Reed, Paul L; Greulich, Jane D; Beadling, Charles W

2017-01-01

In light of the recent Ebola outbreak, there is a critical need for effective disaster management systems in Liberia and other West African nations. To this end, the West Africa Disaster Preparedness Initiative held a disaster management exercise in conjunction with the Liberian national government on November 24-25, 2015. During this tabletop exercise (TTX), interactions within and between the 15 counties and the Liberian national government were conducted and observed to refine and validate the county and national standard operating procedures (SOPs). The exercise took place in three regional locations throughout Liberia: Monrovia, Buchanan, and Bong. The TTX format allowed counties to collaborate utilizing open-source software platforms including Ushahidi, Sahana, QGIS, and KoBoCollect. Four hundred sixty-seven individuals (representing all 15 counties of Liberia) identified as key actors involved with emergency operations and disaster preparedness participated in the exercise. A qualitative survey with open-ended questions was administered to exercise participants to determine needed improvements in the disaster management system in Liberia. Key findings from the exercise and survey include the need for emergency management infrastructure to extend to the community level, establishment of a national disaster management agency and emergency operations center, customized local SOPs, ongoing surveillance, a disaster exercise program, and the need for effective data sharing and hazard maps. These regional exercises initiated the process of validating and refining Liberia's national and county-level SOPs. Liberia's participation in this exercise has provided a foundation for advancing its preparedness, response, and recovery capacities and could provide a template for other countries to use.

Making processes reliable: a validated pubmed search strategy for identifying new or emerging technologies.

PubMed

Varela-Lema, Leonora; Punal-Riobóo, Jeanette; Acción, Beatriz Casal; Ruano-Ravina, Alberto; García, Marisa López

2012-10-01

Horizon scanning systems need to handle a wide range of sources to identify new or emerging health technologies. The objective of this study is to develop a validated Medline bibliographic search strategy (PubMed search engine) to systematically identify new or emerging health technologies. The proposed Medline search strategy combines free text terms commonly used in article titles to denote innovation within index terms that make reference to the specific fields of interest. Efficacy was assessed by running the search over a period of 1 year (2009) and analyzing its retrieval performance (number and characteristics). For comparison purposes, all article abstracts published during 2009 in six preselected key research journals and eight high impact surgery journals were scanned. Sensitivity was defined as the proportion of relevant new or emerging technologies published in key journals that would be identified in the search strategy within the first 2 years of publication. The search yielded 6,228 abstracts of potentially new or emerging technologies. Of these, 459 were classified as new or emerging (383 truly new or emerging and 76 new indications). The scanning of 12,061 journal abstracts identified 35 relevant new or emerging technologies. Of these, twenty-nine were located within the Medline search strategy during the first 2 years of publication (sensitivity = 83 percent). The current search strategy, validated against key journals, has demonstrated to be effective for horizon scanning. Even though it can require adaptations depending on the scope of the horizon scanning system, it could serve to simplify and standardize scanning processes.

Pain patients' experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity, and treatment outcome.

PubMed

Edlund, Sara M; Wurm, Matilda; Holländare, Fredrik; Linton, Steven J; Fruzzetti, Alan E; Tillfors, Maria

2017-10-01

Validating and invalidating responses play an important role in communication with pain patients, for example regarding emotion regulation and adherence to treatment. However, it is unclear how patients' perceptions of validation and invalidation relate to patient characteristics and treatment outcome. The aim of this study was to investigate the occurrence of subgroups based on pain patients' perceptions of validation and invalidation from their physicians. The stability of these perceptions and differences between subgroups regarding pain, pain interference, negative affectivity and treatment outcome were also explored. A total of 108 pain patients answered questionnaires regarding perceived validation and invalidation, pain severity, pain interference, and negative affectivity before and after pain rehabilitation treatment. Two cluster analyses using perceived validation and invalidation were performed, one on pre-scores and one on post-scores. The stability of patient perceptions from pre- to post-treatment was investigated, and clusters were compared on pain severity, pain interference, and negative affectivity. Finally, the connection between perceived validation and invalidation and treatment outcome was explored. Three clusters emerged both before and after treatment: (1) low validation and heightened invalidation, (2) moderate validation and invalidation, and (3) high validation and low invalidation. Perceptions of validation and invalidation were generally stable over time, although there were individuals whose perceptions changed. When compared to the other two clusters, the low validation/heightened invalidation cluster displayed significantly higher levels of pain interference and negative affectivity post-treatment but not pre-treatment. The whole sample significantly improved on pain interference and depression, but treatment outcome was independent of cluster. Unexpectedly, differences between clusters on pain interference and negative affectivity were only found post-treatment. This appeared to be due to the pre- and post-heightened invalidation clusters not containing the same individuals. Therefore, additional analyses were conducted to investigate the individuals who changed clusters. Results showed that patients scoring high on negative affectivity ended up in the heightened invalidation cluster post-treatment. Taken together, most patients felt understood when communicating with their rehabilitation physician. However, a smaller group of patients experienced the opposite: low levels of validation and heightened levels of invalidation. This group stood out as more problematic, reporting greater pain interference and negative affectivity when compared to the other groups after treatment. Patient perceptions were typically stable over time, but some individuals changed cluster, and these movements seemed to be related to negative affectivity and pain interference. These results do not support a connection between perceived validation and invalidation from physicians (meeting the patients pre- and post-treatment) and treatment outcome. Overall, our results suggest that there is a connection between negative affectivity and pain interference in the patients, and perceived validation and invalidation from the physicians. In clinical practice, it is important to pay attention to comorbid psychological problems and level of pain interference, since these factors may negatively influence effective communication. A focus on decreasing invalidating responses and/or increasing validating responses might be particularly important for patients with high levels of psychological problems and pain interference. Copyright © 2017. Published by Elsevier B.V.

Assessing Complex Emergency Management with Clinical Case-Vignettes: A Validation Study

PubMed Central

2015-01-01

Objective To evaluate whether responses to dynamic case-vignettes accurately reflect actual practices in complex emergency situations. We hypothesized that when obstetricians were faced with vignette of emergency situation identical to one they previously managed, they would report the management strategy they actually used. On the other hand, there is no reason to suppose that their response to a vignette based on a source case managed by another obstetrician would be the same as the actual management. Methods A multicenter vignette-based study was used in 7 French maternity units. We chose the example of severe postpartum hemorrhage (PPH) to study the use of case-vignettes for assessing the management of complex situations. We developed dynamic case-vignettes describing incidents of PPH in several steps, using documentation in patient files. Vignettes described the postpartum course and included multiple-choice questions detailing proposed clinical care. Each participating obstetrician was asked to evaluate 4 case-vignettes: 2 directly derived from cases they previously managed and 2 derived from other obstetricians’ cases. We compared the final treatment decision in vignette responses to those documented in the source-case by the overall agreement and the Kappa coefficient, both for the cases the obstetricians previously managed and the cases of others. Results Thirty obstetricians participated. Overall agreement between final treatment decisions in case-vignettes and documented care for cases obstetricians previously managed was 82% (Kappa coefficient: 0.75, 95% CI [0.62–0.88]). Overall agreement between final treatment decisions in case-vignettes and documented care in vignettes derived from other obstetricians’ cases was only 48% (Kappa coefficient: 0.30, 95% CI [0.12–0.48]). Final agreement with documented care was significantly better for cases based on their own previous cases than for others (p<0.001). Conclusions Dynamic case-vignettes accurately reflect actual practices in complex emergency situations. Therefore, they can be used to assess the quality of management in these situations. PMID:26383261

Development and validation of response markers to predict survival and pleurodesis success in patients with malignant pleural effusion (PROMISE): a multicohort analysis.

PubMed

Psallidas, Ioannis; Kanellakis, Nikolaos I; Gerry, Stephen; Thézénas, Marie Laëtitia; Charles, Philip D; Samsonova, Anastasia; Schiller, Herbert B; Fischer, Roman; Asciak, Rachelle; Hallifax, Robert J; Mercer, Rachel; Dobson, Melissa; Dong, Tao; Pavord, Ian D; Collins, Gary S; Kessler, Benedikt M; Pass, Harvey I; Maskell, Nick; Stathopoulos, Georgios T; Rahman, Najib M

2018-06-13

The prevalence of malignant pleural effusion is increasing worldwide, but prognostic biomarkers to plan treatment and to understand the underlying mechanisms of disease progression remain unidentified. The PROMISE study was designed with the objectives to discover, validate, and prospectively assess biomarkers of survival and pleurodesis response in malignant pleural effusion and build a score that predicts survival. In this multicohort study, we used five separate and independent datasets from randomised controlled trials to investigate potential biomarkers of survival and pleurodesis. Mass spectrometry-based discovery was used to investigate pleural fluid samples for differential protein expression in patients from the discovery group with different survival and pleurodesis outcomes. Clinical, radiological, and biological variables were entered into least absolute shrinkage and selection operator regression to build a model that predicts 3-month mortality. We evaluated the model using internal and external validation. 17 biomarker candidates of survival and seven of pleurodesis were identified in the discovery dataset. Three independent datasets (n=502) were used for biomarker validation. All pleurodesis biomarkers failed, and gelsolin, macrophage migration inhibitory factor, versican, and tissue inhibitor of metalloproteinases 1 (TIMP1) emerged as accurate predictors of survival. Eight variables (haemoglobin, C-reactive protein, white blood cell count, Eastern Cooperative Oncology Group performance status, cancer type, pleural fluid TIMP1 concentrations, and previous chemotherapy or radiotherapy) were validated and used to develop a survival score. Internal validation with bootstrap resampling and external validation with 162 patients from two independent datasets showed good discrimination (C statistic values of 0·78 [95% CI 0·72-0·83] for internal validation and 0·89 [0·84-0·93] for external validation of the clinical PROMISE score). To our knowledge, the PROMISE score is the first prospectively validated prognostic model for malignant pleural effusion that combines biological and clinical parameters to accurately estimate 3-month mortality. It is a robust, clinically relevant prognostic score that can be applied immediately, provide important information on patient prognosis, and guide the selection of appropriate management strategies. European Respiratory Society, Medical Research Funding-University of Oxford, Slater & Gordon Research Fund, and Oxfordshire Health Services Research Committee Research Grants. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effects of working memory load and repeated scenario exposure on emergency braking performance.

PubMed

Engström, Johan; Aust, Mikael Ljung; Viström, Matias

2010-10-01

The objective of the present study was to examine the effect of working memory load on drivers' responses to a suddenly braking lead vehicle and whether this effect (if any) is moderated by repeated scenario exposure. Several experimental studies have found delayed braking responses to lead vehicle braking events during concurrent performance of nonvisual, working memory-loading tasks, such as hands-free phone conversation. However, the common use of repeated, and hence somewhat expected, braking events may undermine the generalizability of these results to naturalistic, unexpected, emergency braking scenarios. A critical lead vehicle braking scenario was implemented in a fixed-based simulator.The effects of working memory load and repeated scenario exposure on braking performance were examined. Brake response time was decomposed into accelerator pedal release time and accelerator-to-brake pedal movement time. Accelerator pedal release times were strongly reduced with repeated scenario exposure and were delayed by working memory load with a small but significant amount (178 ms).The two factors did not interact. There were no effects on accelerator-to-brake pedal movement time. The results suggest that effects of working memory load on response performance obtained from repeated critical lead vehicle braking scenarios may be validly generalized to real world unexpected events. The results have important implications for the interpretation of braking performance in experimental settings, in particular in the context of safety-related evaluation of in-vehicle information and communication technologies.

The Student Volunteer Army: a 'repeat emergent' emergency response organisation.

PubMed

Carlton, Sally; Mills, Colleen E

2017-10-01

This paper seeks to contribute to understanding of the factors associated with an effective emergent emergency response organisation and to provide new insights into this understudied area. It examines, through an analysis of a range of textual resources, the emergence and re-emergence of the Student Volunteer Army (SVA) during the devastating earthquakes in Canterbury, New Zealand, in 2010-11. This evaluation is conducted in relation to the four key features of an effective emergency response organisation: adaptability; direction; leadership; and communication. In addition, the paper aims to further understanding of 'emergency entrepreneurship' and thus of the values and strategies that underpin social entrepreneur organisations in times of normalcy. The paper concludes that the unique position of the SVA as a 'repeat emergent' emergency response organisation enabled it to innovate continually and to improve repeatedly its systems, relationships, and image, such that it exhibited features common to emergent and established emergency response organisations. © 2017 The Author(s). Disasters © Overseas Development Institute, 2017.

Geometric state space uncertainty as a new type of uncertainty addressing disparity in ';emergent properties' between real and modeled systems

NASA Astrophysics Data System (ADS)

Montero, J. T.; Lintz, H. E.; Sharp, D.

2013-12-01

Do emergent properties that result from models of complex systems match emergent properties from real systems? This question targets a type of uncertainty that we argue requires more attention in system modeling and validation efforts. We define an ';emergent property' to be an attribute or behavior of a modeled or real system that can be surprising or unpredictable and result from complex interactions among the components of a system. For example, thresholds are common across diverse systems and scales and can represent emergent system behavior that is difficult to predict. Thresholds or other types of emergent system behavior can be characterized by their geometry in state space (where state space is the space containing the set of all states of a dynamic system). One way to expedite our growing mechanistic understanding of how emergent properties emerge from complex systems is to compare the geometry of surfaces in state space between real and modeled systems. Here, we present an index (threshold strength) that can quantify a geometric attribute of a surface in state space. We operationally define threshold strength as how strongly a surface in state space resembles a step or an abrupt transition between two system states. First, we validated the index for application in greater than three dimensions of state space using simulated data. Then, we demonstrated application of the index in measuring geometric state space uncertainty between a real system and a deterministic, modeled system. In particular, we looked at geometric space uncertainty between climate behavior in 20th century and modeled climate behavior simulated by global climate models (GCMs) in the Coupled Model Intercomparison Project phase 5 (CMIP5). Surfaces from the climate models came from running the models over the same domain as the real data. We also created response surfaces from a real, climate data based on an empirical model that produces a geometric surface of predicted values in state space. We used a kernel regression method designed to capture the geometry of real data pattern without imposing shape assumptions a priori on the data; this kernel regression method is known as Non-parametric Multiplicative Regression (NPMR). We found that quantifying and comparing a geometric attribute in more than three dimensions of state space can discern whether the emergent nature of complex interactions in modeled systems matches that of real systems. Further, this method has potentially wider application in contexts where searching for abrupt change or ';action' in any hyperspace is desired.

Development of a Work Climate Scale in Emergency Health Services

PubMed Central

Sanduvete-Chaves, Susana; Lozano-Lozano, José A.; Chacón-Moscoso, Salvador; Holgado-Tello, Francisco P.

2018-01-01

An adequate work climate fosters productivity in organizations and increases employee satisfaction. Workers in emergency health services (EHS) have an extremely high degree of responsibility and consequent stress. Therefore, it is essential to foster a good work climate in this context. Despite this, scales with a full study of their psychometric properties (i.e., validity evidence based on test content, internal structure and relations to other variables, and reliability) are not available to measure work climate in EHS specifically. For this reason, our objective was to develop a scale to measure the quality of work climates in EHS. We carried out three studies. In Study 1, we used a mixed-method approach to identify the latent conceptual structure of the construct work climate. Thus, we integrated the results found in (a) a previous study, where a content analysis of seven in-depth interviews obtained from EHS professionals in two hospitals in Gibraltar Countryside County was carried out; and (b) the factor analysis of the responses given by 113 EHS professionals from these same centers to 18 items that measured the work climate in health organizations. As a result, we obtained 56 items grouped into four factors (work satisfaction, productivity/achievement of aims, interpersonal relationships, and performance at work). In Study 2, we presented validity evidence based on test content through experts' judgment. Fourteen experts from the methodology and health fields evaluated the representativeness, utility, and feasibility of each of the 56 items with respect to their factor (theoretical dimension). Forty items met the inclusion criterion, which was to obtain an Osterlind index value greater than or equal to 0.5 in the three aspects assessed. In Study 3, 201 EHS professionals from the same centers completed the resulting 40-item scale. This new instrument produced validity evidence based on the internal structure in a second-order factor model with four components (RMSEA = 0.079, GFI = 0.97, AGFI = 0.97, CFI = 0.97; NFI = 0.95, and NNFI = 0.97); absence of Differential Item Functioning (DIF) in 80% of the items; reliability (α = 0.96); and validity evidence based on relations to other variables, specifically the test-criterion relationship (ρ = 0.680). Finally, we discuss further developments of the instrument and its possible implications for EHS workers. PMID:29403417

Development of a Work Climate Scale in Emergency Health Services.

PubMed

Sanduvete-Chaves, Susana; Lozano-Lozano, José A; Chacón-Moscoso, Salvador; Holgado-Tello, Francisco P

2018-01-01

An adequate work climate fosters productivity in organizations and increases employee satisfaction. Workers in emergency health services (EHS) have an extremely high degree of responsibility and consequent stress. Therefore, it is essential to foster a good work climate in this context. Despite this, scales with a full study of their psychometric properties (i.e., validity evidence based on test content, internal structure and relations to other variables, and reliability) are not available to measure work climate in EHS specifically. For this reason, our objective was to develop a scale to measure the quality of work climates in EHS. We carried out three studies. In Study 1, we used a mixed-method approach to identify the latent conceptual structure of the construct work climate . Thus, we integrated the results found in (a) a previous study, where a content analysis of seven in-depth interviews obtained from EHS professionals in two hospitals in Gibraltar Countryside County was carried out; and (b) the factor analysis of the responses given by 113 EHS professionals from these same centers to 18 items that measured the work climate in health organizations. As a result, we obtained 56 items grouped into four factors (work satisfaction, productivity/achievement of aims, interpersonal relationships, and performance at work). In Study 2, we presented validity evidence based on test content through experts' judgment. Fourteen experts from the methodology and health fields evaluated the representativeness, utility, and feasibility of each of the 56 items with respect to their factor (theoretical dimension). Forty items met the inclusion criterion, which was to obtain an Osterlind index value greater than or equal to 0.5 in the three aspects assessed. In Study 3, 201 EHS professionals from the same centers completed the resulting 40-item scale. This new instrument produced validity evidence based on the internal structure in a second-order factor model with four components ( RMSEA = 0.079, GFI = 0.97, AGFI = 0.97, CFI = 0.97; NFI = 0.95, and NNFI = 0.97); absence of Differential Item Functioning (DIF) in 80% of the items; reliability (α = 0.96); and validity evidence based on relations to other variables, specifically the test-criterion relationship (ρ = 0.680). Finally, we discuss further developments of the instrument and its possible implications for EHS workers.

40 CFR 300.215 - Title III local emergency response plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... should be closely coordinated with applicable federal ACPs and state emergency response plans. (b... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.215 Title III local emergency response plans... are codified at 40 CFR part 355. (a) Each LEPC is to prepare an emergency response plan in accordance...

40 CFR 300.215 - Title III local emergency response plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... should be closely coordinated with applicable federal ACPs and state emergency response plans. (b... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.215 Title III local emergency response plans... are codified at 40 CFR part 355. (a) Each LEPC is to prepare an emergency response plan in accordance...

40 CFR 300.215 - Title III local emergency response plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... should be closely coordinated with applicable federal ACPs and state emergency response plans. (b... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.215 Title III local emergency response plans... are codified at 40 CFR part 355. (a) Each LEPC is to prepare an emergency response plan in accordance...

29 CFR 2700.24 - Emergency response plan dispute proceedings.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 9 2013-07-01 2013-07-01 false Emergency response plan dispute proceedings. 2700.24... COMMISSION PROCEDURAL RULES Contests of Citations and Orders § 2700.24 Emergency response plan dispute... operator's emergency response plan, or any refusal by the Secretary to approve such a plan. Any referral...

29 CFR 2700.24 - Emergency response plan dispute proceedings.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Emergency response plan dispute proceedings. 2700.24... COMMISSION PROCEDURAL RULES Contests of Citations and Orders § 2700.24 Emergency response plan dispute... operator's emergency response plan, or any refusal by the Secretary to approve such a plan. Any referral...

40 CFR 300.215 - Title III local emergency response plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... should be closely coordinated with applicable federal ACPs and state emergency response plans. (b... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.215 Title III local emergency response plans... are codified at 40 CFR part 355. (a) Each LEPC is to prepare an emergency response plan in accordance...

40 CFR 300.215 - Title III local emergency response plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... should be closely coordinated with applicable federal ACPs and state emergency response plans. (b... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.215 Title III local emergency response plans... are codified at 40 CFR part 355. (a) Each LEPC is to prepare an emergency response plan in accordance...

Development and validation of an item response theory-based Social Responsiveness Scale short form.

PubMed

Sturm, Alexandra; Kuhfeld, Megan; Kasari, Connie; McCracken, James T

2017-09-01

Research and practice in autism spectrum disorder (ASD) rely on quantitative measures, such as the Social Responsiveness Scale (SRS), for characterization and diagnosis. Like many ASD diagnostic measures, SRS scores are influenced by factors unrelated to ASD core features. This study further interrogates the psychometric properties of the SRS using item response theory (IRT), and demonstrates a strategy to create a psychometrically sound short form by applying IRT results. Social Responsiveness Scale analyses were conducted on a large sample (N = 21,426) of youth from four ASD databases. Items were subjected to item factor analyses and evaluation of item bias by gender, age, expressive language level, behavior problems, and nonverbal IQ. Item selection based on item psychometric properties, DIF analyses, and substantive validity produced a reduced item SRS short form that was unidimensional in structure, highly reliable (α = .96), and free of gender, age, expressive language, behavior problems, and nonverbal IQ influence. The short form also showed strong relationships with established measures of autism symptom severity (ADOS, ADI-R, Vineland). Degree of association between all measures varied as a function of expressive language. Results identified specific SRS items that are more vulnerable to non-ASD-related traits. The resultant 16-item SRS short form may possess superior psychometric properties compared to the original scale and emerge as a more precise measure of ASD core symptom severity, facilitating research and practice. Future research using IRT is needed to further refine existing measures of autism symptomatology. © 2017 Association for Child and Adolescent Mental Health.

Measurement Invariance of the Counselor Burnout Inventory across Cultures: A Comparison of U.S. and Korean Counselors

ERIC Educational Resources Information Center

Carrola, Paul A.; Yu, Kumlan; Sass, Daniel A.; Lee, Sang Min

2012-01-01

This study assessed scores from the Counselor Burnout Inventory for factorial validity, convergent and discriminant validity, internal consistency reliability, and measurement invariance across U.S. and Korean counselors. Although evidence existed for factorial validity across both groups, mixed results emerged for the other forms of validity and…

Emergency Response of Iranian Hospitals Against Disasters: A Practical Framework for Improvement.

PubMed

Janati, Ali; Sadeghi-Bazargani, Homayoun; Hasanpoor, Edris; Sokhanvar, Mobin; HaghGoshyie, Elaheh; Salehi, Abdollah

2018-04-01

Hospital emergency management is a continuous process that requires monolithic integration of planning and response attempts with local and national schemes. The aim of the current study is to evaluate emergency response by hospitals against potential disasters in Tabriz, north-west Iran. A cross-sectional study was conducted in the city of Tabriz, in Iran, in 2016. The study population included all hospitals in Tabriz. A total of 18 hospitals were assessed. The hospital emergency response checklist was used to collect data. Tool components included command and control, communication, safety and security, triage, surge capacity, continuity of essential services, human resources, logistics and supply management, and post-disaster recovery. Data entry and analysis were carried out using SPSS software (version 20). The results showed that the emergency response rate of hospitals was 54.26% in Tabriz. The lowest response rates were for Shafaa hospital (18.89%) and the highest response rates were for Razi Hospital (91.67%). The components of hospital emergency response were assessed to be between 48.07% (surge capacity) and 58.95% (communication). On the basis of the World Health Organization checklist, the emergency response rate for hospitals in Tabriz was only 54.26%. Therefore, hospital emergency responses against disasters have to be improved and must be made to reach 100%. It is essential to design a comprehensive framework for hospital emergency response. (Disaster Med Public Health Preparedness. 2018;12:166-171).

An emergency call system for patients in locked-in state using an SSVEP-based brain switch.

PubMed

Lim, Jeong-Hwan; Kim, Yong-Wook; Lee, Jun-Hak; An, Kwang-Ok; Hwang, Han-Jeong; Cha, Ho-Seung; Han, Chang-Hee; Im, Chang-Hwan

2017-11-01

Patients in a locked-in state (LIS) due to severe neurological disorders such as amyotrophic lateral sclerosis (ALS) require seamless emergency care by their caregivers or guardians. However, it is a difficult job for the guardians to continuously monitor the patients' state, especially when direct communication is not possible. In the present study, we developed an emergency call system for such patients using a steady-state visual evoked potential (SSVEP)-based brain switch. Although there have been previous studies to implement SSVEP-based brain switch system, they have not been applied to patients in LIS, and thus their clinical value has not been validated. In this study, we verified whether the SSVEP-based brain switch system can be practically used as an emergency call system for patients in LIS. The brain switch used for our system adopted a chromatic visual stimulus, which proved to be visually less stimulating than conventional checkerboard-type stimuli but could generate SSVEP responses strong enough to be used for brain-computer interface (BCI) applications. To verify the feasibility of our emergency call system, 14 healthy participants and 3 patients with severe ALS took part in online experiments. All three ALS patients successfully called their guardians to their bedsides in about 6.56 seconds. Furthermore, additional experiments with one of these patients demonstrated that our emergency call system maintains fairly good performance even up to 4 weeks after the first experiment without renewing initial calibration data. Our results suggest that our SSVEP-based emergency call system might be successfully used in practical scenarios. © 2017 Society for Psychophysiological Research.

Science in Emergency Response at CDC: Structure and Functions.

PubMed

Iskander, John; Rose, Dale A; Ghiya, Neelam D

2017-09-01

Recent high-profile activations of the US Centers for Disease Control and Prevention (CDC) Emergency Operations Center (EOC) include responses to the West African Ebola and Zika virus epidemics. Within the EOC, emergency responses are organized according to the Incident Management System, which provides a standardized structure and chain of command, regardless of whether the EOC activation occurs in response to an outbreak, natural disaster, or other type of public health emergency. By embedding key scientific roles, such as the associate director for science, and functions within a Scientific Response Section, the current CDC emergency response structure ensures that both urgent and important science issues receive needed attention. Key functions during emergency responses include internal coordination of scientific work, data management, information dissemination, and scientific publication. We describe a case example involving the ongoing Zika virus response that demonstrates how the scientific response structure can be used to rapidly produce high-quality science needed to answer urgent public health questions and guide policy. Within the context of emergency response, longer-term priorities at CDC include both streamlining administrative requirements and funding mechanisms for scientific research.

Expanding CERC beyond public health: sharing best practices with healthcare managers via virtual learning.

PubMed

Hewitt, Anne M; Spencer, Susan S; Ramloll, Rameshsharma; Trotta, Heidi

2008-10-01

Developed by the Center for Disease Control and Prevention in 2002, the Crisis Emergency and Risk Communication (CERC) training module is a nationally and internationally recognized communication model. With the looming threat of a pandemic and the potential for a protracted ongoing siege, a valuable opportunity exists to introduce crisis and emergency preparedness communication best practices to a new population--health care managers and administrators. The CERC toolkit and resources, provide an easy, turn-key solution and a validated template for educators who are not directly involved in public health education but desire to share this content. In this example, graduate students enrolled in an Master of Health Administration program, used a Play2Train scenario, located in the virtual learning environment of SecondLife (2007), to incorporate concepts from the CERC model. By applying the CERC best practices in a real-time virtual learning scenario, students learned collaboration and the leadership competencies necessary to help implement Joint Commission on Accreditation of Health Organizations emergency communication protocols and community collaboration requirements. By expanding the impact of the CERC model and developing unified risk communication responses and information sharing, all health professionals can enhance the effectiveness of their emergency preparedness plans so that the public can be better served.

Scenario-based design: A method for connecting information system design with public health operations and emergency management

PubMed Central

Reeder, Blaine; Turner, Anne M

2011-01-01

Responding to public health emergencies requires rapid and accurate assessment of workforce availability under adverse and changing circumstances. However, public health information systems to support resource management during both routine and emergency operations are currently lacking. We applied scenario-based design as an approach to engage public health practitioners in the creation and validation of an information design to support routine and emergency public health activities. Methods: Using semi-structured interviews we identified the information needs and activities of senior public health managers of a large municipal health department during routine and emergency operations. Results: Interview analysis identified twenty-five information needs for public health operations management. The identified information needs were used in conjunction with scenario-based design to create twenty-five scenarios of use and a public health manager persona. Scenarios of use and persona were validated and modified based on follow-up surveys with study participants. Scenarios were used to test and gain feedback on a pilot information system. Conclusion: The method of scenario-based design was applied to represent the resource management needs of senior-level public health managers under routine and disaster settings. Scenario-based design can be a useful tool for engaging public health practitioners in the design process and to validate an information system design. PMID:21807120

The Cross Validation of the Attitudes toward Mainstreaming Scale (ATMS).

ERIC Educational Resources Information Center

Berryman, Joan D.; Neal, W. R. Jr.

1980-01-01

Reliability and factorial validity of the Attitudes Toward Mainstreaming Scale was supported in a cross-validation study with teachers. Three factors emerged: learning capability, general mainstreaming, and traditional limiting disabilities. Factor intercorrelations varied from .42 to .55; correlations between total scores and individual factors…

Structural Validation of the Holistic Wellness Assessment

ERIC Educational Resources Information Center

Brown, Charlene; Applegate, E. Brooks; Yildiz, Mustafa

2015-01-01

The Holistic Wellness Assessment (HWA) is a relatively new assessment instrument based on an emergent transdisciplinary model of wellness. This study validated the factor structure identified via exploratory factor analysis (EFA), assessed test-retest reliability, and investigated concurrent validity of the HWA in three separate samples. The…

Psychometrics of the scale of attitudes toward physician-pharmacist collaboration: a study with medical students.

PubMed

Hojat, Mohammadreza; Spandorfer, John; Isenberg, Gerald A; Vergare, Michael J; Fassihi, Reza; Gonnella, Joseph S

2012-01-01

Despite the emphasis placed on interdisciplinary education and interprofessional collaboration between physicians and pharmacologists, no psychometrically sound instrument is available to measure attitudes toward collaborative relationships. This study was designed to examine psychometrics of an instrument for measuring attitudes toward physician-pharmacist collaborative relationships for administration to students in medical and pharmacy schools and to physicians and pharmacists. The Scale of Attitudes Toward Physician-Pharmacist Collaboration was completed by 210 students at Jefferson Medical College. Factor analysis and correlational methods were used to examine psychometrics of the instrument. Consistent with the conceptual framework of interprofessional collaboration, three underlying constructs, namely "responsibility and accountability;" "shared authority;" and "interdisciplinary education" emerged from the factor analysis of the instrument providing support for its construct validity. The reliability coefficient alpha for the instrument was 0.90. The instrument's criterion-related validity coefficient with scores of a validated instrument (Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration) was 0.70. Findings provide support for the validity and reliability of the instrument for medical students. The instrument has the potential to be used for the evaluation of interdisciplinary education in medical and pharmacy schools, and for the evaluation of patient outcomes resulting from collaborative physician-pharmacist relationships.

Data interoperability software solution for emergency reaction in the Europe Union

NASA Astrophysics Data System (ADS)

Casado, R.; Rubiera, E.; Sacristan, M.; Schütte, F.; Peters, R.

2015-07-01

Emergency management becomes more challenging in international crisis episodes because of cultural, semantic and linguistic differences between all stakeholders, especially first responders. Misunderstandings between first responders makes decision making slower and more difficult. However, spread and development of networks and IT-based emergency management systems (EMSs) have improved emergency responses, which have become more coordinated. Despite improvements made in recent years, EMSs have not still solved problems related to cultural, semantic and linguistic differences which are the real cause of slower decision making. In addition, from a technical perspective, the consolidation of current EMSs and the different formats used to exchange information offers another problem to be solved in any solution proposed for information interoperability between heterogeneous EMSs in different contexts. To overcome these problems, we present a software solution based on semantic and mediation technologies. EMERGency ELements (EMERGEL) (Fundacion CTIC and AntwortING Ingenieurbüro PartG, 2013), a common and modular ontology shared by all the stakeholders, has been defined. It offers the best solution to gather all stakeholders' knowledge in a unique and flexible data model, taking into account different countries' cultural and linguistic issues. To deal with the diversity of data protocols and formats, we have designed a service-oriented architecture for data interoperability (named DISASTER: Data Interoperability Solution At STakeholders Emergency Reaction) providing a flexible extensible solution to solve the mediation issues. Web services have been adopted as specific technology to implement this paradigm that has the most significant academic and industrial visibility and attraction. Contributions of this work have been validated through the design and development of a cross-border realistic prototype scenario, actively involving both emergency managers and emergency-first responders: the Netherlands-Germany border fire.

Lessons from the History of Quarantine, from Plague to Influenza A

PubMed Central

2013-01-01

In the new millennium, the centuries-old strategy of quarantine is becoming a powerful component of the public health response to emerging and reemerging infectious diseases. During the 2003 pandemic of severe acute respiratory syndrome, the use of quarantine, border controls, contact tracing, and surveillance proved effective in containing the global threat in just over 3 months. For centuries, these practices have been the cornerstone of organized responses to infectious disease outbreaks. However, the use of quarantine and other measures for controlling epidemic diseases has always been controversial because such strategies raise political, ethical, and socioeconomic issues and require a careful balance between public interest and individual rights. In a globalized world that is becoming ever more vulnerable to communicable diseases, a historical perspective can help clarify the use and implications of a still-valid public health strategy. PMID:23343512

Lessons from the history of quarantine, from plague to influenza A.

PubMed

Tognotti, Eugenia

2013-02-01

In the new millennium, the centuries-old strategy of quarantine is becoming a powerful component of the public health response to emerging and reemerging infectious diseases. During the 2003 pandemic of severe acute respiratory syndrome, the use of quarantine, border controls, contact tracing, and surveillance proved effective in containing the global threat in just over 3 months. For centuries, these practices have been the cornerstone of organized responses to infectious disease outbreaks. However, the use of quarantine and other measures for controlling epidemic diseases has always been controversial because such strategies raise political, ethical, and socioeconomic issues and require a careful balance between public interest and individual rights. In a globalized world that is becoming ever more vulnerable to communicable diseases, a historical perspective can help clarify the use and implications of a still-valid public health strategy.

In chronic myeloid leukemia patients on second-line tyrosine kinase inhibitor therapy, deep sequencing of BCR-ABL1 at the time of warning may allow sensitive detection of emerging drug-resistant mutants.

PubMed

Soverini, Simona; De Benedittis, Caterina; Castagnetti, Fausto; Gugliotta, Gabriele; Mancini, Manuela; Bavaro, Luana; Machova Polakova, Katerina; Linhartova, Jana; Iurlo, Alessandra; Russo, Domenico; Pane, Fabrizio; Saglio, Giuseppe; Rosti, Gianantonio; Cavo, Michele; Baccarani, Michele; Martinelli, Giovanni

2016-08-02

Imatinib-resistant chronic myeloid leukemia (CML) patients receiving second-line tyrosine kinase inhibitor (TKI) therapy with dasatinib or nilotinib have a higher risk of disease relapse and progression and not infrequently BCR-ABL1 kinase domain (KD) mutations are implicated in therapeutic failure. In this setting, earlier detection of emerging BCR-ABL1 KD mutations would offer greater chances of efficacy for subsequent salvage therapy and limit the biological consequences of full BCR-ABL1 kinase reactivation. Taking advantage of an already set up and validated next-generation deep amplicon sequencing (DS) assay, we aimed to assess whether DS may allow a larger window of detection of emerging BCR-ABL1 KD mutants predicting for an impending relapse. a total of 125 longitudinal samples from 51 CML patients who had acquired dasatinib- or nilotinib-resistant mutations during second-line therapy were analyzed by DS from the time of failure and mutation detection by conventional sequencing backwards. BCR-ABL1/ABL1%(IS) transcript levels were used to define whether the patient had 'optimal response', 'warning' or 'failure' at the time of first mutation detection by DS. DS was able to backtrack dasatinib- or nilotinib-resistant mutations to the previous sample(s) in 23/51 (45 %) pts. Median mutation burden at the time of first detection by DS was 5.5 % (range, 1.5-17.5 %); median interval between detection by DS and detection by conventional sequencing was 3 months (range, 1-9 months). In 5 cases, the mutations were detectable at baseline. In the remaining cases, response level at the time mutations were first detected by DS could be defined as 'Warning' (according to the 2013 ELN definitions of response to 2nd-line therapy) in 13 cases, as 'Optimal response' in one case, as 'Failure' in 4 cases. No dasatinib- or nilotinib-resistant mutations were detected by DS in 15 randomly selected patients with 'warning' at various timepoints, that later turned into optimal responders with no treatment changes. DS enables a larger window of detection of emerging BCR-ABL1 KD mutations predicting for an impending relapse. A 'Warning' response may represent a rational trigger, besides 'Failure', for DS-based mutation screening in CML patients undergoing second-line TKI therapy.

49 CFR 1.45 - Delegations to the Director of the Office of Intelligence, Security and Emergency Response.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Intelligence, Security and Emergency Response. 1.45 Section 1.45 Transportation Office of the Secretary of... Delegations to the Director of the Office of Intelligence, Security and Emergency Response. The Director of Intelligence, Security, and Emergency Response is delegated authority to: (a) Carry out the functions related...

49 CFR 1.45 - Delegations to the Director of the Office of Intelligence, Security and Emergency Response.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Intelligence, Security and Emergency Response. 1.45 Section 1.45 Transportation Office of the Secretary of... Delegations to the Director of the Office of Intelligence, Security and Emergency Response. The Director of Intelligence, Security, and Emergency Response is delegated authority to: (a) Carry out the functions related...

49 CFR 1.45 - Delegations to the Director of the Office of Intelligence, Security and Emergency Response.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Intelligence, Security and Emergency Response. 1.45 Section 1.45 Transportation Office of the Secretary of... Delegations to the Director of the Office of Intelligence, Security and Emergency Response. The Director of Intelligence, Security, and Emergency Response is delegated authority to: (a) Carry out the functions related...

Emergent Motivation to Read in Prekindergarten Children

ERIC Educational Resources Information Center

Zheng, Guoguo; Schwanenflugel, Paula J.; Rogers, Samantha M.

2016-01-01

This study aimed to develop and validate a measure of emergent reading motivation designed for prekindergarten children, called the Emergent Reading Motivation Scale (ERMS). The development of the ERMS was to overcome the limitation that current existing reading motivation measures are not developmentally appropriate for young children. Fifty-six…

44 CFR 323.3 - Responsibilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) § 323.3 Responsibilities. (a) As stated in The National Plan for Emergency Preparedness, the direction... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Responsibilities. 323.3 Section 323.3 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF...

Measuring Long-Distance Romantic Relationships: A Validity Study

ERIC Educational Resources Information Center

Pistole, M. Carole; Roberts, Amber

2011-01-01

This study investigated aspects of construct validity for the scores of a new long-distance romantic relationship measure. A single-factor structure of the long-distance romantic relationship index emerged, with convergent and discriminant evidence of external validity, high internal consistency reliability, and applied utility of the scores.…

Emergency response to mass casualty incidents in Lebanon.

PubMed

El Sayed, Mazen J

2013-08-01

The emergency response to mass casualty incidents in Lebanon lacks uniformity. Three recent large-scale incidents have challenged the existing emergency response process and have raised the need to improve and develop incident management for better resilience in times of crisis. We describe some simple emergency management principles that are currently applied in the United States. These principles can be easily adopted by Lebanon and other developing countries to standardize and improve their emergency response systems using existing infrastructure.

1996-1997 TEMA/DOE oversite annual report

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-01-01

The Tennessee Emergency Management Agency (TEMA) has entered into a five-year agreement with the Department of Energy (DOE) to provide emergency response activities associated with the Oak Ridge Reservation (ORR). The Agreement in Principle (AIP) delineates the duties and responsibilities of the parties. The agreement tasked TEMA with the following responsibilities: develop offsite emergency plans; conduct emergency management training; develop offsite emergency organizations; develop emergency communications; develop emergency facilities; conduct exercises and drills; provide detection and protection equipment; and develop an emergency staff. This document reports on progress on these tasks during the past year.

1996--1997 TEMA/DOE oversight annual report

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-06-01

The Tennessee Emergency Management Agency (TEMA) has entered into a five-year agreement with the Department of Energy (DOE) to provide emergency response activities associated with the Oak Ridge Reservation (ORR). The Agreement in Principle (AIP) delineates the duties and responsibilities of the parties. The agreement tasked TEMA with the following responsibilities: develop offsite emergency plans; conduct emergency management training; develop offsite emergency organizations; develop emergency communications; develop emergency facilities; conduct exercises and drills; provide detection and protection equipment; and develop an emergency staff. This report describes progress on the 14 deliverables connected with this contract.

Measures of crowding in the emergency department: a systematic review.

PubMed

Hwang, Ula; McCarthy, Melissa L; Aronsky, Dominik; Asplin, Brent; Crane, Peter W; Craven, Catherine K; Epstein, Stephen K; Fee, Christopher; Handel, Daniel A; Pines, Jesse M; Rathlev, Niels K; Schafermeyer, Robert W; Zwemer, Frank L; Bernstein, Steven L

2011-05-01

Despite consensus regarding the conceptual foundation of crowding, and increasing research on factors and outcomes associated with crowding, there is no criterion standard measure of crowding. The objective was to conduct a systematic review of crowding measures and compare them in conceptual foundation and validity. This was a systematic, comprehensive review of four medical and health care citation databases to identify studies related to crowding in the emergency department (ED). Publications that "describe the theory, development, implementation, evaluation, or any other aspect of a 'crowding measurement/definition' instrument (qualitative or quantitative)" were included. A "measurement/definition" instrument is anything that assigns a value to the phenomenon of crowding in the ED. Data collected from papers meeting inclusion criteria were: study design, objective, crowding measure, and evidence of validity. All measures were categorized into five measure types (clinician opinion, input factors, throughput factors, output factors, and multidimensional scales). All measures were then indexed to six validation criteria (clinician opinion, ambulance diversion, left without being seen (LWBS), times to care, forecasting or predictions of future crowding, and other). There were 2,660 papers identified by databases; 46 of these papers met inclusion criteria, were original research studies, and were abstracted by reviewers. A total of 71 unique crowding measures were identified. The least commonly used type of crowding measure was clinician opinion, and the most commonly used were numerical counts (number or percentage) of patients and process times associated with patient care. Many measures had moderate to good correlation with validation criteria. Time intervals and patient counts are emerging as the most promising tools for measuring flow and nonflow (i.e., crowding), respectively. Standardized definitions of time intervals (flow) and numerical counts (nonflow) will assist with validation of these metrics across multiple sites and clarify which options emerge as the metrics of choice in this "crowded" field of measures. © 2011 by the Society for Academic Emergency Medicine.

Discovery of Emerging Per-and Polyfluoroalkyl Substances

EPA Science Inventory

Legacy perfluorinated compounds exhibit significant environmental persistence and bioaccumulation potential, which has spawned an ongoing effort to introduce replacement compounds with reduced toxicological risk profiles. Many of these emerging chemical species lack validated qua...

Surveillance of emerging drugs of abuse in Hong Kong: validation of an analytical tool.

PubMed

Tang, Magdalene H Y; Ching, C K; Tse, M L; Ng, Carol; Lee, Caroline; Chong, Y K; Wong, Watson; Mak, Tony W L

2015-04-01

To validate a locally developed chromatography-based method to monitor emerging drugs of abuse whilst performing regular drug testing in abusers. Cross-sectional study. Eleven regional hospitals, seven social service units, and a tertiary level clinical toxicology laboratory in Hong Kong. A total of 972 drug abusers and high-risk individuals were recruited from acute, rehabilitation, and high-risk settings between 1 November 2011 and 31 July 2013. A subset of the participants was of South Asian ethnicity. In total, 2000 urine or hair specimens were collected. Proof of concept that surveillance of emerging drugs of abuse can be performed whilst conducting routine drug of abuse testing in patients. The method was successfully applied to 2000 samples with three emerging drugs of abuse detected in five samples: PMMA (paramethoxymethamphetamine), TFMPP [1-(3-trifluoromethylphenyl)piperazine], and methcathinone. The method also detected conventional drugs of abuse, with codeine, methadone, heroin, methamphetamine, and ketamine being the most frequently detected drugs. Other findings included the observation that South Asians had significantly higher rates of using opiates such as heroin, methadone, and codeine; and that ketamine and cocaine had significantly higher detection rates in acute subjects compared with the rehabilitation population. This locally developed analytical method is a valid tool for simultaneous surveillance of emerging drugs of abuse and routine drug monitoring of patients at minimal additional cost and effort. Continued, proactive surveillance and early identification of emerging drugs will facilitate prompt clinical, social, and legislative management.

Two Validated Ways of Improving the Ability of Decision-Making in Emergencies; Results from a Literature Review

PubMed Central

Khorram-Manesh, Amir; Berlin, Johan; Carlström, Eric

2016-01-01

The aim of the current review wasto study the existing knowledge about decision-making and to identify and describe validated training tools.A comprehensive literature review was conducted by using the following keywords: decision-making, emergencies, disasters, crisis management, training, exercises, simulation, validated, real-time, command and control, communication, collaboration, and multi-disciplinary in combination or as an isolated word. Two validated training systems developed in Sweden, 3 level collaboration (3LC) and MacSim, were identified and studied in light of the literature review in order to identify how decision-making can be trained. The training models fulfilled six of the eight identified characteristics of training for decision-making.Based on the results, these training models contained methods suitable to train for decision-making. PMID:27878123

State Emergency Response Commissions

EPA Pesticide Factsheets

The Governor of each state has designated a State Emergency Response Commission (SERC) that is responsible for implementing the Emergency Planning and Community Right-to-Know Act (EPCRA) provisions within its state.

Community response grids: using information technology to help communities respond to bioterror emergencies.

PubMed

Jaeger, Paul T; Fleischmann, Kenneth R; Preece, Jennifer; Shneiderman, Ben; Wu, Philip Fei; Qu, Yan

2007-12-01

Access to accurate and trusted information is vital in preparing for, responding to, and recovering from an emergency. To facilitate response in large-scale emergency situations, Community Response Grids (CRGs) integrate Internet and mobile technologies to enable residents to report information, professional emergency responders to disseminate instructions, and residents to assist one another. CRGs use technology to help residents and professional emergency responders to work together in community response to emergencies, including bioterrorism events. In a time of increased danger from bioterrorist threats, the application of advanced information and communication technologies to community response is vital in confronting such threats. This article describes CRGs, their underlying concepts, development efforts, their relevance to biosecurity and bioterrorism, and future research issues in the use of technology to facilitate community response.

40 CFR Appendix F to Part 112 - Facility-Specific Response Plan

Code of Federal Regulations, 2011 CFR

2011-07-01

... of Contents 1.0Model Facility-Specific Response Plan 1.1Emergency Response Action Plan 1.2Facility.... EC01MR92.015 1.1Emergency Response Action Plan Several sections of the response plan shall be co-located... sections shall be called the Emergency Response Action Plan. The Agency intends that the Action Plan...

49 CFR 172.604 - Emergency response telephone number.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 2 2013-10-01 2013-10-01 false Emergency response telephone number. 172.604... telephone number. (a) A person who offers a hazardous material for transportation must provide an emergency response telephone number, including the area code, for use in an emergency involving the hazardous...

Logic feels so good-I like it! Evidence for intuitive detection of logicality in syllogistic reasoning.

PubMed

Morsanyi, Kinga; Handley, Simon J

2012-05-01

When people evaluate syllogisms, their judgments of validity are often biased by the believability of the conclusions of the problems. Thus, it has been suggested that syllogistic reasoning performance is based on an interplay between a conscious and effortful evaluation of logicality and an intuitive appreciation of the believability of the conclusions (e.g., Evans, Newstead, Allen, & Pollard, 1994). However, logic effects in syllogistic reasoning emerge even when participants are unlikely to carry out a full logical analysis of the problems (e.g., Shynkaruk & Thompson, 2006). There is also evidence that people can implicitly detect the conflict between their beliefs and the validity of the problems, even if they are unable to consciously produce a logical response (e.g., De Neys, Moyens, & Vansteenwegen, 2010). In 4 experiments we demonstrate that people intuitively detect the logicality of syllogisms, and this effect emerges independently of participants' conscious mindset and their cognitive capacity. This logic effect is also unrelated to the superficial structure of the problems. Additionally, we provide evidence that the logicality of the syllogisms is detected through slight changes in participants' affective states. In fact, subliminal affective priming had an effect on participants' subjective evaluations of the problems. Finally, when participants misattributed their emotional reactions to background music, this significantly reduced the logic effect. (c) 2012 APA, all rights reserved.

Evaluation of the Psychometric Properties of the Asian Adolescent Depression Scale and Construction of a Short Form: An Item Response Theory Analysis.

PubMed

Lo, Barbara Chuen Yee; Zhao, Yue; Kwok, Alice Wai Yee; Chan, Wai; Chan, Calais Kin Yuen

2017-07-01

The present study applied item response theory to examine the psychometric properties of the Asian Adolescent Depression Scale and to construct a short form among 1,084 teenagers recruited from secondary schools in Hong Kong. Findings suggested that some items of the full form reflected higher levels of severity and were more discriminating than others, and the Asian Adolescent Depression Scale was useful in measuring a broad range of depressive severity in community youths. Differential item functioning emerged in several items where females reported higher depressive severity than males. In the short form construction, preliminary validation suggested that, relative to the 20-item full form, our derived short form offered significantly greater diagnostic performance and stronger discriminatory ability in differentiating depressed and nondepressed groups, and simultaneously maintained adequate measurement precision with a reduced response burden in assessing depression in the Asian adolescents. Cultural variance in depressive symptomatology and clinical implications are discussed.

Commentary: Advancing an implementation science agenda on mental health and psychosocial responses in war-affected settings: comment on trials of a psychosocial intervention for youth affected by the Syrian crisis - by Panter-Brick et al. (2018).

PubMed

Betancourt, Theresa S; Fazel, Mina

2018-05-01

Syria's civil conflict has created the largest humanitarian disaster of our time, causing massive population displacement, tremendous exposure to trauma, and loss. Advancing the mental health and psychosocial responses of war-affected populations both during acute humanitarian emergencies and in post-conflict transition is imperative in forging a constructive implementation agenda. This study makes an important contribution in building evidence toward effective interventions to advance the mental health and well-being of those affected by the Syrian crisis. Using an innovative approach, this work demonstrates that a thoughtful, ethical, and scientifically valid trial can be carried out in the midst of mass displacement. Further research is urgently needed on the effectiveness of interventions for vulnerable populations, with a growing need to embed studies of evidence-based mental health interventions within humanitarian responses. © 2018 Association for Child and Adolescent Mental Health.

The evolving local social contract for managing climate and disaster risk in Vietnam.

PubMed

Christoplos, Ian; Ngoan, Le Duc; Sen, Le Thi Hoa; Huong, Nguyen Thi Thanh; Lindegaard, Lily Salloum

2017-07-01

How do disasters shape local government legitimacy in relation to managing climate- and disaster-related risks? This paper looks at how local authorities in Central Vietnam perceive their social contract for risk reduction, including the partial merging of responsibilities for disaster risk management with new plans for and investments in climate change adaptation and broader socioeconomic development. The findings indicate that extreme floods and storms constitute critical junctures that stimulate genuine institutional change. Local officials are proud of their strengthened role in disaster response and they are eager to boost investment in infrastructure. They have struggled to reinforce their legitimacy among their constituents, but given the shifting roles of the state, private sector, and civil society, and the undiminished emphasis on high-risk development models, their responsibilities for responding to emerging climate change scenarios are increasingly nebulous. The past basis for legitimacy is no longer valid, but tomorrow's social contract is not yet defined. © 2017 The Author(s). Disasters © Overseas Development Institute, 2017.

A Host-Based RT-PCR Gene Expression Signature to Identify Acute Respiratory Viral Infection

PubMed Central

Zaas, Aimee K.; Burke, Thomas; Chen, Minhua; McClain, Micah; Nicholson, Bradly; Veldman, Timothy; Tsalik, Ephraim L.; Fowler, Vance; Rivers, Emanuel P.; Otero, Ronny; Kingsmore, Stephen F.; Voora, Deepak; Lucas, Joseph; Hero, Alfred O.; Carin, Lawrence; Woods, Christopher W.; Ginsburg, Geoffrey S.

2014-01-01

Improved ways to diagnose acute respiratory viral infections could decrease inappropriate antibacterial use and serve as a vital triage mechanism in the event of a potential viral pandemic. Measurement of the host response to infection is an alternative to pathogen-based diagnostic testing and may improve diagnostic accuracy. We have developed a host-based assay with a reverse transcription polymerase chain reaction (RT-PCR) TaqMan low-density array (TLDA) platform for classifying respiratory viral infection. We developed the assay using two cohorts experimentally infected with influenza A H3N2/Wisconsin or influenza A H1N1/Brisbane, and validated the assay in a sample of adults presenting to the emergency department with fever (n = 102) and in healthy volunteers (n = 41). Peripheral blood RNA samples were obtained from individuals who underwent experimental viral challenge or who presented to the emergency department and had microbiologically proven viral respiratory infection or systemic bacterial infection. The selected gene set on the RT-PCR TLDA assay classified participants with experimentally induced influenza H3N2 and H1N1 infection with 100 and 87% accuracy, respectively. We validated this host gene expression signature in a cohort of 102 individuals arriving at the emergency department. The sensitivity of the RT-PCR test was 89% [95% confidence interval (CI), 72 to 98%], and the specificity was 94% (95% CI, 86 to 99%). These results show that RT-PCR–based detection of a host gene expression signature can classify individuals with respiratory viral infection and sets the stage for prospective evaluation of this diagnostic approach in a clinical setting. PMID:24048524

How to Better Prepare Your Community for a Chemical Emergency: A Guide for State, Tribal and Local Agencies

EPA Pesticide Factsheets

This guide provides an overview of EPCRA requirements for State Emergency Response Commissions, Tribal Emergency Response Commissions, Local Emergency Planning Committees, and Tribal Emergency Planning Committees.

A novel sample preparation procedure for effect-directed analysis of micro-contaminants of emerging concern in surface waters.

PubMed

Osorio, Victoria; Schriks, Merijn; Vughs, Dennis; de Voogt, Pim; Kolkman, Annemieke

2018-08-15

A novel sample preparation procedure relying on Solid Phase Extraction (SPE) combining different sorbent materials on a sequential-based cartridge was optimized and validated for the enrichment of 117 widely diverse contaminants of emerging concern (CECs) from surface waters (SW) and further combined chemical and biological analysis on subsequent extracts. A liquid chromatography coupled to high resolution tandem mass spectrometry LC-(HR)MS/MS protocol was optimized and validated for the quantitative analysis of organic CECs in SW extracts. A battery of in vitro CALUX bioassays for the assessment of endocrine, metabolic and genotoxic interference and oxidative stress were performed on the same SW extracts. Satisfactory recoveries ([70-130]%) and precision (< 30%) were obtained for the majority of compounds tested. Internal standard calibration curves used for quantification of CECs, achieved the linearity criteria (r 2 > 0.99) over three orders of magnitude. Instrumental limits of detection and method limits of quantification were of [1-96] pg injected and [0.1-58] ng/L, respectively; while corresponding intra-day and inter-day precision did not exceed 11% and 20%. The developed procedure was successfully applied for the combined chemical and toxicological assessment of SW intended for drinking water supply. Levels of compounds varied from < 10 ng/L to < 500 ng/L. Endocrine (i.e. estrogenic and anti-androgenic) and metabolic interference responses were observed. Given the demonstrated reliability of the validated sample preparation method, the authors propose its integration in an effect-directed analysis procedure for a proper evaluation of SW quality and hazard assessment of CECs. Copyright © 2018 Elsevier B.V. All rights reserved.

OR fire virtual training simulator: design and face validity.

PubMed

Dorozhkin, Denis; Olasky, Jaisa; Jones, Daniel B; Schwaitzberg, Steven D; Jones, Stephanie B; Cao, Caroline G L; Molina, Marcos; Henriques, Steven; Wang, Jinling; Flinn, Jeff; De, Suvranu

2017-09-01

The Virtual Electrosurgical Skill Trainer is a tool for training surgeons the safe operation of electrosurgery tools in both open and minimally invasive surgery. This training includes a dedicated team-training module that focuses on operating room (OR) fire prevention and response. The module was developed to allow trainees, practicing surgeons, anesthesiologist, and nurses to interact with a virtual OR environment, which includes anesthesia apparatus, electrosurgical equipment, a virtual patient, and a fire extinguisher. Wearing a head-mounted display, participants must correctly identify the "fire triangle" elements and then successfully contain an OR fire. Within these virtual reality scenarios, trainees learn to react appropriately to the simulated emergency. A study targeted at establishing the face validity of the virtual OR fire simulator was undertaken at the 2015 Society of American Gastrointestinal and Endoscopic Surgeons conference. Forty-nine subjects with varying experience participated in this Institutional Review Board-approved study. The subjects were asked to complete the OR fire training/prevention sequence in the VEST simulator. Subjects were then asked to answer a subjective preference questionnaire consisting of sixteen questions, focused on the usefulness and fidelity of the simulator. On a 5-point scale, 12 of 13 questions were rated at a mean of 3 or greater (92%). Five questions were rated above 4 (38%), particularly those focusing on the simulator effectiveness and its usefulness in OR fire safety training. A total of 33 of the 49 participants (67%) chose the virtual OR fire trainer over the traditional training methods such as a textbook or an animal model. Training for OR fire emergencies in fully immersive VR environments, such as the VEST trainer, may be the ideal training modality. The face validity of the OR fire training module of the VEST simulator was successfully established on many aspects of the simulation.

Intelligent Medical Systems for Aerospace Emergency Medical Services

NASA Technical Reports Server (NTRS)

Epler, John; Zimmer, Gary

2004-01-01

The purpose of this project is to develop a portable, hands free device for emergency medical decision support to be used in remote or confined settings by non-physician providers. Phase I of the project will entail the development of a voice-activated device that will utilize an intelligent algorithm to provide guidance in establishing an airway in an emergency situation. The interactive, hands free software will process requests for assistance based on verbal prompts and algorithmic decision-making. The device will allow the CMO to attend to the patient while receiving verbal instruction. The software will also feature graphic representations where it is felt helpful in aiding in procedures. We will also develop a training program to orient users to the algorithmic approach, the use of the hardware and specific procedural considerations. We will validate the efficacy of this mode of technology application by testing in the Johns Hopkins Department of Emergency Medicine. Phase I of the project will focus on the validation of the proposed algorithm, testing and validation of the decision making tool and modifications of medical equipment. In Phase 11, we will produce the first generation software for hands-free, interactive medical decision making for use in acute care environments.

40 CFR 1.47 - Office of Solid Waste and Emergency Response.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Office of Solid Waste and Emergency... ORGANIZATION AND GENERAL INFORMATION Headquarters § 1.47 Office of Solid Waste and Emergency Response. The Office of Solid Waste and Emergency Response (OSWER), under the supervision of the Assistant...

40 CFR 1.47 - Office of Solid Waste and Emergency Response.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Office of Solid Waste and Emergency... ORGANIZATION AND GENERAL INFORMATION Headquarters § 1.47 Office of Solid Waste and Emergency Response. The Office of Solid Waste and Emergency Response (OSWER), under the supervision of the Assistant...

49 CFR 172.604 - Emergency response telephone number.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 2 2011-10-01 2011-10-01 false Emergency response telephone number. 172.604... telephone number. (a) A person who offers a hazardous material for transportation must provide an emergency response telephone number, including the area code, for use in the event of an emergency involving the...

76 FR 78227 - Notice of Request for Extension of Approval of an Information Collection; Emergency Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

...] Notice of Request for Extension of Approval of an Information Collection; Emergency Management Response... approval of an information collection associated with the Emergency Management Response System. DATES: We...: For information on the Emergency Management Response System, contact Dr. Steven Finch, Senior Staff...

Emerging Technologies for the Diagnosis of Perihilar Cholangiocarcinoma.

PubMed

Rizvi, Sumera; Eaton, John; Yang, Ju Dong; Chandrasekhara, Vinay; Gores, Gregory J

2018-05-01

The diagnosis of malignant biliary strictures remains problematic, especially in the perihilar region and in primary sclerosing cholangitis (PSC). Conventional cytology obtained during endoscopic retrograde cholangiography (ERC)-guided brushings of biliary strictures is suboptimal due to limited sensitivity, albeit it remains the gold standard with a high specificity. Emerging technologies are being developed and validated to address this pressing unmet patient need. Such technologies include enhanced visualization of the biliary tree by cholangioscopy, intraductal ultrasound, and confocal laser endomicroscopy. Conventional cytology can be aided by employing complementary and advanced cytologic techniques such as fluorescent in situ hybridization (FISH), and this technique should be widely adapted. Interrogation of bile and serum by examining extracellular vesicle number and cargo, and exploiting next-generation sequencing and proteomic technologies, is also being explored. Examination of circulating cell-free deoxyribonucleic acid (cfDNA) for differentially methylated regions is a promising test which is being rigorously validated. The special expertise required for these analyses has to date hampered their validation and adaptation. Herein, we will review these emerging technologies to inform the reader of the progress made and encourage further studies, as well as adaptation of validated approaches. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Validation of the Omron HEM-650 wrist blood pressure device using the British Hypertension Society protocol in emergency patients in Hong Kong].

PubMed

Hung, Kevin KC; Lai, W Y; Cocks, Robert A; Rainer, Timothy H; Graham, Colin A

2015-10-01

Automated wrist cuff blood pressure (BP) devices are more compact and easier to use, particularly when access to the upper arm is restricted, for example in emergencies. We tested the Omron HEM-650 wrist device using the validation criteria of the British Hypertension Society (BHS) protocol in a major emergency department (ED) in Hong Kong. 85 patients had three measurements each by both the Omron HEM-650 wrist device and the mercury sphygmomanometer. The conventional automated BP with arm cuff was also measured using an oscillometric (Colin BP-88S NXT) device for comparison. The Omron HEM-650 achieved a grade B for both systolic and diastolic BP and demonstrated acceptable accuracy and reliability in Chinese patients in the emergency setting. The Omron HEM 650 wrist device can be recommended for use in adult emergency patients. Further research is warranted for its use in pregnant women and critically ill patients.

44 CFR 352.27 - Federal role in the emergency response.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Federal role in the emergency response. 352.27 Section 352.27 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS COMMERCIAL NUCLEAR POWER PLANTS: EMERGENCY PREPAREDNESS PLANNING...

Validation of the clinical dehydration scale for children with acute gastroenteritis.

PubMed

Goldman, Ran D; Friedman, Jeremy N; Parkin, Patricia C

2008-09-01

We previously created a clinical dehydration scale. Our objective was to validate the clinical dehydration scale with a new cohort of patients with acute gastroenteritis who were assessed in a tertiary emergency department in a developed country. A prospective observational study was performed in an emergency department at a large pediatric tertiary center in Canada. Children 1 month to 5 years of age with symptoms of acute gastroenteritis who were assessed in the emergency department were enrolled consecutively during a 4-month period. The main outcome measures were length of stay, proportion of children receiving intravenous fluid rehydration, and proportions of children with abnormal serum pH values or bicarbonate levels. A total of 205 children were enrolled, with a mean age of 22.4 +/- 14.9 months; 103 (50%) were male. The distribution of severity categories was as follows: no dehydration (score of 0), n = 117 (57%); some dehydration (score of 1-4), n = 83 (41%); moderate/severe dehydration (score of 5-8), n = 5 (2%). The 3 dehydration categories were significantly different with respect to the validation hypotheses (length of stay, mean +/- SD: none, 245 +/- 181 minutes; some, 397 +/- 302 minutes; moderate/severe, 501 +/- 389 minutes; treatment with intravenous fluids: none, n =17, 15%; some, n = 41, 49%; moderate/severe, n = 4, 80%; number of vomiting episodes in the 7 days before the emergency department visit: none, 8.4 +/- 7.7 episodes; some, 13 +/- 10.7 episodes; moderate/severe, 30.2 +/- 14.8 episodes). The clinical dehydration scale and the 3 severity categories were valid for a prospectively enrolled cohort of patients who were assessed in our tertiary emergency department. The scoring system was valuable in predicting a longer length of stay and the need for intravenous fluid rehydration for children with symptoms of acute gastroenteritis.

Radiological emergency: Malaysian preparedness and response.

PubMed

Yusof, Mohd Abd Wahab; Ali, Hamrah Mohd

2011-07-01

Planning and preparation in advance for radiological emergencies can help to minimise potential public health and environmental threats if and when an actual emergency occurs. During the planning process, emergency response organisations think through how they would respond to each type of incident and the resources that will be needed. In Malaysia, planning, preparation for and response to radiological emergencies involve many parties. In the event of a radiological emergency and if it is considered a disaster, the National Security Council, the Atomic Energy Licensing Board and the Malaysian Nuclear Agency (Nuclear Malaysia) will work together with other federal agencies, state and local governments, first responders and international organisations to monitor the situation, contain the release, and clean up the contaminated site. Throughout the response, these agencies use their protective action guidelines. This paper discusses Malaysian preparedness for, and response to, any potential radiological emergency.

Application of an integrated flight/propulsion control design methodology to a STOVL aircraft

NASA Technical Reports Server (NTRS)

Garg, Sanjay; Mattern, Duane L.

1991-01-01

Results are presented from the application of an emerging Integrated Flight/Propulsion Control (IFPC) design methodology to a Short Take Off and Vertical Landing (STOVL) aircraft in transition flight. The steps in the methodology consist of designing command shaping prefilters to provide the overall desired response to pilot command inputs. A previously designed centralized controller is first validated for the integrated airframe/engine plant used. This integrated plant is derived from a different model of the engine subsystem than the one used for the centralized controller design. The centralized controller is then partitioned in a decentralized, hierarchical structure comprising of airframe lateral and longitudinal subcontrollers and an engine subcontroller. Command shaping prefilters from the pilot control effector inputs are then designed and time histories of the closed loop IFPC system response to simulated pilot commands are compared to desired responses based on handling qualities requirements. Finally, the propulsion system safety and nonlinear limited protection logic is wrapped around the engine subcontroller and the response of the closed loop integrated system is evaluated for transients that encounter the propulsion surge margin limit.

Emergency material allocation with time-varying supply-demand based on dynamic optimization method for river chemical spills.

PubMed

Liu, Jie; Guo, Liang; Jiang, Jiping; Jiang, Dexun; Wang, Peng

2018-04-13

Aiming to minimize the damage caused by river chemical spills, efficient emergency material allocation is critical for an actual emergency rescue decision-making in a quick response. In this study, an emergency material allocation framework based on time-varying supply-demand constraint is developed to allocate emergency material, minimize the emergency response time, and satisfy the dynamic emergency material requirements in post-accident phases dealing with river chemical spills. In this study, the theoretically critical emergency response time is firstly obtained for the emergency material allocation system to select a series of appropriate emergency material warehouses as potential supportive centers. Then, an enumeration method is applied to identify the practically critical emergency response time, the optimum emergency material allocation and replenishment scheme. Finally, the developed framework is applied to a computational experiment based on south-to-north water transfer project in China. The results illustrate that the proposed methodology is a simple and flexible tool for appropriately allocating emergency material to satisfy time-dynamic demands during emergency decision-making. Therefore, the decision-makers can identify an appropriate emergency material allocation scheme in a balance between time-effective and cost-effective objectives under the different emergency pollution conditions.

Emergency and trauma care in Pakistan: a cross-sectional study of healthcare levels

PubMed Central

Razzak, Junaid A; Baqir, Syed M; Khan, Uzma Rahim; Heller, David; Bhatti, Junaid; Hyder, Adnan A

2015-01-01

Background The importance of emergency medical care for the successful functioning of health systems has been increasingly recognised. This study aimed to evaluate emergency and trauma care facilities in four districts of the province of Sindh, Pakistan. Method We conducted a cross-sectional health facility survey in four districts of the province of Sindh in Pakistan using a modified version of WHO’s Guidelines for essential trauma care. 93 public health facilities (81 primary care facilities, nine secondary care hospitals, three tertiary hospitals) and 12 large private hospitals were surveyed. Interviews of healthcare providers and visual inspections of essential equipment and supplies as per guidelines were performed. A total of 141 physicians providing various levels of care were tested for their knowledge of basic emergency care using a validated instrument. Results Only 4 (44%) public secondary, 3 (25%) private secondary hospitals and all three tertiary care hospitals had designated emergency rooms. The majority of primary care health facilities had less than 60% of all essential equipments overall. Most of the secondary level public hospitals (78%) had less than 60% of essential equipments, and none had 80% or more. A fourth of private secondary care facilities and all tertiary care hospitals (n=3; 100%) had 80% or more essential equipments. The average percentage score on the physician knowledge test was 30%. None of the physicians scored above 60% correct responses. Conclusions The study findings demonstrated a gap in both essential equipment and provider knowledge necessary for effective emergency and trauma care. PMID:24157684

[Validation of a triage scale: first step in patient admission and in emergency service models].

PubMed

Legrand, A; Thys, F; Vermeiren, E; Touwaide, M; D'Hoore, W; Hubin, V; Reynaert, M S

2003-03-01

At present, most emergency services handle the multitude of various demands in the same unity of place and by the same team of nurses aides, with direct consequences on the waiting time and in the handling of problems of varying degrees of importance. Our service examines other administrative models based on a triage of time and of orientation. In a prospective study on 679 patients, we have validated a triage tool inspired from the ICEM model (International Cooperation of Emergency Medicine) allowing patients to receive, while they wait, information and training, based on the resources provided, in order to deal with their particular medical problem. The validation of this tool was carried out in terms of its utilization as well as its reliability. It appears that, with the type of triage offered, there is a theoretical reserve of waiting time for the patients in which the urgency is relative, and which could be better used in the handling of more vital cases.

Development and validation of sustainability criteria of administrative green schools in Iran.

PubMed

Meiboudi, Hossein; Lahijanian, Akramolmolok; Shobeiri, Seyed Mohammad; Jozi, Seyed Ali; Azizinezhad, Reza

2017-07-15

Environmental responsibility in school has led to the emergence of a variety of criteria to administer green schools' contributions to sustainability. Sustainability criteria of administrative green schools need validity, reliability and norms. The aim of the current study was to develop and validate assessment criteria for green schools in Iran based on the role of academia. A national survey was conducted to obtain data on sustainability criteria initiatives for green schools and the Iranian profile was defined. An initial pool of 71 items was generated and after its first edition, 63 items were selected to comprise the sustainability criteria. Engineering-architectural and behavioral aspects of this sustainability criteria were evaluated through a sample of 1218 graduate students with environmental degrees from Iran's universities. Exploratory factor analysis using principal components and promax rotation method showed that these 9 criteria have simple structures and are consistent with the theoretical framework. The reliability coefficients of subscales ranged between 0.62 (participation) and 0.84 (building location and position). The study's survey of correlation coefficients between items and subscales illustrated that those coefficients varied between 0.24 and 0.68. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Emergency response management near the tracks of the public railway network: special aspects of missions connected with the German national railway system].

PubMed

Krämer, P; Aul, A; Vock, B; Frank, C

2010-11-01

Emergency response management and rescue operations concerning the railway network in Germany need special attention and implementation in several ways. The emergency response concerning the German national railway network managed by Deutsche Bahn AG is subject to various rules and regulations which have to be followed precisely. Only by following these rules and procedures is the safety of all emergency staff at the scene ensured. The German national railway network (Deutsche Bahn AG) provides its own emergency response control center, which specializes in managing its response to emergencies and dispatches an emergency response manager to the scene. This person serves as the primary Deutsche Bahn AG representative at the scene and is the only person who is allowed to earth the railway electrical power lines. This article will discuss different emergency situations concerning railway accidents and the emergency medical response to them based on a near collision with a high speed train during a rescue mission close to the railway track. Injury to personnel could only be avoided by chance and luck. The dangers and risks for rescue staff are specified. Furthermore, the article details practical guidelines for rescue operations around the German national railway track system.

Scenario-based design: a method for connecting information system design with public health operations and emergency management.

PubMed

Reeder, Blaine; Turner, Anne M

2011-12-01

Responding to public health emergencies requires rapid and accurate assessment of workforce availability under adverse and changing circumstances. However, public health information systems to support resource management during both routine and emergency operations are currently lacking. We applied scenario-based design as an approach to engage public health practitioners in the creation and validation of an information design to support routine and emergency public health activities. Using semi-structured interviews we identified the information needs and activities of senior public health managers of a large municipal health department during routine and emergency operations. Interview analysis identified 25 information needs for public health operations management. The identified information needs were used in conjunction with scenario-based design to create 25 scenarios of use and a public health manager persona. Scenarios of use and persona were validated and modified based on follow-up surveys with study participants. Scenarios were used to test and gain feedback on a pilot information system. The method of scenario-based design was applied to represent the resource management needs of senior-level public health managers under routine and disaster settings. Scenario-based design can be a useful tool for engaging public health practitioners in the design process and to validate an information system design. Copyright © 2011 Elsevier Inc. All rights reserved.

National programmes for validating physician competence and fitness for practice: a scoping review.

PubMed

Horsley, Tanya; Lockyer, Jocelyn; Cogo, Elise; Zeiter, Jeanie; Bursey, Ford; Campbell, Craig

2016-04-15

To explore and categorise the state of existing literature for national programmes designed to affirm or establish the continuing competence of physicians. Scoping review. MEDLINE, ERIC, Sociological Abstracts, web/grey literature (2000-2014). Included when a record described a (1) national-level physician validation system, (2) recognised as a system for affirming competence and (3) reported relevant data. Using bibliographic software, title and abstracts were reviewed using an assessment matrix to ensure duplicate, paired screening. Dyads included both a methodologist and content expert on each assessment, reflective of evidence-informed best practices to decrease errors. 45 reports were included. Publication dates ranged from 2002 to 2014 with the majority of publications occurring in the previous six years (n=35). Country of origin--defined as that of the primary author--included the USA (N=32), the UK (N=8), Canada (N=3), Kuwait (N=1) and Australia (N=1). Three broad themes emerged from this heterogeneous data set: contemporary national programmes, contextual factors and terminological consistency. Four national physician validation systems emerged from the data: the American Board of Medical Specialties Maintenance of Certification Program, the Federation of State Medical Boards Maintenance of Licensure Program, the Canadian Revalidation Program and the UK Revalidation Program. Three contextual factors emerged as stimuli for the implementation of national validation systems: medical regulation, quality of care and professional competence. Finally, great variation among the definitions of key terms was identified. There is an emerging literature focusing on national physician validation systems. Four major systems have been implemented in recent years and it is anticipated that more will follow. Much of this work is descriptive, and gaps exist for the extent to which systems build on current evidence or theory. Terminology is highly variable across programmes for validating physician competence and fitness for practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

National programmes for validating physician competence and fitness for practice: a scoping review

PubMed Central

Horsley, Tanya; Lockyer, Jocelyn; Cogo, Elise; Zeiter, Jeanie; Bursey, Ford; Campbell, Craig

2016-01-01

Objective To explore and categorise the state of existing literature for national programmes designed to affirm or establish the continuing competence of physicians. Design Scoping review. Data sources MEDLINE, ERIC, Sociological Abstracts, web/grey literature (2000–2014). Selection Included when a record described a (1) national-level physician validation system, (2) recognised as a system for affirming competence and (3) reported relevant data. Data extraction Using bibliographic software, title and abstracts were reviewed using an assessment matrix to ensure duplicate, paired screening. Dyads included both a methodologist and content expert on each assessment, reflective of evidence-informed best practices to decrease errors. Results 45 reports were included. Publication dates ranged from 2002 to 2014 with the majority of publications occurring in the previous six years (n=35). Country of origin—defined as that of the primary author—included the USA (N=32), the UK (N=8), Canada (N=3), Kuwait (N=1) and Australia (N=1). Three broad themes emerged from this heterogeneous data set: contemporary national programmes, contextual factors and terminological consistency. Four national physician validation systems emerged from the data: the American Board of Medical Specialties Maintenance of Certification Program, the Federation of State Medical Boards Maintenance of Licensure Program, the Canadian Revalidation Program and the UK Revalidation Program. Three contextual factors emerged as stimuli for the implementation of national validation systems: medical regulation, quality of care and professional competence. Finally, great variation among the definitions of key terms was identified. Conclusions There is an emerging literature focusing on national physician validation systems. Four major systems have been implemented in recent years and it is anticipated that more will follow. Much of this work is descriptive, and gaps exist for the extent to which systems build on current evidence or theory. Terminology is highly variable across programmes for validating physician competence and fitness for practice. PMID:27084276

Neural Correlates of Reward Processing in Depressed and Healthy Preschool-Age Children.

PubMed

Belden, Andy C; Irvin, Kelsey; Hajcak, Greg; Kappenman, Emily S; Kelly, Danielle; Karlow, Samantha; Luby, Joan L; Barch, Deanna M

2016-12-01

Adults and adolescents with major depressive disorder (MDD) show a blunted neural response to rewards. Depression has been validated in children as young as age 3; however, it remains unclear whether blunted response to reward is also a core feature of preschool-onset depression. If so, this would provide further validation for the continuity of the neural correlates of depression across the life span and would identify a potential target for treatment in young children. Fifty-three 4- to 7-year-old children with depression and 25 psychiatrically healthy 4- to 7-year-old children completed a simple guessing task in which points could be won or lost on each trial while event-related potentials (ERPs) were recorded. Psychiatric diagnosis was established using a preschool version of the Kiddie Schedule for Affective Disorders and Depression. Young children with depression showed a reduced differentiation between response to gains and losses, and this finding was driven by a blunted response to reward (i.e., the reward positivity [RewP]). These findings held even when controlling for co-occurring attention-deficit/hyperactivity disorder, oppositional defiant disorder, and generalized anxiety disorder. The RewP did not vary as a function of depression severity within the group with depression. Similar to adults and adolescents with depression, preschoolers with depression display reductions in responsivity to rewards as indexed by the RewP. These findings provide further evidence for continuity in the neural mechanisms associated with depression across the lifespan, and point to altered reward sensitivity as an early-emerging potential target for intervention in preschool-onset depression. Clinical trial registration information-A Randomized Controlled Trial of PCIT-ED for Preschool Depression; http://clinicaltrials.gov/; NCT02076425. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Republic of Georgia estimates for prevalence of drug use: Randomized response techniques suggest under-estimation.

PubMed

Kirtadze, Irma; Otiashvili, David; Tabatadze, Mzia; Vardanashvili, Irina; Sturua, Lela; Zabransky, Tomas; Anthony, James C

2018-06-01

Validity of responses in surveys is an important research concern, especially in emerging market economies where surveys in the general population are a novelty, and the level of social control is traditionally higher. The Randomized Response Technique (RRT) can be used as a check on response validity when the study aim is to estimate population prevalence of drug experiences and other socially sensitive and/or illegal behaviors. To apply RRT and to study potential under-reporting of drug use in a nation-scale, population-based general population survey of alcohol and other drug use. For this first-ever household survey on addictive substances for the Country of Georgia, we used the multi-stage probability sampling of 18-to-64-year-old household residents of 111 urban and 49 rural areas. During the interviewer-administered assessments, RRT involved pairing of sensitive and non-sensitive questions about drug experiences. Based upon the standard household self-report survey estimate, an estimated 17.3% [95% confidence interval, CI: 15.5%, 19.1%] of Georgian household residents have tried cannabis. The corresponding RRT estimate was 29.9% [95% CI: 24.9%, 34.9%]. The RRT estimates for other drugs such as heroin also were larger than the standard self-report estimates. We remain unsure about what is the "true" value for prevalence of using illegal psychotropic drugs in the Republic of Georgia study population. Our RRT results suggest that standard non-RRT approaches might produce 'under-estimates' or at best, highly conservative, lower-end estimates. Copyright © 2018 Elsevier B.V. All rights reserved.

Experiential and rational decision making: a survey to determine how emergency physicians make clinical decisions.

PubMed

Calder, Lisa A; Forster, Alan J; Stiell, Ian G; Carr, Laura K; Brehaut, Jamie C; Perry, Jeffrey J; Vaillancourt, Christian; Croskerry, Patrick

2012-10-01

Dual-process psychological theories argue that clinical decision making is achieved through a combination of experiential (fast and intuitive) and rational (slower and systematic) cognitive processes. To determine whether emergency physicians perceived their clinical decisions in general to be more experiential or rational and how this compared with other physicians. A validated psychometric tool, the Rational Experiential Inventory (REI-40), was sent through postal mail to all emergency physicians registered with the College of Physicians and Surgeons of Ontario, according to their website in November 2009. Forty statements were ranked on a Likert scale from 1 (Definitely False) to 5 (Definitely True). An initial survey was sent out, followed by reminder cards and a second survey to non-respondents. Analysis included descriptive statistics, Student t tests, analysis of variance and comparison of mean scores with those of cardiologists from New Zealand. The response rate in this study was 46.9% (434/925). The respondents' median age was 41-50 years; they were mostly men (72.6%) and most had more than 10 years of clinical experience (66.8%). The mean REI-40 rational scores were higher than the experiential scores (3.93/5 (SD 0.35) vs 3.33/5 (SD 0.49), p<0.0001), similar to the mean scores of cardiologists from New Zealand (mean rational 3.93/5, mean experiential 3.05/5). The mean experiential scores were significantly higher for female respondents than for male respondents (3.40/5 (SD 0.49) vs 3.30/5 (SD 0.48), p=0.003). Overall, emergency physicians favoured rational decision making rather than experiential decision making; however, female emergency physicians had higher experiential scores than male emergency physicians. This has important implications for future knowledge translation and decision support efforts among emergency physicians.

Data interoperability software solution for emergency reaction in the Europe Union

NASA Astrophysics Data System (ADS)

Casado, R.; Rubiera, E.; Sacristan, M.; Schütte, F.; Peters, R.

2014-09-01

Emergency management becomes more challenging in international crisis episodes because of cultural, semantic and linguistic differences between all stakeholders, especially first responders. Misunderstandings between first responders makes decision-making slower and more difficult. However, spread and development of networks and IT-based Emergency Management Systems (EMS) has improved emergency responses, becoming more coordinated. Despite improvements made in recent years, EMS have not still solved problems related to cultural, semantic and linguistic differences which are the real cause of slower decision-making. In addition, from a technical perspective, the consolidation of current EMS and the different formats used to exchange information offers another problem to be solved in any solution proposed for information interoperability between heterogeneous EMS surrounded by different contexts. To overcome these problems we present a software solution based on semantic and mediation technologies. EMERGency ELements (EMERGEL) (Fundacion CTIC and AntwortING Ingenieurbüro PartG 2013), a common and modular ontology shared by all the stakeholders, has been defined. It offers the best solution to gather all stakeholders' knowledge in a unique and flexible data model, taking into account different countries cultural linguistic issues. To deal with the diversity of data protocols and formats, we have designed a Service Oriented Architecture for Data Interoperability (named DISASTER) providing a flexible extensible solution to solve the mediation issues. Web Services have been adopted as specific technology to implement such paradigm that has the most significant academic and industrial visibility and attraction. Contributions of this work have been validated through the design and development of a cross-border realistic prototype scenario, actively involving both emergency managers and emergency first responders: the Netherlands-Germany border fire.

The knowledge, attitude and behavior about public health emergencies and the response capacity of primary care medical staffs of Guangdong Province, China.

PubMed

Zhiheng, Zhou; Caixia, Wang; Jiaji, Wang; Huajie, Yang; Chao, Wang; Wannian, Liang

2012-09-25

Primary care medical staffs' knowledge, attitude and behavior about health emergency and the response capacity are directly related to the control and prevention of public health emergencies. Therefore, it is of great significance for improving primary care to gain in-depth knowledge about knowledge, attitude and behavior and the response capacity of primary care medical staffs. The main objective of this study is to explore knowledge, attitude and behavior, and the response capacity of primary care medical staffs of Guangdong Province, China. Stratified clustered sample method was used in the anonymous questionnaire investigation about knowledge, attitude and behavior, and the response capacity of 3410 primary care medical staffs in 15 cities of Guangdong Province, China from July, 2010 to October 2010. The emergency response capacity was evaluated by 33 questions. The highest score of the response capacity was 100 points (full score), score of 70 was a standard. 62.4% primary care medical staffs believed that public health emergencies would happen. Influenza (3.86 ± 0.88), food poisoning (3.35 ± 0.75), and environmental pollution events (3.23 ± 0.80) (the total score was 5) were considered most likely to occur. Among the 7 public health emergency skills, the highest self-assessment score is "public health emergency prevention skills" (2.90 ± 0.68), the lowest is "public health emergency risk management (the total score was 5)" (1.81 ± 0.40). Attitude evaluation showed 66.1% of the medical staffs believed that the community awareness of risk management were ordinary. Evaluation of response capacity of health emergency showed that the score of primary care medical staffs was 67.23 ± 10.61, and the response capacity of senior physicians, public health physicians and physicians with relatively long-term practice were significantly better (P <0.05). Multiple linear stepwise regression analysis showed gender, title, position, type of work, work experience and whether to participate relative training were the main factors affecting the health emergency response capacity. The knowledge, attitude and behavior about public health emergencies and the response capacity of primary care medical staffs of Guangdong Province (China) were poor. Health administrative departments should strengthen the training of health emergency knowledge and skills of the primary care medical staffs to enhance their health emergency response capabilities.

49 CFR 1.44 - Office of Intelligence, Security and Emergency Response.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 1 2013-10-01 2013-10-01 false Office of Intelligence, Security and Emergency... DELEGATION OF POWERS AND DUTIES Office of the Secretary Ost Officials § 1.44 Office of Intelligence, Security and Emergency Response. The Director of the Office of Intelligence, Security and Emergency Response is...

49 CFR 1.44 - Office of Intelligence, Security and Emergency Response.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 1 2014-10-01 2014-10-01 false Office of Intelligence, Security and Emergency... DELEGATION OF POWERS AND DUTIES Office of the Secretary Ost Officials § 1.44 Office of Intelligence, Security and Emergency Response. The Director of the Office of Intelligence, Security and Emergency Response is...

49 CFR 1.44 - Office of Intelligence, Security and Emergency Response.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 1 2012-10-01 2012-10-01 false Office of Intelligence, Security and Emergency... DELEGATION OF POWERS AND DUTIES Office of the Secretary Ost Officials § 1.44 Office of Intelligence, Security and Emergency Response. The Director of the Office of Intelligence, Security and Emergency Response is...

CDC's Evolving Approach to Emergency Response.

PubMed

Redd, Stephen C; Frieden, Thomas R

The Centers for Disease Control and Prevention (CDC) transformed its approach to preparing for and responding to public health emergencies following the anthrax attacks of 2001. The Office of Public Health Preparedness and Response, an organizational home for emergency response at CDC, was established, and 4 programs were created or greatly expanded after the anthrax attacks: (1) an emergency management program, including an Emergency Operations Center; (2) increased support of state and local health department efforts to prepare for emergencies; (3) a greatly enlarged Strategic National Stockpile of medicines, vaccines, and medical equipment; and (4) a regulatory program to assure that work done on the most dangerous pathogens and toxins is done as safely and securely as possible. Following these changes, CDC led responses to 3 major public health emergencies: the 2009-10 H1N1 influenza pandemic, the 2014-16 Ebola epidemic in West Africa, and the ongoing Zika epidemic. This article reviews the programs of CDC's Office of Public Health Preparedness, the major responses, and how these responses have resulted in changes in CDC's approach to responding to public health emergencies.

From SARS to H7N9: the mechanism of responding to emerging communicable diseases has made great progress in China.

PubMed

Yao, Linong; Chen, Enfu; Chen, Zhiping; Gong, Zhenyu

2013-12-01

The outbreak of severe acute respiratory syndrome (SARS) in 2003 indicated that China's existing former mechanism for emergency management was very vulnerable. The Chinese Government has since established a new mechanism for responding to emerging communicable diseases. This paper examined the current status of and developments in China's response to emerging communicable diseases from the outbreak of SARS in 2003 to the outbreak of H7N9 virus infection in 2013. Results indicated that the current mechanism for emergency responses to emerging communicable diseases in China has made great achievements in terms of command and decision-making, organization and collaboration, monitoring and early warning systems, protection, and international communication and cooperation. This mechanism for responding to emerging communicable diseases allowed China to successfully deal with outbreaks of the H5N1 bird flu, H1N1 flu, and H7N9 bird flu. However, a better coordination system, a more complete Office of Responses to Public Health Emergencies, administrative responsibility and error correction, better personnel training, and government responsibility may help to improve the response to emerging communicable diseases. Such improvements are eagerly anticipated.

Teamwork Assessment Tools in Obstetric Emergencies: A Systematic Review.

PubMed

Onwochei, Desire N; Halpern, Stephen; Balki, Mrinalini

2017-06-01

Team-based training and simulation can improve patient safety, by improving communication, decision making, and performance of team members. Currently, there is no general consensus on whether or not a specific assessment tool is better adapted to evaluate teamwork in obstetric emergencies. The purpose of this qualitative systematic review was to find the tools available to assess team effectiveness in obstetric emergencies. We searched Embase, Medline, PubMed, Web of Science, PsycINFO, CINAHL, and Google Scholar for prospective studies that evaluated nontechnical skills in multidisciplinary teams involving obstetric emergencies. The search included studies from 1944 until January 11, 2016. Data on reliability and validity measures were collected and used for interpretation. A descriptive analysis was performed on the data. Thirteen studies were included in the final qualitative synthesis. All the studies assessed teams in the context of obstetric simulation scenarios, but only six included anesthetists in the simulations. One study evaluated their teamwork tool using just validity measures, five using just reliability measures, and one used both. The most reliable tools identified were the Clinical Teamwork Scale, the Global Assessment of Obstetric Team Performance, and the Global Rating Scale of performance. However, they were still lacking in terms of quality and validity. More work needs to be conducted to establish the validity of teamwork tools for nontechnical skills, and the development of an ideal tool is warranted. Further studies are required to assess how outcomes, such as performance and patient safety, are influenced when using these tools.

49 CFR 172.600 - Applicability and general requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MATERIALS TABLE, SPECIAL PROVISIONS, HAZARDOUS MATERIALS COMMUNICATIONS, EMERGENCY RESPONSE INFORMATION, TRAINING REQUIREMENTS, AND SECURITY PLANS Emergency Response Information § 172.600 Applicability and... prescribes requirements for providing and maintaining emergency response information during transportation...

49 CFR 172.600 - Applicability and general requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... MATERIALS TABLE, SPECIAL PROVISIONS, HAZARDOUS MATERIALS COMMUNICATIONS, EMERGENCY RESPONSE INFORMATION, TRAINING REQUIREMENTS, AND SECURITY PLANS Emergency Response Information § 172.600 Applicability and... prescribes requirements for providing and maintaining emergency response information during transportation...

Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring

PubMed Central

Syed, Shahbaz; Gatien, Mathieu; Perry, Jeffrey J.; Chaudry, Hina; Kim, Soo-Min; Kwong, Kenneth; Mukarram, Muhammad; Thiruganasambandamoorthy, Venkatesh

2017-01-01

BACKGROUND: Most patients with chest pain in the emergency department are assigned to cardiac monitoring for several hours, blocking access for patients in greater need. We sought to validate a previously derived decision rule for safe removal of patients from cardiac monitoring after initial evaluation in the emergency department. METHODS: We prospectively enrolled adults (age ≥ 18 yr) who presented with chest pain and were assigned to cardiac monitoring at 2 academic emergency departments over 18 months. We collected standardized baseline characteristics, findings from clinical evaluations and predictors for the Ottawa Chest Pain Cardiac Monitoring Rule: whether the patient is currently free of chest pain, and whether the electrocardiogram is normal or shows only nonspecific changes. The outcome was an arrhythmia requiring intervention in the emergency department or within 8 hours of presentation to the emergency department. We calculated diagnostic characteristics for the clinical prediction rule. RESULTS: We included 796 patients (mean age 63.8 yr, 55.8% male, 8.9% admitted to hospital). Fifteen patients (1.9%) had an arrhythmia, and the rule performed with the following characteristics: sensitivity 100% (95% confidence interval [CI] 78.2%–100%) and specificity 36.4% (95% CI 33.0%–39.6%). Application of the Ottawa Chest Pain Cardiac Monitoring Rule would have allowed 284 out of 796 patients (35.7%) to be safely removed from cardiac monitoring. INTERPRETATION: We successfully validated the decision rule for safe removal of a large subset of patients with chest pain from cardiac monitoring after initial evaluation in the emergency department. Implementation of this simple yet highly sensitive rule will allow for improved use of health care resources. PMID:28246315

The grateful are patient: Heightened daily gratitude is associated with attenuated temporal discounting.

PubMed

Dickens, Leah; DeSteno, David

2016-06-01

Past research has regularly linked the experience of affect to increased impatience and, thereby, decreased self-control. Given emerging work identifying the emotion gratitude as a fairly unique affective state capable of enhancing, rather than inhibiting, patience, the present study examined the association between chronically elevated gratitude and individual differences in temporal discounting. Participants' levels of gratitude were assessed in response to a standardized lab induction and then over a 3-week period prior to measurement of their financial patience in the form of an incentivized delay discounting task. Analyses revealed a strong relation between lab-based and naturally occurring gratitude levels, thereby confirming the validity of the daily online measures. Of import, mean levels of daily gratitude were significantly associated with increased patience in the form of decreased temporal discounting. As expected, no similar relation emerged for daily levels of happiness, thereby confirming the relative specificity of the positive state of gratitude. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Targeting HER2 in the treatment of non-small cell lung cancer.

PubMed

Mar, Nataliya; Vredenburgh, James J; Wasser, Jeffrey S

2015-03-01

Oncogenic driver mutations have emerged as major treatment targets for molecular therapies in a variety of cancers. HER2 positivity has been well-studied in breast cancer, but its importance is still being explored in non-small cell lung cancer (NSCLC). Laboratory methods for assessment of HER2 positivity in NSCLC include immunohistochemistry (IHC) for protein overexpression, fluorescent in situ hybridization (FISH) for gene amplification, and next generation sequencing (NGS) for gene mutations. The prognostic and predictive significance of these tests remain to be validated, with an emerging association between HER2 gene mutations and response to HER2 targeted therapies. Despite the assay used to determine the HER2 status of lung tumors, all patients with advanced HER2 positive lung adenocarcinoma should be evaluated for treatment with targeted agents. Several clinical approaches for inclusion of these drugs into patient treatment plans exist, but there is no defined algorithm specific to NSCLC. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A structural model of the VEGF signalling pathway: emergence of robustness and redundancy properties.

PubMed

Lignet, Floriane; Calvez, Vincent; Grenier, Emmanuel; Ribba, Benjamin

2013-02-01

The vascular endothelial growth factor (VEGF) is known as one of the main promoter of angiogenesis - the process of blood vessel formation. Angiogenesis has been recognized as a key stage for cancer development and metastasis. In this paper, we propose a structural model of the main molecular pathways involved in the endothelial cells response to VEGF stimuli. The model, built on qualitative information from knowledge databases, is composed of 38 ordinary differential equations with 78 parameters and focuses on the signalling driving endothelial cell proliferation, migration and resistance to apoptosis. Following a VEGF stimulus, the model predicts an increase of proliferation and migration capability, and a decrease in the apoptosis activity. Model simulations and sensitivity analysis highlight the emergence of robustness and redundancy properties of the pathway. If further calibrated and validated, this model could serve as tool to analyse and formulate new hypothesis on th e VEGF signalling cascade and its role in cancer development and treatment.

Unravelling tumour heterogeneity using next-generation imaging: radiomics, radiogenomics, and habitat imaging.

PubMed

Sala, E; Mema, E; Himoto, Y; Veeraraghavan, H; Brenton, J D; Snyder, A; Weigelt, B; Vargas, H A

2017-01-01

Tumour heterogeneity in cancers has been observed at the histological and genetic levels, and increased levels of intra-tumour genetic heterogeneity have been reported to be associated with adverse clinical outcomes. This review provides an overview of radiomics, radiogenomics, and habitat imaging, and examines the use of these newly emergent fields in assessing tumour heterogeneity and its implications. It reviews the potential value of radiomics and radiogenomics in assisting in the diagnosis of cancer disease and determining cancer aggressiveness. This review discusses how radiogenomic analysis can be further used to guide treatment therapy for individual tumours by predicting drug response and potential therapy resistance and examines its role in developing radiomics as biomarkers of oncological outcomes. Lastly, it provides an overview of the obstacles in these emergent fields today including reproducibility, need for validation, imaging analysis standardisation, data sharing and clinical translatability and offers potential solutions to these challenges towards the realisation of precision oncology. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Chemometric and biological validation of a capillary electrophoresis metabolomic experiment of Schistosoma mansoni infection in mice.

PubMed

Garcia-Perez, Isabel; Angulo, Santiago; Utzinger, Jürg; Holmes, Elaine; Legido-Quigley, Cristina; Barbas, Coral

2010-07-01

Metabonomic and metabolomic studies are increasingly utilized for biomarker identification in different fields, including biology of infection. The confluence of improved analytical platforms and the availability of powerful multivariate analysis software have rendered the multiparameter profiles generated by these omics platforms a user-friendly alternative to the established analysis methods where the quality and practice of a procedure is well defined. However, unlike traditional assays, validation methods for these new multivariate profiling tools have yet to be established. We propose a validation for models obtained by CE fingerprinting of urine from mice infected with the blood fluke Schistosoma mansoni. We have analysed urine samples from two sets of mice infected in an inter-laboratory experiment where different infection methods and animal husbandry procedures were employed in order to establish the core biological response to a S. mansoni infection. CE data were analysed using principal component analysis. Validation of the scores consisted of permutation scrambling (100 repetitions) and a manual validation method, using a third of the samples (not included in the model) as a test or prediction set. The validation yielded 100% specificity and 100% sensitivity, demonstrating the robustness of these models with respect to deciphering metabolic perturbations in the mouse due to a S. mansoni infection. A total of 20 metabolites across the two experiments were identified that significantly discriminated between S. mansoni-infected and noninfected control samples. Only one of these metabolites, allantoin, was identified as manifesting different behaviour in the two experiments. This study shows the reproducibility of CE-based metabolic profiling methods for disease characterization and screening and highlights the importance of much needed validation strategies in the emerging field of metabolomics.

Systematic Identification of Combinatorial Drivers and Targets in Cancer Cell Lines

PubMed Central

Tabchy, Adel; Eltonsy, Nevine; Housman, David E.; Mills, Gordon B.

2013-01-01

There is an urgent need to elicit and validate highly efficacious targets for combinatorial intervention from large scale ongoing molecular characterization efforts of tumors. We established an in silico bioinformatic platform in concert with a high throughput screening platform evaluating 37 novel targeted agents in 669 extensively characterized cancer cell lines reflecting the genomic and tissue-type diversity of human cancers, to systematically identify combinatorial biomarkers of response and co-actionable targets in cancer. Genomic biomarkers discovered in a 141 cell line training set were validated in an independent 359 cell line test set. We identified co-occurring and mutually exclusive genomic events that represent potential drivers and combinatorial targets in cancer. We demonstrate multiple cooperating genomic events that predict sensitivity to drug intervention independent of tumor lineage. The coupling of scalable in silico and biologic high throughput cancer cell line platforms for the identification of co-events in cancer delivers rational combinatorial targets for synthetic lethal approaches with a high potential to pre-empt the emergence of resistance. PMID:23577104

Systematic identification of combinatorial drivers and targets in cancer cell lines.

PubMed

Tabchy, Adel; Eltonsy, Nevine; Housman, David E; Mills, Gordon B

2013-01-01

There is an urgent need to elicit and validate highly efficacious targets for combinatorial intervention from large scale ongoing molecular characterization efforts of tumors. We established an in silico bioinformatic platform in concert with a high throughput screening platform evaluating 37 novel targeted agents in 669 extensively characterized cancer cell lines reflecting the genomic and tissue-type diversity of human cancers, to systematically identify combinatorial biomarkers of response and co-actionable targets in cancer. Genomic biomarkers discovered in a 141 cell line training set were validated in an independent 359 cell line test set. We identified co-occurring and mutually exclusive genomic events that represent potential drivers and combinatorial targets in cancer. We demonstrate multiple cooperating genomic events that predict sensitivity to drug intervention independent of tumor lineage. The coupling of scalable in silico and biologic high throughput cancer cell line platforms for the identification of co-events in cancer delivers rational combinatorial targets for synthetic lethal approaches with a high potential to pre-empt the emergence of resistance.

Undergraduate nursing students' perspectives on clinical assessment at transition to practice.

PubMed

Wu, Xi Vivien; Wang, Wenru; Pua, Lay Hoon; Heng, Doreen Gek Noi; Enskär, Karin

2015-01-01

Assessment of clinical competence requires explicitly defined standards meeting the national standards of the nursing profession. This is a complex process because of the diverse nature of nursing practice. To explore the perceptions of final-year undergraduate nursing students regarding clinical assessment at transition to practice. An exploratory qualitative approach was adopted. Twenty-four students participated in three focus group discussions. Thematic analysis was conducted. Five themes emerged: the need for a valid and reliable clinical assessment tool, the need for a flexible style of reflection and specific feedback, the dynamic clinical learning environment, students' efforts in learning and assessment, and the unclear support system for preceptors. Workload, time, resource availability, adequate preparation of preceptors, and the provision of valid and reliable clinical assessment tools were deemed to influence the quality of students' clinical learning and assessment. Nursing leadership in hospitals and educational institutions has a joint responsibility in shaping the clinical learning environment and providing clinical assessments for the students.

Age-dependent impairment of auditory processing under spatially focused and divided attention: an electrophysiological study.

PubMed

Wild-Wall, Nele; Falkenstein, Michael

2010-01-01

By using event-related potentials (ERPs) the present study examines if age-related differences in preparation and processing especially emerge during divided attention. Binaurally presented auditory cues called for focused (valid and invalid) or divided attention to one or both ears. Responses were required to subsequent monaurally presented valid targets (vowels), but had to be suppressed to non-target vowels or invalidly cued vowels. Middle-aged participants were more impaired under divided attention than young ones, likely due to an age-related decline in preparatory attention following cues as was reflected in a decreased CNV. Under divided attention, target processing was increased in the middle-aged, likely reflecting compensatory effort to fulfill task requirements in the difficult condition. Additionally, middle-aged participants processed invalidly cued stimuli more intensely as was reflected by stimulus ERPs. The results suggest an age-related impairment in attentional preparation after auditory cues especially under divided attention and latent difficulties to suppress irrelevant information.

The structure and validity of directional measures of appearance social comparison among emerging adults in China.

PubMed

Liao, Jun; Jackson, Todd; Chen, Hong

2014-09-01

We evaluated the structure and validity of the Upward Appearance Comparison Scale (UPACS) and Downward Appearance Comparison Scale (DACS) (O'Brien et al., 2009) in Chinese samples. In Study 1, principal component analysis on an initial sample (427 women, 123 men) and confirmatory factor analysis on another sample (447 women, 121 men) found that a 15-item, two component model had the best overall fit. Derived components had moderate correlations with most conceptually related measures and low correlations with less conceptually related indices. Study 2 participants (310 women, 201 men) completed the UPACS and DACS as well as measures of disordered eating, fatness concern, and negative affect; they were re-assessed one year later. Baseline UPACS scores predicted changes in disordered eating for women and fatness concerns for men, independent of initial disturbances, but DACS responses were not related to outcomes. Findings highlighted the potential utility of derived UPACS and DACS within a Chinese context. Copyright © 2014 Elsevier Ltd. All rights reserved.

The validity of three tests of temperament in guppies (Poecilia reticulata).

PubMed

Burns, James G

2008-11-01

Differences in temperament (consistent differences among individuals in behavior) can have important effects on fitness-related activities such as dispersal and competition. However, evolutionary ecologists have put limited effort into validating their tests of temperament. This article attempts to validate three standard tests of temperament in guppies: the open-field test, emergence test, and novel-object test. Through multiple reliability trials, and comparison of results between different types of test, this study establishes the confidence that can be placed in these temperament tests. The open-field test is shown to be a good test of boldness and exploratory behavior; the open-field test was reliable when tested in multiple ways. There were problems with the emergence test and novel-object test, which leads one to conclude that the protocols used in this study should not be considered valid tests for this species. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

Development of urban planning guidelines for improving emergency response capacities in seismic areas of Iran.

PubMed

Hosseini, Kambod Amini; Jafari, Mohammad Kazem; Hosseini, Maziar; Mansouri, Babak; Hosseinioon, Solmaz

2009-10-01

This paper presents the results of research carried out to improve emergency response activities in earthquake-prone areas of Iran. The research concentrated on emergency response operations, emergency medical care, emergency transportation, and evacuation-the most important issues after an earthquake with regard to saving the lives of victims. For each topic, some guidelines and criteria are presented for enhancing emergency response activities, based on evaluations of experience of strong earthquakes that have occurred over the past two decades in Iran, notably Manjil (1990), Bam (2003), Firouz Abad-Kojour (2004), Zarand (2005) and Broujerd (2006). These guidelines and criteria are applicable to other national contexts, especially countries with similar seismic and social conditions as Iran. The results of this study should be incorporated into comprehensive plans to ensure sustainable development or reconstruction of cities as well as to augment the efficiency of emergency response after an earthquake.

Lessons Learned from Emergency Response Vaccination Efforts for Cholera, Typhoid, Yellow Fever, and Ebola

PubMed Central

Date, Kashmira A.; Sreenivasan, Nandini; Harris, Jennifer B.; Hyde, Terri B.

2017-01-01

Countries must be prepared to respond to public health threats associated with emergencies, such as natural disasters, sociopolitical conflicts, or uncontrolled disease outbreaks. Rapid vaccination of populations vulnerable to epidemic-prone vaccine-preventable diseases is a major component of emergency response. Emergency vaccination planning presents challenges, including how to predict resource needs, expand vaccine availability during global shortages, and address regulatory barriers to deliver new products. The US Centers for Disease Control and Prevention supports countries to plan, implement, and evaluate emergency vaccination response. We describe work of the Centers for Disease Control and Prevention in collaboration with global partners to support emergency vaccination against cholera, typhoid, yellow fever, and Ebola, diseases for which a new vaccine or vaccine formulation has played a major role in response. Lessons learned will help countries prepare for future emergencies. Integration of vaccination with emergency response augments global health security through reducing disease burden, saving lives, and preventing spread across international borders. PMID:29155670

Topical sodium metabisulfite for the treatment of calcinosis cutis: a promising new therapy.

PubMed

Del Barrio-Díaz, P; Moll-Manzur, C; Álvarez-Veliz, S; Vera-Kellet, C

2016-09-01

Calcinosis cutis is a chronic calcium-mediated disease that causes significant morbidity. Multiple treatments have been tried, with varying results; indeed, to date, no standard treatment has been generally accepted. Sodium metabisulfite is an inorganic compound that, when it reacts with oxygen, becomes sodium sulfate, a metabolite of sodium thiosulfate that has a similar ability to inhibit calcium oxalate agglomeration. Four women diagnosed with calcinosis cutis, secondary to dermatomyositis, systemic sclerosis and radiodermatitis after breast cancer, were evaluated for their response to topical 25% sodium metabisulfite. In all patients a decrease in lesion size, erythema and pain from injuries was shown, with complete resolution of the associated ulcers. One patient had a complete response. None experienced adverse effects. Topical sodium metabisulfite is a promising emerging therapy that should be considered as a valid alternative treatment in calcinosis cutis. Randomized prospective studies are required to evaluate its true efficacy. © 2016 British Association of Dermatologists.

Emerging proteomics biomarkers and prostate cancer burden in Africa

PubMed Central

Adeola, Henry A.; Blackburn, Jonathan M.; Rebbeck, Timothy R.; Zerbini, Luiz F.

2017-01-01

Various biomarkers have emerged via high throughput omics-based approaches for use in diagnosis, treatment, and monitoring of prostate cancer. Many of these have yet to be demonstrated as having value in routine clinical practice. Moreover, there is a dearth of information on validation of these emerging prostate biomarkers within African cohorts, despite the huge burden and aggressiveness of prostate cancer in men of African descent. This review focusses of the global landmark achievements in prostate cancer proteomics biomarker discovery and the potential for clinical implementation of these biomarkers in Africa. Biomarker validation processes at the preclinical, translational and clinical research level are discussed here, as are the challenges and prospects for the evaluation and use of novel proteomic prostate cancer biomarkers. PMID:28388542

Emerging proteomics biomarkers and prostate cancer burden in Africa.

PubMed

Adeola, Henry A; Blackburn, Jonathan M; Rebbeck, Timothy R; Zerbini, Luiz F

2017-06-06

Various biomarkers have emerged via high throughput omics-based approaches for use in diagnosis, treatment, and monitoring of prostate cancer. Many of these have yet to be demonstrated as having value in routine clinical practice. Moreover, there is a dearth of information on validation of these emerging prostate biomarkers within African cohorts, despite the huge burden and aggressiveness of prostate cancer in men of African descent. This review focusses of the global landmark achievements in prostate cancer proteomics biomarker discovery and the potential for clinical implementation of these biomarkers in Africa. Biomarker validation processes at the preclinical, translational and clinical research level are discussed here, as are the challenges and prospects for the evaluation and use of novel proteomic prostate cancer biomarkers.

Guidelines for Reporting Case Studies on Extracorporeal Treatments in Poisonings: Methodology

PubMed Central

Lavergne, Valéry; Ouellet, Georges; Bouchard, Josée; Galvao, Tais; Kielstein, Jan T; Roberts, Darren M; Kanji, Salmaan; Mowry, James B; Calello, Diane P; Hoffman, Robert S; Gosselin, Sophie; Nolin, Thomas D; Goldfarb, David S; Burdmann, Emmanuel A; Dargan, Paul I; Decker, Brian Scott; Hoegberg, Lotte C; Maclaren, Robert; Megarbane, Bruno; Sowinski, Kevin M; Yates, Christopher; Mactier, Robert; Wiegand, Timothy; Ghannoum, Marc

2014-01-01

A literature review performed by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup highlighted deficiencies in the existing literature, especially the reporting of case studies. Although general reporting guidelines exist for case studies, there are none in the specific field of extracorporeal treatments in toxicology. Our goal was to construct and propose a checklist that systematically outlines the minimum essential items to be reported in a case study of poisoned patients undergoing extracorporeal treatments. Through a modified two-round Delphi technique, panelists (mostly chosen from the EXTRIP workgroup) were asked to vote on the pertinence of a set of items to identify those considered minimally essential for reporting complete and accurate case reports. Furthermore, independent raters validated the clarity of each selected items between each round of voting. All case reports containing data on extracorporeal treatments in poisoning published in Medline in 2011 were reviewed during the external validation rounds. Twenty-one panelists (20 from the EXTRIP workgroup and an invited expert on pharmacology reporting guidelines) participated in the modified Delphi technique. This group included journal editors and experts in nephrology, clinical toxicology, critical care medicine, emergency medicine, and clinical pharmacology. Three independent raters participated in the validation rounds. Panelists voted on a total of 144 items in the first round and 137 items in the second round, with response rates of 96.3% and 98.3%, respectively. Twenty case reports were evaluated at each validation round and the independent raters' response rate was 99.6% and 98.8% per validation round. The final checklist consists of 114 items considered essential for case study reporting. This methodology of alternate voting and external validation rounds was useful in developing the first reporting guideline for case studies in the field of extracorporeal treatments in poisoning. We believe that this guideline will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports may provide early signals of effectiveness and/or harm, thereby improving healthcare decision-making. PMID:24890576

School Emergency Preparedness in North Dakota Public School Districts

ERIC Educational Resources Information Center

Swiontek, Steven Wayne

2009-01-01

The basis for this study was to determine: (1) If school districts in North Dakota have an emergency response plan; (2) How comprehensive their emergency response plan is; (3) How well prepared school districts in North Dakota are for any type of disaster; and (4) The extent to which North Dakota LEAD Center school emergency response training and…

Establishment of CDC Global Rapid Response Team to Ensure Global Health Security.

PubMed

Stehling-Ariza, Tasha; Lefevre, Adrienne; Calles, Dinorah; Djawe, Kpandja; Garfield, Richard; Gerber, Michael; Ghiselli, Margherita; Giese, Coralie; Greiner, Ashley L; Hoffman, Adela; Miller, Leigh Ann; Moorhouse, Lisa; Navarro-Colorado, Carlos; Walsh, James; Bugli, Dante; Shahpar, Cyrus

2017-12-01

The 2014-2016 Ebola virus disease epidemic in West Africa highlighted challenges faced by the global response to a large public health emergency. Consequently, the US Centers for Disease Control and Prevention established the Global Rapid Response Team (GRRT) to strengthen emergency response capacity to global health threats, thereby ensuring global health security. Dedicated GRRT staff can be rapidly mobilized for extended missions, improving partner coordination and the continuity of response operations. A large, agencywide roster of surge staff enables rapid mobilization of qualified responders with wide-ranging experience and expertise. Team members are offered emergency response training, technical training, foreign language training, and responder readiness support. Recent response missions illustrate the breadth of support the team provides. GRRT serves as a model for other countries and is committed to strengthening emergency response capacity to respond to outbreaks and emergencies worldwide, thereby enhancing global health security.

Screening for Psychosocial Distress amongst War-Affected Children: Cross-Cultural Construct Validity of the CPDS

ERIC Educational Resources Information Center

Jordans, M. J. D.; Komproe, I. H.; Tol, W. A.; De Jong, J. T. V. M.

2009-01-01

Background: Large-scale psychosocial interventions in complex emergencies call for a screening procedure to identify individuals at risk. To date there are no screening instruments that are developed within low- and middle-income countries and validated for that purpose. The present study assesses the cross-cultural validity of the brief,…

The Multiple-Use of Accountability Assessments: Implications for the Process of Validation

ERIC Educational Resources Information Center

Koch, Martha J.

2014-01-01

Implications of the multiple-use of accountability assessments for the process of validation are examined. Multiple-use refers to the simultaneous use of results from a single administration of an assessment for its intended use and for one or more additional uses. A theoretical discussion of the issues for validation which emerge from…

NASA EEE Parts and Advanced Interconnect Program (AIP)

NASA Technical Reports Server (NTRS)

Gindorf, T.; Garrison, A.

1996-01-01

none given From Program Objectives: I. Accelerate the readiness of new technologies through development of validation, assessment and test method/tools II. Provide NASA Projects infusion paths for emerging technologies III. Provide NASA Projects technology selection, application and validation guidelines for harware and processes IV. Disseminate quality assurance, reliability, validation, tools and availability information to the NASA community.

30 CFR 254.23 - What information must I include in the “Emergency response action plan” section?

Code of Federal Regulations, 2013 CFR

2013-07-01

... LOCATED SEAWARD OF THE COAST LINE Oil-Spill Response Plans for Outer Continental Shelf Facilities § 254.23 What information must I include in the “Emergency response action plan” section? The “Emergency response action plan” section is the core of the response plan. Put information in easy-to-use formats such...

30 CFR 254.23 - What information must I include in the “Emergency response action plan” section?

Code of Federal Regulations, 2011 CFR

2011-07-01

... FOR FACILITIES LOCATED SEAWARD OF THE COAST LINE Oil-Spill Response Plans for Outer Continental Shelf Facilities § 254.23 What information must I include in the “Emergency response action plan” section? The “Emergency response action plan”section is the core of the response plan. Put information in easy-to-use...

30 CFR 254.23 - What information must I include in the “Emergency response action plan” section?

Code of Federal Regulations, 2014 CFR

2014-07-01

... LOCATED SEAWARD OF THE COAST LINE Oil-Spill Response Plans for Outer Continental Shelf Facilities § 254.23 What information must I include in the “Emergency response action plan” section? The “Emergency response action plan” section is the core of the response plan. Put information in easy-to-use formats such...

30 CFR 254.23 - What information must I include in the “Emergency response action plan” section?

Code of Federal Regulations, 2012 CFR

2012-07-01

... LOCATED SEAWARD OF THE COAST LINE Oil-Spill Response Plans for Outer Continental Shelf Facilities § 254.23 What information must I include in the “Emergency response action plan” section? The “Emergency response action plan” section is the core of the response plan. Put information in easy-to-use formats such...

The German approach to emergency/disaster management.

PubMed

Domres, B; Schauwecker, H H; Rohrmann, K; Roller, G; Maier, G W; Manger, A

2000-01-01

Disaster control and disaster relief in Germany are public tasks. But the government has shifted the responsibility of the administration of these tasks to the 16 states, the so called "Lander", because the EFG is a federal republic. The same is valid for the civil defense and the civil protection in the case of military or international risks. The 16 states are also responsible for the legislation of rescue service, fire fighting service and disaster control (natural and technical disasters). Counties and district-free cities are responsible for the organisation of these services. The German system is based on the principle of subsidiary between official and private institutions. A lot of official and private relief organisations are responsible for the execution of disaster relief tasks. In Germany the following organisations exist: Official (GO): Technisches Hilfswerk (THW/Federal Technical Support Service), Feuerwehren (Fire Brigades/professionals and volunteers) Academie of Emergency Planning and Civil Defense Private (NGO): Arbeiter-Samariter-Bund Deutschland (ASB/Workers' Samaritan Association Germany), Deutsche Gesellschaft zur Rettung Schiffbruchiger (DGzRS, German Lifesaving Association), Deutsches Rotes Kreuz (DRK/German Red Cross), Johanniter-Unfall-Hilfe (JUH/St. John's Ambulance), Malteser Hilfsdienst (MEID/Maltese-Relief-Organisation). ASB, DRK, JUH and MHD are specialised in the field of rescue, medical and welfare services and medical disaster relief. 80% of the German rescue service and 95% of the German disaster medical relief are realised by these NGO's. NGO's and GO's employ more than 1.2 million volunteers and appr. 100,000 professionals. Rescue service is carried out by professionals, disaster relief by volunteers. The German constitution allows to call the federal army in case of disaster, to support the disaster relief organisations (for example: flood Oder River 1997, train-crash "ICE" 1998). In all counties and district free cities disaster control staffs are set up by the administration. During disaster relief operations a operational command is on site. Most of the counties and district free cities, medical executives, rescue staff executives along with fire executive officers are responsible for the medical rescue organisation. All emergency physicians and medical executives have attended special training or a 520 hours-training-course (Paramedics). All volunteers of the medical service in the disaster relief organisations are trained in separate special courses (90 hours). Over the last years, civil protection, disaster relief and rescue services in the FRG have been reorganised. In 1997, the civil protection was reformed by a new federal act. Disaster relief of the "Lander" is supported by Federal Government with about 9000 vehicles and a budget for training. Emergency physicians have to take part in a (80) eighty hours lasting course on emergency medicine from an interdisciplinary point of view; they are only allowed to do rescue missions after having proved basic experience in emergency medicine as well as having completed a (18) eighteen-months-postgraduate training period at least. Senior emergency physicians receive and additional (40) forty-hours-lasting theoretical and practical training-after three years practice in rescue services as a minimum. There are special training courses offered for Medical and Non-Medical Personal to cope with disaster situation by different institutions and organisations.

User acceptance of mobile health services from users' perspectives: The role of self-efficacy and response-efficacy in technology acceptance.

PubMed

Zhang, Xiaofei; Han, Xiaocui; Dang, Yuanyuan; Meng, Fanbo; Guo, Xitong; Lin, Jiayue

2017-03-01

With the swift emergence of electronic medical information, the global popularity of mobile health (mHealth) services continues to increase steadily. This study aims to investigate the efficacy factors that directly or indirectly influence individuals' acceptance of mHealth services. Based on the technology acceptance model, this research incorporates efficacy factors into the acceptance decision process. A research model was proposed involving the direct and indirect effects of self-efficacy and response-efficacy on acceptance intention, along with their moderating effects. The model and hypotheses were validated using data collected from a field survey of 650 potential service users. The results reveal that: (1) self-efficacy and response-efficacy are both positively associated with perceived ease of use; and (2) self-efficacy and response-efficacy moderate the impact of perceived usefulness toward adoption intention. Self-efficacy and response-efficacy both play an important role in individuals' acceptance of mHealth services, which not only affect their perceived ease of use of mHealth services, but also positively moderate the effects of perceived usefulness on adoption intention. Our findings serve to provide recommendations that are specifically customized for mHealth service providers and their marketers.

10 CFR 50.47 - Emergency plans.

Code of Federal Regulations, 2010 CFR

2010-01-01

... responsibilities for emergency response by the nuclear facility licensee and by State and local organizations... supporting organizations have been specifically established, and each principal response organization has... licensee's near-site Emergency Operations Facility have been made, and other organizations capable of...

40 CFR 300.4 - Abbreviations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Function FCO—Federal Coordinating Officer FRERP—Federal Radiological Emergency Response Plan FRP—Federal Response Plan FS—Feasibility Study HRS—Hazard Ranking System LEPC—Local Emergency Planning Committee NCP... Action RCP—Regional Contingency Plan RD—Remedial Design RERT—Radiological Emergency Response Team RI...

40 CFR 300.4 - Abbreviations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Function FCO—Federal Coordinating Officer FRERP—Federal Radiological Emergency Response Plan FRP—Federal Response Plan FS—Feasibility Study HRS—Hazard Ranking System LEPC—Local Emergency Planning Committee NCP... Action RCP—Regional Contingency Plan RD—Remedial Design RERT—Radiological Emergency Response Team RI...

40 CFR 300.4 - Abbreviations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Function FCO—Federal Coordinating Officer FRERP—Federal Radiological Emergency Response Plan FRP—Federal Response Plan FS—Feasibility Study HRS—Hazard Ranking System LEPC—Local Emergency Planning Committee NCP... Action RCP—Regional Contingency Plan RD—Remedial Design RERT—Radiological Emergency Response Team RI...

40 CFR 300.4 - Abbreviations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Function FCO—Federal Coordinating Officer FRERP—Federal Radiological Emergency Response Plan FRP—Federal Response Plan FS—Feasibility Study HRS—Hazard Ranking System LEPC—Local Emergency Planning Committee NCP... Action RCP—Regional Contingency Plan RD—Remedial Design RERT—Radiological Emergency Response Team RI...

Utilization of military support in the response to hurricane Marilyn: implications for future military-civilian cooperation.

PubMed

Weddle, M; Prado-Monje, H

1999-01-01

The past decade has been a period of evolution for the Federal disaster response system within the United States. Two domestic hurricanes were pivotal events that influenced the methods used for organizing Federal disaster assistance. The lessons of Hurricane Hugo (1989) and Hurricane Andrew (1992) were incorporated into the successful response to Hurricane Marilyn in the U.S. Virgin Islands in 1995. Following each of these storms, the Department of Defense was a major component of the response by the health sector. Despite progress in many areas, lack of clear communication between military and civilian managers and confusion among those requesting Department of Defense health resources may remain as obstacles to rapid response. This discussion is based on an unpublished case report utilizing interviews with military and civilian managers involved in the Hurricane Marilyn response. The findings suggest that out-of-channel pathways normally utilized in the warning and emergency phase of the response remained operational after more formal civilian-military communication pathways and local assessment capability had been established. It is concluded that delays may be avoided if the system in place was to make all active pathways for the request and validation of military resources visible to the designated Federal managers located within the area of operations.

The promise of dynamic contrast-enhanced imaging in radiation therapy.

PubMed

Cao, Yue

2011-04-01

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and computed tomography (CT) scanning are emerging as valuable tools to quantitatively map the spatial distribution of vascular parameters, such as perfusion, vascular permeability, blood volume, and mean transit time in tumors and normal organs. DCE MRI/CT have shown prognostic and predictive value for response of certain cancers to chemotherapy and radiation therapy. DCE MRI/CT offer the promise of early assessment of tumor response to radiation therapy, opening a window for adaptively optimizing radiation therapy based upon functional alterations that occur earlier than morphologic changes. DCE MRI/CT has also shown the potential of mapping dose responses in normal organs and tissue for evaluation of individual sensitivity to radiation, providing additional opportunities to minimize risks of radiation injury. The evidence for potentially applying DCE MRI and CT for selection and delineation of radiation boost targets is growing. The clinical use of DCE MRI and CT scanning as a biomarker or even a surrogate endpoint for radiation therapy assessment of tumor and normal organs must consider technical validation issues, including standardization, reproducibility, accuracy and robustness, and clinical validation of the sensitivity and specificity for each specific problem of interest. Although holding great promise, to date, DCE MRI and CT scanning have not been qualified as a surrogate endpoint for radiation therapy assessment or for treatment modification in any prospective phase III clinical trial for any tumor site. Copyright © 2011 Elsevier Inc. All rights reserved.

75 FR 15362 - Demand Response Compensation in Organized Wholesale Energy Markets

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-29

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission 18 CFR Part 35 [Docket No. RM10-17-000... FERC ] 61,213, PJM Interconnection, LLC, Docket No. EL09-68-000 Notice of Proposed Rulemaking Table of... Emergency Demand Response; NYISO's Emergency Demand Response Program; PJM's Emergency Load Response; and ISO...

A Building-Resolved Wind Field Library for Vancouver: Facilitating CBRN Emergency Response for the 2010 Winter Olympic Games

DTIC Science & Technology

2010-06-01

Vancouver. Facilitating CBRN Emergency Response for the 2010 Winter Olympic Games E. Vee Defence R&D Canada- Suffield F.-S. Lien University of...ana a A Building-Resolved Wind Field Library for Vancouver. Facilitating CBRN Emergency Response for the 2010 Winter Olympic Games E. Yee Defence...support of emergency response applications (requiring quick turn- around times) for the 2010 Winter Olympic Games . To this purpose, mean wind and

A quantitative structure-activity relationship to predict efficacy of granular activated carbon adsorption to control emerging contaminants.

PubMed

Kennicutt, A R; Morkowchuk, L; Krein, M; Breneman, C M; Kilduff, J E

2016-08-01

A quantitative structure-activity relationship was developed to predict the efficacy of carbon adsorption as a control technology for endocrine-disrupting compounds, pharmaceuticals, and components of personal care products, as a tool for water quality professionals to protect public health. Here, we expand previous work to investigate a broad spectrum of molecular descriptors including subdivided surface areas, adjacency and distance matrix descriptors, electrostatic partial charges, potential energy descriptors, conformation-dependent charge descriptors, and Transferable Atom Equivalent (TAE) descriptors that characterize the regional electronic properties of molecules. We compare the efficacy of linear (Partial Least Squares) and non-linear (Support Vector Machine) machine learning methods to describe a broad chemical space and produce a user-friendly model. We employ cross-validation, y-scrambling, and external validation for quality control. The recommended Support Vector Machine model trained on 95 compounds having 23 descriptors offered a good balance between good performance statistics, low error, and low probability of over-fitting while describing a wide range of chemical features. The cross-validated model using a log-uptake (qe) response calculated at an aqueous equilibrium concentration (Ce) of 1 μM described the training dataset with an r(2) of 0.932, had a cross-validated r(2) of 0.833, and an average residual of 0.14 log units.

Use of poisons information resources and satisfaction with electronic products by Victorian emergency department staff.

PubMed

Luke, Stephen; Fountain, John S; Reith, David M; Braitberg, George; Cruickshank, Jaycen

2014-10-01

ED staff use a range of poisons information resources of varying type and quality. The present study aims to identify those resources utilised in the state of Victoria, Australia, and assess opinion of the most used electronic products. A previously validated self-administered survey was conducted in 15 EDs, with 10 questionnaires sent to each. The survey was then repeated following the provision of a 4-month period of access to Toxinz™, an Internet poisons information product novel to the region. The study was conducted from December 2010 to August 2011. There were 117 (78%) and 48 (32%) responses received from the first and second surveys, respectively, a 55% overall response rate. No statistically significant differences in professional group, numbers of poisoned patients seen or resource type accessed were identified between studies. The electronic resource most used in the first survey was Poisindex® (48.68%) and Toxinz™ (64.1%) in the second. There were statistically significant (P < 0.01) improvements in satisfaction in 26 of 42 questions between surveys, and no decrements. Although the majority of responders possessed mobile devices, less than half used them for poisons information but would do so if a reputable product was available. The order of poisons information sources most utilised was: consultation with a colleague, in-house protocols and electronic resources. There was a significant difference in satisfaction with electronic poisons information resources and a movement away from existing sources when choice was provided. Interest in increased use of mobile solutions was identified. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Complex small pelagic fish population patterns arising from individual behavioral responses to their environment

NASA Astrophysics Data System (ADS)

Brochier, Timothée; Auger, Pierre-Amaël; Pecquerie, Laure; Machu, Eric; Capet, Xavier; Thiaw, Modou; Mbaye, Baye Cheikh; Braham, Cheikh-Baye; Ettahiri, Omar; Charouki, Najib; Sène, Ousseynou Ndaw; Werner, Francisco; Brehmer, Patrice

2018-05-01

Small pelagic fish (SPF) species are heavily exploited in eastern boundary upwelling systems (EBUS) as their transformation products are increasingly used in the world's food chain. Management relies on regular monitoring, but there is a lack of robust theories for the emergence of the populations' traits and their evolution in highly variable environments. This work aims to address existing knowledge gaps by combining physical and biogeochemical modelling with an individual life-cycle based model applied to round sardinella (Sardinella aurita) off northwest Africa, a key species for regional food security. Our approach focused on the processes responsible for seasonal migrations, spatio-temporal size-structure, and interannual biomass fluctuations. Emergence of preferred habitat resulted from interactions between natal homing behavior and environmental variability that impacts early life stages. Exploration of the environment by the fishes was determined by swimming capabilities, mesoscale to regional habitat structure, and horizontal currents. Fish spatio-temporal abundance variability emerged from a complex combination of distinct life-history traits. An alongshore gradient in fish size distributions is reported and validated by in situ measurements. New insights into population structure are provided, within an area where the species is abundant year-round (Mauritania) and with latitudinal migrations of variable (300-1200 km) amplitude. Interannual biomass fluctuations were linked to modulations of fish recruitment over the Sahara Bank driven by variability in alongshore current intensity. The identified processes constitute an analytical framework that can be implemented in other EBUS and used to explore impacts of regional climate change on SPF.

Addressing the gap between public health emergency planning and incident response

PubMed Central

Freedman, Ariela M; Mindlin, Michele; Morley, Christopher; Griffin, Meghan; Wooten, Wilma; Miner, Kathleen

2013-01-01

Objectives: Since 9/11, Incident Command System (ICS) and Emergency Operations Center (EOC) are relatively new concepts to public health, which typically operates using less hierarchical and more collaborative approaches to organizing staff. This paper describes the 2009 H1N1 influenza outbreak in San Diego County to explore the use of ICS and EOC in public health emergency response. Methods: This study was conducted using critical case study methodology consisting of document review and 18 key-informant interviews with individuals who played key roles in planning and response. Thematic analysis was used to analyze data. Results: Several broad elements emerged as key to ensuring effective and efficient public health response: 1) developing a plan for emergency response; 2) establishing the framework for an ICS; 3) creating the infrastructure to support response; 4) supporting a workforce trained on emergency response roles, responsibilities, and equipment; and 5) conducting regular preparedness exercises. Conclusions: This research demonstrates the value of investments made and that effective emergency preparedness requires sustained efforts to maintain personnel and material resources. By having the infrastructure and experience based on ICS and EOC, the public health system had the capability to surge-up: to expand its day-to-day operation in a systematic and prolonged manner. None of these critical actions are possible without sustained funding for the public health infrastructure. Ultimately, this case study illustrates the importance of public health as a key leader in emergency response. PMID:28228983

Intelligent transportation systems field operational test cross-cutting study : emergency notification and response.

DOT National Transportation Integrated Search

1998-09-01

Emergency Notification and Response report summarizes and interprets the results of two Field Operational Tests (FOTs) that included emergency notification and response system components. The tests included in this report are: Colorado Mayday and Pug...

47 CFR 0.192 - Emergency Response Interoperability Center.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 1 2014-10-01 2014-10-01 false Emergency Response Interoperability Center. 0.192 Section 0.192 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMISSION ORGANIZATION Organization Public Safety and Homeland Security Bureau § 0.192 Emergency Response Interoperability Center. (a...

47 CFR 0.192 - Emergency Response Interoperability Center.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 1 2013-10-01 2013-10-01 false Emergency Response Interoperability Center. 0.192 Section 0.192 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMISSION ORGANIZATION Organization Public Safety and Homeland Security Bureau § 0.192 Emergency Response Interoperability Center. (a...

47 CFR 0.192 - Emergency Response Interoperability Center.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Emergency Response Interoperability Center. 0.192 Section 0.192 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMISSION ORGANIZATION Organization Public Safety and Homeland Security Bureau § 0.192 Emergency Response Interoperability Center. (a...

Validation of the breast evaluation questionnaire for breast hypertrophy and breast reduction.

PubMed

Lewin, Richard; Elander, Anna; Lundberg, Jonas; Hansson, Emma; Thorarinsson, Andri; Claudelin, Malin; Bladh, Helena; Lidén, Mattias

2018-06-13

There is a lack of published, validated questionnaires for evaluating psychosocial morbidity in patients with breast hypertrophy undergoing breast reduction surgery. To validate the breast evaluation questionnaire (BEQ), originally developed for the assessment of breast augmentation patients, for the assessment of psychosocial morbidity in patients with breast hypertrophy undergoing breast reduction surgery. Validation study Subjects: Women with macromastia Methods: The validation of the BEQ, adapted to breast reduction, was performed in several steps. Content validity, reliability, construct validity and responsiveness were assessed. The original version was adjusted according to the results for content validity and resulted in item reduction and a modified BEQ (mBEQ) that was then assessed for reliability, construct validity and responsiveness. Internal and external validation was performed for the modified BEQ. Convergent validity was tested against Breast-Q (reduction) and discriminate validity was tested against the SF-36. Known-groups validation revealed significant differences between the normal population and patients undergoing breast reduction surgery. The BEQ showed good reliability by test-re-test analysis and high responsiveness. The modified BEQ may be reliable, valid and responsive instrument for assessing women who undergo breast reduction.

44 CFR 352.25 - Limitation on committing Federal facilities and resources for emergency preparedness.

Code of Federal Regulations, 2013 CFR

2013-10-01

... licensee offsite emergency response plan only to the extent necessary to compensate for the... response plan. ... Federal facilities and resources for emergency preparedness. 352.25 Section 352.25 Emergency Management...

44 CFR 352.25 - Limitation on committing Federal facilities and resources for emergency preparedness.

Code of Federal Regulations, 2014 CFR

2014-10-01

... licensee offsite emergency response plan only to the extent necessary to compensate for the... response plan. ... Federal facilities and resources for emergency preparedness. 352.25 Section 352.25 Emergency Management...

44 CFR 352.25 - Limitation on committing Federal facilities and resources for emergency preparedness.

Code of Federal Regulations, 2012 CFR

2012-10-01

... licensee offsite emergency response plan only to the extent necessary to compensate for the... response plan. ... Federal facilities and resources for emergency preparedness. 352.25 Section 352.25 Emergency Management...

Incident Management Systems and Building Emergency Management Capacity during the 2014-2016 Ebola Epidemic - Liberia, Sierra Leone, and Guinea.

PubMed

Brooks, Jennifer C; Pinto, Meredith; Gill, Adrienne; Hills, Katherine E; Murthy, Shivani; Podgornik, Michelle N; Hernandez, Luis F; Rose, Dale A; Angulo, Frederick J; Rzeszotarski, Peter

2016-07-08

Establishing a functional incident management system (IMS) is important in the management of public health emergencies. In response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC established the Emergency Management Development Team (EMDT) to coordinate technical assistance for developing emergency management capacity in Guinea, Liberia, and Sierra Leone. EMDT staff, deployed staff, and partners supported each country to develop response goals and objectives, identify gaps in response capabilities, and determine strategies for coordinating response activities. To monitor key programmatic milestones and assess changes in emergency management and response capacities over time, EMDT implemented three data collection methods in country: coordination calls, weekly written situation reports, and an emergency management dashboard tool. On the basis of the information collected, EMDT observed improvements in emergency management capacity over time in all three countries. The collaborations in each country yielded IMS structures that streamlined response and laid the foundation for long-term emergency management programs.The activities summarized in this report would not have been possible without collaboration with many U.S and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

Emergency Department Care in the Postpartum Period: California Births, 2009-2011.

PubMed

Batra, Priya; Fridman, Moshe; Leng, Mei; Gregory, Kimberly D

2017-11-01

To use population data to identify patient characteristics associated with a postpartum maternal emergency department visit within 90 days of discharge after birth. This retrospective cross-sectional study analyzed linked maternal discharge and emergency department data for all live California births from 2009 to 2011. The primary outcome was at least one emergency department visit within 90 days of hospital discharge after birth. Secondary outcomes included three or more visits within 90 days ("high utilization") and inpatient readmission. Independent variables included demographics (age, race or ethnicity, payer, income) and clinical characteristics (length of stay, antepartum complications, mode of delivery, and severe maternal morbidity at delivery). Multilevel logistic regression identified variables associated study outcomes; we validated the predictive model with a split-sample approach and receiver operating characteristic curve analysis. Of 1,071,232 deliveries included, 88,674 women (8.3%) visited the emergency department at least once in the 90 days after delivery discharge. Emergency department use was significantly associated with Medicaid insurance (adjusted odds ratio [OR] 2.15, 95% CI 2.08-2.21), age younger than 20 years (adjusted OR 2.08, 95% CI 1.98-2.19), severe maternal morbidity at delivery (adjusted OR 1.58, 95% CI 1.49-1.71), antepartum complications (adjusted OR 1.46, 95% CI 1.42-1.50), and cesarean delivery (adjusted OR 1.40, 95% CI 1.37-1.44). Approximately one fifth of visits occurred within 4 days of discharge, and more than half were within 3 weeks. High utilizers comprised 0.5% of the entire sample (5,171 women) and only 1.2% of women presenting for emergency department care were readmitted. Receiver operating curve model analysis using the validation sample supported predictive accuracy for postpartum emergency department use (area under the curve=0.95). One in 12 California women visited the emergency department in the first 90 days after postpartum discharge. Women at increased risk for postpartum emergency department use per our validated model (eg, low income, birth complications) may benefit from earlier scheduled postpartum visits.

The knowledge, attitude and behavior about public health emergencies and the response capacity of primary care medical staffs of Guangdong Province, China

PubMed Central

2012-01-01

Background Primary care medical staffs’ knowledge, attitude and behavior about health emergency and the response capacity are directly related to the control and prevention of public health emergencies. Therefore, it is of great significance for improving primary care to gain in-depth knowledge about knowledge, attitude and behavior and the response capacity of primary care medical staffs. The main objective of this study is to explore knowledge, attitude and behavior, and the response capacity of primary care medical staffs of Guangdong Province, China. Methods Stratified clustered sample method was used in the anonymous questionnaire investigation about knowledge, attitude and behavior, and the response capacity of 3410 primary care medical staffs in 15 cities of Guangdong Province, China from July, 2010 to October 2010. The emergency response capacity was evaluated by 33 questions. The highest score of the response capacity was 100 points (full score), score of 70 was a standard. Results 62.4% primary care medical staffs believed that public health emergencies would happen. Influenza (3.86 ± 0.88), food poisoning (3.35 ± 0.75), and environmental pollution events (3.23 ± 0.80) (the total score was 5) were considered most likely to occur. Among the 7 public health emergency skills, the highest self-assessment score is “public health emergency prevention skills” (2.90 ± 0.68), the lowest is “public health emergency risk management (the total score was 5)” (1.81 ± 0.40). Attitude evaluation showed 66.1% of the medical staffs believed that the community awareness of risk management were ordinary. Evaluation of response capacity of health emergency showed that the score of primary care medical staffs was 67.23 ± 10.61, and the response capacity of senior physicians, public health physicians and physicians with relatively long-term practice were significantly better (P <0.05). Multiple linear stepwise regression analysis showed gender, title, position, type of work, work experience and whether to participate relative training were the main factors affecting the health emergency response capacity. Conclusions The knowledge, attitude and behavior about public health emergencies and the response capacity of primary care medical staffs of Guangdong Province (China) were poor. Health administrative departments should strengthen the training of health emergency knowledge and skills of the primary care medical staffs to enhance their health emergency response capabilities. PMID:23009075

A validation of ground ambulance pre-hospital times modeled using geographic information systems.

PubMed

Patel, Alka B; Waters, Nigel M; Blanchard, Ian E; Doig, Christopher J; Ghali, William A

2012-10-03

Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS) using geographic information systems (GIS). The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US) studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval). The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7-8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a non-US context. The preference for researchers should be to use actual EMS trip records from the proposed research study area. In the absence of EMS trip data researchers should determine which modeling assumptions more accurately reflect the EMS protocols across their study area.

Selecting concepts for a concept-based curriculum: application of a benchmark approach.

PubMed

Giddens, Jean Foret; Wright, Mary; Gray, Irene

2012-09-01

In response to a transformational movement in nursing education, faculty across the country are considering changes to curricula and approaches to teaching. As a result, an emerging trend in many nursing programs is the adoption of a concept-based curriculum. As part of the curriculum development process, the selection of concepts, competencies, and exemplars on which to build courses and base content is needed. This article presents a benchmark approach used to validate and finalize concept selection among educators developing a concept-based curriculum for a statewide nursing consortium. These findings are intended to inform other nurse educators who are currently involved with or are considering this curriculum approach. Copyright 2012, SLACK Incorporated.

Drug discovery in the next millennium.

PubMed

Ohlstein, E H; Ruffolo, R R; Elliott, J D

2000-01-01

Selection and validation of novel molecular targets have become of paramount importance in light of the plethora of new potential therapeutic drug targets that have emerged from human gene sequencing. In response to this revolution within the pharmaceutical industry, the development of high-throughput methods in both biology and chemistry has been necessitated. This review addresses these technological advances as well as several new areas that have been created by necessity to deal with this new paradigm, such as bioinformatics, cheminformatics, and functional genomics. With many of these key components of future drug discovery now in place, it is possible to map out a critical path for this process that will be used into the new millennium.

Soft-Matter Resistive Sensor for Measuring Shear and Pressure Stresses

NASA Astrophysics Data System (ADS)

Tepayotl-Ramirez, Daniel; Roberts, Peter; Majidi, Carmel

2013-03-01

Building on emerging paradigms in soft-matter electronics, we introduce liquid-phase electronic sensors that simultaneously measures elastic pressure and shear deformation. The sensors are com- posed of a sheet of elastomer that is embedded with fluidic channels containing eutectic Gallium- Indium (EGaIn), a metal alloy that is liquid at room temperature. Applying pressure or shear traction to the surface of the surrounding elastomer causes the elastomer to elastically deform and changes the geometry and electrical properties of the embedded liquid-phase circuit elements. We introduce analytic models that predict the electrical response of the sensor to prescribed surface tractions. These models are validated with both Finite Element Analysis (FEA) and experimental measurements.

Basaltic volcanism - The importance of planet size

NASA Technical Reports Server (NTRS)

Walker, D.; Stolper, E. M.; Hays, J. F.

1979-01-01

The volumetrically abundant basalts on the earth, its moon, and the eucrite parent planet all have chemical compositions that are controlled to a large extent by dry, low-pressure, crystal-liquid equilibria. Since this generalization is valid for these three planetary bodies, we infer that it may also apply to the other unsampled terrestrial planets. Other characteristics of basaltic volcanism show variations which appear to be related to planet size: the eruption temperatures, degrees of fractionation, and chemical variety of basalts and the endurance of basaltic volcanism all increase with planet size. Although the processes responsible for chemical differences between basalt suites are known, no simple systematization of the chemical differences between basalts from planet to planet has emerged.

Implicit Review Instrument to Evaluate Quality of Care Delivered by Physicians to Children in Emergency Departments.

PubMed

Marcin, James P; Romano, Patrick S; Dharmar, Madan; Chamberlain, James M; Dudley, Nanette; Macias, Charles G; Nigrovic, Lise E; Powell, Elizabeth C; Rogers, Alexander J; Sonnett, Meridith; Tzimenatos, Leah; Alpern, Elizabeth R; Andrews-Dickert, Rebecca; Borgialli, Dominic A; Sidney, Erika; Casper, Charlie; Dean, Jonathan Michael; Kuppermann, Nathan

2018-06-01

To evaluate the consistency, reliability, and validity of an implicit review instrument that measures the quality of care provided to children in the emergency department (ED). Medical records of randomly selected children from 12 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Eight pediatric emergency medicine physicians applied the instrument to 620 medical records. We determined internal consistency using Cronbach's alpha and inter-rater reliability using the intraclass correlation coefficient (ICC). We evaluated the validity of the instrument by correlating scores with four condition-specific explicit review instruments. Individual reviewers' Cronbach's alpha had a mean of 0.85 with a range of 0.76-0.97; overall Cronbach's alpha was 0.90. The ICC was 0.49 for the summary score with a range from 0.40 to 0.46. Correlations between the quality of care score and the four condition-specific explicit review scores ranged from 0.24 to 0.38. The quality of care instrument demonstrated good internal consistency, moderate inter-rater reliability, high inter-rater agreement, and evidence supporting validity. The instrument could be useful for systems' assessment and research in evaluating the care delivered to children in the ED. © Health Research and Educational Trust.

Development and Validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: The ED Prevention Quality Indicators for General Health Conditions.

PubMed

Davies, Sheryl; Schultz, Ellen; Raven, Maria; Wang, Nancy Ewen; Stocks, Carol L; Delgado, Mucio Kit; McDonald, Kathryn M

2017-10-01

To develop and validate rates of potentially preventable emergency department (ED) visits as indicators of community health. Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project 2008-2010 State Inpatient Databases and State Emergency Department Databases. Empirical analyses and structured panel reviews. Panels of 14-17 clinicians and end users evaluated a set of ED Prevention Quality Indicators (PQIs) using a Modified Delphi process. Empirical analyses included assessing variation in ED PQI rates across counties and sensitivity of those rates to county-level poverty, uninsurance, and density of primary care physicians (PCPs). ED PQI rates varied widely across U.S. communities. Indicator rates were significantly associated with county-level poverty, median income, Medicaid insurance, and levels of uninsurance. A few indicators were significantly associated with PCP density, with higher rates in areas with greater density. A clinical and an end-user panel separately rated the indicators as having strong face validity for most uses evaluated. The ED PQIs have undergone initial validation as indicators of community health with potential for use in public reporting, population health improvement, and research. © Health Research and Educational Trust.

Contraceptive availability during an emergency response in the United States.

PubMed

Ellington, Sascha R; Kourtis, Athena P; Curtis, Kathryn M; Tepper, Naomi; Gorman, Susan; Jamieson, Denise J; Zotti, Marianne; Barfield, Wanda

2013-03-01

This article provides the evidence for contraceptive need to prevent unintended pregnancy during an emergency response, discusses the most appropriate types of contraceptives for disaster situations, and details the current provisions in place to provide contraceptives during an emergency response.

40 CFR 68.180 - Emergency response program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Emergency response program. 68.180 Section 68.180 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.180 Emergency response program...

A Framework for Validating Traffic Simulation Models at the Vehicle Trajectory Level

DOT National Transportation Integrated Search

2017-03-01

Based on current practices, traffic simulation models are calibrated and validated using macroscopic measures such as 15-minute averages of traffic counts or average point-to-point travel times. For an emerging number of applications, including conne...

aLicante sUrgical Community Emergencies New Tool for the enUmeration of Morbidities: a simplified auditing tool for community-acquired gastrointestinal surgical emergencies.

PubMed

Villodre, Celia; Rebasa, Pere; Estrada, José Luís; Zaragoza, Carmen; Zapater, Pedro; Mena, Luís; Lluís, Félix

2016-11-01

In a previous study, we found that Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) overpredicts morbidity risk in emergency gastrointestinal surgery. Our aim was to find a POSSUM equation adjustment. A prospective observational study was performed on 2,361 patients presenting with a community-acquired gastrointestinal surgical emergency. The first 1,000 surgeries constituted the development cohort, the second 1,000 events were the first validation intramural cohort, and the remaining 361 cases belonged to a second validation extramural cohort. (1) A modified POSSUM equation was obtained. (2) Logistic regression was used to yield a statistically significant equation that included age, hemoglobin, white cell count, sodium and operative severity. (3) A chi-square automatic interaction detector decision tree analysis yielded a statistically significant equation with 4 variables, namely cardiac failure, sodium, operative severity, and peritoneal soiling. A modified POSSUM equation and a simplified scoring system (aLicante sUrgical Community Emergencies New Tool for the enUmeration of Morbidities [LUCENTUM]) are described. Both tools significantly improve prediction of surgical morbidity in community-acquired gastrointestinal surgical emergencies. Copyright © 2016 Elsevier Inc. All rights reserved.

Emergent intraverbal responses via tact and match-to-sample instruction.

PubMed

Grannan, Leigh; Rehfeldt, Ruth Anne

2012-01-01

The present investigation evaluated the effectiveness of category tact and match-to-sample instruction in facilitating the emergence of intraverbal responses (i.e., naming several items belonging to a specific category) for 2 children with autism. Results demonstrated the emergence of untaught responses, suggesting an effective instructional protocol for establishing intraverbal responses without direct instruction.

Predictive Validity of Measures of the Pathfinder Scaling Algorithm on Programming Performance: Alternative Assessment Strategy for Programming Education

ERIC Educational Resources Information Center

Lau, Wilfred W. F.; Yuen, Allan H. K.

2009-01-01

Recent years have seen a shift in focus from assessment of learning to assessment for learning and the emergence of alternative assessment methods. However, the reliability and validity of these methods as assessment tools are still questionable. In this article, we investigated the predictive validity of measures of the Pathfinder Scaling…

Exploratory analysis of real personal emergency response call conversations: considerations for personal emergency response spoken dialogue systems.

PubMed

Young, Victoria; Rochon, Elizabeth; Mihailidis, Alex

2016-11-14

The purpose of this study was to derive data from real, recorded, personal emergency response call conversations to help improve the artificial intelligence and decision making capability of a spoken dialogue system in a smart personal emergency response system. The main study objectives were to: develop a model of personal emergency response; determine categories for the model's features; identify and calculate measures from call conversations (verbal ability, conversational structure, timing); and examine conversational patterns and relationships between measures and model features applicable for improving the system's ability to automatically identify call model categories and predict a target response. This study was exploratory and used mixed methods. Personal emergency response calls were pre-classified according to call model categories identified qualitatively from response call transcripts. The relationships between six verbal ability measures, three conversational structure measures, two timing measures and three independent factors: caller type, risk level, and speaker type, were examined statistically. Emergency medical response services were the preferred response for the majority of medium and high risk calls for both caller types. Older adult callers mainly requested non-emergency medical service responders during medium risk situations. By measuring the number of spoken words-per-minute and turn-length-in-words for the first spoken utterance of a call, older adult and care provider callers could be identified with moderate accuracy. Average call taker response time was calculated using the number-of-speaker-turns and time-in-seconds measures. Care providers and older adults used different conversational strategies when responding to call takers. The words 'ambulance' and 'paramedic' may hold different latent connotations for different callers. The data derived from the real personal emergency response recordings may help a spoken dialogue system classify incoming calls by caller type with moderate probability shortly after the initial caller utterance. Knowing the caller type, the target response for the call may be predicted with some degree of probability and the output dialogue could be tailored to this caller type. The average call taker response time measured from real calls may be used to limit the conversation length in a spoken dialogue system before defaulting to a live call taker.

Emergency Response Virtual Environment for Safe Schools

NASA Technical Reports Server (NTRS)

Wasfy, Ayman; Walker, Teresa

2008-01-01

An intelligent emergency response virtual environment (ERVE) that provides emergency first responders, response planners, and managers with situational awareness as well as training and support for safe schools is presented. ERVE incorporates an intelligent agent facility for guiding and assisting the user in the context of the emergency response operations. Response information folders capture key information about the school. The system enables interactive 3D visualization of schools and academic campuses, including the terrain and the buildings' exteriors and interiors in an easy to use Web..based interface. ERVE incorporates live camera and sensors feeds and can be integrated with other simulations such as chemical plume simulation. The system is integrated with a Geographical Information System (GIS) to enable situational awareness of emergency events and assessment of their effect on schools in a geographic area. ERVE can also be integrated with emergency text messaging notification systems. Using ERVE, it is now possible to address safe schools' emergency management needs with a scaleable, seamlessly integrated and fully interactive intelligent and visually compelling solution.

The Consumer Quality Index in an accident and emergency department: internal consistency, validity and discriminative capacity.

PubMed

Bos, Nanne; Sturms, Leontien M; Stellato, Rebecca K; Schrijvers, Augustinus J P; van Stel, Henk F

2015-10-01

Patients' experiences are an indicator of health-care performance in the accident and emergency department (A&E). The Consumer Quality Index for the Accident and Emergency department (CQI A&E), a questionnaire to assess the quality of care as experienced by patients, was investigated. The internal consistency, construct validity and discriminative capacity of the questionnaire were examined. In the Netherlands, twenty-one A&Es participated in a cross-sectional survey, covering 4883 patients. The questionnaire consisted of 78 questions. Principal components analysis determined underlying domains. Internal consistency was determined by Cronbach's alpha coefficients, construct validity by Pearson's correlation coefficients and the discriminative capacity by intraclass correlation coefficients and reliability of A&E-level mean scores (G-coefficient). Seven quality domains emerged from the principal components analysis: information before treatment, timeliness, attitude of health-care professionals, professionalism of received care, information during treatment, environment and facilities, and discharge management. Domains were internally consistent (range: 0.67-0.84). Five domains and the 'global quality rating' had the capacity to discriminate among A&Es (significant intraclass correlation coefficient). Four domains and the 'global quality rating' were close to or above the threshold for reliably demonstrating differences among A&Es. The patients' experiences score on the domain timeliness showed the largest range between the worst- and best-performing A&E. The CQI A&E is a validated survey to measure health-care performance in the A&E from patients' perspective. Five domains regarding quality of care aspects and the 'global quality rating' had the capacity to discriminate among A&Es. © 2013 John Wiley & Sons Ltd.

Contraceptive Availability During an Emergency Response in the United States

PubMed Central

Ellington, Sascha R; Kourtis, Athena P; Curtis, Kathryn M; Tepper, Naomi; Gorman, Susan; Jamieson, Denise J; Zotti, Marianne; Barfield, Wanda

2015-01-01

This article provides the evidence for contraceptive need to prevent unintended pregnancy during an emergency response, discusses the most appropriate types of contraceptives for disaster situations, and details the current provisions in place to provide contraceptives during an emergency response. PMID:23421580

44 CFR 334.6 - Department and agency responsibilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Department and agency responsibilities. 334.6 Section 334.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS GRADUATED MOBILIZATION RESPONSE § 334.6 Department and agency...

44 CFR 334.6 - Department and agency responsibilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Department and agency responsibilities. 334.6 Section 334.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS GRADUATED MOBILIZATION RESPONSE § 334.6 Department and agency...

44 CFR 334.6 - Department and agency responsibilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Department and agency responsibilities. 334.6 Section 334.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS GRADUATED MOBILIZATION RESPONSE § 334.6 Department and agency...

44 CFR 206.42 - Responsibilities of coordinating officers.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Responsibilities of coordinating officers. 206.42 Section 206.42 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... Process § 206.42 Responsibilities of coordinating officers. (a) Following a declaration of a major...

44 CFR 206.42 - Responsibilities of coordinating officers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Responsibilities of coordinating officers. 206.42 Section 206.42 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... Process § 206.42 Responsibilities of coordinating officers. (a) Following a declaration of a major...

44 CFR 206.42 - Responsibilities of coordinating officers.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Responsibilities of coordinating officers. 206.42 Section 206.42 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... Process § 206.42 Responsibilities of coordinating officers. (a) Following a declaration of a major...

44 CFR 206.42 - Responsibilities of coordinating officers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Responsibilities of coordinating officers. 206.42 Section 206.42 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... Process § 206.42 Responsibilities of coordinating officers. (a) Following a declaration of a major...

Physiological time model for predicting adult emergence of western corn rootworm (Coleoptera: Chrysomelidae) in the Texas High Plains.

PubMed

Stevenson, Douglass E; Michels, Gerald J; Bible, John B; Jackman, John A; Harris, Marvin K

2008-10-01

Field observations at three locations in the Texas High Plains were used to develop and validate a degree-day phenology model to predict the onset and proportional emergence of adult Diabrotica virgifera virgifera LeConte (Coleoptera: Chrysomelidae) adults. Climatic data from the Texas High Plains Potential Evapotranspiration network were used with records of cumulative proportional adult emergence to determine the functional lower developmental temperature, optimum starting date, and the sum of degree-days for phenological events from onset to 99% adult emergence. The model base temperature, 10 degrees C (50 degrees F), corresponds closely to known physiological lower limits for development. The model uses a modified Gompertz equation, y = 96.5 x exp (-(exp(6.0 - 0.00404 x (x - 4.0), where x is cumulative heat (degree-days), to predict y, cumulative proportional emergence expressed as a percentage. The model starts degree-day accumulation on the date of corn, Zea mays L., emergence, and predictions correspond closely to corn phenological stages from tasseling to black layer development. Validation shows the model predicts cumulative proportional adult emergence within a satisfactory interval of 4.5 d. The model is flexible enough to accommodate early planting, late emergence, and the effects of drought and heat stress. The model provides corn producers ample lead time to anticipate and implement adult control practices.

Boundaries as Mechanisms for Learning in Emergency Exercises with Students from Emergency Service Organisations

ERIC Educational Resources Information Center

Andersson, Annika

2016-01-01

To prepare emergency response organisations for collaborative work in unpredictable and dynamic situations, various types of exercises are widely used. Still, our knowledge of collaboration exercises with emergency response students is limited. This study aimed to contribute to this field by exploring boundaries that emerged between collaborating…

Preparing nurses internationally for emergency planning and response.

PubMed

Weiner, Elizabeth

2006-09-30

Competency-based education provides an international infrastructure for nurses to learn about emergency preparedness and response. The International Nursing Coalition for Mass Casualty Education (INCMCE) has developed competencies for all nurses, as well as online modules for meeting those competencies. In addition, other curriculum resources are available that range from face-to-face classes, web-based modules, and electronic journals, to complete pre-packaged materials. The author of this article describes competencies needed for emergency preparedness identified by Columbia University, Vanderbilt University, and the International Nursing Coalition for Mass Casualty Education, as well as various curriculum resources for emergency planning and response and also processes to prepare nurses for emergency responses. Examples of international "Best Practices" feature programs that provide examples of innovative educational strategies for preparing nurses for emergency response are presented. The author concludes that while curriculum resources are widely available, a better centralized clearinghouse could be made available for both faculty and students.

Introduction of an Emergency Response Plan for flood loading of Sultan Abu Bakar Dam in Malaysia

NASA Astrophysics Data System (ADS)

Said, N. F. Md; Sidek, L. M.; Basri, H.; Muda, R. S.; Razad, A. Z. Abdul

2016-03-01

Sultan Abu Bakar Dam Emergency Response Plan (ERP) is designed to assist employees for identifying, monitoring, responding and mitigation dam safety emergencies. This paper is outlined to identification of an organization chart, responsibility for emergency management team and triggering level in Sultan Abu Bakar Dam ERP. ERP is a plan that guides responsibilities for proper operation of Sultan Abu Bakar Dam in respond to emergency incidents affecting the dam. Based on this study four major responsibilities are needed for Abu Bakar Dam owing to protect any probable risk for downstream which they can be Incident Commander, Deputy Incident Commander, On-Scene Commander, Civil Engineer. In conclusion, having organization charts based on ERP studies can be helpful for decreasing the probable risks in any projects such as Abu Bakar Dam and it is a way to identify and suspected and actual dam safety emergencies.

Using a mobile app and mobile workforce to validate data about emergency public health resources

PubMed Central

Chang, Anna Marie; Leung, Alison C; Saynisch, Olivia; Griffis, Heather; Hill, Shawndra; Hershey, John C; Becker, Lance B; Asch, David A; Seidman, Ariel; Merchant, Raina Martha

2013-01-01

Background Social media and mobile applications that allow people to work anywhere are changing the way people can contribute and collaborate. Objective We sought to determine the feasibility of using mobile workforce technology to validate the locations of automated external defibrillators (AEDs), an emergency public health resource. Methods We piloted the use of a mobile workforce application, to verify the location of 40 AEDs in Philadelphia county. AEDs were pre-identified in public locations for baseline data. The task of locating AEDs was posted online for a mobile workforce from October 2011 to January 2012. Participants were required to submit a mobile phone photo of AEDs and descriptions of the location. Results Thirty-five of the 40 AEDs were identified within the study period. Most, 91% (32/35) of the submitted AED photo information was confirmed project baseline data. Participants also provided additional data such as business hours and other nearby AEDs. Conclusions It is feasible to engage a mobile workforce to complete health research-related tasks. Participants were able to validate information about emergency public health resources. PMID:23666486

Proof of Concept for the Trajectory-Level Validation Framework for Traffic Simulation Models

DOT National Transportation Integrated Search

2017-10-30

Based on current practices, traffic simulation models are calibrated and validated using macroscopic measures such as 15-minute averages of traffic counts or average point-to-point travel times. For an emerging number of applications, including conne...

78 FR 33467 - Second Allocation of Public Transportation Emergency Relief Funds in Response to Hurricane Sandy...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-04

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Second Allocation of Public Transportation Emergency Relief Funds in Response to Hurricane Sandy: Response, Recovery & Resiliency; Correction... allocation of $3.7 billion under the Public Transportation Emergency Relief Program to the four FTA...

40 CFR 68.95 - Emergency response program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... emergency response plan, which shall be maintained at the stationary source and contain at least the...; and (4) Procedures to review and update, as appropriate, the emergency response plan to reflect... that complies with other Federal contingency plan regulations or is consistent with the approach in the...

40 CFR 68.95 - Emergency response program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... emergency response plan, which shall be maintained at the stationary source and contain at least the...; and (4) Procedures to review and update, as appropriate, the emergency response plan to reflect... that complies with other Federal contingency plan regulations or is consistent with the approach in the...

40 CFR 68.95 - Emergency response program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... emergency response plan, which shall be maintained at the stationary source and contain at least the...; and (4) Procedures to review and update, as appropriate, the emergency response plan to reflect... that complies with other Federal contingency plan regulations or is consistent with the approach in the...

40 CFR 68.95 - Emergency response program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... emergency response plan, which shall be maintained at the stationary source and contain at least the...; and (4) Procedures to review and update, as appropriate, the emergency response plan to reflect... that complies with other Federal contingency plan regulations or is consistent with the approach in the...

40 CFR 68.95 - Emergency response program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... emergency response plan, which shall be maintained at the stationary source and contain at least the...; and (4) Procedures to review and update, as appropriate, the emergency response plan to reflect... that complies with other Federal contingency plan regulations or is consistent with the approach in the...

77 FR 35962 - Utilizing Rapidly Deployable Aerial Communications Architecture in Response to an Emergency

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

... Aerial Communications Architecture in Response to an Emergency AGENCY: Federal Communications Commission... deployable aerial communications architecture (DACA) in facilitating emergency response by rapidly restoring... copying during normal business hours in the FCC Reference Information Center, Portals II, 445 12th Street...

Emergency Preparedness and Response in the School Setting--The Role of the School Nurse. Position Statement

ERIC Educational Resources Information Center

Tuck, Christine M.; Haynie, Kathey; Davis, Catherine

2014-01-01

It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) provides leadership in all phases of emergency preparedness and response. School nurses are a vital part of the school team responsible for developing emergency response procedures for the…

Recommended emergency preparedness guidelines for elderly and disabled rail-transit passengers. Final report, November 1987-March 1989

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hathaway, W.T.; Markos, S.H.; Balog, J.N.

1989-08-01

Rail transit has become an important source of transportation for many elderly and disabled persons. The principal reasons for the increased use are improved accessibility, low cost, and expanded areas of service. For the purposes of the report, 'elderly' is defined as any member of the population who is 60 years of age or older, and 'disabled' is defined as any person who has some type of disability. The Urban Mass Transportation Administration (UMTA) has recognized the need to consider the unique characteristics of elderly and disabled passengers in rail-transit emergency response planning. The needs of these passengers can bemore » addressed through carefully planned emergency response procedures, proper training of transit and emergency-response personnel, and effective use of equipment. The recommendations contained herein are therefore intended to assist rail-transit and emergency response organization personnel in evaluating their emergency response plans in terms of the needs of elderly and disabled passengers and, if necessary, to modify or supplement those plans accordingly. The report is intended to supplement the UMTA publication Recommended Emergency Preparedness Guidelines for Rail Transit Systems. That report contains general guidelines designed to assist rail-transit systems in assessing, developing, documenting, and improving their capabilities for responding to emergencies and in coordinating those efforts with emergency response organizations.« less

Orbit Determination and Navigation of the Time History of Events and Macroscale Interactions during Substorms (THEMIS)

NASA Technical Reports Server (NTRS)

Morinelli, Patrick; Cosgrove, Jennifer; Blizzard, Mike; Robertson, Mike

2007-01-01

This paper provides an overview of the launch and early orbit activities performed by the NASA Goddard Space Flight Center's (GSFC) Flight Dynamics Facility (FDF) in support of five probes comprising the Time History of Events and Macroscale Interactions during Substorms (THEMIS) spacecraft. The FDF was tasked to support THEMIS in a limited capacity providing backup orbit determination support for validation purposes for all five THEMIS probes during launch plus 30 days in coordination with University of California Berkeley Flight Dynamics Center (UCB/FDC)2. The FDF's orbit determination responsibilities were originally planned to be as a backup to the UCB/FDC for validation purposes only. However, various challenges early on in the mission and a Spacecraft Emergency declared thirty hours after launch placed the FDF team in the role of providing the orbit solutions that enabled contact with each of the probes and the eventual termination of the Spacecraft Emergency. This paper details the challenges and various techniques used by the GSFC FDF team to successfully perform orbit determination for all five THEMIS probes during the early mission. In addition, actual THEMIS orbit determination results are presented spanning the launch and early orbit mission phase. Lastly, this paper enumerates lessons learned from the THEMIS mission, as well as demonstrates the broad range of resources and capabilities within the FDF for supporting critical launch and early orbit navigation activities, especially challenging for constellation missions.

Orbit Determination and Navigation of the Time History of Events and Macroscale Interactions during Substorms (THEMIS)

NASA Technical Reports Server (NTRS)

Morinelli, Patrick; Cosgrove, jennifer; Blizzard, Mike; Nicholson, Ann; Robertson, Mika

2007-01-01

This paper provides an overview of the launch and early orbit activities performed by the NASA Goddard Space Flight Center's (GSFC) Flight Dynamics Facility (FDF) in support of five probes comprising the Time History of Events and Macroscale Interactions during Substorms (THEMIS) spacecraft. The FDF was tasked to support THEMIS in a limited capacity providing backup orbit determination support for validation purposes for all five THEMIS probes during launch plus 30 days in coordination with University of California Berkeley Flight Dynamics Center (UCB/FDC). The FDF's orbit determination responsibilities were originally planned to be as a backup to the UCB/FDC for validation purposes only. However, various challenges early on in the mission and a Spacecraft Emergency declared thirty hours after launch placed the FDF team in the role of providing the orbit solutions that enabled contact with each of the probes and the eventual termination of the Spacecraft Emergency. This paper details the challenges and various techniques used by the GSFC FDF team to successfully perform orbit determination for all five THEMIS probes during the early mission. In addition, actual THEMIS orbit determination results are presented spanning the launch and early orbit mission phase. Lastly, this paper enumerates lessons learned from the THEMIS mission, as well as demonstrates the broad range of resources and capabilities within the FDF for supporting critical launch and early orbit navigation activities, especially challenging for constellation missions.

Validation of a Framework for Measuring Hospital Disaster Resilience Using Factor Analysis

PubMed Central

Zhong, Shuang; Clark, Michele; Hou, Xiang-Yu; Zang, Yuli; FitzGerald, Gerard

2014-01-01

Hospital disaster resilience can be defined as “the ability of hospitals to resist, absorb, and respond to the shock of disasters while maintaining and surging essential health services, and then to recover to its original state or adapt to a new one.” This article aims to provide a framework which can be used to comprehensively measure hospital disaster resilience. An evaluation framework for assessing hospital resilience was initially proposed through a systematic literature review and Modified-Delphi consultation. Eight key domains were identified: hospital safety, command, communication and cooperation system, disaster plan, resource stockpile, staff capability, disaster training and drills, emergency services and surge capability, and recovery and adaptation. The data for this study were collected from 41 tertiary hospitals in Shandong Province in China, using a specially designed questionnaire. Factor analysis was conducted to determine the underpinning structure of the framework. It identified a four-factor structure of hospital resilience, namely, emergency medical response capability (F1), disaster management mechanisms (F2), hospital infrastructural safety (F3), and disaster resources (F4). These factors displayed good internal consistency. The overall level of hospital disaster resilience (F) was calculated using the scoring model: F = 0.615F1 + 0.202F2 + 0.103F3 + 0.080F4. This validated framework provides a new way to operationalise the concept of hospital resilience, and it is also a foundation for the further development of the measurement instrument in future studies. PMID:24945190

10 CFR 850.33 - Beryllium emergencies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Beryllium emergencies. (a) The responsible employer must comply with 29 CFR 1910.120(l) for handling beryllium emergencies related to decontamination and decommissioning operations. (b) The responsible employer must comply with 29 CFR 1910.120(q) for handling beryllium emergencies related to all other...

10 CFR 76.91 - Emergency planning.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... The Corporation shall establish, maintain, and be prepared to follow a written emergency plan. The emergency plan submitted under § 76.35(f) must include the following information: (a) Plant description. A... responsibilities of all individuals supporting emergency response should an accident occur, including...

10 CFR 76.91 - Emergency planning.

Code of Federal Regulations, 2012 CFR

2012-01-01

.... The Corporation shall establish, maintain, and be prepared to follow a written emergency plan. The emergency plan submitted under § 76.35(f) must include the following information: (a) Plant description. A... responsibilities of all individuals supporting emergency response should an accident occur, including...

Smart Growth Streets and Emergency Response

EPA Pesticide Factsheets

This page describes how street networks and street design affect emergency response and links to resources for designing streets that work for emergency responders and communities' smart growth goals.

A Novel Tool for Assessment of Emergency Medicine Resident Skill in Determining Diagnosis and Management for Emergent Electrocardiograms: A Multicenter Study.

PubMed

Hartman, Nicholas D; Wheaton, Natasha B; Williamson, Kelly; Quattromani, Erin N; Branzetti, Jeremy B; Aldeen, Amer Z

2016-12-01

Reading emergent electrocardiograms (ECGs) is one of the emergency physician's most crucial tasks, yet no well-validated tool exists to measure resident competence in this skill. To assess validity of a novel tool measuring emergency medicine resident competency for interpreting, and responding to, critical ECGs. In addition, we aim to observe trends in this skill for resident physicians at different levels of training. This is a multi-center, prospective study of postgraduate year (PGY) 1-4 residents at five emergency medicine (EM) residency programs in the United States. An assessment tool was created that asks the physician to identify either the ECG diagnosis or the best immediate management. One hundred thirteen EM residents from five EM residency programs submitted completed assessment surveys, including 43 PGY-1s, 33 PGY-2s, and 37 PGY-3/4s. PGY-3/4s averaged 74.6% correct (95% confidence interval [CI] 70.9-78.4) and performed significantly better than PGY-1s, who averaged 63.2% correct (95% CI 58.0-68.3). PGY-2s averaged 69.0% (95% CI 62.2-73.7). Year-to-year differences were more pronounced in management than in diagnosis. Residency training in EM seems to be associated with improved ability to interpret "critical" ECGs as measured by our assessment tool. This lends validity evidence for the tool by correlating with a previously observed association between residency training and improved ECG interpretation. Resident skill in ECG interpretation remains less than ideal. Creation of this sort of tool may allow programs to assess resident performance as well as evaluate interventions designed to improve competency. Copyright © 2016 Elsevier Inc. All rights reserved.

Moderate sensitivity and high specificity of emergency department administrative data for transient ischemic attacks.

PubMed

Yu, Amy Y X; Quan, Hude; McRae, Andrew; Wagner, Gabrielle O; Hill, Michael D; Coutts, Shelagh B

2017-09-18

Validation of administrative data case definitions is key for accurate passive surveillance of disease. Transient ischemic attack (TIA) is a condition primarily managed in the emergency department. However, prior validation studies have focused on data after inpatient hospitalization. We aimed to determine the validity of the Canadian 10th International Classification of Diseases (ICD-10-CA) codes for TIA in the national ambulatory administrative database. We performed a diagnostic accuracy study of four ICD-10-CA case definition algorithms for TIA in the emergency department setting. The study population was obtained from two ongoing studies on the diagnosis of TIA and minor stroke versus stroke mimic using serum biomarkers and neuroimaging. Two reference standards were used 1) the emergency department clinical diagnosis determined by chart abstractors and 2) the 90-day final diagnosis, both obtained by stroke neurologists, to calculate the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the ICD-10-CA algorithms for TIA. Among 417 patients, emergency department adjudication showed 163 (39.1%) TIA, 155 (37.2%) ischemic strokes, and 99 (23.7%) stroke mimics. The most restrictive algorithm, defined as a TIA code in the main position had the lowest sensitivity (36.8%), but highest specificity (92.5%) and PPV (76.0%). The most inclusive algorithm, defined as a TIA code in any position with and without query prefix had the highest sensitivity (63.8%), but lowest specificity (81.5%) and PPV (68.9%). Sensitivity, specificity, PPV, and NPV were overall lower when using the 90-day diagnosis as reference standard. Emergency department administrative data reflect diagnosis of suspected TIA with high specificity, but underestimate the burden of disease. Future studies are necessary to understand the reasons for the low to moderate sensitivity.

40 CFR 266.204 - Standards applicable to emergency responses.

Code of Federal Regulations, 2013 CFR

2013-07-01

... HAZARDOUS WASTE MANAGEMENT FACILITIES Military Munitions § 266.204 Standards applicable to emergency responses. Explosives and munitions emergencies involving military munitions or explosives are subject to 40...

40 CFR 266.204 - Standards applicable to emergency responses.

Code of Federal Regulations, 2012 CFR

2012-07-01

... HAZARDOUS WASTE MANAGEMENT FACILITIES Military Munitions § 266.204 Standards applicable to emergency responses. Explosives and munitions emergencies involving military munitions or explosives are subject to 40...

49 CFR 1.69 - Delegations to the Director of Intelligence, Security, and Emergency Response.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Delegations to the Director of Intelligence... Intelligence, Security, and Emergency Response. The Director of Intelligence, Security, and Emergency Response is delegated authority for the following: (a) Intelligence and Security. Carry out the functions...

49 CFR 1.69 - Delegations to the Director of Intelligence, Security, and Emergency Response.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false Delegations to the Director of Intelligence... Intelligence, Security, and Emergency Response. The Director of Intelligence, Security, and Emergency Response is delegated authority for the following: (a) Intelligence and Security. Carry out the functions...

44 CFR 72.4 - Submittal/payment procedures and FEMA response.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Submittal/payment procedures and FEMA response. 72.4 Section 72.4 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... PROCEDURES AND FEES FOR PROCESSING MAP CHANGES § 72.4 Submittal/payment procedures and FEMA response. (a) The...

30 CFR 75.1507 - Emergency Response Plan; refuge alternatives.

Code of Federal Regulations, 2011 CFR

2011-07-01

....1507 Emergency Response Plan; refuge alternatives. (a) The Emergency Response Plan (ERP) shall include... request and the District Manager may approve an alternative location in the ERP if mining involves two... constructed prior to an event in a secure space and an isolated atmosphere, the ERP shall specify that— (1...

44 CFR 72.4 - Submittal/payment procedures and FEMA response.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Submittal/payment procedures and FEMA response. 72.4 Section 72.4 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... PROCEDURES AND FEES FOR PROCESSING MAP CHANGES § 72.4 Submittal/payment procedures and FEMA response. (a) The...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

The Drawdown and Distribution Management Manual (DDMM) provides a comprehensive guide to the planning, preparation, and operational processes associated with an SPR system response to an energy emergency. Although parts of the process may be unique to a particular situation, the manual describes the end-to-end continuity of the response by including those activities that would be common to most situations. This manual follows DOE policy contained in DOE Office of Energy Emergencies (OEE) documents that define comprehensive DOE energy emergency response procedures, currently known as the Energy Emergency Response Management System (EERMS). 6 refs.

Crisis Resources for Emergency Workers (CREW II): results of a pilot study and simulation-based crisis resource management course for emergency medicine residents.

PubMed

Hicks, Christopher M; Kiss, Alex; Bandiera, Glen W; Denny, Christopher J

2012-11-01

Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviation-based crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of "Crisis Resources for Emergency Workers" (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents. Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and postcourse simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS). Postcourse survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a nonsignificant trend toward improved team-based attitudes as assessed by the HFAS (p  =  0.210). Postcourse performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p  =  0.16). EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size.

Summaries of Research - Fiscal Year 1985.

DTIC Science & Technology

1986-01-01

emergencies, not trauma-related, 2) diagnosis of dental emergencies, trauma-related, 3) differential diagnosis of soft tissue lesions, 4) definitions of terms...on 49 different soft tissue lesions. Preliminary validation was accomplished by a variety of dentists who input over 200 simulated emergencies. The...non-specific opsonin, that promotes adhesion of fibroblasts to collagen, and influences the attachment of bacteria to soft tissues . As a first step

GYM score: 30-day mortality predictive model in elderly patients attended in the emergency department with infection.

PubMed

González Del Castillo, Juan; Escobar-Curbelo, Luis; Martínez-Ortíz de Zárate, Mikel; Llopis-Roca, Ferrán; García-Lamberechts, Jorge; Moreno-Cuervo, Álvaro; Fernández, Cristina; Martín-Sánchez, Francisco Javier

2017-06-01

To determine the validity of the classic sepsis criteria or systemic inflammatory response syndrome (heart rate, respiratory rate, temperature, and leukocyte count) and the modified sepsis criteria (systemic inflammatory response syndrome criteria plus glycemia and altered mental status), and the validity of each of these variables individually to predict 30-day mortality, as well as develop a predictive model of 30-day mortality in elderly patients attended for infection in emergency departments (ED). A prospective cohort study including patients at least 75 years old attended in three Spanish university ED for infection during 2013 was carried out. Demographic variables and data on comorbidities, functional status, hemodynamic sepsis diagnosis variables, site of infection, and 30-day mortality were collected. A total of 293 patients were finally included, mean age 84.0 (SD 5.5) years, and 158 (53.9%) were men. Overall, 185 patients (64%) fulfilled the classic sepsis criteria and 224 patients (76.5%) fulfilled the modified sepsis criteria. The all-cause 30-day mortality was 13.0%. The area under the curve of the classic sepsis criteria was 0.585 [95% confidence interval (CI) 0.488-0.681; P=0.106], 0.594 for modified sepsis criteria (95% CI: 0.502-0.685; P=0.075), and 0.751 (95% CI: 0.660-0.841; P<0.001) for the GYM score (Glasgow <15; tachYpnea>20 bpm; Morbidity-Charlson index ≥3) to predict 30-day mortality, with statistically significant differences (P=0.004 and P<0.001, respectively). The GYM score showed good calibration after bootstrap correction, with an area under the curve of 0.710 (95% CI: 0.605-0.815). The GYM score showed better capacity than the classic and the modified sepsis criteria to predict 30-day mortality in elderly patients attended for infection in the ED.

Survey and online discussion groups to develop a patient-rated outcome measure on acceptability of treatment response in vitiligo

PubMed Central

2014-01-01

Background Vitiligo is a chronic depigmenting skin disorder which affects around 0.5-1% of the world’s population. The outcome measures used most commonly in trials to judge treatment success focus on repigmentation. Patient-reported outcome measures of treatment success are rarely used, although recommendations have been made for their inclusion in vitiligo trials. This study aimed to evaluate the face validity of a new patient-reported outcome measure of treatment response, for use in future trials and clinical practice. Method An online survey to gather initial views on what constitutes treatment success for people with vitiligo or their parents/carers, followed by online discussion groups with patients to reach consensus on what constitutes treatment success for individuals with vitiligo, and how this can be assessed in the context of trials. Participants were recruited from an existing database of vitiligo patients and through posts on the social network sites Facebook and Twitter. Results A total of 202 survey responses were received, of which 37 were excluded and 165 analysed. Three main themes emerged as important in assessing treatment response: a) the match between vitiligo and normal skin (how well it blends in); b) how noticeable the vitiligo is and c) a reduction in the size of the white patches. The majority of respondents said they would consider 80% or more repigmentation to be a worthwhile treatment response after 9 months of treatment. Three online discussion groups involving 12 participants led to consensus that treatment success is best measured by asking patients how noticeable their vitiligo is after treatment. This was judged to be best answered using a 5-point Likert scale, on which a score of 4 or 5 represents treatment success. Conclusions This study represents the first step in developing a patient reported measure of treatment success in vitiligo trials. Further work is now needed to assess its construct validity and responsiveness to change. PMID:24929563

[ASO-TSO, emergency interventions: has anything changed? Old and new psychiatrist's professional responsibilities].

PubMed

Carabellese, Felice; Taratufolo, Rosa; Candelli, Chiara; Grattagliano, Ignazio; La Tegola, Donatella

2012-01-01

The Law 833 of 1978 on the subject of psychiatric emergency treatments in absence of consensus has contributed to grant mental patients equal guaranties and equal constitutional rights which, until that moment, they had been denied. This standpoint includes TSO in favor of mental patients. Ordered by the constitutional laws which guarantee a person's inviolable rights, TSO finds itself positioned between individual freedom and the freedom of treatment on the one hand, and the right to safeguard health on the other hand. The procedure of TSO is noticeable in its various phases so as to provide for the various levels of safeguarding a person who is temporarily deprived of the capacity to express valid consensus. On the other side it also has a certain amount of flexibility in its application, which guarantees adaptability of the norm in various contexts and various incidental situations. Nevertheless, the complexity of the law on TSO, as well as the interpretation margins of the procedure have contributed to the creation of an application frame which is not free of criticism. In this context, the recommendations of the Conference of Regions and Autonomous Provinces have particular importance. These recommendations deserve careful analysis, both for the presence of elements of novelty (in the very particular cases of TSO for children under 18 and TSO for decisionally impaired subjects) and for the reminder of the full application of "non-hospitalized TSO". The latter was provided for in Law 833/78 but has never been adequately and completely adopted because it has never been explained in its concrete applicability. Therefore, bearing in mind the already known responsibility of a psychiatrist in an emergency case, and with renewed interest in new medical performance a psychiatrist of public service has to guarantee, we are preparing to give our contribution on the subject of professional obligations at a historical moment in which known trials seem to assign the responsibility for the "dangerousness" of a mental patient to the psychiatrist.

Validation of the German version of the insomnia severity index in adolescents, young adults and adult workers: results from three cross-sectional studies.

PubMed

Gerber, Markus; Lang, Christin; Lemola, Sakari; Colledge, Flora; Kalak, Nadeem; Holsboer-Trachsler, Edith; Pühse, Uwe; Brand, Serge

2016-05-31

A variety of objective and subjective methods exist to assess insomnia. The Insomnia Severity Index (ISI) was developed to provide a brief self-report instrument useful to assess people's perception of sleep complaints. The ISI was developed in English, and has been translated into several languages including German. Surprisingly, the psychometric properties of the German version have not been evaluated, although the ISI is often used with German-speaking populations. The psychometric properties of the ISI are tested in three independent samples: 1475 adolescents, 862 university students, and 533 police and emergency response service officers. In all three studies, participants provide information about insomnia (ISI), sleep quality (Pittsburgh Sleep Quality Index), and psychological functioning (diverse instruments). Descriptive statistics, gender differences, homogeneity and internal consistency, convergent validity, and factorial validity (including measurement invariance across genders) are examined in each sample. The findings show that the German version of the ISI has generally acceptable psychometric properties and sufficient concurrent validity. Confirmatory factor analyses show that a 1-factor solution achieves good model fit. Furthermore, measurement invariance across gender is supported in all three samples. While the ISI has been widely used in German-speaking countries, this study is the first to provide empirical evidence that the German version of this instrument has good psychometric properties and satisfactory convergent and factorial validity across various age groups and both men and women. Thus, the German version of the ISI can be recommended as a brief screening measure in German-speaking populations.

Validation of the alcohol use item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS).

PubMed

Pilkonis, Paul A; Yu, Lan; Dodds, Nathan E; Johnston, Kelly L; Lawrence, Suzanne M; Daley, Dennis C

2016-04-01

The Patient-Reported Outcomes Measurement Information System (PROMIS) includes five item banks for alcohol use. There are limited data, however, regarding their validity (e.g., convergent validity, responsiveness to change). To provide such data, we conducted a prospective study with 225 outpatients being treated for substance abuse. Assessments were completed shortly after intake and at 1-month and 3-month follow-ups. The alcohol item banks were administered as computerized adaptive tests (CATs). Fourteen CATs and one six-item short form were also administered from eight other PROMIS domains to generate a comprehensive health status profile. After modeling treatment outcome for the sample as a whole, correlates of outcome from the PROMIS health status profile were examined. For convergent validity, the largest correlation emerged between the PROMIS alcohol use score and the Alcohol Use Disorders Identification Test (r=.79 at intake). Regarding treatment outcome, there were modest changes across the target problem of alcohol use and other domains of the PROMIS health status profile. However, significant heterogeneity was found in initial severity of drinking and in rates of change for both abstinence and severity of drinking during follow-up. This heterogeneity was associated with demographic (e.g., gender) and health-profile (e.g., emotional support, social participation) variables. The results demonstrated the validity of PROMIS CATs, which require only 4-6 items in each domain. This efficiency makes it feasible to use a comprehensive health status profile within the substance use treatment setting, providing important prognostic information regarding abstinence and severity of drinking. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The DSM-5 Trait Measure in a Psychiatric Sample of Late Adolescents and Emerging Adults: Structure, Reliability, and Validity.

PubMed

De Caluwé, Elien; Verbeke, Lize; van Aken, Marcel; van der Heijden, Paul T; De Clercq, Barbara

2018-02-22

The inclusion of a dimensional trait model of personality pathology in DSM-5 creates new opportunities for research on developmental antecedents of personality pathology. The traits of this model can be measured with the Personality Inventory for DSM-5 (PID-5), initially developed for adults, but also demonstrating validity in adolescents. The present study adds to the growing body of literature on the psychometrics of the PID-5, by examining its structure, validity, and reliability in 187 psychiatric-referred late adolescents and emerging adults. PID-5, Big Five Inventory, and Kidscreen self-reports were provided, and 88 non-clinical matched controls completed the PID-5. Results confirm the PID-5's five-factor structure, indicate adequate psychometric properties, and underscore the construct and criterion validity, showing meaningful associations with adaptive traits and quality of life. Results are discussed in terms of the PID-5's applicability in vulnerable populations who are going through important developmental transition phases, such as the step towards early adulthood.

ALS Biomarkers for Therapy Development: State of the Field & Future Directions

PubMed Central

Benatar, Michael; Boylan, Kevin; Jeromin, Andreas; Rutkove, Seward B.; Berry, James; Atassi, Nazem; Bruijn, Lucie

2015-01-01

Biomarkers have become the focus of intense research in the field of amyotrophic lateral sclerosis (ALS), with the hope that they might aid therapy development efforts. Notwithstanding the discovery of many candidate biomarkers, none have yet emerged as validated tools for drug development. In this review we present a nuanced view of biomarkers based on the perspective of the FDA; highlight the distinction between discovery and validation; describe existing and emerging resources; review leading biological fluid-based, electrophysiological and neuroimaging candidates relevant to therapy development efforts; discuss lessons learned from biomarker initiatives in related neurodegenerative diseases; and outline specific steps that we, as a field, might take in order to hasten the development and validation of biomarkers that will prove useful in enhancing efforts to develop effective treatments for ALS patients. Most important among these perhaps is the proposal to establish a federated ALS Biomarker Consortium (ABC) in which all interested and willing stakeholders may participate with equal opportunity to contribute to the broader mission of biomarker development and validation. PMID:26574709

The German Version of the Manchester Triage System and Its Quality Criteria – First Assessment of Validity and Reliability

PubMed Central

Gräff, Ingo; Goldschmidt, Bernd; Glien, Procula; Bogdanow, Manuela; Fimmers, Rolf; Hoeft, Andreas; Kim, Se-Chan; Grigutsch, Daniel

2014-01-01

Background The German Version of the Manchester Triage System (MTS) has found widespread use in EDs across German-speaking Europe. Studies about the quality criteria validity and reliability of the MTS currently only exist for the English-language version. Most importantly, the content of the German version differs from the English version with respect to presentation diagrams and change indicators, which have a significant impact on the category assigned. This investigation offers a preliminary assessment in terms of validity and inter-rater reliability of the German MTS. Methods Construct validity of assigned MTS level was assessed based on comparisons to hospitalization (general / intensive care), mortality, ED and hospital length of stay, level of prehospital care and number of invasive diagnostics. A sample of 45,469 patients was used. Inter-rater agreement between an expert and triage nurses (reliability) was calculated separately for a subset group of 167 emergency patients. Results For general hospital admission the area under the curve (AUC) of the receiver operating characteristic was 0.749; for admission to ICU it was 0.871. An examination of MTS-level and number of deceased patients showed that the higher the priority derived from MTS, the higher the number of deaths (p<0.0001 / χ2 Test). There was a substantial difference in the 30-day survival among the 5 MTS categories (p<0.0001 / log-rank test).The AUC for the predict 30-day mortality was 0.613. Categories orange and red had the highest numbers of heart catheter and endoscopy. Category red and orange were mostly accompanied by an emergency physician, whereas categories blue and green were walk-in patients. Inter-rater agreement between expert triage nurses was almost perfect (κ = 0.954). Conclusion The German version of the MTS is a reliable and valid instrument for a first assessment of emergency patients in the emergency department. PMID:24586477

Educating First Responders to Provide Emergency Services to Individuals with Disabilities

PubMed Central

Wolf-Fordham, Susan B.; Twyman, Janet S.; Hamad, Charles D.

2015-01-01

Objective Individuals with disabilities experience more negative outcomes due to natural and manmade disasters and emergencies than do people without disabilities. This vulnerability appears due in part to knowledge gaps among public health and safety emergency planning and response personnel (responders). The research assessed the effectiveness of an online program to increase emergency responder knowledge about emergency planning and response for individuals with disabilities. Method Researchers developed an online course designed to teach public health, emergency planning/management and other first response personnel about appropriate, efficient and equitable emergency planning, response, interaction and communication with children and adults with disabilities before, during and after disasters or emergencies. Course features include an ongoing storyline, exercises embedded in the form of “real life” scenarios, and game-like features such as points and timed segments. Results Evaluation measures indicated significant pre- to post-test gains in learner knowledge and simulated applied skills. Conclusion An online program using scenarios and simulations is an effective means to make disability-related training available to a wide variety of emergency responders across geographically disparate areas. PMID:25859692

Screening adolescents in the emergency department for weapon carriage.

PubMed

Cunningham, Rebecca M; Resko, Stella M; Harrison, Stephanie Roahen; Zimmerman, Marc; Stanley, Rachel; Chermack, Stephen T; Walton, Maureen A

2010-02-01

The objective was to describe the prevalence and correlates of past-year weapon involvement among adolescents seeking care in an inner-city emergency department (ED). This cross-sectional study administered a computerized survey to all eligible adolescents (age 14-18 years), 7 days a week, who were seeking care over an 18-month period at an inner-city Level 1 ED. Validated measures were administered, including measures of demographics, sexual activity, substance use, injury, violent behavior, weapon carriage, and/or weapon use. Zero-inflated Poisson (ZIP) regression models were used to identify correlates of the occurrence and past-year frequency of these weapons variables. Adolescents (n = 2069, 86% response rate) completed the computerized survey. Fifty-five percent were female; 56.5% were African American. In the past year, 20% of adolescents reported knife or razor carriage, 7% reported gun carriage, and 6% pulled a knife or gun on someone. Although gun carriage was more frequent among males, females were as likely to carry a knife or pull a weapon in the past year. One-fifth of all adolescents seeking care in this inner-city ED have carried a weapon. Understanding weapon carriage among teens seeking ED care is a critical first step to future ED-based injury prevention initiatives. (c) 2010 by the Society for Academic Emergency Medicine.

Assessing Emergency Preparedness and Response Capacity Using Community Assessment for Public Health Emergency Response Methodology: Portsmouth, Virginia, 2013.

PubMed

Kurkjian, Katie M; Winz, Michelle; Yang, Jun; Corvese, Kate; Colón, Ana; Levine, Seth J; Mullen, Jessica; Ruth, Donna; Anson-Dwamena, Rexford; Bayleyegn, Tesfaye; Chang, David S

2016-04-01

For the past decade, emergency preparedness campaigns have encouraged households to meet preparedness metrics, such as having a household evacuation plan and emergency supplies of food, water, and medication. To estimate current household preparedness levels and to enhance disaster response planning, the Virginia Department of Health with remote technical assistance from the Centers for Disease Control and Prevention conducted a community health assessment in 2013 in Portsmouth, Virginia. Using the Community Assessment for Public Health Emergency Response (CASPER) methodology with 2-stage cluster sampling, we randomly selected 210 households for in-person interviews. Households were questioned about emergency planning and supplies, information sources during emergencies, and chronic health conditions. Interview teams completed 180 interviews (86%). Interviews revealed that 70% of households had an emergency evacuation plan, 67% had a 3-day supply of water for each member, and 77% had a first aid kit. Most households (65%) reported that the television was the primary source of information during an emergency. Heart disease (54%) and obesity (40%) were the most frequently reported chronic conditions. The Virginia Department of Health identified important gaps in local household preparedness. Data from the assessment have been used to inform community health partners, enhance disaster response planning, set community health priorities, and influence Portsmouth's Community Health Improvement Plan.

44 CFR 352.26 - Arrangements for Federal response in the licensee offsite emergency response plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS COMMERCIAL NUCLEAR POWER PLANTS: EMERGENCY PREPAREDNESS PLANNING Federal Participation § 352.26 Arrangements for... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Arrangements for Federal...

WHO-REMPAN for global health security and strengthening preparedness and response to radiation emergencies.

PubMed

Carr, Zhanat

2010-06-01

In response to the changing global environment and emerging new issues related to health security, the World Health Organization (WHO) is putting in place new tools for collective defense, such as the revised International Health Regulations (IHR) (2005). The new framework puts additional responsibilities on both Member States and WHO itself in order to effectively implement the IHR (2005) and react effectively in case of public health emergency events of any nature. Since its establishment in 1987, the Radiation Emergency Medical Preparedness and Assistance Network of WHO (WHO-REMPAN) has become an important asset for the organization's capacity to respond to radiation emergencies and to assist its Member States to strengthen their own response capacities. The paper describes in detail the framework for the WHO's role in preparedness and response to radiation emergencies, including Emergency Conventions and IHR (2005), and how the WHO-REMPAN, through its activities (i.e., technical guidelines development, training, education, research, and information sharing), provides a significant contribution to the organization's program of work towards achievement of the global health security goal.

A Hybrid Demand Response Simulator Version 1.0

DOE Office of Scientific and Technical Information (OSTI.GOV)

2012-05-02

A hybrid demand response simulator is developed to test different control algorithms for centralized and distributed demand response (DR) programs in a small distribution power grid. The HDRS is designed to model a wide variety of DR services such as peak having, load shifting, arbitrage, spinning reserves, load following, regulation, emergency load shedding, etc. The HDRS does not model the dynamic behaviors of the loads, rather, it simulates the load scheduling and dispatch process. The load models include TCAs (water heaters, air conditioners, refrigerators, freezers, etc) and non-TCAs (lighting, washer, dishwasher, etc.) The ambient temperature changes, thermal resistance, capacitance, andmore » the unit control logics can be modeled for TCA loads. The use patterns of the non-TCA can be modeled by probability of use and probabilistic durations. Some of the communication network characteristics, such as delays and errors, can also be modeled. Most importantly, because the simulator is modular and greatly simplified the thermal models for TCA loads, it is very easy and fast to be used to test and validate different control algorithms in a simulated environment.« less

Emerging biomarkers in breast cancer care.

PubMed

Napieralski, Rudolf; Brünner, Nils; Mengele, Karin; Schmitt, Manfred

2010-08-01

Currently, decision-making for breast cancer treatment in the clinical setting is mainly based on clinical data, histomorphological features of the tumor tissue and a few cancer biomarkers such as steroid hormone receptor status (estrogen and progesterone receptors) and oncoprotein HER2 status. Although various therapeutic options were introduced into the clinic in recent decades, with the objective of improving surgery, radiotherapy, biochemotherapy and chemotherapy, varying response of individual patients to certain types of therapy and therapy resistance is still a challenge in breast cancer care. Therefore, since breast cancer treatment should be based on individual features of the patient and her tumor, tailored therapy should be an option by integrating cancer biomarkers to define patients at risk and to reliably predict their course of the disease and/or response to cancer therapy. Recently, candidate-marker approaches and genome-wide transcriptomic and epigenetic screening of different breast cancer tissues and bodily fluids resulted in new promising biomarker panels, allowing breast cancer prognosis, prediction of therapy response and monitoring of therapy efficacy. These biomarkers are now subject of validation in prospective clinical trials.

Electronic Reporting and Signature under EPCRA Section 312

EPA Pesticide Factsheets

This memorandum provides guidance for State Emergency Response Commissions, Tribal Emergency Response Commissions, and local governments regarding electronic reporting and signature under the Emergency Planning and Community Right-to-Know Act.

High wavenumber Raman spectroscopy in the characterization of urinary metabolites of normal subjects, oral premalignant and malignant patients

NASA Astrophysics Data System (ADS)

Brindha, Elumalai; Rajasekaran, Ramu; Aruna, Prakasarao; Koteeswaran, Dornadula; Ganesan, Singaravelu

2017-01-01

Urine has emerged as one of the diagnostically potential bio fluids, as it has many metabolites. As the concentration and the physiochemical properties of the urinary metabolites may vary under pathological transformation, Raman spectroscopic characterization of urine has been exploited as a significant tool in identifying several diseased conditions, including cancers. In the present study, an attempt was made to study the high wavenumber (HWVN) Raman spectroscopic characterization of urine samples of normal subjects, oral premalignant and malignant patients. It is concluded that the urinary metabolites flavoproteins, tryptophan and phenylalanine are responsible for the observed spectral variations between the normal and abnormal groups. Principal component analysis-based linear discriminant analysis was carried out to verify the diagnostic potentiality of the present technique. The discriminant analysis performed across normal and oral premalignant subjects classifies 95.6% of the original and 94.9% of the cross-validated grouped cases correctly. In the second analysis performed across normal and oral malignant groups, the accuracy of the original and cross-validated grouped cases was 96.4% and 92.1% respectively. Similarly, the third analysis performed across three groups, normal, oral premalignant and malignant groups, classifies 93.3% and 91.2% of the original and cross-validated grouped cases correctly.

A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST).

PubMed

Babl, Franz E; Lyttle, Mark D; Bressan, Silvia; Borland, Meredith; Phillips, Natalie; Kochar, Amit; Dalziel, Stuart R; Dalton, Sarah; Cheek, John A; Furyk, Jeremy; Gilhotra, Yuri; Neutze, Jocelyn; Ward, Brenton; Donath, Susan; Jachno, Kim; Crowe, Louise; Williams, Amanda; Oakley, Ed

2014-06-13

Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting. This study is a prospective observational study of children aged 0 to less than 18 years presenting to 10 emergency departments within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network in Australia and New Zealand after head injuries of any severity. Predictor variables identified in CATCH, CHALICE and PECARN clinical decision rules will be collected. Patients will be managed as per the treating clinicians at the participating hospitals. All patients not undergoing cranial CT will receive a follow up call 14 to 90 days after the injury. Outcome data collected will include results of cranial CTs (if performed) and details of admission, intubation, neurosurgery and death. The performance accuracy of each of the rules will be assessed using rule specific outcomes and inclusion and exclusion criteria. This study will allow the simultaneous comparative application and validation of three major paediatric head injury clinical decision rules outside their derivation setting. The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR)- ACTRN12614000463673 (registered 2 May 2014).

Model-Based Analysis of Cell Cycle Responses to Dynamically Changing Environments

PubMed Central

Seaton, Daniel D; Krishnan, J

2016-01-01

Cell cycle progression is carefully coordinated with a cell’s intra- and extracellular environment. While some pathways have been identified that communicate information from the environment to the cell cycle, a systematic understanding of how this information is dynamically processed is lacking. We address this by performing dynamic sensitivity analysis of three mathematical models of the cell cycle in Saccharomyces cerevisiae. We demonstrate that these models make broadly consistent qualitative predictions about cell cycle progression under dynamically changing conditions. For example, it is shown that the models predict anticorrelated changes in cell size and cell cycle duration under different environments independently of the growth rate. This prediction is validated by comparison to available literature data. Other consistent patterns emerge, such as widespread nonmonotonic changes in cell size down generations in response to parameter changes. We extend our analysis by investigating glucose signalling to the cell cycle, showing that known regulation of Cln3 translation and Cln1,2 transcription by glucose is sufficient to explain the experimentally observed changes in cell cycle dynamics at different glucose concentrations. Together, these results provide a framework for understanding the complex responses the cell cycle is capable of producing in response to dynamic environments. PMID:26741131

Recursive Fury: Conspiracist Ideation in the Blogosphere in Response to Research on Conspiracist Ideation

PubMed Central

Lewandowsky, Stephan; Cook, John; Oberauer, Klaus; Marriott, Michael

2013-01-01

Conspiracist ideation has been repeatedly implicated in the rejection of scientific propositions, although empirical evidence to date has been sparse. A recent study involving visitors to climate blogs found that conspiracist ideation was associated with the rejection of climate science and the rejection of other scientific propositions such as the link between lung cancer and smoking, and between HIV and AIDS (Lewandowsky et al., in press; LOG12 from here on). This article analyses the response of the climate blogosphere to the publication of LOG12. We identify and trace the hypotheses that emerged in response to LOG12 and that questioned the validity of the paper’s conclusions. Using established criteria to identify conspiracist ideation, we show that many of the hypotheses exhibited conspiratorial content and counterfactual thinking. For example, whereas hypotheses were initially narrowly focused on LOG12, some ultimately grew in scope to include actors beyond the authors of LOG12, such as university executives, a media organization, and the Australian government. The overall pattern of the blogosphere’s response to LOG12 illustrates the possible role of conspiracist ideation in the rejection of science, although alternative scholarly interpretations may be advanced in the future. PMID:23508808

42 CFR 493.565 - Selection for validation inspection-laboratory responsibilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Selection for validation inspection-laboratory... Program § 493.565 Selection for validation inspection—laboratory responsibilities. A laboratory selected for a validation inspection must do the following: (a) Authorize its accreditation organization or...

42 CFR 493.565 - Selection for validation inspection-laboratory responsibilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Selection for validation inspection-laboratory... Program § 493.565 Selection for validation inspection—laboratory responsibilities. A laboratory selected for a validation inspection must do the following: (a) Authorize its accreditation organization or...

42 CFR 493.565 - Selection for validation inspection-laboratory responsibilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Selection for validation inspection-laboratory... Program § 493.565 Selection for validation inspection—laboratory responsibilities. A laboratory selected for a validation inspection must do the following: (a) Authorize its accreditation organization or...

42 CFR 493.565 - Selection for validation inspection-laboratory responsibilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Selection for validation inspection-laboratory... Program § 493.565 Selection for validation inspection—laboratory responsibilities. A laboratory selected for a validation inspection must do the following: (a) Authorize its accreditation organization or...

42 CFR 493.565 - Selection for validation inspection-laboratory responsibilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Selection for validation inspection-laboratory... Program § 493.565 Selection for validation inspection—laboratory responsibilities. A laboratory selected for a validation inspection must do the following: (a) Authorize its accreditation organization or...

Public health emergencies and responses: what are they, how long do they last, and how many staff does your agency need?

PubMed

Posid, Joseph M; Bruce, Sherrie M; Guarnizo, Julie T; O'Connor, Ralph C; Papagiotas, Stephen S; Taylor, Melissa L

2013-12-01

Responding to outbreaks is one of the most routine yet most important functions of a public health agency. However, some outbreaks are bigger, more visible, or more complex than others, prompting discussion about when an "outbreak" becomes a "public health emergency." When a public health emergency is identified, resources (eg, funding, staff, space) may need to be redirected from core public health programs to contribute to the public health emergency response. The need to sustain critical public health functions while preparing for public health emergency responses raises a series of operational and resource management questions, including when a public health emergency begins and ends, why additional resources are needed, how long an organization should expect staff to be redirected, and how many staff (or what proportion of the agency's staff ) an organization should anticipate will be needed to conduct a public health emergency response. This article addresses these questions from a national perspective by reviewing events for which the Centers for Disease Control and Prevention redirected staff from core public health functions to respond to a series of public health emergencies. We defined "public health emergency" in both operational and public health terms and found that on average each emergency response lasted approximately 4 months and used approximately 9.5% of our workforce. We also provide reasons why public health agencies should consider the impact of redirecting resources when preparing for public health emergencies.

Constructing a Community Response Grid (CRG): The Dublin, Ohio Case Study

ERIC Educational Resources Information Center

Freund, John F., III.

2012-01-01

During an emergency, information availability is critical to preserving life and minimizing damages. During the emergency response, however, information may not be available to those who need it. A community response grid (CRG) can help ameliorate this lack of availability by allowing people to document and distribute emergency information to…

44 CFR 350.5 - Criteria for review and approval of State and local radiological emergency plans and preparedness.

Code of Federal Regulations, 2010 CFR

2010-10-01

... response by the nuclear facility licensee, and by State and local organizations within the Emergency Planning Zones have been assigned, the emergency responsibilities of the various supporting organizations have been specifically established and each principal response organization has staff to respond to and...

44 CFR 350.5 - Criteria for review and approval of State and local radiological emergency plans and preparedness.

Code of Federal Regulations, 2011 CFR

2011-10-01

... response by the nuclear facility licensee, and by State and local organizations within the Emergency Planning Zones have been assigned, the emergency responsibilities of the various supporting organizations have been specifically established and each principal response organization has staff to respond to and...

Very serious and non-ignorable problem: Crisis in emergency medical response in catastrophic event.

PubMed

Shen, Weifeng; Jiang, Libing; Zhang, Mao; Ma, Yuefeng; Jiang, Guanyu; He, Xiaojun

2015-12-01

The crisis of medical response caused by catastrophic events might significantly affect emergency response, and might even initiate more serious social crisis. Therefore, early identification and timely blocking the formation of crisis in the early phase after a major disaster will improve the efficiency of medical response in a major disaster and avoid serious consequences. In the present paper, we described the emergency strategy to crisis management of medical response after a major disaster. Major catastrophic events often lead to various crises, including excess demand, the crisis of response in barrier and the structural crisis in response. The corresponding emergency response strategies include: (i) shunt of catastrophic medical surge; (ii) scalability of medical surge capacity; (iii) matching of the structural elements of response; (iv) maintaining the functions of support system for medical response and maximising the operation of the integrated response system; and (v) selection of appropriate care 'standard' in extreme situations of overload of disaster medical surge. In conclusion, under the impact of a major catastrophic event, medical response is often complex and the medical surge beyond the conventional response capacity and it is easy to be in crisis. In addition to the current consensus of disaster response, three additional aspects should be considered. First, all relevant society forces led by the government and military should be linkages. Second, a powerful medical response system must be based on a strong support system. Third, countermeasures of medical surge should be applied flexibly to the special and specific disaster environment, to promote the effective medical response force. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Occupational Safety and Health System for Workers Engaged in Emergency Response Operations in the USA.

PubMed

Toyoda, Hiroyuki; Kubo, Tatsuhiko; Mori, Koji

2016-12-03

To study the occupational safety and health systems used for emergency response workers in the USA, we performed interviews with related federal agencies and conducted research on related studies. We visited the Federal Emergency Management Agency (FEMA) and National Institute for Occupational Safety and Health (NIOSH) in the USA and performed interviews with their managers on the agencies' roles in the national emergency response system. We also obtained information prepared for our visit from the USA's Occupational Safety and Health Administration (OSHA). In addition, we conducted research on related studies and information on the website of the agencies. We found that the USA had an established emergency response system based on their National Incident Management System (NIMS). This enabled several organizations to respond to emergencies cooperatively using a National Response Framework (NRF) that clarifies the roles and cooperative functions of each federal agency. The core system in NIMS was the Incident Command System (ICS), within which a Safety Officer was positioned as one of the command staff supporting the commander. All ICS staff were required to complete a training program specific to their position; in addition, the Safety Officer was required to have experience. The All-Hazards model was commonly used in the emergency response system. We found that FEMA coordinated support functions, and OSHA and NIOSH, which had specific functions to protect workers, worked cooperatively under NRF. These agencies employed certified industrial hygienists that play a professional role in safety and health. NIOSH recently executed support activities during disasters and other emergencies. The USA's emergency response system is characterized by functions that protect the lives and health of emergency response workers. Trained and experienced human resources support system effectiveness. The findings provided valuable information that could be used to improve the occupational safety and health function in the Japanese system.

Geospatial Information Response Team

USGS Publications Warehouse

Witt, Emitt C.

2010-01-01

Extreme emergency events of national significance that include manmade and natural disasters seem to have become more frequent during the past two decades. The Nation is becoming more resilient to these emergencies through better preparedness, reduced duplication, and establishing better communications so every response and recovery effort saves lives and mitigates the long-term social and economic impacts on the Nation. The National Response Framework (NRF) (http://www.fema.gov/NRF) was developed to provide the guiding principles that enable all response partners to prepare for and provide a unified national response to disasters and emergencies. The NRF provides five key principles for better preparation, coordination, and response: 1) engaged partnerships, 2) a tiered response, 3) scalable, flexible, and adaptable operations, 4) unity of effort, and 5) readiness to act. The NRF also describes how communities, tribes, States, Federal Government, privatesector, and non-governmental partners apply these principles for a coordinated, effective national response. The U.S. Geological Survey (USGS) has adopted the NRF doctrine by establishing several earth-sciences, discipline-level teams to ensure that USGS science, data, and individual expertise are readily available during emergencies. The Geospatial Information Response Team (GIRT) is one of these teams. The USGS established the GIRT to facilitate the effective collection, storage, and dissemination of geospatial data information and products during an emergency. The GIRT ensures that timely geospatial data are available for use by emergency responders, land and resource managers, and for scientific analysis. In an emergency and response capacity, the GIRT is responsible for establishing procedures for geospatial data acquisition, processing, and archiving; discovery, access, and delivery of data; anticipating geospatial needs; and providing coordinated products and services utilizing the USGS' exceptional pool of geospatial experts and equipment.

Development and preliminary validation of a leadership competency instrument for existing and emerging allied health professional leaders.

PubMed

Ang, Hui-Gek; Koh, Jeremy Meng-Yeow; Lee, Jeffrey; Pua, Yong-Hao

2016-02-19

No instruments, to our knowledge, exist to assess leadership competency in existing and emerging allied health professional (AHP) leaders. This paper describes the development and preliminary exploration of the psychometric properties of a leadership competency instrument for existing and emerging AHP leaders and examines (i) its factor structure, (ii) its convergent validity with the Leadership Practices Inventory (LPI), and (iii) its discriminative validity in AHPs with different grades. During development, we included 25 items in the AHEAD (Aspiring leaders in Healthcare-Empowering individuals, Achieving excellence, Developing talents) instrument. A cross-sectional study was then conducted in 106 high-potential AHPs from Singapore General Hospital (34 men and 72 women) of different professional grades (49 principal-grade AHPs, 41 senior-grade AHPs, and 16 junior-grade AHPs) who completed both AHEAD and LPI instruments. Exploratory factor analysis was used to test the theoretical structure of AHEAD. Spearman correlation analysis was performed to evaluate the convergent validity of AHEAD with LPI. Using proportional odds regression models, we evaluated the association of grades of AHPs with AHEAD and LPI. To assess discriminative validity, the c-statistics - a measure of discrimination - were derived from these ordinal models. As theorized, factor analysis suggested a two-factor solution, where "skills" and "values" formed separate factors. Internal consistency of AHEAD was excellent (α-values > 0.88). Total and component AHEAD and LPI scores correlated moderately (Spearman ρ-values, 0.37 to 0.58). The c-index for discriminating between AHP grades was higher for AHEAD than for the LPI (0.76 vs. 0.65). The factorial structure of AHEAD was generally supported in our study. AHEAD showed convergent validity with the LPI and outperformed the LPI in terms of discriminative validity. These results provide initial evidence for the use of AHEAD to assess leadership competency in AHPs.

A collaborative user-producer assessment of earthquake-response products

USGS Publications Warehouse

Gomberg, Joan; Jakobitz, Allen

2013-01-01

The U.S. Geological Survey (USGS) and the Washington State Emergency Management Division assessed how well USGS earthquake-response products met the needs of emergency managers at county and local levels. Focus-group responses guided development of new products for testing in a regional-scale earthquake exercise. The assessment showed that (1) emergency responders consider most USGS products unnecessary after the first few postearthquake hours because the products are predictors, and responders are quickly immersed in reality; (2) during crises a significant fraction of personnel engaged in emergency response are drawn from many sectors, increasing the breadth of education well beyond emergency management agencies; (3) many emergency personnel do not use maps; and (4) information exchange, archiving, and analyses involve mechanisms and technical capabilities that vary among agencies, so widely used products must be technically versatile and easy to use.

Understanding the Emergence of Alshabab in Somalia

DTIC Science & Technology

2011-12-16

UNDERSTANDING THE EMERGENCE OF ALSHABAB IN SOMALIA A thesis presented to the Faculty of the U.S. Army Command and General...failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE...

Emergency Management and Tourism Stakeholder Responses to Crises: A Global Survey.

PubMed

Morakabati, Yeganeh; Page, Stephen J; Fletcher, John

2017-03-01

This article examines the contested area of the responsibility for destinations and tourists, within emergency settings. It incorporates a Delphi-Scenario technique to facilitate a structured discussion of emergency management for different destination stakeholders. The Delphi exercise engaged 123 senior international stakeholders, from 9 different industry sectors, across 34 countries to provide a global perspective. The study's principal focus is on the notion of emergency management, to identify the challenges that stakeholders would face within a disaster scenario. The exercise asked stakeholders to identify with whom the responsibility rests for 18 distinct disaster-related activities. The study proposes a responsibility allocation building-block framework that could help speed up the emergency management responses by "knowing who is going to do what" with a particular focus on dealing with international tourists as a community in a disaster zone.

Emergency Management and Tourism Stakeholder Responses to Crises

PubMed Central

Morakabati, Yeganeh; Page, Stephen J.; Fletcher, John

2016-01-01

This article examines the contested area of the responsibility for destinations and tourists, within emergency settings. It incorporates a Delphi-Scenario technique to facilitate a structured discussion of emergency management for different destination stakeholders. The Delphi exercise engaged 123 senior international stakeholders, from 9 different industry sectors, across 34 countries to provide a global perspective. The study’s principal focus is on the notion of emergency management, to identify the challenges that stakeholders would face within a disaster scenario. The exercise asked stakeholders to identify with whom the responsibility rests for 18 distinct disaster-related activities. The study proposes a responsibility allocation building-block framework that could help speed up the emergency management responses by “knowing who is going to do what” with a particular focus on dealing with international tourists as a community in a disaster zone. PMID:29708106

Surrogate endpoints and emerging surrogate endpoints for risk reduction of cardiovascular disease.

PubMed

Rasnake, Crystal M; Trumbo, Paula R; Heinonen, Therese M

2008-02-01

This article reviews surrogate endpoints and emerging biomarkers that were discussed at the annual "Cardiovascular Biomarkers and Surrogate Endpoints" symposium cosponsored by the US Food and Drug Administration (FDA) and the Montreal Heart Institute. The FDA's Center for Food Safety and Applied Nutrition (CFSAN) uses surrogate endpoints in its scientific review of a substance/disease relationship for a health claim. CFSAN currently recognizes three validated surrogate endpoints: blood pressure, blood total cholesterol, and blood low-density lipoprotein (LDL) concentration in its review of a health claim for cardiovascular disease (CVD). Numerous potential surrogate endpoints of CVD are being evaluated as the pathophysiology of heart disease is becoming better understood. However, these emerging biomarkers need to be validated as surrogate endpoints before they are used by CFSAN in the evaluation of a CVD health claim.

The federal response plan and disaster medical assistance teams in domestic disasters.

PubMed

Roth, P B; Gaffney, J K

1996-05-01

Through a variety of processes over the last 30 years, an organized federal plan has emerged for the response to domestic disasters. This plan incorporates several aspects of medical response into two areas: (1) health and medical and (2) urban search and rescue. This article discusses the development of the federal response plan with emphasis specifically on medicine. Highlighted are disaster medical assistance teams, urban search and rescue task forces, and roles and responsibilities of emergency physicians and other emergency health professionals in a federal disaster response.

Assessment and risk classification protocol for patients in emergency units1

PubMed Central

Silva, Michele de Freitas Neves; Oliveira, Gabriela Novelli; Pergola-Marconato, Aline Maino; Marconato, Rafael Silva; Bargas, Eliete Boaventura; Araujo, Izilda Esmenia Muglia

2014-01-01

Objective to develop, validate the contents and verify the reliability of a risk classification protocol for an Emergency Unit. Method the content validation was developed in a University Hospital in a country town located in the state of Sao Paulo and was carried out in two stages: the first with the individual assessment of specialists and the second with the meeting between the researchers and the specialists. The use of the protocol followed a specific guide. Concerning reliability, the concordance or equivalent method among observers was used. Results the protocol developed showed to have content validity and, after the suggested changes were made, there were excellent results concerning reliability. Conclusion the assistance flow chart was shown to be easy to use, and facilitate the search for the complaint in each assistance priority. PMID:26107828

44 CFR 334.6 - Department and agency responsibilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... responsibilities. 334.6 Section 334.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS GRADUATED MOBILIZATION RESPONSE § 334.6 Department and agency responsibilities. (a) During Stage 3, each Federal department and agency with mobilization responsibilities will...

Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED.

PubMed

Zemek, Roger; Barrowman, Nick; Freedman, Stephen B; Gravel, Jocelyn; Gagnon, Isabelle; McGahern, Candice; Aglipay, Mary; Sangha, Gurinder; Boutis, Kathy; Beer, Darcy; Craig, William; Burns, Emma; Farion, Ken J; Mikrogianakis, Angelo; Barlow, Karen; Dubrovsky, Alexander S; Meeuwisse, Willem; Gioia, Gerard; Meehan, William P; Beauchamp, Miriam H; Kamil, Yael; Grool, Anne M; Hoshizaki, Blaine; Anderson, Peter; Brooks, Brian L; Yeates, Keith Owen; Vassilyadi, Michael; Klassen, Terry; Keightley, Michelle; Richer, Lawrence; DeMatteo, Carol; Osmond, Martin H

2016-03-08

Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n = 2006 in the derivation cohort; n = 1057 in the validation cohort) and 2584 of whom (n = 1701 [85%] in the derivation cohort; n = 883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n = 510 [30.0%] in the derivation cohort and n = 291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. A clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.

Efficiency of instant messaging applications in coordination of emergency calls for combat injuries: A pilot study.

PubMed

Eksert, Sami; Aşık, Mehmet Burak; Akay, Sinan; Keklikçi, Kenan; Aydın, Fevzi Nuri; Çoban, Mehmet; Kantemir, Ali; Güngör, Onur; Garip, Beyazıt; Turgut, Mustafa Suphi; Olcay, Kenan

2017-05-01

Coordination of an emergency response team is an important determinant of prompt treatment for combat injuries in hospitals. The authors hypothesized that instant messaging applications for smartphones could be appropriate tools for notifying emergency response team members. The objective of this study was to investigate the efficiency of a commercial instant messaging application (WhatsApp, Mountain View, CA) as a communication tool for the emergency team in a level-I trauma center. We retrospectively evaluated the messages in the instant messaging application group that was formed to coordinate responses to patients who suffered from combat injuries and who were transported to our hospital via helicopter during an 8-week period. We evaluated the response times, response time periods during or outside of work hours, and the differences in the response times of doctors, nurses, and technicians among the members of the emergency team to the team leader's initial message about the patients. A total of 510 emergency call messages pertaining to 17 combat injury emergency cases were logged. The median time of emergency response was 4.1 minutes, 6 minutes, and 5.3 minutes for doctors, nurses, and the other team members, respectively. The differences in these response times between the groups were statistically significant (p=0.03), with subgroup analyses revealing significant differences between doctors and nurses (p=0.038). However, no statistically significant differences were observed between the doctors and the technicians (p=0.19) or the nurses and the technicians (p=1.0). From the team leader's perspective, using this application reduced the workload and the time loss, and also encouraged the team. Instant messaging applications for smartphones can be efficient, easy-to-operate, and time-saving communication tools in the transfer of medical information and the coordination of emergency response team members in hospitals.

The assessment of emergency physicians by a regulatory authority.

PubMed

Lockyer, Jocelyn M; Violato, Claudio; Fidler, Herta

2006-12-01

To determine whether it is possible to develop a feasible, valid, and reliable multisource feedback program (360 degree evaluation) for emergency physicians. Surveys with 16, 20, 30, and 31 items were developed to assess emergency physicians by 25 patients, eight coworkers, eight medical colleagues, and self, respectively, using five-point scales along with an "unable to assess" category. Items addressed key competencies related to communication skills, professionalism, collegiality, and self-management. Data from 187 physicians who identified themselves as emergency physicians were available. The mean number of respondents per physician was 21.6 (SD +/- 3.87) (93%) for patients, 7.6 (SD +/- 0.89) (96%) for coworkers, and 7.7 (SD +/- 0.61) (95%) for medical colleagues, suggesting it was a feasible tool. Only the patient survey had four items with "unable to assess" percentages > or = 15%. The factor analysis indicated there were two factors on the patient questionnaire (communication/professionalism and patient education), two on the coworker survey (communication/collegiality and professionalism), and four on the medical colleague questionnaire (clinical performance, professionalism, self-management, and record management) that accounted for 80.0%, 62.5%, and 71.9% of the variance on the surveys, respectively. The factors were consistent with the intent of the instruments, providing empirical evidence of validity for the instruments. Reliability was established for the instruments (Cronbach's alpha > 0.94) and for each physician (generalizability coefficients were 0.68 for patients, 0.85 for coworkers, and 0.84 for medical colleagues). The psychometric examination of the data suggests that the instruments developed to assess emergency physicians were feasible and provide evidence for validity and reliability.

Psychometric properties of the Chinese version of the attitudes towards cardiopulmonary resuscitation with defibrillation (ACPRD-C) among female hospital nurses in Taiwan.

PubMed

Lin, Hsing-Long; Lin, Mei-Hsiang; Ho, Chao-Chung; Fu, Chin-Hua; Koo, Malcolm

2017-07-01

Nurses are often the first responders to in-hospital cardiac emergencies. A positive attitude towards cardiopulmonary resuscitation with defibrillation may contribute to early cardiopulmonary resuscitation and rapid defibrillation, which are associated with enhanced long-term survival. The aim of this study was to translate and adapt the 31-item attitudes towards cardiopulmonary resuscitation with defibrillation and the national resuscitation guidelines (ACPRD) instrument into Chinese and to evaluate its psychometric properties in a sample of Taiwanese hospital nurses. The ACPRD instrument was translated into Chinese using professional translation services. Content validity index based on five experts to refine the translated instrument. The final instrument was applied to a sample of 290 female nurses, recruited from a regional hospital in southern Taiwan, to assess its internal consistency, factor structure, and discriminative validity. The Chinese ACPRD instrument showed good internal consistency (Cronbach's alpha=0.87). Seven factors emerged from the factor analysis. The instrument showed good discriminative validity and were able to differentiate the attitudes of nurses with more experience of defibrillation or cardiopulmonary resuscitation from those with less experience. Nurses working in emergency ward or intensive care unit also showed significantly higher overall scores compared to those working in other units. The Chinese ACPRD demonstrated adequate content validity, internal consistency, sensible factor structure, and good discriminative validity. Among Chinese-speaking nurses, it may be used as a tool for assessing the effectiveness of educational programs that aim to improve their confidence in performing cardiopulmonary resuscitation with defibrillation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Single-joint outcome measures: preliminary validation of patient-reported outcomes and physical examination.

PubMed

Heald, Alison E; Fudman, Edward J; Anklesaria, Pervin; Mease, Philip J

2010-05-01

To assess the validity, responsiveness, and reliability of single-joint outcome measures for determining target joint (TJ) response in patients with inflammatory arthritis. Patient-reported outcomes (PRO), consisting of responses to single questions about TJ global status on a 100-mm visual analog scale (VAS; TJ global score), function on a 100-mm VAS (TJ function score), and pain on a 5-point Likert scale (TJ pain score) were piloted in 66 inflammatory arthritis subjects in a phase 1/2 clinical study of an intraarticular gene transfer agent and compared to physical examination measures (TJ swelling, TJ tenderness) and validated function questionnaires (Disabilities of the Arm, Shoulder and Hand scale, Rheumatoid Arthritis Outcome Score, and the Health Assessment Questionnaire). Construct validity was assessed by evaluating the correlation between the single-joint outcome measures and validated function questionnaires using Spearman's rank correlation. Responsiveness or sensitivity to change was assessed through calculating effect size and standardized response means (SRM). Reliability of physical examination measures was assessed by determining interobserver agreement. The single-joint PRO were highly correlated with each other and correlated well with validated functional measures. The TJ global score exhibited modest effect size and modest SRM that correlated well with the patient's assessment of response on a 100-mm VAS. Physical examination measures exhibited high interrater reliability, but correlated less well with validated functional measures and the patient's assessment of response. Single-joint PRO, particularly the TJ global score, are simple to administer and demonstrate construct validity and responsiveness in patients with inflammatory arthritis. (ClinicalTrials.gov identifier NCT00126724).

Hazards Data Distribution System (HDDS)

USGS Publications Warehouse

Jones, Brenda; Lamb, Rynn M.

2015-07-09

When emergencies occur, first responders and disaster response teams often need rapid access to aerial photography and satellite imagery that is acquired before and after the event. The U.S. Geological Survey (USGS) Hazards Data Distribution System (HDDS) provides quick and easy access to pre- and post-event imagery and geospatial datasets that support emergency response and recovery operations. The HDDS provides a single, consolidated point-of-entry and distribution system for USGS-hosted remotely sensed imagery and other geospatial datasets related to an event response. The data delivery services are provided through an interactive map-based interface that allows emergency response personnel to rapidly select and download pre-event ("baseline") and post-event emergency response imagery.

Evaluating the Reliability of Emergency Response Systems for Large-Scale Incident Operations

PubMed Central

Jackson, Brian A.; Faith, Kay Sullivan; Willis, Henry H.

2012-01-01

Abstract The ability to measure emergency preparedness—to predict the likely performance of emergency response systems in future events—is critical for policy analysis in homeland security. Yet it remains difficult to know how prepared a response system is to deal with large-scale incidents, whether it be a natural disaster, terrorist attack, or industrial or transportation accident. This research draws on the fields of systems analysis and engineering to apply the concept of system reliability to the evaluation of emergency response systems. The authors describe a method for modeling an emergency response system; identifying how individual parts of the system might fail; and assessing the likelihood of each failure and the severity of its effects on the overall response effort. The authors walk the reader through two applications of this method: a simplified example in which responders must deliver medical treatment to a certain number of people in a specified time window, and a more complex scenario involving the release of chlorine gas. The authors also describe an exploratory analysis in which they parsed a set of after-action reports describing real-world incidents, to demonstrate how this method can be used to quantitatively analyze data on past response performance. The authors conclude with a discussion of how this method of measuring emergency response system reliability could inform policy discussion of emergency preparedness, how system reliability might be improved, and the costs of doing so. PMID:28083267

The nature of placebo response in clinical studies of major depressive disorder.

PubMed

Papakostas, George I; Østergaard, Søren D; Iovieno, Nadia

2015-04-01

To review factors influencing placebo response and clinical trial outcome in depression, and suggest ways to optimize trial success in mood disorders. PubMed searches were conducted by cross-referencing the terms depression, depressive with placebo, clinical trial, and clinical trials for studies published in English between 1970 and September 2013. Relevant abstracts were identified in PubMed, including clinical trials, quantitative studies, and qualitative research. We obtained and reviewed relevant articles and utilized their information to synthesize the present review. Included articles were grouped in the following areas of relevance: (1) biological validity of illness, (2) baseline severity of illness, (3) chronicity of the index episode of depression, (4) age of participants, (5) medical and psychiatric comorbidity, (6) probability of receiving placebo, (7) use of prospective treatment phases (lead-in) (8) dosing schedule, (9) trial duration, (10) frequency of follow-up assessments, and (11) study outcome measure. Several key elements emerge as critical to the ultimate success of a clinical trial, including the probability of receiving placebo, study duration, dosing schedule, visit frequency, the use of blinded lead-in phases, the use of centralized raters, illness severity and duration, and comorbid anxiety. Our increasing understanding of the placebo response in clinical trials of major depressive disorder lends to a, gradually, more predictable phenomenon and, hopefully, to one that becomes lesser in magnitude and variability. Several elements have emerged that seem to play a critical role in trial success, gradually reshaping the design of clinical, translational, as well as mechanistic studies in depression. © Copyright 2015 Physicians Postgraduate Press, Inc.

Facilitators and barriers to application of the Canadian C-spine rule by emergency department triage nurses.

PubMed

Clement, Catherine M; Stiell, Ian G; Lowe, Maureen A; Brehaut, Jamie C; Calder, Lisa A; Vaillancourt, Christian; Perry, Jeffrey J

2016-07-01

We recently conducted a multicentre implementation study on the use of the Canadian C-Spine Rule (CCR) by emergency department (ED) nurses to clear the c-spine in alert and stable trauma patients (n = 4506). The objective of this study was to conduct a survey of nurses, physicians, and administrators to evaluate their views on the facilitators and barriers to the implementation of the CCR. We conducted both a paper-based and an electronic survey of the three different ED hospital staff groups of nine large teaching hospitals in Ontario, including six regional trauma centres. The content of this survey was informed by a qualitative evaluation of the opinions of the study nurses who had participated in the validation study. 57.5% (281/489) ED triage nurses, 50.2% ED physicians, and 82.8% of administrators responded. Nurse responses most often showed support from manager/educators and teamwork between physicians, nurses, and managers as being important facilitators to the use of the CCR. Physician responses most often identified the importance of a nurse leader/champion/educator, and presence of strong physician leaders. Administrator responses indicated the importance of nurse educators/champions, nurse engagement, and educational support. Barriers indicated by all three groups included busy department, lack of physician support, and lack of nursing support. Bringing about change in clinical practice is complex. Strong leadership, effective communication, and senior physician buy-in appear to be very important. Identification of system-specific barriers and facilitators are important components of successful knowledge translation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Quantitative comparison of PZT and CMUT probes for photoacoustic imaging: Experimental validation.

PubMed

Vallet, Maëva; Varray, François; Boutet, Jérôme; Dinten, Jean-Marc; Caliano, Giosuè; Savoia, Alessandro Stuart; Vray, Didier

2017-12-01

Photoacoustic (PA) signals are short ultrasound (US) pulses typically characterized by a single-cycle shape, often referred to as N-shape. The spectral content of such wideband signals ranges from a few hundred kilohertz to several tens of megahertz. Typical reception frequency responses of classical piezoelectric US imaging transducers, based on PZT technology, are not sufficiently broadband to fully preserve the entire information contained in PA signals, which are then filtered, thus limiting PA imaging performance. Capacitive micromachined ultrasonic transducers (CMUT) are rapidly emerging as a valid alternative to conventional PZT transducers in several medical ultrasound imaging applications. As compared to PZT transducers, CMUTs exhibit both higher sensitivity and significantly broader frequency response in reception, making their use attractive in PA imaging applications. This paper explores the advantages of the CMUT larger bandwidth in PA imaging by carrying out an experimental comparative study using various CMUT and PZT probes from different research laboratories and manufacturers. PA acquisitions are performed on a suture wire and on several home-made bimodal phantoms with both PZT and CMUT probes. Three criteria, based on the evaluation of pure receive impulse response, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) respectively, have been used for a quantitative comparison of imaging results. The measured fractional bandwidths of the CMUT arrays are larger compared to PZT probes. Moreover, both SNR and CNR are enhanced by at least 6 dB with CMUT technology. This work highlights the potential of CMUT technology for PA imaging through qualitative and quantitative parameters.

Number of organ dysfunctions predicts mortality in emergency department patients with suspected infection: a multicenter validation study.

PubMed

Jessen, Marie K; Skibsted, Simon; Shapiro, Nathan I

2017-06-01

The aim of this study was to validate the association between number of organ dysfunctions and mortality in emergency department (ED) patients with suspected infection. This study was conducted at two medical care center EDs. The internal validation set was a prospective cohort study conducted in Boston, USA. The external validation set was a retrospective case-control study conducted in Aarhus, Denmark. The study included adult patients (>18 years) with clinically suspected infection. Laboratory results and clinical data were used to assess organ dysfunctions. Inhospital mortality was the outcome measure. Multivariate logistic regression was used to determine the independent mortality odds for number and types of organ dysfunctions. We enrolled 4952 (internal) and 483 (external) patients. The mortality rate significantly increased with increasing number of organ dysfunctions: internal validation: 0 organ dysfunctions: 0.5% mortality, 1: 3.6%, 2: 9.5%, 3: 17%, and 4 or more: 37%; external validation: 2.2, 6.7, 17, 41, and 57% mortality (both P<0.001 for trend). Age-adjusted and comorbidity-adjusted number of organ dysfunctions remained an independent predictor. The effect of specific types of organ dysfunction on mortality was most pronounced for hematologic [odds ratio (OR) 3.3 (95% confidence interval (CI) 2.0-5.4)], metabolic [OR 3.3 (95% CI 2.4-4.6); internal validation], and cardiovascular dysfunctions [OR 14 (95% CI 3.7-50); external validation]. The number of organ dysfunctions predicts sepsis mortality.

Design and Evaluation of the Psychometric Properties of a Paternal Adaptation Questionnaire.

PubMed

Eskandari, Narges; Simbar, Masoumeh; Vadadhir, AbouAli; Baghestani, Ahmad Reza

2016-07-25

The present study aimed to design and evaluate the psychometric properties of the Paternal Adaptation Questionnaire (PAQ). The study was a mixed (qualitative and quantitative) sequential exploratory study. In the qualitative phase, a preliminary questionnaire with 210 items emerged from in-depth interviews with 17 fathers and 15 key informants. In the quantitative phase, psychometric properties of the PAQ were assessed. Considering cutoff points as 1.5 for item impact, 0.49 for content validity ratio (CVR), and 0.7 for content validity index (CVI), items of the questionnaire were reduced from 210 to 132. Assessment of the content validity of the questionnaire demonstrated S-CVR = 0.68 and S-CVI = 0.92. Exploratory factor analysis resulted in the development of a PAQ with 38 items classified under five factors (ability in performing the roles and responsibilities; perceiving the parental development; stabilization in paternal position; spiritual stability and internal satisfaction; and challenges and concerns), which explained 52.19% of cumulative variance. Measurement of internal consistency reported a Cronbach's α of .89 for PAQ (.61-.86 for subscales), and stability assessment of the PAQ through the test-retest demonstrated Spearman's correlation coefficients and intraclass correlation coefficient of .96 (.81-.97 for subscales). It was identified that the PAQ is a valid and reliable instrument that could be used to assess fatherhood adaptation with the paternal roles and fathers' needs, as well as to design appropriate interventions and to evaluate their effectiveness. © The Author(s) 2016.

Paleophysiology: From Fossils to the Future.

PubMed

Vermeij, Geerat J

2015-10-01

Future environments may resemble conditions that have not existed for millions of years. To assess the adaptive options available to organisms evolving under such circumstances, it is instructive to probe paleophysiology, the ways in which ancient life coped with its physical and chemical surroundings. To do this, we need reliable proxies that are based on fundamental principles, quantitatively verified in living species, and observable in fossil remains. Insights have already come from vertebrates and plants, and others will likely emerge for marine animals if promising proxies are validated. Many questions remain about the circumstances for the evolution of environmental tolerances, metabolic rates, biomineralization, and physiological responses to interacting species, and about how living organisms will perform under exceptional conditions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Two objective measures of self-esteem.

PubMed

Lorr, M; Wunderlich, R A

1986-01-01

Two scales were constructed to assess self-esteem, conceptualized as reflecting (a) feelings of competence and efficacy, and (b) perceived positive appraisal from significant others. To control for response bias a paired choice format was chosen for the items constructed. A buffer scale designed to measure social assertiveness was also included. Data were collected on three samples of high school boys. The item intercorrelations were subjected to principal component analyses followed by Varimax rotations. In each of the three analyses factors of Confidence, Popularity (Social Approval), and Social Assertiveness emerged. The revised self-esteem scales, each defined by 11 items, have been shown to have acceptable reliability and some concurrent validity based on correlations with the well-known Rosenberg Self-Esteem Scale.

Organs-on-chips at the frontiers of drug discovery

PubMed Central

Esch, Eric W.; Bahinski, Anthony; Huh, Dongeun

2016-01-01

Improving the effectiveness of preclinical predictions of human drug responses is critical to reducing costly failures in clinical trials. Recent advances in cell biology, microfabrication and microfluidics have enabled the development of microengineered models of the functional units of human organs — known as organs-on-chips — that could provide the basis for preclinical assays with greater predictive power. Here, we examine the new opportunities for the application of organ-on-chip technologies in a range of areas in preclinical drug discovery, such as target identification and validation, target-based screening, and phenotypic screening. We also discuss emerging drug discovery opportunities enabled by organs-on-chips, as well as important challenges in realizing the full potential of this technology. PMID:25792263

Dilemmas in Treating Smoldering Multiple Myeloma

PubMed Central

Ahn, Inhye E.; Mailankody, Sham; Korde, Neha; Landgren, Ola

2015-01-01

Novel therapies hold promise for high-risk smoldering multiple myeloma (SMM). Recent studies suggest that modern combination approaches can be options for high-risk SMM to obtain deep molecular responses with favorable toxicity profiles. Although pioneering treatment trials based on small numbers of patients suggest progression-free and overall survival benefits, application of the data to real-life practice remains to be validated. Therapeutic modulation of disease tempo, disease burden, clonal evolution, and tumor microenvironment in SMM remains to be understood and calls for reliable biomarkers reflective of disease biology. Here, we review studies that open a new management platform for SMM, address ongoing dilemmas in practice and under investigation, and highlight emerging scientific questions in the era of SMM treatment. PMID:25422486

Bridging Scientific Model Outputs with Emergency Response Needs in Catastrophic Earthquake Responses

ERIC Educational Resources Information Center

Johannes, Tay W.

2010-01-01

In emergency management, scientific models are widely used for running hazard simulations and estimating losses often in support of planning and mitigation efforts. This work expands utility of the scientific model into the response phase of emergency management. The focus is on the common operating picture as it gives context to emergency…

30 CFR 254.23 - What information must I include in the “Emergency response action plan” section?

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Your methods to implement your dispersant use plan and your in situ burning plan. ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What information must I include in the â... must I include in the “Emergency response action plan” section? The “Emergency response action plan...

Increased Authenticity in Practical Assessment Using Emergency Case OSCE Stations

ERIC Educational Resources Information Center

Ruesseler, Miriam; Weinlich, Michael; Byhahn, Christian; Muller, Michael P.; Junger, Jana; Marzi, Ingo; Walcher, Felix

2010-01-01

In case of an emergency, a fast and structured patient management is crucial for patient's outcome. The competencies needed should be acquired and assessed during medical education. The objective structured clinical examination (OSCE) is a valid and reliable assessment format to evaluate practical skills. However, traditional OSCE stations examine…

Connections to Economic Prosperity: Money Aspirations from Adolescence to Emerging Adulthood

ERIC Educational Resources Information Center

Beutler, Ivan F.

2012-01-01

This study examines the "living well" aspirations of an emerging adult sample and compares them with earlier results of middle and high school samples. The tenor of emerging adult responses was more stridently extrinsic and more convincingly intrinsic than adolescent responses, revealing less middle ground as emerging adults more clearly take a…

Emergency and disaster planning at Ohio animal shelters.

PubMed

Decker, Shanna M; Lord, Linda K; Walker, William L; Wittum, Thomas E

2010-01-01

Results of a cross-sectional study to determine the level of emergency and disaster response planning at Ohio nonhuman animal shelters and the role Ohio agencies have in emergency and disaster response planning in their communities indicated a lack of preparedness coupled with underutilization of the agencies as a resource. A total of 115 agencies (68%) responded to a standardized survey mailed to 170 Ohio agencies. Most (68%) agencies agreed that emergency and disaster response planning was important to their organization, although only 13% of agencies had completed a written emergency and disaster response plan. The majority (80%) of agencies indicated they would provide critical resources in an emergency or disaster in their community. Only 38 (33%) of the responding agencies were aware of the PETS Act of 2006. Although many agencies indicated the importance of an emergency and disaster plan, there may be insufficient resources, including time and proper training, available to ensure plans are developed. Improved coordination among veterinarians, local veterinary medical associations, emergency preparedness agencies, and animal shelters would enhance the relief efforts in a crisis.

Spanish and Catalan translation, cultural adaptation and validation of the Picker Patient Experience Questionnaire-15.

PubMed

Bertran, M J; Viñarás, M; Salamero, M; Garcia, F; Graham, C; McCulloch, A; Escarrabill, J

To develop and test a culturally adapted core set of questions to measure patients' experience after in-patient care. Following the methodology recommended by international guides, a basic set of patient experience questions, selected from Picker Institute Europe questionnaires (originally in English), was translated to Spanish and Catalan. Acceptability, construct validity and reliability of the adapted questionnaire were assessed via a cross-sectional validation study. The inclusion criteria were patients aged >18 years, discharged within one week to one month prior to questionnaire sending and whose email was available. Day cases, emergency department patients and deaths were excluded. Invitations were sent by email (N=876) and questionnaire was fulfilled through an online platform. An automatic reminder was sent 5 days later to non-respondents. A questionnaire, in Spanish and Catalan, with adequate conceptual and linguistic equivalence was obtained. Response rate was 44.4% (389 responses). The correlation matrix was factorable. Four factors were extracted with Parallel Analysis, which explained 43% of the total variance. First factor: information and communication received during discharge. Second factor: low sensitivity attitudes of professionals. Third factor: assessment of communication of medical and nursing staff. Fourth factor: global items. The value of the Cronbach alpha was 0.84, showing a high internal consistency. The obtained experience patient questionnaire, in Spanish and Catalan, shows good results in the psychometric properties evaluated and could be a useful tool to identify opportunities for health care improvement in our context. Email could become a feasible tool for greater patient participation in everything that concerns his health. Copyright © 2018 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Dynamic real-time routing for evacuation response planning and execution : [summary].

DOT National Transportation Integrated Search

2011-09-01

Strategic planning for emergency response is critical for : effective response to natural or deliberate disasters. Re- sponse vehicle routing and evacuation of : the affected people are part of emergency response operations under disasters. The respo...

DEVELOPMENT AND VALIDATION OF ANALYTICAL METHODS FOR ENUMERATION OF FECAL INDICATORS AND EMERGING CHEMICAL CONTAMINANTS IN BIOSOLIDS

EPA Science Inventory

In 2002 the National Research Council (NRC) issued a report which identified a number of issues regarding biosolids land application practices and pointed out the need for improved and validated analytical techniques for regulated indicator organisms and pathogens. They also call...

47 CFR 64.615 - TRS User Registration Database and administrator.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false TRS User Registration Database and... Registration Database and administrator. (a) TRS User Registration Database. (1) VRS providers shall validate... Database on a per-call basis. Emergency 911 calls are excepted from this requirement. (i) Validation shall...

47 CFR 64.615 - TRS User Registration Database and administrator.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false TRS User Registration Database and... Registration Database and administrator. (a) TRS User Registration Database. (1) VRS providers shall validate... Database on a per-call basis. Emergency 911 calls are excepted from this requirement. (i) Validation shall...

Generalizability Theory and the Fair and Valid Assessment of Linguistic Minorities

ERIC Educational Resources Information Center

Solano-Flores, Guillermo; Li, Min

2013-01-01

We discuss generalizability (G) theory and the fair and valid assessment of linguistic minorities, especially emergent bilinguals. G theory allows examination of the relationship between score variation and language variation (e.g., variation of proficiency across languages, language modes, and social contexts). Studies examining score variation…

Principals' Learning Mechanisms: Exploring an Emerging Construct

ERIC Educational Resources Information Center

Schechter, Chen; Qadach, Mowafaq

2016-01-01

This exploration of principal learning mechanisms (PLM) to support a learning-centered school aimed to develop, field-test, and validate a PLM-measuring instrument. Following exploratory and confirmatory factor analyses of items to examine factorial validity, the developed scale was correlated with other work-related established constructs (e.g.,…

New strategies in drug discovery.

PubMed

Ohlstein, Eliot H; Johnson, Anthony G; Elliott, John D; Romanic, Anne M

2006-01-01

Gene identification followed by determination of the expression of genes in a given disease and understanding of the function of the gene products is central to the drug discovery process. The ability to associate a specific gene with a disease can be attributed primarily to the extraordinary progress that has been made in the areas of gene sequencing and information technologies. Selection and validation of novel molecular targets have become of great importance in light of the abundance of new potential therapeutic drug targets that have emerged from human gene sequencing. In response to this revolution within the pharmaceutical industry, the development of high-throughput methods in both biology and chemistry has been necessitated. Further, the successful translation of basic scientific discoveries into clinical experimental medicine and novel therapeutics is an increasing challenge. As such, a new paradigm for drug discovery has emerged. This process involves the integration of clinical, genetic, genomic, and molecular phenotype data partnered with cheminformatics. Central to this process, the data generated are managed, collated, and interpreted with the use of informatics. This review addresses the use of new technologies that have arisen to deal with this new paradigm.

Mobile Emergency Response Water Treatment Technology Results

EPA Science Inventory

When natural disasters like hurricanes, floods and earthquakes occur, safe drinking water can be compromised, limited or unavailable. Under such situations, communities have emergency response plans. One of many options for providing safe drinking water during emergency situati...

Assessment of thought-shape fusion: initial validation of a short version of the trait thought-shape fusion scale.

PubMed

Coelho, Jennifer S; Baeyens, Céline; Purdon, Christine; Shafran, Roz; Roulin, Jean-Luc; Bouvard, Martine

2013-01-01

Thought-shape fusion (TSF) is a cognitive distortion that has been linked to eating pathology. Two studies were conducted to further explore this phenomenon and to establish the psychometric properties of a French short version of the TSF scale. In Study 1, students (n = 284) completed questionnaires assessing TSF and related psychopathology. In Study 2, the responses of women with eating disorders (n = 22) and women with no history of an eating disorder (n = 23) were compared. The French short version of the TSF scale has a unifactorial structure, with convergent validity with measures of eating pathology, and good internal consistency. Depression, eating pathology, body dissatisfaction, and thought-action fusion emerged as predictors of TSF. Individuals with eating disorders have higher TSF, and more clinically relevant food-related thoughts than do women with no history of an eating disorder. This research suggests that the shortened TSF scale can suitably measure this construct, and provides support for the notion that TSF is associated with eating pathology. Copyright © 2012 Wiley Periodicals, Inc.

The use of virtual reality in the military's assessment of service members with traumatic brain injury: recent developments and emerging opportunities.

PubMed

Edwards, Joe; Vess, James; Reger, Greg; Cernich, Alison

2014-01-01

Traumatic brain injury (TBI) is a common event in the current extended conflicts by American service members, with estimates that as many as 300,000 have sustained combat-related concussions during Operation Iraqi Freedom and Operation Enduring Freedom. The limited ecological validity of traditional neuropsychological assessment measures presents a challenge to effective postconcussion evaluation of service members in relation to fitness-for-duty decisions or rehabilitation needs. Virtual reality (VR) technology offers a promising opportunity to advance the field of functional assessment for TBI. This article reviews the current professional literature on VR applications for TBI assessment, with special emphasis on those that are particularly relevant to U.S. service members. VR affords several advantages for clinical use. These include assessment of complex sets of cognitive and behavioral functions rather than the isolated components assessed by traditional measures; more precise control over the standardized presentation of task stimuli and the recording of response data; and enhanced ecological validity that can lead to more useful assessment data in the applied contexts faced by the U.S. military.

Development of a survey instrument to measure connectivity to evaluate national public health preparedness and response performance.

PubMed

Dorn, Barry C; Savoia, Elena; Testa, Marcia A; Stoto, Michael A; Marcus, Leonard J

2007-01-01

Survey instruments for evaluating public health preparedness have focused on measuring the structure and capacity of local, state, and federal agencies, rather than linkages among structure, process, and outcomes. To focus evaluation on the latter, we evaluated the linkages among individuals, organizations, and systems using the construct of "connectivity" and developed a measurement instrument. Results from focus groups of emergency preparedness first responders generated 62 items used in the development sample of 187 respondents. Item reduction and factors analyses were conducted to confirm the scale's components. The 62 items were reduced to 28. Five scales explained 70% of the total variance (number of items, percent variance explained, Cronbach's alpha) including connectivity with the system (8, 45%, 0.94), coworkers (7, 7%, 0.91), organization (7, 12%, 0.93), and perceptions (6, 6%, 0.90). Discriminant validity was found to be consistent with the factor structure. We developed a Connectivity Measurement Tool for the public health workforce consisting of a 34-item questionnaire found to be a reliable measure of connectivity with preliminary evidence of construct validity.

Design-based modeling of magnetically actuated soft diaphragm materials

NASA Astrophysics Data System (ADS)

Jayaneththi, V. R.; Aw, K. C.; McDaid, A. J.

2018-04-01

Magnetic polymer composites (MPC) have shown promise for emerging biomedical applications such as lab-on-a-chip and implantable drug delivery. These soft material actuators are capable of fast response, large deformation and wireless actuation. Existing MPC modeling approaches are computationally expensive and unsuitable for rapid design prototyping and real-time control applications. This paper proposes a macro-scale 1-DOF model capable of predicting force and displacement of an MPC diaphragm actuator. Model validation confirmed both blocked force and displacement can be accurately predicted in a variety of working conditions i.e. different magnetic field strengths, static/dynamic fields, and gap distances. The contribution of this work includes a comprehensive experimental investigation of a macro-scale diaphragm actuator; the derivation and validation of a new phenomenological model to describe MPC actuation; and insights into the proposed model’s design-based functionality i.e. scalability and generalizability in terms of magnetic filler concentration and diaphragm diameter. Due to the lumped element modeling approach, the proposed model can also be adapted to alternative actuator configurations, and thus presents a useful tool for design, control and simulation of novel MPC applications.

Using social network analysis to understand Missouri's system of public health emergency planners.

PubMed

Harris, Jenine K; Clements, Bruce

2007-01-01

Effective response to large-scale public health threats requires well-coordinated efforts among individuals and agencies. While guidance is available to help states put emergency planning programs into place, little has been done to evaluate the human infrastructure that facilitates successful implementation of these programs. This study examined the human infrastructure of the Missouri public health emergency planning system in 2006. The Center for Emergency Response and Terrorism (CERT) at the Missouri Department of Health and Senior Services has responsibility for planning, guiding, and funding statewide emergency response activities. Thirty-two public health emergency planners working primarily in county health departments contract with CERT to support statewide preparedness. We surveyed the planners to determine whom they communicate with, work with, seek expertise from, and exchange guidance with regarding emergency preparedness in Missouri. Most planners communicated regularly with planners in their region but seldom with planners outside their region. Planners also reported working with an average of 12 local entities (e.g., emergency management, hospitals/ clinics). Planners identified the following leaders in Missouri's public health emergency preparedness system: local public health emergency planners, state epidemiologists, the state vaccine and grant coordinator, regional public health emergency planners, State Emergency Management Agency area coordinators, the state Strategic National Stockpile coordinator, and Federal Bureau of Investigation Weapons of Mass Destruction coordinators. Generally, planners listed few federal-level or private-sector individuals in their emergency preparedness networks. While Missouri public health emergency planners maintain large and varied emergency preparedness networks, there are opportunities for strengthening existing ties and seeking additional connections.

Development of an Online Toolkit for Measuring Performance in Health Emergency Response Exercises.

PubMed

Agboola, Foluso; Bernard, Dorothy; Savoia, Elena; Biddinger, Paul D

2015-10-01

Exercises that simulate emergency scenarios are accepted widely as an essential component of a robust Emergency Preparedness program. Unfortunately, the variability in the quality of the exercises conducted, and the lack of standardized processes to measure performance, has limited the value of exercises in measuring preparedness. In order to help health organizations improve the quality and standardization of the performance data they collect during simulated emergencies, a model online exercise evaluation toolkit was developed using performance measures tested in over 60 Emergency Preparedness exercises. The exercise evaluation toolkit contains three major components: (1) a database of measures that can be used to assess performance during an emergency response exercise; (2) a standardized data collection tool (form); and (3) a program that populates the data collection tool with the measures that have been selected by the user from the database. The evaluation toolkit was pilot tested from January through September 2014 in collaboration with 14 partnering organizations representing 10 public health agencies and four health care agencies from eight states across the US. Exercise planners from the partnering organizations were asked to use the toolkit for their exercise evaluation process and were interviewed to provide feedback on the use of the toolkit, the generated evaluation tool, and the usefulness of the data being gathered for the development of the exercise after-action report. Ninety-three percent (93%) of exercise planners reported that they found the online database of performance measures appropriate for the creation of exercise evaluation forms, and they stated that they would use it again for future exercises. Seventy-two percent (72%) liked the exercise evaluation form that was generated from the toolkit, and 93% reported that the data collected by the use of the evaluation form were useful in gauging their organization's performance during the exercise. Seventy-nine percent (79%) of exercise planners preferred the evaluation form generated by the toolkit to other forms of evaluations. Results of this project show that users found the newly developed toolkit to be user friendly and more relevant to measurement of specific public health and health care capabilities than other tools currently available. The developed toolkit may contribute to the further advancement of developing a valid approach to exercise performance measurement.

Development of key performance indicators for prehospital emergency care.

PubMed

Murphy, Adrian; Wakai, Abel; Walsh, Cathal; Cummins, Fergal; O'Sullivan, Ronan

2016-04-01

Key performance indicators (KPIs) are used to monitor and evaluate critical areas of clinical and support functions that influence patient outcome. Traditional prehospital emergency care performance monitoring has focused solely on response time metrics. The landscape of emergency care delivery in Ireland is in the process of significant national reconfiguration. The development of KPIs is therefore considered one of the key priorities in prehospital research. The aim of this study was to develop a suite of KPIs for prehospital emergency care in Ireland. A systematic literature review of prehospital care performance measurement was undertaken followed by a three-round Delphi consensus process facilitated by a broad-based multidisciplinary group of panellists. The consensus process was conducted between June 2012 and October 2013. Each candidate indicator on the Delphi survey questionnaire was rated using a 5-point Likert-type rating scale. Agreement was defined as at least 70% of responders rating an indicator as 'agree' or 'strongly agree' on the rating scale. Data were analysed using descriptive statistics. Sensitivity of the ratings was examined for robustness by bootstrapping the original sample. Of the 78 citations identified by the systematic review, 5 relevant publications were used to select candidate indicators for the Delphi round 1 questionnaire. Response rates in Delphi rounds 1 and 2 were 89% and 83%, respectively. Following the consensus development conference, 101 KPIs reached consensus. Based on the Donabedian framework for quality-of-care indicators, 7 of the KPIs which reached agreement were structure KPIs, 74 were process KPIs and 20 were outcome KPIs. The highest ranked indicator was a process KPI ('Direct transport of ST-elevation myocardial infarction patients to a primary percutaneous intervention (PCI)-capable facility for ECG to PCI time <90 min'). Improving the quality of prehospital care requires the development and implementation of performance measurement using scientifically valid and reliable KPIs. Employing a Delphi panel of key multidisciplinary Emergency Medical Service stakeholders, it was feasible to develop a suite of 101 KPIs for performance monitoring of prehospital emergency care in Ireland. This suite of KPIs may contribute to a framework for achieving safer, better care in the prehospital environment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

[The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decision rule for the use of radiography in acute wrist trauma].

PubMed

Walenkamp, Monique M J; Bentohami, Abdelali; Slaar, Annelie; Beerekamp, M S H Suzan; Maas, Mario; Jager, L C Cara; Sosef, Nico L; van Velde, Romuald; Ultee, Jan M; Steyerberg, Ewout W; Goslings, J C Carel; Schep, Niels W L

2016-01-01

Although only 39% of patients with wrist trauma have sustained a fracture, the majority of patients is routinely referred for radiography. The purpose of this study was to derive and externally validate a clinical decision rule that selects patients with acute wrist trauma in the Emergency Department (ED) for radiography. This multicenter prospective study consisted of three components: (1) derivation of a clinical prediction model for detecting wrist fractures in patients following wrist trauma; (2) external validation of this model; and (3) design of a clinical decision rule. The study was conducted in the EDs of five Dutch hospitals: one academic hospital (derivation cohort) and four regional hospitals (external validation cohort). We included all adult patients with acute wrist trauma. The main outcome was fracture of the wrist (distal radius, distal ulna or carpal bones) diagnosed on conventional X-rays. A total of 882 patients were analyzed; 487 in the derivation cohort and 395 in the validation cohort. We derived a clinical prediction model with eight variables: age; sex, swelling of the wrist; swelling of the anatomical snuffbox, visible deformation; distal radius tender to palpation; pain on radial deviation and painful axial compression of the thumb. The Area Under the Curve at external validation of this model was 0.81 (95% CI: 0.77-0.85). The sensitivity and specificity of the Amsterdam Wrist Rules (AWR) in the external validation cohort were 98% (95% CI: 95-99%) and 21% (95% CI: 15%-28). The negative predictive value was 90% (95% CI: 81-99%). The Amsterdam Wrist Rules is a clinical prediction rule with a high sensitivity and negative predictive value for fractures of the wrist. Although external validation showed low specificity and 100 % sensitivity could not be achieved, the Amsterdam Wrist Rules can provide physicians in the Emergency Department with a useful screening tool to select patients with acute wrist trauma for radiography. The upcoming implementation study will further reveal the impact of the Amsterdam Wrist Rules on the anticipated reduction of X-rays requested, missed fractures, Emergency Department waiting times and health care costs.

Integrating Social Media Monitoring Into Public Health Emergency Response Operations.

PubMed

Hadi, Tamer A; Fleshler, Keren

2016-10-01

Social media monitoring for public health emergency response and recovery is an essential response capability for any health department. The value of social media for emergency response lies not only in the capacity to rapidly communicate official and critical incident information, but as a rich source of incoming data that can be gathered to inform leadership decision-making. Social media monitoring is a function that can be formally integrated into the Incident Command System of any response agency. The approach to planning and required resources, such as staffing, logistics, and technology, is flexible and adaptable based on the needs of the agency and size and scope of the emergency. The New York City Department of Health and Mental Hygiene has successfully used its Social Media Monitoring Team during public health emergency responses and planned events including major Ebola and Legionnaires' disease responses. The concepts and implementations described can be applied by any agency, large or small, interested in building a social media monitoring capacity. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).

40 CFR 300.4 - Abbreviations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Substances and Disease Registry CDC—Centers for Disease Control DOC—Department of Commerce DOD—Department of... Response Advisory Team DRG—District Response Group ERT—Environmental Response Team ESF—Emergency Support... Action RCP—Regional Contingency Plan RD—Remedial Design RERT—Radiological Emergency Response Team RI...

44 CFR 352.20 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... providing Federal technical assistance to the licensee for developing its offsite emergency response plan... response functions which Federal agencies may be called upon to provide; (d) Describes the process for allocating responsibilities among Federal agencies for planning site-specific emergency response functions...

44 CFR 352.20 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... providing Federal technical assistance to the licensee for developing its offsite emergency response plan... response functions which Federal agencies may be called upon to provide; (d) Describes the process for allocating responsibilities among Federal agencies for planning site-specific emergency response functions...

44 CFR 352.20 - Purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... providing Federal technical assistance to the licensee for developing its offsite emergency response plan... response functions which Federal agencies may be called upon to provide; (d) Describes the process for allocating responsibilities among Federal agencies for planning site-specific emergency response functions...

44 CFR 352.20 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... providing Federal technical assistance to the licensee for developing its offsite emergency response plan... response functions which Federal agencies may be called upon to provide; (d) Describes the process for allocating responsibilities among Federal agencies for planning site-specific emergency response functions...

Development and validation of a fast and simple multi-analyte procedure for quantification of 40 drugs relevant to emergency toxicology using GC-MS and one-point calibration.

PubMed

Meyer, Golo M J; Weber, Armin A; Maurer, Hans H

2014-05-01

Diagnosis and prognosis of poisonings should be confirmed by comprehensive screening and reliable quantification of xenobiotics, for example by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-mass spectrometry (LC-MS). The turnaround time should be short enough to have an impact on clinical decisions. In emergency toxicology, quantification using full-scan acquisition is preferable because this allows screening and quantification of expected and unexpected drugs in one run. Therefore, a multi-analyte full-scan GC-MS approach was developed and validated with liquid-liquid extraction and one-point calibration for quantification of 40 drugs relevant to emergency toxicology. Validation showed that 36 drugs could be determined quickly, accurately, and reliably in the range of upper therapeutic to toxic concentrations. Daily one-point calibration with calibrators stored for up to four weeks reduced workload and turn-around time to less than 1 h. In summary, the multi-analyte approach with simple liquid-liquid extraction, GC-MS identification, and quantification over fast one-point calibration could successfully be applied to proficiency tests and real case samples. Copyright © 2013 John Wiley & Sons, Ltd.

Methodology for developing quality indicators for the care of older people in the Emergency Department

PubMed Central

2013-01-01

Background Compared with younger people, older people have a higher risk of adverse health outcomes when presenting to emergency departments. As the population ages, older people will make up an increasing proportion of the emergency department population. Therefore it is timely that consideration be given to the quality of care received by older persons in emergency departments, and to consideration of those older people with special needs. Particular attention will be focused on important groups of older people, such as patients with cognitive impairment, residents of long term care and patients with palliative care needs. This project will develop a suite of quality indicators focused on the care of older persons in the emergency department. Methods/design Following input from an expert panel, an initial set of structural, process, and outcome indicators will be developed based on thorough systematic search in the scientific literature. All initial indicators will be tested in eight emergency departments for their validity and feasibility. Results of the data from the field studies will be presented to the expert panel at a second meeting. A suite of Quality Indicators for the older emergency department population will be finalised following a formal voting process. Discussion The predicted burgeoning in the number of older persons presenting to emergency departments combined with the recognised quality deficiencies in emergency department care delivery to this population, highlight the need for a quality framework for the care of older persons in emergency departments. Additionally, high quality of care is associated with improved survival & health outcomes of elderly patients. The development of well-selected, validated and economical quality indicators will allow appropriate targeting of resources (financial, education or quality management) to improve quality in areas with maximum potential for improvement. PMID:24314126

The Role of Psychometric Modeling in Test Validation: An Application of Multidimensional Item Response Theory

ERIC Educational Resources Information Center

Schilling, Stephen G.

2007-01-01

In this paper the author examines the role of item response theory (IRT), particularly multidimensional item response theory (MIRT) in test validation from a validity argument perspective. The author provides justification for several structural assumptions and interpretations, taking care to describe the role he believes they should play in any…

Convergence among Data Sources, Response Bias, and Reliability and Validity of a Structured Job Analysis Questionnaire.

ERIC Educational Resources Information Center

Smith, Jack E.; Hakel, Milton D.

1979-01-01

Examined are questions pertinent to the use of the Position Analysis Questionnaire: Who can use the PAQ reliably and validly? Must one rely on trained job analysts? Can people having no direct contact with the job use the PAQ reliably and validly? Do response biases influence PAQ responses? (Author/KC)

Faster response time : effective use of resources : integrating transportation systems and emergency management systems

DOT National Transportation Integrated Search

1999-01-01

This brochure discusses how coordinating the efforts of emergency dispatchers with transportation management agencies can improve efficiency and response times. It is noted that when emergency services agencies share facilities and traffic monitoring...

Emergency response planning in hospitals, United States: 2003-2004.

PubMed

Niska, Richard W; Burt, Catharine W

2007-08-20

This study presents baseline data to determine which hospital characteristics are associated with preparedness for terrorism and natural disaster in the areas of emergency response planning and availability of equipment and specialized care units. Information from the Bioterrorism and Mass Casualty Preparedness Supplements to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in hospital emergency response plans and resources by residency and medical school affiliation, hospital size, ownership, metropolitan statistical area status, and Joint Commission accreditation. Of 874 sampled hospitals with emergency or outpatient departments, 739 responded for an 84.6 percent response rate. Estimates are presented with 95 percent confidence intervals. About 92 percent of hospitals had revised their emergency response plans since September 11, 2001, but only about 63 percent had addressed natural disasters and biological, chemical, radiological, and explosive terrorism in those plans. Only about 9 percent of hospitals had provided for all 10 of the response plan components studied. Hospitals had a mean of about 14 personal protective suits, 21 critical care beds, 12 mechanical ventilators, 7 negative pressure isolation rooms, and 2 decontamination showers each. Hospital bed capacity was the factor most consistently associated with emergency response planning and availability of resources.

44 CFR 208.3 - Authority for the National US&R Response System.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Order 12148. (b) Implementing plan. The National Response Plan identifies DHS as the primary Federal...&R Response System. 208.3 Section 208.3 Emergency Management and Assistance FEDERAL EMERGENCY... RESPONSE SYSTEM General § 208.3 Authority for the National US&R Response System. (a) Enabling legislation...

44 CFR 208.3 - Authority for the National US&R Response System.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Order 12148. (b) Implementing plan. The National Response Plan identifies DHS as the primary Federal...&R Response System. 208.3 Section 208.3 Emergency Management and Assistance FEDERAL EMERGENCY... RESPONSE SYSTEM General § 208.3 Authority for the National US&R Response System. (a) Enabling legislation...

44 CFR 208.3 - Authority for the National US&R Response System.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Order 12148. (b) Implementing plan. The National Response Plan identifies DHS as the primary Federal...&R Response System. 208.3 Section 208.3 Emergency Management and Assistance FEDERAL EMERGENCY... RESPONSE SYSTEM General § 208.3 Authority for the National US&R Response System. (a) Enabling legislation...

44 CFR 208.3 - Authority for the National US&R Response System.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Order 12148. (b) Implementing plan. The National Response Plan identifies DHS as the primary Federal...&R Response System. 208.3 Section 208.3 Emergency Management and Assistance FEDERAL EMERGENCY... RESPONSE SYSTEM General § 208.3 Authority for the National US&R Response System. (a) Enabling legislation...

44 CFR 208.3 - Authority for the National US&R Response System.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Order 12148. (b) Implementing plan. The National Response Plan identifies DHS as the primary Federal...&R Response System. 208.3 Section 208.3 Emergency Management and Assistance FEDERAL EMERGENCY... RESPONSE SYSTEM General § 208.3 Authority for the National US&R Response System. (a) Enabling legislation...

Correcting Blindness In the Nerve Center: How To Improve Situational Awareness

DTIC Science & Technology

2015-12-01

Civil Defence Emergency Management released the Response Management, Director’s Guideline for CDEM Group and Local Controllers document in October...Defence & Emergency Management, Response Management: Director’s Guideline for CDEM Group and Local Controllers (Wellington, New Zealand: Ministry of...Response Management: Director’s Guideline for CDEM Group and Local Controllers . Wellington, New Zealand: Ministry of Civil Defence & Emergency

Percent Grammatical Responses as a General Outcome Measure: Initial Validity

ERIC Educational Resources Information Center

Eisenberg, Sarita L.; Guo, Ling-Yu

2018-01-01

Purpose: This report investigated the validity of using percent grammatical responses (PGR) as a measure for assessing grammaticality. To establish construct validity, we computed the correlation of PGR with another measure of grammar skills and with an unrelated skill area. To establish concurrent validity for PGR, we computed the correlation of…

Did Harvey Learn from Katrina? Initial Observations of the Response to Companion Animals during Hurricane Harvey.

PubMed

Glassey, Steve

2018-03-30

The aftermath of Hurricane Katrina in 2005 became the genesis of animal emergency management and created significant reforms in the US particularly the passage of the Pets Emergency and Transportation Standards Act in 2006 that required state and local emergency management arrangements to be pet- and service animal-inclusive. More than a decade later Hurricane Harvey struck the Gulf states with all 68 directly related deaths occurring in the state of Texas. In this study, six key officials involved in the response underwent a semi-structured interview to investigate the impact of the PETS Act on preparedness and response. Though the results have limitations due to the low sample size, it was found that the PETS Act and the lessons of Hurricane Katrina had contributed to a positive cultural shift to including pets (companion animals) in emergency response. However, there was a general theme that plans required under the PETS Act were under-developed and many of the animal response lessons from previous emergencies remain unresolved. The study also observed the first empirical case of disaster hoarding which highlights the need for animal law enforcement agencies to be active in emergency response.

Collaborative Response and Recovery from a Foot-and-Mouth Disease Animal Health Emergency: Supporting Decision Making in a Complex Environment with Multiple Stakeholders

DTIC Science & Technology

2013-12-01

RESPONSE AND RECOVERY FROM A FOOT-AND- MOUTH DISEASE ANIMAL HEALTH EMERGENCY: SUPPORTING DECISION MAKING IN A COMPLEX ENVIRONMENT WITH MULTIPLE...Thesis 4. TITLE AND SUBTITLE COLLABORATIVE RESPONSE AND RECOVERY FROM A FOOT-AND- MOUTH DISEASE ANIMAL HEALTH EMERGENCY: SUPPORTING DECISION MAKING...200 words ) This thesis recommends ways to support decision makers who must operate within the multi-stakeholder complex situation of response and

Disaster Monitoring and Emergency Response Services in China

NASA Astrophysics Data System (ADS)

Wu, J.; Han, X.; Zhou, Y.; Yue, P.; Wang, X.; Lu, J.; Jiang, W.; Li, J.; Tang, H.; Wang, F.; Li, X.; Fan, J.

2018-04-01

The Disaster Monitoring and Emergency Response Service(DIMERS) project was kicked off in 2017 in China, with the purpose to improve timely responsive service of the institutions involved in the management of natural disasters and man-made emergency situations with the timely and high-quality products derived from Space-based, Air-based and the in-situ Earth observation. The project team brought together a group of top universities and research institutions in the field of Earth observations as well as the operational institute in typical disaster services at national level. The project will bridge the scientific research and the response services of massive catastrophe in order to improve the emergency response capability of China and provide scientific and technological support for the implementation of the national emergency response strategy. In response to the call for proposal of "Earth Observation and Navigation" of 2017 National Key R&D Program of China, Professor Wu Jianjun, the deputy chairman of Faculty of Geographical Science of Beijing Normal University, submitted the Disaster Monitoring and Emergency Response Service (DIMERS) project, jointly with the experts and scholars from Institute of Remote Sensing and Digital Earth, Chinese Academy of Sciences, Wuhan University, China Institute of Earthquake Forecasting of China Earthquake Administration and China Institute of Water Resources and Hydropower Science. After two round evaluations, the proposal was funded by Ministry of Science and Technology of China.

41 CFR 102-75.760 - Who must the Office of Justice Programs (OJP) and the Federal Emergency Management Agency (FEMA...

Code of Federal Regulations, 2014 CFR

2014-01-01

... Response Purposes § 102-75.760 Who must the Office of Justice Programs (OJP) and the Federal Emergency... Justice Programs (OJP) and the Federal Emergency Management Agency (FEMA) notify that surplus real property is available for correctional facility, law enforcement, or emergency management response purposes...

41 CFR 102-75.760 - Who must the Office of Justice Programs (OJP) and the Federal Emergency Management Agency (FEMA...

Code of Federal Regulations, 2011 CFR

2011-01-01

... Response Purposes § 102-75.760 Who must the Office of Justice Programs (OJP) and the Federal Emergency... Justice Programs (OJP) and the Federal Emergency Management Agency (FEMA) notify that surplus real property is available for correctional facility, law enforcement, or emergency management response purposes...

41 CFR 102-75.760 - Who must the Office of Justice Programs (OJP) and the Federal Emergency Management Agency (FEMA...

Code of Federal Regulations, 2012 CFR

2012-01-01

... Response Purposes § 102-75.760 Who must the Office of Justice Programs (OJP) and the Federal Emergency... Justice Programs (OJP) and the Federal Emergency Management Agency (FEMA) notify that surplus real property is available for correctional facility, law enforcement, or emergency management response purposes...